Millions of people in the United States are affected by eating disorders. More than 90% of those afflicted are adolescents or young adult women. Although all eating disorders share some common manifestations, anorexia nervosa, bulimia nervosa, and binge eating each have distinctive symptoms and risks.

People who intentionally starve themselves (even while experiencing severe hunger pains) suffer from anorexia nervosa. The disorder, which usually begins around the time of puberty, involves extreme weight loss to at least 15% below the individual’s normal body weight. Many people with the disorder look emaciated but are convinced they are overweight. In patients with anorexia nervosa, starvation can damage vital organs such as the heart and brain. To protect itself, the body shifts into slow gear: Menstrual periods stop, blood pressure rates drop, and thyroid function slows. Excessive thirst and frequent urination may occur. Dehydration contributes to constipation, and reduced body fat leads to lowered body temperature and the inability to withstand cold. Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur in anorexia nervosa.

Anorexia nervosa sufferers can exhibit sudden angry outbursts or become socially withdrawn. One in ten cases of anorexia nervosa leads to death from starvation, cardiac arrest, other medical complications, or suicide. Clinical depression and anxiety place many individuals with eating disorders at risk for suicidal behavior.

People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Individuals with bulimia who use drugs to stimulate vomiting, bowel movements, or urination may be in considerable danger, as this practice increases the risk of heart failure. Dieting heavily between episodes of binging and purging is common.

Because many individuals with bulimia binge and purge in secret and maintain normal or above normal body weight, they can often successfully hide their problem for years. But bulimia nervosa patients—even those of normal weight—can severely damage their bodies by frequent binge eating and purging. In rare instances, binge eating causes the stomach to rupture; purging may result in heart failure due to loss of vital minerals such as potassium. Vomiting can cause the esophagus to become inflamed and glands near the cheeks to become swollen. As in anorexia nervosa, bulimia may lead to irregular menstrual periods. Psychological effects include compulsive stealing as well as possible indications of obsessive-compulsive disorder, an illness characterized by repetitive thoughts and behaviors. Obsessive compulsive disorder can also accompany anorexia nervosa. As with anorexia nervosa, bulimia typically begins during adolescence. Eventually, half of those with anorexia nervosa will develop bulimia. The condition occurs most often in women but is also found in men.

Binge-eating disorder is found in about 2% of the general population. As many as one-third of this group are men. It also affects older women, though with less frequency. Recent research shows that binge-eating disorder occurs in about 30% of people participating in medically supervised weight-control programs. This disorder differs from bulimia because its sufferers do not purge. Individuals with binge-eating disorder feel that they lose control of themselves when eating. They eat large quantities of food and do not stop until they are uncomfortably full. Most sufferers are overweight or obese and have a history of weight fluctuations. As a result, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Usually they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Like anorexic and bulimic sufferers who exhibit psychological problems, individuals with binge-eating disorder have high rates of simultaneously occurring psychiatric illnesses, especially depression.

Patrick Henry is considered one of the great patriots of America’s early history. He was a leader in every protest against British tyranny and in every movement for colonial rights, openly speaking against the unfair taxation and overly burdensome regulations imposed upon the American colonists by the British Parliament.

In March 1775, Patrick Henry urged his fellow Virginians to arm themselves in self-defense. He spoke boldly in Richmond, Virginia, during the meeting of the state legislature. He closed that famous speech with the immortal words, “I know not what course others may take; but as for me, give me liberty or give me death.”

Use the first passage to answer questions 1 through 9 and the second passage to answer questions 10 and 11.