We encounter a wide variety of people our lives through. Many of them touch us in some positive way. Occasionally, however, we encounter those individuals who, for whatever reason, can be difficult to deal with. Perhaps this person is a colleague or your boss or close friend that you feel is deliberately being obtuse, inviting in trouble, or doing foolish things that you find annoying. Sometimes, it may be possible to appease or avoid those people short term. Dealing with them in the long term, however, can be exhausting. The behavior of difficult people can even make you feel like losing your temper, but keep your cool. Staying calm is the first step, especially when you are ready to confront them.
Avoiding a difficult person can improve impossible and not in your best interest, especially if you live or work together. Likewise, attempts to steer clear of them can become a source of stress and anxiety when they are a part of your social circle. When this is the case, it is best to kindly address the problem. Try not to let their actions or mood affect you. You also may want to try expressing your feelings directly. Tell to the person how their actions make you feel and encourage them toward a more positive course of action. Speak assertively, but respectfully, and don’t portray yourself as a victim. Another approach for dealing with a difficult individual is to gain a deeper understanding of who that person is. Ask them why they do or say certain things. If you disagree with their motives, question them further so you can try and discover the root of their behaviors. In doing so, you may be able to gently shift their perceptions, or at least help them understand your ! point of view.
You may want to think about what you want to say to a difficult person before you actually talk to them. If you can, avoid being judgmental or defensive, and try to approach the conversation objectively. If the person is open to the idea, try coming to an agreement. If approaching them fails, let it go and move on. There is no reason to let difficult person or situation have power over your state of being. Remember that a lot can be accomplished when you take the time to listen and offer up alternative perspectives.
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).
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.
The signs and symptoms of eating disorders vary with the particular type of eating disorder.
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
*Flat mood or lack of emotion
*Preoccupation with food
*Dizziness or fainting
*Soft, downy hair present on the body (lanugo)
*Menstrual irregularities or loss of menstruation (amenorrhea)
*Frequently being cold
*Irregular heart rhythms
*Low blood pressure
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
*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
*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
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.
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:
*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.
“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)
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 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 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.
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.
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).
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.
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.
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:
*Suicidal thoughts or behavior
*Absence of menstruation (amenorrhea)
*Severe tooth decay
*High or low blood pressure
*Type 2 diabetes
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.
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).
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.
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.
*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 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
*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)
*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.
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.
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.
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.
Research has shown again and again that patients who follow aerobic-exercise regimens see improvement in their depression — improvements comparable to that of those treated with medication. Exercise not only relieves depressive symptoms but also appears to prevent them from recurring.
Adolescents who went to bed early were less likely to suffer from depression or contemplate suicide, a new study has found. click to see
It shows that adolescents with parental-set bedtimes of midnight or later were 24 percent more likely to suffer from depression and 20 percent more likely to have suicidal thoughts than those with parental-set bedtimes set for 10 p.m. or earlier.
Those who reported sleeping five or fewer hours per night were 71 percent more likely to suffer from depression and 48 percent more likely to think about committing suicide than those who reported eight hours of sleep.
Also, participants who reported that they “usually get enough sleep” were significantly less likely to suffer from depression and suicidal ideation.
James E. Gangwisch, assistant professor at the Columbia University Medical Centre (CUMC), who led the study, said the results strengthen the argument that short sleep duration could play a role in a person’s history of depression.
“Our results are consistent with the theory that inadequate sleep is a risk factor for depression, working with other risk and protective factors through multiple possible causal pathways to the development of this mood disorder,” said Gangwisch.
“Adequate quality sleep could, therefore, be a preventive measure against depression and a treatment for the disease,” added Gangwisch, according to a CUMC release.
Data were collected from 15,659 adolescents and their parents who had participated in the National Longitudinal Study of Adolescent Health (Add Health), a school-based, nationally representative, probability-based sample of US students in grades seven to 12 in 1994 to 1996.
Source: The study was published in the Friday issue of Sleep. (Republished in the Times Of India)
Almost everyone overeats on occasion, having seconds or thirds of a holiday meal or devouring an entire bag of chips while watching a scary movie. Sometimes, though, overeating becomes a regular occurrence, shrouded in shame and secrecy. It’s called binge-eating disorder(BED), a serious eating disorder in which you frequently consume unusually large amounts of food.
Binge eating disorder is characterized by compulsive overeating in which people consume huge amounts of food while feeling out of control and powerless to stop.Even the best of us occasionally overeats, helping ourselves to seconds, and even thirds; especially on holiday or festive celebrations. This is not a binge eating disorder. It becomes a disorder when the bingeing occurs regularly, and the binger is shrouded in shame and secrecy. The binger is deeply embarrassed about overeating and vows never to do it again. However, the compulsion is so strong that subsequent urges to gorge themselves cannot be resisted.
Binge eating disorder (BED), is the most common eating disorder in the United States affecting 3.5% of females and 2% of males and is prevalent in up to 30% of those seeking weight loss treatment, Although it is not yet classified as a separate disorder it was first described in 1959 by psychiatrist and researcher, Albert Stunkard and was first termed Night Eating Syndrome (NES), Binge Eating Disorder was coined to describe the same bingeing type eating behavior without the nocturnal component. BED usually leads to obesity although it can occur in normal weight individuals. There may be a genetic inheritance factor involved in BED independent of other obesity risks and there is also a higher incidence of psychiatric comorbidity, with the percentage of individuals with BED and an Axis I comorbid psychiatric disorder being 78.9% and for those with subclinical BED, 63.6%.
Some experts say that binge-eating disorder is the most common of all eating disorders. Estimates suggest that up to 4 percent of the U.S. population has binge-eating disorder, with girls and women slightly more likely than boys and men to develop the condition. Both children and adults can develop binge-eating disorder, but it’s most common when in your 40s and 50s.
In many parts of the world binge eating disorder is not considered a distinct condition. However, it is the most common of all eating disorders. Perhaps as more research is published and scientists learn more about it, this may change.
You may have no obvious physical signs or symptoms when you have binge-eating disorder. You may be overweight or obese, or you may be of a normal weight. In fact, most obese people don’t have binge-eating disorder.
On the other hand, when you have binge-eating disorder you often have numerous behavioral and emotional signs and symptoms. These may include:
*Periodically does not exercise control over consumption of food.Eating large amounts of food
*Eats an unusually large amount of food at one time—more than a normal person would eat in the same amount of time.
*Eats much more quickly during binge episodes than during normal eating episodes.
*Eats until physically uncomfortable and physically feels like they’re on the verge of throwing up due to the amount of food just consumed.
*Eating even when you’re full
*Eats when depressed, sad, or bored.
*Eats large amounts of food even when not really hungry.
*Usually eats alone during binge eating episodes, in order to avoid discovery of the disorder.
*Often eats alone during periods of normal eating, owing to feelings of embarrassment about food.
*Feels disgusted, depressed, or guilty after binge eating.
*Feeling that your eating behavior is out of control
*Frequently eating alone
*Hiding empty food containers
*Feeling depressed, disgusted or upset about your eating.
After a binge, you may try to diet or eat normal meals. But restricting your eating may simply lead to more binge eating, creating a vicious cycle. Causes:
No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder, whether binge eating disorder causes depression, or whether the two have a common cause, is not known for sure.
The trigger point can be emotion such as happiness, anger, sadness or boredom. Impulsive behavior and certain other emotional problems can be more common in people with binge eating disorder. However, many people also claim that bingeing occurs regardless of their mood.It is also unclear whether dieting and binge eating are related. Some studies show that about half of all people with binge eating disorder had binge episodes before they started to diet.
As with many mental illnesses, it’s thought that a variety of factors are at play in binge-eating disorder and may include:
*Biological. Biological vulnerability may play a role in developing binge-eating disorder. Both genes and brain chemicals may be involved. In addition, researchers are studying appetite regulation of the central nervous system for clues, along with gastrointestinal changes that might shed light on causes.
*Psychological. Psychological and emotional characteristics may also contribute to the condition. You may have low self-worth and trouble controlling impulsive behaviors, managing moods or expressing anger.
*Sociocultural. Modern Western culture often cultivates and reinforces a desire for thinness. Although most people who have binge-eating disorder are overweight, they’re acutely aware of their body shape and appearance and berate themselves after eating binges. Some people with binge-eating disorder have a history of being sexually abused.
Researchers also say that binge eating disorder is more common among competitive athletes such as swimmers or gymnasts whose body form is regularly on public display. Affected athletes in these sports tend to compare their own bodies in a negative way with those of their teammates. There is a research into how brain chemicals and metabolism affect binge eating disorder, but this study is in its early stages. Complecations & Risk Factors:–
Complications that binge-eating disorder may cause or be associated with include:
*Substance or alcohol abuse
*High blood pressure
*Type 2 diabetes
*High blood cholesterol
Frequent consumption of large amounts of food in a short period of time usually leads to weight gain and obesity, even though sufferers can maintain a normal weight for extended periods of time due to naturally high metabolism. The most problematic health consequences of this type of eating disorder is brought on by the weight gain resulting from the bingeing episodes.
People with binge eating disorder may become ill due to a lack of proper nutrition. Bingeing episodes usually include foods that are high in sugar and/or salt, but low in healthier nutrients, and are usually very upset by their binge eating and may become depressed. Those who are obese and also have binge eating disorder are at risk for type 2 diabetes, high blood pressure, high blood cholesterol levels, gallbladder disease, heart disease, and certain types of cancer.
Most people with binge eating disorder have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school, or social activities to binge eat. Obese people with binge eating disorder often feel bad about themselves and may avoid social gatherings. Those who binge eat, whether obese or not, feel ashamed, are well aware of their disordered eating patterns, and try to hide their problems. Often they become so good at hiding it that even close friends and family members don’t know they binge eat.
Mental health experts are still trying to understand what factors may increase the risk of developing binge-eating disorder. The risk factors may vary from those of other eating disorders, such as anorexia or bulimia. Risk factors for binge-eating disorder may include:
*Dieting. Dieting is often a risk factor for anorexia and bulimia, but it’s not clear what role it plays in binge-eating disorder. People with binge-eating disorder have a mixed history of dieting — some have dieted to excess dating back to childhood, while others haven’t dieted. Dieting may trigger an urge to binge eat.
*Psychological issues. Certain behaviors and emotional problems are more common when you have binge-eating disorder. As with bulimia, you may act impulsively and feel a lack of control over your behavior. You may have a history of depression or substance abuse. Binge eaters may have trouble coping with anger, sadness, boredom, worry and stress.
*Sexual abuse. Some people with binge-eating disorder say they were sexually abused as children.
*Media and society. A preoccupation with body shape, weight and appearance is common when you have binge-eating disorder. Messages in the media that equate thinness with success may heighten the self-criticism that’s common in binge eating. *Biology – the development of binge eating disorder may be linked to a person’s biological vulnerability, involving genes as well as brain chemicals. Current research is looking at how the appetite regulation of the central nervous system may affect people’s eating habits. There may also be clues in how some people’s gut functions.
*Some jobs – there is some looming evidence that a higher percentage of sportsmen, sportswomen and models have binge eating disorder compared to other people. Although some people suggest that individuals who work in catering (making and serving food) may be susceptible, further studies are required. Diagnosis:
Binge-eating disorder is not yet officially classified as a mental disorder, and not all experts think it should be. Mental health experts hope that ongoing research will determine if binge eating is a distinct medical condition, a nonspecific type of eating disorder, or simply a cluster of symptoms.
Binge eating is similar to bulimia nervosa, another eating disorder, and some experts think it may be a form of bulimia. But unlike people with bulimia, who purge after eating, people with binge-eating disorder don’t try to rid themselves of the extra calories they consume by self-induced vomiting, overexercising or other unhealthy methods. That’s why most people with binge-eating disorder are overweight. In fact, some experts say that binge eating may be a type of obesity disorder.
In any case, when doctors suspect someone has an eating disorder, they typically run a battery of tests and exams. These can help pinpoint a diagnosis and also assess any related complications.
These exams and tests generally include:
*Physical exam. This may include such things as measuring height and weight; assessing body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin; listening to the heart and lungs; and examining the abdomen.
*Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check such things as cholesterol levels, thyroid functioning, electrolytes and blood sugar, which may determine if you have metabolic syndrome.
*Psychological evaluation. A doctor or mental health professional will discuss your thoughts, feelings and eating habits with you. You may be asked about binge-eating symptoms, including when they started, how severe they are, how they affect your daily life and whether you’ve had similar issues in the past. You may also be asked to complete psychological self-assessments and questionnaires.
*Other studies. Other studies may be done to check for health consequences of binge-eating disorder, such as heart problems, gallbladder disease or sleep apnea.
Criteria for diagnosis:-
All these evaluations help doctors determine if you meet the criteria for binge-eating disorder or if you may have another eating disorder, such as bulimia. The criteria to diagnose mental health conditions are set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
The DSM says more research is needed before determining whether binge-eating disorder is truly a unique medical condition. However, it offers some criteria for diagnosing binge-eating disorder.
DSM diagnostic criteria for binge-eating disorder include:
*Recurrent episodes of binge eating, including eating an abnormally large amount of food and feeling a lack of control over eating
*Binge eating that’s associated with at least three of these factors: eating rapidly; eating until you’re uncomfortably full; eating large amounts when you’re not hungry; eating alone out of embarrassment; or feeling disgusted, depressed or guilty after eating.
*Distress about your binge eating
*Binge eating occurs at least twice a week for at least six months
*Binge eating isn’t associated with inappropriate methods to compensate for overeating, such as self-induced vomiting
Some people may not meet all of these criteria but still have an eating disorder. As researchers learn more about eating disorders, the diagnostic criteria may evolve and change. Don’t try to diagnose yourself — get professional help if you have any eating disorder symptoms.
People with binge eating disorder, whether or not they want to lose weight, should get help from health professionals including physicians, nutritionists, psychiatrists, psychologists, clinical social workers or by attending 12-step Overeaters Anonymous meetings. Even those who are not overweight are usually upset by their binge eating, and treatment can help them.
Although mental health professionals may be attuned to the signs of binge eating disorders, most physicians do not raise the question, either because they are uninformed about the condition or too embarrassed to ask about it. Because it is not a recognized psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders, it is difficult to get insurance reimbursement for treatments.
There are several different ways to treat binge eating disorder. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people.
Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program to improve health and to build self-esteem, as well as counselling to pinpoint the root of their psychological problems triggering their binge episodes, might be the best choice.
While there’s no sure way to prevent binge-eating disorder, there may be ways to help. For instance, pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development. During routine well-child checks or medical appointments, pediatricians can ask children questions about their eating habits and satisfaction with their appearance. Parents can also cultivate and reinforce a healthy body image in their children no matter what their size or shape. Be certain not to tease or joke about a child’s size, shape or appearance.
In addition, if you notice a family member or friend with low self-esteem, severe dieting, frequent overeating, hoarding of food or dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent binge-eating disorder or another eating disorder from developing you can talk about healthier behavior or treatment options. Lifestyle and home remedies: Binge-eating disorder generally isn’t an illness that you can treat on your own. But you can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care steps for binge eating:
*Stick to your treatment. Don’t skip therapy sessions. If you have meal plans, do your best to stick to them and don’t let setbacks derail your overall efforts. *Avoid dieting. Trying to diet can trigger more binge episodes, leading to a vicious cycle that’s hard to break. *Eat breakfast. Many people with binge-eating disorder skip breakfast. But studies show that if you eat breakfast, you’re less prone to eating higher calorie meals later in the day. *Don’t stock up. Keep less food in your home than you normally do. That may mean more-frequent trips to the grocery store, but it may also take away the temptation and ability to binge eat. *Get the right nutrients. Just because you may be eating a lot during binges doesn’t mean you’re eating the kinds of food that supply all of your essential nutrients. Talk to your doctor about vitamin and mineral supplements. *Stay connected. Don’t isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart. *Get active. Talk to your health care providers about what kind of exercise is appropriate for you, especially if you have health problems related to being overweight.
Regular Exercise and Routine diet is the best form of remedy for BED
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.