Eating disorder

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Eating Disorder
Classification and external resources
ICD-10	F50.
ICD-9	307.5
MeSH	D001068

An eating disorder is to eat, or avoid eating, in a manner which 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."^[1] Anorexia nervosa and bulimia nervosa are the most common eating disorders generally recognized by medical classification schemes,^[2] with a significant diagnostic overlap between the two.^[3] Together, they affect an estimated 5-7% of females in the United States during their lifetimes.^[4]There are several other eating disorders which are prevalent amongst certain demographics that are being investigated and defined - Rumination syndrome, Compulsive overeating, and Selective eating disorder.

Contents 1 Disorders 1.1 Anorexia nervosa 1.2 Bulimia nervosa 1.3 Rumination syndrome 1.4 Orthorexia nervosa 1.5 Selective eating disorder 1.6 Compulsive overeating 2 Causes 2.1 Environmental 2.2 Biological 2.3 Developmental etiology 2.4 Trauma 3 Gender differences 4 Diagnosis 5 Notes 6 References 7 External links

[edit] Disorders

[edit] Anorexia nervosa

Anorexia nervosa is deliberate and sustained weight loss driven by a fear of distorted body image. It is a serious disorder that can lead to death.^[5] It is not to be confused with anorexia, which is a 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 of gaining weight or becoming fat and a preoccupation with body weight and shape.^[6]

The appearance of anorexia often occurs during adolescence, with 76% reporting onset of the disorder between the ages of 11 and 20.^[7] It is about ten times more likely to occur with females than males.^[5] 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.^[8]

Anorexics have a distorted view of their body. Even when they are extremely thin, they see themselves as too fat.^[5] 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.^[5]

[edit] Bulimia nervosa

Bulimia nervosa is a cyclical and recurring pattern of binge eating (uncontrolled bursts of overeating) followed by guilt, self-recrimination and overcompensatory behavior such as crash dieting, overexercising and purging to compensate for the excessive caloric intake.^[5]

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 (either by self-induced vomiting or using a laxative), making up for their mistake.^[5] 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.

The appearance of bulimia nervosa often occurs during late adolescence or early adulthood.^[5] 90 Percent of bulimics are women.^[5] Roughly 70 percent of individuals who develop bulimia nervosa eventually recover.^[5]

Compulsive exercising is a type of bulimia nervosa, where those afflicted exercise excessively in order to purge excess calories.^[9][9] One that struggles with this disorder takes part of vigorous physical activity to the point that it is unhealthy and unsafe. It is often referred to as obligatory exercise or anorexia athletic. The individual usually feels compelled to exercise and has problems with anxiety and guilt until exercising. Someone that has compulsive exercising disorder will still force themselves to work out even when sick or injured. He or she will often calculate how much they have eaten and exercise on the amount of calories they have eaten and usually have low energy because of all the calories they have burned.^[10] People who struggle with this disorder usually do it to have more control in their life. Praise is often given to the individual about how in shape he/she may look which gives that person more of a drive to continue to work out. Females most commonly have compulsive exercising disorder and measure their self worth through their performance. They often take out their emotions like anger, depression, or frustration when exercising by pushing their bodies to the limit.^[11]

[edit] Rumination syndrome

Rumination Syndrome is a rarely diagnosed chronic eating disorder of unknown prevalence. Though classically described as an illness of infancy or people with cognitive disabilities, its effects on otherwise healthy adults and adolescents is gaining increasing awareness in the medical community. Patients of this disorder experience effortless post-prandial (after ingestion) regurgitation of meals without the smells and tastes associated with normal vomitting. There is no nausea or retching preceding the event. Rumination syndrome is often misdiagnosed as bulimia nervosa by doctors, due to the lack of awareness of the disorder, the similarity in symptoms, and the common teenage onset of the disorder.^[12]

[edit] Orthorexia nervosa

Orthorexia nervosa is a recently discovered disease previously thought to be Anorexia. This type of disorder is an obsession with eating only healthy types of foods. This disorder derives from the drive to become pure, so that a sufferer begins to become obsessed with everything that he or she is consuming. Someone who struggles with orthorexia nervosa will do things like planning out their meals for the next day. This means that they will have a strict planned schedule of breakfast, lunch and dinner. Thinness often results due to the restricted types and amounts of food eaten, but is a side effect rather than an intended result. People who have orthorexia nervosa are often critical of what others eat, and usually isolate themselves from surroundings.^[13]

[edit] Selective eating disorder

Selective Eating Disorder (SED) prevents the consumption of certain foods. Although it is often viewed as a phase of childhood that is generally overcome with age, one may continue to be afflicted with SED throughout his or her adult life. Those with the disorder eat a "highly limited range of foods" and are unlikely to try new foods, as well. When the disorder persists into middle childhood and adolescence, it can result in conflict, anxiety, and social avoidance.^[14]

Sufferers of SED have an inability to eat certain foods based on texture or aroma. "Safe" foods may be limited to only certain types of food or even specific brands. Afflicted individuals may exclude whole food groups, such as fruits or vegetables.

[edit] Compulsive overeating

Obsessive Compulsive Overeating [OCO] (Also known as binge eating) is one of the most common mental disorders and is linked with Obsessive Compulsive Disorder (OCD). It involves the consumption of very large amounts of food in a short period of time. About 2 percent of all adults in the United States struggle with binge eating. People at any age can develop this particular disorder, but it is seen most in young adults. Clinical studies have continued to find that obese binge eaters have much higher levels of depression than other obese individuals that do not have a binge eating disorder.^[15] The individual has feelings of disgust and guilt that leads to depression.

People that struggle with binge eating are likely to have alcohol problems and engage in impulsive behavior, such as not thinking before acting out.^{[citation needed]} They do not feel that they can control themselves, are typically not close with their community, and have difficulty discussing their problems and feelings. They also have more health problems, a hard time sleeping at night, joint pain, muscle pains, menstrual problems, and headaches. Affected people often have suicidal thoughts, struggle digesting their food, and are stressed. People that have a binge eating disorder are usually ashamed and become very good at hiding the fact that they have it. They become so good at hiding that most people around them, including close friends and family members, do not even know about their disorder. ("Binge Eating Disorder", 2008)

Although it is not diagnosed very often, several factors can make it more difficult to diagnose than other eating disorders. Because COE is an eating disorder which is less commonly taught in school or talked about, a large amount of people who have the disorder just blame their weight on their binges and don't consider that there might be a psychological reason behind their binge eating, or are not even aware that the disorder exists altogether. One way to determine if a person has COE is by looking at their eating patterns. It is not uncommon in some that their food habits can be completely random: healthy foods a few days, attempted dieting or even crash dieting, which are followed by a relapse into binge eating. A very common misconception is that people who have COE do not know healthy eating habits or simply "don't know better," however, what makes this specifically an eating disorder is the addiction of eating large amounts of food and repeated relapsing in attempts to changing to healthy eating habits.^{[citation needed]} Binge eating sometimes is because of a certain emotion (boredom, anger, sadness, etc.).

[edit] Causes

[edit] Environmental

Family and friends are very influential when it comes to eating disorders. The media may be a significant influence on eating disorders through its impact on values, norms, and image standards accepted by modern society.^[16] The media sends a message that "thin is beautiful" in their choice of fashion models, which many young girls want to emulate.^[5] 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.^[17] 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.^[5] The surrounding culture in which an adolescent is raised greatly affects how they feel they are supposed to look, potentially contributing to an eating disorder.^[5]

[edit] Biological

Patients with severe obsessive compulsive disorder, depression or bulimia were all found to have abnormally low serotonin levels.^[18] Neurotransmitters such as serotonin, dopamine and norepinephrine are secreted by the intestines and central nervous system during digestion.^[19]

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.^[19]

Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism.^[19] High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus.^[20] 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.^[21]

Many of these chemicals and hormones are associated with the hypothalamus in the brain.^[22] Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level. Uher & Treasure (2005) performed a study researching brain lesions effects on eating disorders. They evaluated 54 formally published cases of eating disorders and brain damage. They found many correlations between eating disorders and damage to the hypothalamus. People with brain lesions in the hypothalamus had abnormal eating behaviors; unprovoked and self induced vomiting, over concern with becoming fat, cheating with eating, frequent sleepiness, depression, obsessive compulsive behavior and diabetes insipidus.^[23]

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."^[24]

[edit] 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.^[25]

[edit] 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 one's 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."^[26]

[edit] Gender differences

"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."^[27]

Exercise addiction is common in men and women, especially in those who suffer from eating disorders and obsessive-compulsive disorder. It is the result of a fear of becoming fat, and allowing their need to stay fit to overtake their lives. Exercise addicts are risking their health in order to get a "runner's high". ^[28] They are in search of the ideal body type and place the importance of exercise above the needs of their children, parents, friends and health.

In male and female sports there are different reasons to lose weight.^{[citation needed]} For a female many of the eating disorders are for more dancing related sports such as poms, cheerleading, and many other forms of competitive forms of dance.^{[citation needed]} While in many male predominant sports it is also necessary such as wrestling, mixed martial arts, and sports where weigh-ins are necessary.^{[citation needed]} This puts a lot of stress on the male to make the cut leading to many of the eating disorders such as bulimia and anorexia nervosa.^{[original research?]}

Education sources that we depend on don't always give us the accurate information on eating disorders. Eating disorders affect women and men but we don't recognize that fact.^{[original research?]} Men suffer from a different type of eating disorders than women.^{[citation needed]} They may not starve themselves^{[original research?]} but sometimes they use drugs to bulk up. They have the pressure of being "strong, bulk, hot".^{[dubious – discuss][original research?]}"A survey published in Psychology Today reported that only 15% of men said that they are unhappy with their weight. Increasingly, men feel the same pressure that women feel to be attractive and slender. If these trends continue, the incidence rate for eating disorders among men will increase" (Pipher 16).

Pipher, Mary. Hunger pains: The moderns woman's tragic quest for thinness. New York: Ballantine Books, 1995.

[edit] Diagnosis

This section requires expansion.

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 diagnose depression.^[29]

[edit] Notes

[edit] References

[edit] External links

• BALANCE eating disorder center
• F.E.A.S.T -- Families Empowered and Supporting Treatment of Eating Disorders
• National Association of Anorexia Nervosa and Associated Disorders
• National Eating Disorders Association

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