Tag Archives: Binge eating

Eating Disorder

Definition:
Eating disorders are a group of conditions characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and emotional health, binge eating disorder, bulimia nervosa, anorexia nervosa being the most common specific forms in the United States, Though primarily thought of as affecting females (an estimated 5–10 million being affected in the U.S.), eating disorders affect males as well (an estimated 1 million U.S. males being affected).

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Generally, eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habits that disrupt normal body function and daily activities.

The causes of eating disorders are complex and poorly understood, though it is clear that they are often associated with other conditions and social situations; for example, one study found that girls with ADHD are many times more likely to develop certain eating disorders and another found that women raised in foster care are many times more likely to develop bulimia nervosa. It is generally thought   that peer pressure and idealized body-types seen in the media are also a significant factor.

It’s important to remember that eating disorders can easily get out of hand and are difficult habits to break. Eating disorders are serious clinical problems that require professional treatment by doctors, therapists, and nutritionists.

While proper treatment can be highly effective for many of the specific types of eating disorder, the consequences of eating disorders can be severe, including death (whether from direct medical effects of disturbed eating habits or from comorbid conditions such as suicidal thinking).

Specific eating disorders
*Anorexia nervosa (AN), characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight

*Bulimia nervosa (BN), characterized by recurrent binge eating followed by compensatory behaviors such as purging (self-induced vomiting or excessive use of laxatives)

*Binge eating disorder (BED), binge eating without compensatory behavior (Considered to be in the eating disorders not otherwise specified category)

*Purging disorder, characterized by recurrent purging to control weight or shape in the absence of binge eating episodes

*Rumination syndrome, involving the repeated painless regurgitation of food following a meal which is then either re-chewed and re-swallowed, or discarded.

*Diabulimia is the deliberate manipulation of insulin levels in an effort to control their weight.

*Food maintenance syndrome is characterized by a set of aberrant eating behaviors of children in foster care.

*Female athlete triad is a syndrome in which disordered eating behavior, amenorrhea and/or oligomenorrhea, and decreased bone mineral density (osteoporosis and osteoenia) are present (though not all patients exhibit all three components).

*Eating disorders not otherwise specified can refer to a number of disorders. It can refer to a female individual who suffers from anorexia but still has her period; it can refer to someone who may still be an “average healthy weight” but be suffering from anorexia; it can mean the sufferer equally participates in some anorexic as well as bulimic behaviors (sometimes referred to as purge-type anorexia).

*Pica is defined as a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition. These can include such things as chalk, plaster, paint chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes.

*Night eating syndrome consists of morning anorexia, evening polyphagia (abnormally increased appetite for consumption of food frequently associated with injury to the hypothalamus) and insomnia.

*Nocturnal Sleep Related Eating Disorder

*Orthorexia nervosa is an obsession with a “pure” diet, where it interferes with a person’s life. It becomes a way of life filled with chronic concern for the quality of food being consumed. When the person suffering with orthorexia slips up from wavering from their “perfect” diet, they may resort to extreme acts of further self-discipline, including even stricter regimens and fasting.

Several of the above mentioned disorders, such as diabulimia, food maintenance syndrome and orthorexia nervosa, are not recognized as mental disorders in any of the medical manuals, such as the ICD-10 or the DSM-IV.

Symptoms:
The signs and symptoms of eating disorders vary with the particular type of eating disorder.

Anorexia nervosa
When you have anorexia nervosa (an-o-REK-see-uh nur-VOH-suh), you’re obsessed with food and being thin, sometimes to the point of deadly self-starvation.

Anorexia signs and symptoms may include:

*Refusing to eat and denying hunger
*An intense fear of gaining weight
*Negative or distorted self-image
*Excessively exercising
*Flat mood or lack of emotion
*Preoccupation with food
*Social withdrawal
*Thin appearance
*Dizziness or fainting
*Soft, downy hair present on the body (lanugo)
*Menstrual irregularities or loss of menstruation (amenorrhea)
*Constipation
*Abdominal pain
*Dry skin
*Frequently being cold
*Irregular heart rhythms
*Low blood pressure
*Dehydration

Bulimia nervosa:-
When you have bulimia, you have episodes of bingeing and purging. During these episodes, you typically eat a large amount of food in a short duration and then try to rid yourself of the extra calories by vomiting or excessive exercise. You actually may be at a normal weight or even a bit overweight.

Bulimia signs and symptoms may include:
*Eating until the point of discomfort or pain, often with high-fat or sweet foods
*Self-induced vomiting
*Laxative use
*Excessively exercising
*Unhealthy focus on body shape and weight
*Having a distorted, excessively negative body image
*Going to the bathroom after eating or during meals
*Feeling that you can’t control your eating behavior
*Abnormal bowel functioning
*Damaged teeth and gums
*Swollen salivary glands in the cheeks
*Sores in the throat and mouth
*Dehydration
*Irregular heartbeat
*Sores, scars or calluses on the knuckles or hands
*Menstrual irregularities or loss of menstruation (amenorrhea)
*Constant dieting or fasting
*Possibly, drug or alcohol abuse

Binge-eating disorder
When you have binge-eating disorder, you regularly eat excessive amounts of food (binge). You may eat when you’re not hungry and continue eating even long after you’re uncomfortably full. After a binge, you may try to diet or eat normal meals, triggering a new round of bingeing. You may be a normal weight, overweight or obese.

Symptoms of binge-eating disorder may include:
*Eating to the point of discomfort or pain
*Eating much more food during a binge episode than during a normal meal or snack
*Eating faster during binge episodes
*Feeling that your eating behavior is out of control
*Frequently eating alone
*Feeling depressed, disgusted or upset over the amount eaten

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women. Though often associated with obesity it can occur in normal weight individuals. PCOS has been associated with binge eating and bulimic behavior.


Causes
:-
It is not known with certainty what causes eating disorders.As with other mental illnesses, there may be many causes. It can be due to a combination of biological, psychological or environmental causes. It is often said “Genetics loads the gun, environment pulls the trigger.” In other words, some people are born with a predisposition to have an ED, and it is brought to the surface pending on their environment and reactions to it. Most people with eating disorders suffer also from body dysmorphic disorder, altering the way a person sees themselves.. Possible causes of eating disorders include:

Biological
*Genetic: Numerous studies have been undertaken that show a possible genetic predisposition toward eating disorders as a result of Mendelian inheritance.

*Epigenetics: Epigenetic mechanisms are means by which environmental effects alter gene expression via methods such as DNA methylation; these are independent of and do not alter the underlying DNA sequence. They are heritable, but also may occur throughout the lifespan, and are potentially reversible. Dysregulation of dopaminergic neurotransmission due to epigenetic mechanisms has been implicated in various eating disoders.[20]

“We conclude that epigenetic mechanisms may contribute to the known alterations of ANP homeostasis in women with eating disorders.”

*Biochemical: Eating behavior is a complex process controlled by the neuroendocrine system of which the Hypothalamus-pituitary-adrenal-axis (HPA axis) is a major component. Dysregulation of the HPA axis has been associated with eating disorders, such as irregularities in the manufacture, amount or transmission of certain neurotransmitters, hormones or neuropeptides  and amino acids such as homocysteine, elevated levels of which are found in AN and BN as well as depression.

*serotonin: a neurotransmitter involved in depression also has an inhibitory effect on eating behavior.

*norepinephrine is both a neurotransmitter and a hormone; abnormalities in either capacity may affect eating behavior.

*dopamine: which in addition to being a precursor of norepinephrine and epinephrine is also a neurotransmitter which regulates the rewarding property of food.

*leptin and ghrelin: leptin is a hormone produced primarily by the fat cells in the body; it has an inhibitory effect on appetite by inducing a feeling of saiety. Ghrelin is an appetite inducing hormone produced in the stomach and the upper portion of the small intestine. Circulating levels of both hormones are an important factor in weight control. While often associated with obesity, both hormones and their respective effects have been implicated in the pathophysiology of anorexia nervosa and bulimia nervosa.

*immune system: studies have shown that a majority of patients with anorexia and bulimia nervosa have elevated levels of autoantibodies that affect hormones and neuropeptides that regulate appetite control and the stress response. There may be a direct correlation between autoantibody levels and associated psychological traits.

*infection: PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Children with PANDAS “have obsessive-compulsive disorder (OCD) and/or tic disorders such as Tourette syndrome, and in whom symptoms worsen following infections such as “strep throat” and scarlet fever.” (NIMH) There is a possibility that PANDAS may be a precipitating factor in the development of anorexia nervosa in some cases, (PANDAS AN).

*lesions: studies have shown that lesions to the right frontal lobe or temporal lobe can cause the pathological symptoms of an eating disorder.

*tumors: tumors in various regions of the brain have been implicated in the development of abnormal eating patterns.

*brain calcification: a study highlights a case in which prior calcification of the right thalumus may have contributed to development of anorexia nervosa.

*somatosensory homunculus: is the representation of the body located in the somatosensory cortex, first described by renowned neurosurgeon Wilder Penfield. The illustration was originally termed “Penfield’s Homunculus”, homunculus meaning little man. “In normal development this representation should adapt as the body goes through its pubertal growth spurt. However, in AN it is hypothesized that there is a lack of plasticity in this area, which may result in impairments of sensory processing and distortion of body image”. (Bryan Lask, also proposed by VS Ramachandran)

*Obstetric complications: There have been studies done which show maternal smoking, obstetric and perinatal complications such as maternal anemia, very pre-term birth (32<wks.), being born small for gestational age, neonatal cardiac problems, preeclampsia, placental infarction and sustaining a cephalhematoma at birth increase the risk factor for developing either anorexia nervosa or bulimia nervosa. Some of this developmental risk as in the case of placental infarction, maternal anemia and cardiac problems may cause intrauterine hypoxia, umbilical cord occlusion or cord prolapse may cause ischemia, resulting in cerebral injury, the prefrontal cortex in the fetus and neonate is highly susceptible to damage as a result of oxygen deprivation which has been shown to contribute to executive dysfunction, ADHD, and may affect personality traits associated with both eating disorders and comorbid disorders such as impulsivity, mental rigidity and obsessionality. The problem of perinatal brain injury, in terms of the costs to society and to the affected individuals and their families, is extraordinary. (Yafeng Dong, PhD)

Psychological
Eating disorders are classified as Axis I disorders in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV) published by the American Psychiatric Association. There are various other psychological issues that may factor into eating disorders, some fulfill the criteria for a separate Axis I diagnosis or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Axis II disorders are subtyped into 3 “clusters”, A, B and C. The causality between personality disorders and eating disorders has yet to be fully established. Some people have a previous disorder which may increase their vulnerability to developing an eating disorder. Some develop them afterwards. The severity and type of eating disorder symptoms have been shown to affect comorbidity. The DSM-IV should not be used by laypersons to diagnose themselves, even when used by professionals there has been considerable controversy over the diagnostic criteria used for various diagnoses, including eating disorders. There has been controversy over various editions of the DSM including the latest edition, DSM-V, due in May 2013.

Environmental:-
Child maltreatment
Child abuse which encompasses physical, psychological and sexual abuse, as well as neglect has been shown by innumerable studies to be a precipitating factor in a wide variety of psychiatric disorders, including eating disorders. Children who are subjugated to abuse may develop a disordered eating pattern in an effort to gain some sense of control or for a sense of comfort. Or they may be in an environment where the diet is unhealthy or insufficient. Child abuse and neglect can cause profound changes in both the physiological structure and the neurochemistry of the developing brain. Children who, as wards of the state, were placed in orphanages or foster homes are especially susceptible to developing a disordered eating pattern. In a study done in New Zealand 25% of the study subjects in foster care exhibited an eating disorder (Tarren-Sweeney M. 2006). An unstable home environment is detrimental to the emotional well-being of children, even in the absence of blatant abuse or neglect the stress of an unstable home can contribute to the development of an eating disorder.

Social isolation
Social isolation has been shown to have a deleterious effect on an individuals’ physical and emotional well-being. Those that are socially isolated have a higher mortality rate in general as compared to individuals that have established social relationships. This effect on mortality is markedly increased in those with pre-existing medical or psychiatric conditions, and has been especially noted in cases of coronary heart disease. “The magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors.” (Brummett et al.)

Social isolation can be inherently stressful, depressing and anxiety provoking. In an attempt to ameliorate these distressful feelings an individual may engage in emotional eating in which food serves as a source of comfort. The loneliness of social isolation and the inherent stressors thus associated have been implicated as triggering factors in binge eating as well.

Parental influence
Parental influence has been shown to be an intrinsic component in developing the eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents’ own body shape and eating patterns, the degree of involvement and expectations of their children’s eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders. As to the more subtle aspects of parental influence it has been shown that eating patterns are established in early childhood and that children should be allowed to decide when their appetite is satisfied as early as the age of two. A direct link has been proven between obesity and parental pressure to eat more.

Coercive tactics in regard to diet have not been proven to be efficacious in controlling a child’s eating behavior. Affection and attention have been shown to affect the degree of a childs’ finickiness and their acceptance of a more varied diet.

Peer pressure
In various studies such as one conducted by The McKnight Investigators, peer pressure was shown to be a significant contributor to body image concerns and attitudes toward eating among subjects in their teens and early twenties.

Eleanor Mackey and co-author, Annette M. La Greca of the University of Miami, studied 236 teen girls from public high schools in southeast Florida. “Teen girls’ concerns about their own weight, about how they appear to others and their perceptions that their peers want them to be thin are significantly related to weight-control behavior,” says psychologist Eleanor Mackey of the Children’s National Medical Center in Washington and lead author of the study. “Those are really important.”

According to one study, 40% of 9- and 10-year-old girls are already trying to lose weight.  Such dieting is reported to being influenced by peer behavior, with many of those individuals on a diet reporting that their friends also were dieting. The number of friends dieting and the number of friends who pressured them to diet also played a significant role in their own choices.

Cultural pressure
There is a cultural emphasis on thinness which is especially pervasive in western society. There is an unrealistic stereotype of what constitutes beauty and the ideal body type as portrayed by the media, fashion and entertainment industries. “The cultural pressure on men and women to be “[perfect]” is an important predisposing factor for the development of eating disorders” (Bryan Lask, PhD).

In men
It is estimated that 8 million people in the United States are suffering from an Eating Disorder, and of that number 10% are men. Professionals suggest that the percentage suffering that are men is much higher, but because of the old fashioned idea that this illness strikes only women, few men come forward to find the help they deserve.

To date, the evidence suggests that the gender bias of clinicians means that diagnosing either bulimia or anorexia in men is less likely despite identical behavior. Men are more likely to be diagnosed as suffering depression with associated appetite changes than receive a primary diagnosis of an eating disorder.

In addition, there may often be shrouds of secrecy because of the lack of therapy groups and treatment centers offering groups specifically designed for men. They may feel very alone at the thought of having to sit in a group of women, to be part of a program designed for women, and even at the prospect that a treatment facility will turn them down because of their sex.

Men who participate in low-weight oriented sports such as jockeys, wrestlers and runners are at an increased risk of developing an Eating Disorder such as Anorexia or Bulimia. The pressure to succeed, to be the best, to be competitive and to win at all costs, combined with any non-athletic pressures in their lives (relationship issues, family problems, abuse, etc.) can help to contribute the onset of their disordered eating.

It is not uncommon for men suffering with an Eating Disorder to also suffer with alcohol abuse and/or substance abuse simultaneously (though many women also suffer both disordered eating and substance abuse problems, combined). This may be due to the addictive nature of their psychological health, combined with the strong images put out by society of men’s overindulgence in alcohol.

There may also be a link between ADHD, with male sufferers of Anorexia, Bulimia, and self-injury. More research is still needing to be done in this area.

For all those who suffer, men and women alike, there are many possible co-existing psychological illnesses that can be present, including depression, anxiety, PTSD, self-injury behaviors, substance abuse, OCD, borderline personality disorder, and Multiple Personality Disorders.

It is important to remember is that most of the underlying psychological factors that lead to an Eating Disorder are the same for both men and women; low self-esteem, a need to be accepted, depression, anxiety, an inability to cope with emotions & personal issues, and other existing psychological illnesses. All of the physical dangers and complications associated with being the sufferer of an Eating Disorder are the same. A great number of the causes are the same or very similar (family problems, relationship issues, alcoholic/addictive parent, abuse, societal pressure). Most of all, it is important to remember that all people with eating disorders deserve to find recovery, happiness, and self-love on the other side.

Risk factors:-
Certain situations and events might increase the risk of developing an eating disorder. These risk factors may include:

*Being female. Teenage girls and young women are more likely than teenage boys and young men to have eating disorders.

*Age. Although eating disorders can occur across a broad age range — from pre-adolescents to older adults — they are much more common during the teens and early 20s.

*Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings who’ve had an eating disorder.

*Family influences. People who feel less secure in their families, whose parents and siblings may be overly critical, or whose families tease them about their appearance are at higher risk of eating disorders.

*Emotional disorders. People with depression, anxiety disorders and obsessive-compulsive disorder are more likely to have an eating disorder.

*Dieting. People who lose weight are often reinforced by positive comments from others and by their changing appearance. This may cause some people to take dieting too far, leading to an eating disorder.

*Transitions. Whether it’s heading off to college, moving, landing a new job or a relationship breakup, change can bring emotional distress, which may increase your susceptibility to an eating disorder.

*Sports, work and artistic activities. Athletes, actors and television personalities, dancers, and models are at higher risk of eating disorders. Eating disorders are particularly common among ballerinas, gymnasts, runners and wrestlers. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight.

Sever Complications:-
Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications. Complications may include:

*Death

*Heart disease

*Depression

*Suicidal thoughts or behavior

*Absence of menstruation (amenorrhea)

*Bone loss

*Stunted growth

*Seizures

*Digestive problems

*Bowel irregularities

*Kidney damage

*Severe tooth decay

*High or low blood pressure

*Type 2 diabetes

*Gallbladder disease

Diagnosis:-
The initial diagnosis should be made by a competent medical professional. “The medical history is the most powerful tool for diagnosing eating disorders”(American Family Physician). There are many medical disorders that mimic eating disorders and comorbid psychiatric disorders. All organic causes should be ruled out prior to a diagnosis of an eating disorder or any other psychiatric disorder is made.

Medical

The diagnostic workup typically includes complete medical and psychosocial history and follows a rational and formulaic approach to the diagnosis. Neuroimaging using fMRI, MRI, PET and SPECT scans have been used to detect cases in which a lesion, tumor or other organic condition has been either the sole causative or contributory factor in an eating disorder. “Right frontal intracerebral lesions with their close relationship to the limbic system could be causative for eating disorders, we therefore recommend performing a cranial MRI in all patients with suspected eating disorders” (Trummer M et al. 2002), “intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective”.(O’Brien et al. 2001).

Psychological

Eating Disorder Specific Psychometric Tests Eating Attitudes Test SCOFF questionnaire
Body Attitudes Test Body Attitudes Questionnaire
Eating Disorder Inventory  Eating Disorder Examination Interview

After ruling out organic causes and the initial diagnosis of an eating disorder being made by a medical professional, a trained mental health professional aids in the assessment and treatment of the underlying psychological components of the eating disorder and any comorbid psychological conditions. The clinician conducts a clinical interview and may employ various psychometric tests. Some are general in nature while others were devised specifically for use in the assessment of eating disorders. Some of the general tests that may be used are the Hamilton Depression Rating Scale and the Beck Depression Inventory.

Differential diagnoses
There are a variety of medical conditions which may be misdiagnosed as an eating disorder such as Lyme disease which is known as the “great imitator”, as it may present as a variety of psychiatric or neurologic disorders including anorexia nervosa.

*Addison’s Disease is a disorder of the adrenal cortex which results in decreased hormonal production. Addison’s disease, even in subclinical form may mimic many of the symptoms of anorexia nervosa.

*Gastric adenocarcinoma is one of the most common forms of cancer in the world. Complications due to this condition have been misdiagnosed as an eating disorder.

*Helicobacter pylori is a bacterium which causes stomach ulcers and gastritis and has been shown to be a precipitating factor in the development of gastric carcinomas. It also has an effect on circulating levels of leptin and ghrelin, two hormones which help regulate appetite. Upon successful treatment of helicobacter pylori associated gastritis in pre-pubertal children they showed “significant increase in BMI, lean and fat mass along with a significant decrease in circulating ghrelin levels and an increase in leptin levels” (Pacifico, L).”SUMMARY: H. pylori has an influence on the release of gastric hormones and therefore plays a role in the regulation of body weight, hunger and satiety,”(Weigt J, Malfertheiner P).

*Hypothyroidism, hyperthyroidism, hypoparathyroidism and hyperparathyroidism may mimic some of the symptoms of, can occur concurrently with, be masked by or exacerbate an eating disorder.

There are multiple medical conditions which may be misdiagnosed as a primary psychiatric disorder. These may have a synergistic effect on conditions which mimic an eating disorder or on a properly diagnosed ED. They also may make it more difficult to diagnose and treat an ED.

Lupus: 19 psychiatric conditions have been associated with systemic lupus erythematosus (SLE), including depression and bipolar disorder.

*Toxoplasma seropositivity: even in the absence of symptomatic toxoplasmosis, toxoplasma gondii exposure has been linked to changes in human behavior and psychiatric disorders including those comorbid with eating disorders such as depression. In reported case studies the response to antidepressant treatment improved only after adequate treatment for toxoplasma.

*Neurosyphilis: It is estimated that there may be up to one million cases of untreated syphyilis in the US alone. “The disease can present with psychiatric symptoms alone, psychiatric symptoms that can mimic any other psychiatric illness”. Many of the manifestations may appear atypical. Up to 1.3% of short term psychiatric admissions may be attributable to neurosyphilis, with a much higher rate in the general psychiatric population. Neurosyphilis like Lyme disease has been given the appellation the “great imitator” for it may present in various ways such as depression and chronic alcoholism. (Ritchie, M Perdigao J,)

*Dysautonomia: a term used to describe a wide variety of autonomic nervous system (ANS) disorders may cause a wide variety of psychiatric symptoms including anxiety, panic attacks and depression. Dysautonomia usually involves failure of sympathetic or parasympathetic components of the ANS system but may also include excessive ANS activity. Dysautonomia can occur in conditions such as diabetes and alcoholism.

There are separate psychological disorders which may be misdiagnosed as an eating disorder.

*Emetophobia is an anxiety disorder characterized by an intense fear of vomiting. A person so afflicted may develop rigorous standards of food hygiene, such as not touching food with their hands. They may become socially withdrawn to avoid situations which in their perception may make them vomit. Many who suffer from emetophobia are diagnosed with anorexia or self-starvation. In severe cases of emetophobia they may drastically reduce their food intake.[163][164]

*Phagophobia is an anxiety disorder characterized by a fear of eating, it is usually initiated by an adverse experience while eating such as choking or vomiting. Persons with this disorder may present with complaints of pain while swallowing.

*Body dysmorphic disorder (BDD) is listed as a somatoform disorder that affects up to 2% of the population. BDD is characterized by excessive rumination over an actual or perceived physical flaw. BDD has been diagnosed equally among men and women. While BDD has been misdiagnosed as anorexia nervosa, it also occurs comorbidly in 39% of eating disorder cases. BDD is a chronic and debilitating condition which may lead to social isolation, major depression and suicidal ideation and attempts. Neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe and left parietal lobe showing hemispheric imbalance in information processing. There is a reported case of the development of BDD in a 21 year old male following an inflammatory brain process. Neuroimaging showed the presence of a new atrophy in the frontotemporal region.

Treatment:-
Treatment varies according to type and severity of eating disorder, and usually more than one treatment option is utilized. Some of the treatment methods are:

*Cognitive behavioral therapy (CBT), which postulates that an individual’s feelings and behaviors are caused by their own thoughts instead of external stimuli such as other people, situations or events; the idea is to change how a person thinks and reacts to a situation even if the situation itself does not change.

*Acceptance and commitment therapy: a type of CBT

*Dialectical behavior therapy, another form of CBT

*Cognitive Remediation Therapy (CRT), a set of cognitive drills or compensatory interventions designed to enhance
*cognitive functioning.

*Family therapy including “conjoint family therapy” (CFT), “separated family therapy” (SFT) and Maudsley Family Therapy.

*Behavioral therapy: focuses on gaining control and changing unwanted behaviors.

*Interpersonal psychotherapy (IPT)

*Music Therapy

*Recreation Therapy

*Art therapy

*Nutrition counseling and Medical nutrition therapy

*Medication: Orlistat is used in obesity treatment. Olanzapine seems to promote weight gain as well as the ability to ameliorate obsessional behaviors concerning weight gain. zinc supplements have been shown to be helpful, and cortisol is also being investigated.

*Self help and guided self help have been shown to be helpful in AN, BN and BED;  this includes support groups and self-help groups such as Eating Disorders Anonymous and Overeaters Anonymous.

*Psychoanalysis

*Inpatient care

There are few studies on the cost-effectiveness of the various treatments. Treatment can be expensive;  due to limitations in health care coverage, patients hospitalized with anorexia nervosa may be discharged while still underweight, resulting in relapse and rehospitalization.

Prognosis estimates are complicated by non-uniform criteria used by various studies, but for AN, BN, and BED, there seems to be general agreement that full recovery rates are in the 50% to 85% range, with larger proportions of patients experiencing at least partial remission.


Lifestyle and home remedies:-

When you have an eating disorder, taking care of your health needs often isn’t one of your priorities. But proper self-care can help you feel better during and after treatment and help maintain your overall health.

Try to make these steps a part of your daily routine:

*Stick to your treatment plan. Don’t skip therapy sessions and try not to stray from meal plans.

*Talk to your doctor about appropriate vitamin and mineral supplements to make sure you’re getting all the essential nutrients.

*Don’t isolate yourself from caring family members and friends who want to see you get healthy and have your best interests at heart.

*Talk to your health care providers about what kind of exercise, if any, is appropriate for you.

*Read self-help books that offer sound, practical advice. Consider discussing the books with your health care providers.

*Resist urges to weigh yourself or check yourself in the mirror frequently. Otherwise, you may simply fuel your drive to maintain unhealthy habits.

Alternative medicine:-
Usually, when people turn to alternative medicine it’s to improve their health, but for people with eating disorders this isn’t always the case. Alternative medicine treatments have both negative and positive consequences when it comes to eating disorders.

The bad

There are numerous dietary supplement and herbal products designed to suppress the appetite or aid in weight loss, and these products may be abused by people with eating disorders. Many people with eating disorders have used such products. These products can have potentially dangerous interactions with other medications, such as laxatives or diuretics, that are commonly used by people with eating disorders.

Additionally, weight-loss supplements or herbs can have serious side effects on their own, such as irregular heartbeats, tremors, hallucinations, insomnia, nausea, dizziness and nervousness. Discuss the potential risks of using dietary supplements or herbs for weight loss with your doctor.

The good
Although yoga has not yet been well studied as a treatment for people with eating disorders, some research has found that yoga may be beneficial as an additional treatment. It may help people with eating disorders by increasing a sense of well-being and promoting relaxation.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.


Resources:

http://en.wikipedia.org/wiki/Eating_disorder
http://www.mayoclinic.com/health/eating-disorders/DS00294/DSECTION=symptoms
http://www.mayoclinic.com/health/eating-disorders/DS00294/DSECTION=complications
http://www.mayoclinic.com/health/eating-disorders/DS00294/DSECTION=alternative-medicine
http://www.mayoclinic.com/health/eating-disorders/DS00294/DSECTION=lifestyle-and-home-remedies

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“Eating disorders are serious mental health problems and can be very distressing for both patients and their families,” said Christopher Fairburn, professor and principal research fellow at the University of Oxford.

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These disorders are a major cause of physical and psycho-social impairment in young women, affecting at least one in 20 between the ages of 18 and 30. Eating disorders are less common in young men.

Three eating disorders are recognised: anorexia nervosa, (hunger signals are ignored to control the desire to eat), accounting for 10% cases in adults; bulimia nervosa, (repeated binge eating) which accounts for a third of all cases; and the remainder are classed as atypical eating disorders, which account for over half of all cases.

In these atypical cases, the features of anorexia nervosa and bulimia nervosa are combined in a different way, according to an Oxford release.

These disorders vary in their severity, but typically involve extreme and relentless dieting, self-induced vomiting or laxative misuse, binge eating, driven exercising and in some cases marked weight loss.

Common associated features are depression, social withdrawal, perfectionism and low self-esteem. The disorders tend to run a chronic course and are notoriously difficult to treat. Relapse is common.

This new “enhanced” form of cognitive behavioural therapy (CBT-E) improves the current leading treatment for bulimia nervosa as recommended by the National Institute of Health and Clinical Excellence (NICE).

CBT-E is the first treatment to be shown to be suitable for the majority of cases of eating disorders. This new treatment derives from an earlier form of CBT. Both were developed exclusively for patients with Bulimia Nervosa by Fairburn.

Sources:The American Journal of Psychiatry

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Eating Disorder

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Definition:
An eating disorder is a compulsion to eat, or avoid eating, that negatively affects both one’s physical and mental health. Eating disorders are all encompassing. They affect every part of the person’s life. According to the authors of Surviving an Eating Disorder, “feelings about work, school, relationships, day-to-day activities and one’s experience of emotional well being are determined by what has or has not been eaten or by a number on a scale.” Anorexia nervosa and bulimia nervosa are the most common eating disorders generally recognized by medical classification schemes, with a significant diagnostic overlap between the two. Together, they affect an estimated 5-7% of females in the United States during their lifetimes. There is a third type of eating disorder currently being investigated and defined – Binge Eating Disorder. This is a chronic condition that occurs when an individual consumes huge amounts of food during a brief period of time and feels totally out of control and unable to stop their eating. It can lead to serious health conditions such as morbid obesity, diabetes, hypertension, and cardiovascular disease. ANAD, or the National Association of Anorexia Nervosa and Associated Disorders is a non profit organization aimed at fighting these disorders. They work primarily in areas such as research, educating the public and running a hotline which is dedicated to referring those afflicted by disorders to support groups, therapists, or inpatient/outpatient clinics.

…CLICK  SEE.

Eating disorders often are long-term illnesses that may require long-term treatment. In addition, eating disorders frequently occur with other mental disorders such as depression, substance abuse, and anxiety disorders (NIMH, 2002). The earlier these disorders are diagnosed and treated, the better the chances are for full recovery.

Who Is At Risk?
Eating disorders,many people believe, occur mainly among young white females. This is not the case. While eating disorders do mainly affect women between the ages of 12 and 35, other groups are also at risk of developing eating disorders. Eating disorders affect all ethnic and racial groups and while the specific nature of the problem and the risk factors may vary, no population is exempt. Younger and younger children seem to be at risk of developing eating disorders. While most children who develop eating disorders are between 11 and 13, studies have shown that 80% of 3rd through 6th graders are dissatisfied with their bodies or their weight and by age 9 somewhere between 30 and 40% of girls have already been on a diet. Between ages 10 and 16, the statistic jumps to 80%. Many eating disorder experts attribute this behavior to the effects of cultural expectations. Stress is also considered to be a factor in the development of eating disorders. According to Abigail Natenshon, a psychotherapist specializing in eating disorders, children as young as 5 show signs of stress related eating disorders. This includes compulsively exercising and running to burn off calories. Natanshon notes that as children reach puberty younger and younger, they are less equipped to understand the changes in their bodies. They understand the message of the media to be “thin” and try to fit in without comprehending the effects on their bodies. While eating disorders affect younger and younger children, not only girls but also boys suffer from eating disorders. Boys who participate in sports where weight is an issue and often boys who experience issues regarding sexual identity are at risk of developing eating disorders.

Anorexia nervosa :……..CLICK & SEE

Anorexia nervosa is deliberate and sustained weight loss driven by a fear of becoming overweight and a distorted body image. It is not to be confused with anorexia, which is its symptomatic general loss of appetite or disinterest in food. DSM-IV characterizes anorexia nervosa as:

* An abnormally low body weight (the suggested guideline = 85% of normal for age and height, or BMI = 17.5).
* For postmenarcheal females, amenorrhea (the absence of three consecutive menstrual cycles).
* An intense fear gaining weight or becoming fat and a preoccupation with body weight and shape.

Most anorexics become so as adolescents, with 76% reporting onset of the disorder between the ages of 11 and 20.The mortality rate for those diagnosed with anorexia nervosa is approximately 6%—the highest of any mental illness—with roughly half of those due to suicide.There is a third type of eating disorder currently being investigated – Binge Eating Disorder. People who suffer from this disorder experience chronic episodes where they consume huge amounts of food in a very brief period. They experience feelings of being out of control. Unlike bulimia nervosa, they do not purge. Binge eating can lead to serious health risks such as morbid obesity, diabetes, hypertension, and an increased likelihood of cardiovascular disease.

Anorexics are commonly perfectionists, driven to succeed; yet they set unattainable standards of performance for themselves. When they fail to meet these standards, they look for a part of their lives they can control; food and weight become that “control” for them. Low self-esteem and constant self-criticism cause anorexics to constantly fear losing control, and even consuming a small amount of food could be considered a loss of control.

Bulimia nervosa………..CLICK & SEE
Bulimia nervosa is a cyclical and recurring pattern of binge eating (uncontrolled bursts of overeating) followed by guilt, self-recrimination and overcompensatory behaviour such as crash dieting, overexercising and purging to compensate for the excessive caloric intake.

Bulimics often have “binge food,” which is the food they typically consume during binges. Some describe their binge episodes as a physical high they feel, numbing out, going into auto-pilot, losing all control, immediate comfort, etc. The reasoning or triggers behind a binge may serve different purposes for different people. This binge episode leads the individual to feel guilt, shame, embarrassment, and complete failure. Bulimics try to regain control of themselves and the situation by purging the food–making up for their mistake. This leads to feeling famished and empty again, and therefore, another uncontrollable binge, followed by feeling powerless, and the vicious binge/purge cycle continues. Bulimics have extreme eating and exercising habits, instead of demonstrating moderation. This compulsive behavior is often echoed in similar destructive behavior such as sexual promiscuity, pathological lying, and shoplifting. Some bulimics not only struggle with the eating disorder, but these other harmful behaviors as well.

Binge-eating disorder……..CLICK & SEE
People with this recently recognized disorder have frequent episodes of compulsive overeating, but unlike those with bulimia, they do not purge their bodies of food (NIMH, 2002). During these food binges, they often eat alone and very quickly, regardless of whether they feel hungry or full. They often feel shame or guilt over their actions. Unlike anorexia and bulimia, binge-eating disorder occurs almost as often in men as in women (National Eating Disorders Association, 2002).

Causes:

Environmental

The media may be a significant influence on eating disorders through its impact on values, norms, and image standards accepted by modern society.  Both society’s exposure to media and eating disorders have grown immensely over the past decade. Researchers and clinicians are concerned about the relationship between these two phenomena and finding ways to reduce the negative influence thin-ideal media has on women’s body perception and susceptibility to eating disorders. The dieting industry makes billions of dollars each year by consumers continually buying products in an effort to be the ideal weight. Hollywood displays an unrealistic standard of beauty that makes the public feel incredibly inadequate and dissatisfied and forces people to strive for an unattainable appearance.  This takes an enormous toll on one’s self-esteem and can easily lead to dieting behaviors, disordered eating, body shame, and ultimately an eating disorder.

Biological

Patients with severe obsessive compulsive disorder, depression or bulimia patients were all found to have abnormally low serotonin levels. Neurotransmitters such as serotonin, dopamine and norepinephrine are secreted by the intestines and central nervous system during digestion.

Researchers have also found low cholecystokinin levels in bulimics. Cholecystokinin is a hormone that causes one to feel full and decreases eating. Low levels of this hormone are likely to cause a lack of satiative feedback when eating, which can lead to overeating. Another explanation researchers found for overeating is abnormalities in the neuromodulator peptides, neuropeptide Y and peptide YY. Both of these peptides increase eating and work with another peptide called leptin. Leptin is released by fat cells and is known to decrease eating. Research found the majority of people who overate produced normal amounts of leptin but they might have complications with the blood-brain barrier preventing an optimal amount to reach the brain.

Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism.High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus. A study in London at Maudsley Hospital found that anorexics were found to have a large variation of serotonin receptors and a high level of serotonin.

Many of these chemicals and hormones are associated with the hypothalamus in the brain. Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level.

While scientists have determined that there are possible biochemical or biological causes leading to eating disorders because certain chemicals which control hunger, appetite or digestions are out of balance, experts such as Dr. Edward J. Cumella, executive director of the Remuda Treatment Programs, states that there are three components to eating disorders: 1. The genetic component; 2. The unique environmental factors, such as personal experiences; and 3) The shared environmental factors, such as culture. According to Dr. Cumella, “Some people are born with a predisposition to having an eating disorder and there are genetic markers that can push a person in the direction of anorexia or bulimia…but it does not guarantee that a person will automatically suffer from an eating disorder. The environment – a person’s life experience – still has to pull the trigger.”

Developmental etiology

Research from a family systems perspective indicates that eating disorders stem from both the adolescent’s difficulty in separating from over-controlling parents, and disturbed patterns of communication. When parents are critical and unaffectionate, their children are more prone to becoming self-destructive and self-critical, and have difficulty developing the skills to engage in self-care giving behaviors. Such developmental failures in early relationships with others, particularly maternal empathy, impairs the development of an internal sense of self and leads to an over-dependence on the environment. When coping strategies have not been developed in the family system, food and drugs serve as a substitute.

Trauma
Eating disorders should also be understood in the context of experienced trauma, with many eating problems beginning as survival strategies rather than vanity or obsession with appearance. According to sociologist Becky Thompson, eating disorders stemming from women of varying socio-economic status, sexual orientation and race, and finds that eating disorders and a disconnected relationship with ones body is commonly a response to environmental stresses, including sexual, physical, and emotional abuse, racism, and poverty. This reality is further detrimental for women of color and other minority women, since they are forced to live in a culture that embraces a narrowly defined conception of beauty: “people furthest from the dominant ideal of beauty, specifically women of color, may suffer the psychological effects of low self-esteem, poor body image, and eating disorders.

Gender wise:
“Frequent dieting and trying to look like persons in the media were independent predictors of binge eating in females of all ages. In males, negative comments about weight by fathers was predictive of starting to binge at least weekly.

Diagnosis:
Clinically, eating disorders are evaluated using instruments such as the Questionnaire of Eating and Weight Patterns (QEWP), which has specialized versions for adolescents and parents (QEWP-A, and QEWP-P). In addition to evaluating eating patterns, these tests also measure depression.

Medical problems that may arise as a result of eating disorders:

* Anorexia nervosa – Anorexia can slow the heart rate and lower blood pressure, increasing the chance of heart failure. Those who use drugs to stimulate vomiting, bowel movements, or urination are also at high risk for heart failure. Starvation can also lead to heart failure, as well as damage the brain. Anorexia may also cause hair and nails to grow brittle. Skin may dry out, become yellow, and develop a covering of soft hair called lanugo. Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur as a consequence of this eating disorder. Severe cases of anorexia can lead to brittle bones that break easily as a result of calcium loss.
* Bulimia nervosa – The acid in vomit can wear down the outer layer of the teeth, inflame and damage the esophagus (a tube in the throat through which food passes to the stomach), and enlarge the glands near the cheeks (giving the appearance of swollen cheeks). Damage to the stomach can also occur from frequent vomiting. Irregular heartbeats, heart failure, and death can occur from chemical imbalances and the loss of important minerals such as potassium. Peptic ulcers, pancreatitis (inflammation of the pancreas, which is a large gland that aids digestion), and long-term constipation are also consequences of bulimia.
* Binge-eating disorder – Binge-eating disorder can cause high blood pressure and high cholesterol levels. Other effects of binge-eating disorder include fatigue, joint pain, Type II diabetes, gallbladder disease, and heart disease.

Treatment:
* Anorexia nervosa – The first goal for the treatment of anorexia is to ensure the person’s physical health, which involves restoring a healthy weight (NIMH, 2002). Reaching this goal may require hospitalization. Once a person’s physical condition is stable, treatment usually involves individual psychotherapy and family therapy during which parents help their child learn to eat again and maintain healthy eating habits on his or her own. Behavioral therapy also has been effective for helping a person return to healthy eating habits. Supportive group therapy may follow, and self-help groups within communities may provide ongoing support.
* Bulimia nervosa – Unless malnutrition is severe, any substance abuse problems that may be present at the time the eating disorder is diagnosed are usually treated first. The next goal of treatment is to reduce or eliminate the person’s binge eating and purging behavior (NIMH, 2002). Behavioral therapy has proven effective in achieving this goal. Psychotherapy has proven effective in helping to prevent the eating disorder from recurring and in addressing issues that led to the disorder. Studies have also found that Prozac, an antidepressant, may help people who do not respond to psychotherapy (APA, 2002). As with anorexia, family therapy is also recommended.

.* Binge-eating disorder – The goals and strategies for treating binge-eating disorder are similar to those for bulimia. Binge-eating disorder was recognized only recently as an eating disorder, and research is under way to study the effectiveness of different interventions (NIMH, 2002).

You may click for more information :->BBC NEWS:20 Dec.2000

->National Institute Of Mental Health

Resources:
http://en.wikipedia.org/wiki/Eating_disorder
http://mentalhealth.samhsa.gov/publications/allpubs/ken98-0047/default.asp

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