Download E A T I N G D I S O R D E R S

EATING
DISORDERS
Eating disorders, including anorexia and bulimia, are complicated, serious and potentially
devastating. They’re caused by a complex combination of factors, including genetic,
biochemical, psychological, cultural and environmental. While researchers haven’t been able
to pinpoint the specifics behind these causes, they can identify various factors that make
individuals susceptible to eating disorders.
There are many misconceptions in our society about what causes eating disorders.
Eating disorders are rarely about food or wanting to be thin. Instead, sufferers use food and
unhealthy behaviors like dieting, starving, bingeing and purging to cope with unpleasant and
overwhelming emotions and stressful situations. At least in the short term, these behaviors
relieve anxiety and stress. Long term, however, they actually increase anxiety and stress and
create other serious complications.
Eating disorders are illnesses, not character flaws or choices. Individuals don’t
choose to have an eating disorder. You also can’t tell whether a person has an eating disorder
just by looking at their appearance. People with eating disorders can be underweight, normal
weight or overweight. It’s impossible to diagnose anyone just by looking at them.
While no one thing causes eating disorders, here are some of the factors that may
contribute to the problem:
GENETICS:
Genetics has a significant contribution and may predispose individuals to eating disorders.
Researchers have found that eating disorders tend to run in families. Also, there seem to be
higher rates of eating disorders in identical twins than in fraternal twins or other siblings. In
addition, specific chromosomes have been linked to both bulimia and anorexia.
BIOCHEMISTRY
Individuals with eating disorders may have abnormal levels of certain chemicals that regulate
such processes as appetite, mood, sleep and stress. For instance, both people with bulimia and
anorexia have higher levels of the stress hormone cortisol. Some research also suggests that
individuals with anorexia have too much serotonin, which keeps them in a constant state of
stress. Various psychological factors can contribute to eating disorders. In fact, eating
disorders are common in individuals who struggle with clinical depression, anxiety disorders
and obsessive-compulsive disorder.
PSYCHOLOGY
Various psychological factors can contribute to eating disorders. In fact, eating disorders are
common in individuals who struggle with clinical depression, anxiety disorders and
obsessive-compulsive disorder. Other factors include: low self-esteem
, feelings of
hopelessness and inadequacy, trouble coping with emotions or expressing your emotions,
perfectionism, impulsivity…
CULTURE
Dieting, body dissatisfaction and wanting to be thin are all factors that increase the risk for an
eating disorder. Unfortunately, our society encourages all three. You can’t walk by a cash
register without seeing a magazine that encourages rapid weight loss, calorie counting or
feeling guilty after a meal. Here are some aspects of our culture that contribute to eating
disorders:
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an over-emphasis on appearance, at the expense of more meaningful attributes
societal beauty standards that promote an unrealistically thin body shape
associating thinness with positive qualities like attractiveness, health, success and
love media’s focus on dieting and striving for a slim and toned silhouette messages that perpetuate a fear of fat and food; viewing fat as undesirable or foods
as “good,” “bad” or “sinful”
ENVINROMENT
Your environment can also play a major role in developing an eating disorder. These factors
include:
o family or other relationship problems
o difficult or turbulent childhood
history of physical or sexual abuse
o activities that encourage thinness or focus on weight, such as gymnastics, dancing,
running, wrestling, ballet and modeling
o peer pressure
o being bullied because of weight or appearance in general
ANOREXIA NERVOSA
1.1.Definition
Anorexia nervosa is an eating disorder characterized by refusal to stay at even the
minimum body weight considered normal for the person's age and height. Other symptoms of
the disorder include distorted body image and an intense fear of weight gain.
Inadequate eating or excessive exercising results in severe weight loss. Eating
disorders frequently develop during adolescence or early adulthood, but some reports indicate
their onset can occur during childhood or later in adulthood. Anorexia nervosa is one of the
two major types of eating disorders; the other is bulimia.
People with anorexia see themselves as overweight even though they are dangerously
thin. The process of eating becomes an obsession to them. Unusual eating habits develop,
such as avoiding what they perceive as high caloric food and meals, picking out a few foods
and eating only these in small quantities, or carefully weighing and portioning food. People
with anorexia may repeatedly check their body weight and many engage in other techniques
to control their weight, such as intense and compulsive exercise or purging by means of
vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a
delayed onset of their first menstrual period.
Eating disorders frequently co-occur with other psychiatric disorders, such as
depression, substance abuse, and anxiety disorders. In addition, people who suffer from eating
disorders can experience a wide range of physical health complications, including serious
heart conditions and kidney failure, that may lead to death. Recognition of eating disorders as
real and treatable diseases, therefore, is critically important.
1.2. Symptoms
An estimated 0.5 percent to 3.7 percent of females and 0.1 percent to 0.2 percent of males
suffer from anorexia nervosa in their lifetime. Symptoms of anorexia nervosa include:
•
refusal to maintaining body weight at or above a minimally normal weight for one's
age and height
•
intense fear of gaining weight or becoming fat, even though one is underweight
•
disturbance in the way in which one's body weight or shape is experienced, undue
influence of body weight or shape on self-evaluation, or denial of the seriousness of
low body weight
 infrequent or absent menstrual periods (in females who have reached puberty)
1.3. Treatments
Eating disorders can be treated, and a healthy weight can be restored. The sooner
these disorders are diagnosed and treated, the better the outcome is likely to be. Because of
their complexity, eating disorders require a comprehensive treatment plan involving medical
care and monitoring, psychosocial interventions, nutritional counseling, and, when
appropriate, medication management.
Treatment of anorexia calls for a specific program that involves three main phases:
(1) restoring weight lost to severe dieting and purging,
(2) treating psychological disturbances such as distortion of body image,
low self-esteem, and interpersonal conflicts,
(3) achieving either long-term remission and rehabilitation or full recovery.
At the time of diagnosis, the clinician must determine whether the person is in
immediate danger and requires hospitalization. Use of psychotropic medication in people with
anorexia should be considered only after weight gain has been established. Certain selective
serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance
and for resolving mood and anxiety symptoms associated with anorexia.
The acute management of severe weight loss is usually provided in an inpatient
hospital setting, where feeding plans address the person's medical and nutritional needs. In
some cases intravenous feeding is recommended. Once malnutrition has been corrected and
weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal
psychotherapy) can help people with anorexia overcome low self-esteem and address
distorted thought and behavior patterns. Families are sometimes included in the therapeutic
process.
People with eating disorders often do not recognize or admit that they are ill. As a
result, they may strongly resist getting into and staying in treatment. Family members or other
trusted individuals can be helpful in ensuring that the person with an eating disorder receives
needed care and rehabilitation. For some people, treatment may be long-term.
BULIMIA NERVOSA
1.1. Definition
Bulimia Nervosa is characterized by recurrent and frequent episodes of binge eating,
unusually large amounts of food consumed in a short time—and a feeling that one lacks
control over eating. A bulimic can consume as much as 3,400 calories in little more than an
hour, and as much as 20,000 calories in eight hours.
People with bulimia often know they have a problem and are afraid of their inability
to stop eating. Binging is then followed by purging—namely, self-induced vomiting or the
abuse of diuretics or laxatives. Binging and purging are often performed in secret, with
feelings of shame alternating with relief.
Unlike anorexia, people with bulimia can maintain a normal weight for their age. But
like people with anorexia, they often fear gaining weight, want desperately to lose weight,
and are intensely unhappy with their body size and shape, which may explain why bulimic
behavior often takes place in secret. The binging and purging cycle usually repeats several
times a week. As with anorexia, people with bulimia often have coexisting psychological
illnesses, such as depression and anxiety, and substance abuse problems. Many physical
dysfunctions result from the purging, including electrolyte imbalances, gastrointestinal
troubles, and dental problems.
An estimated 1 to 4 percent of females have bulimia nervosa during their lifetime.
Most cases begin in the late teens and early 20s, but can go undetected until the 30s or 40s.
1.2. Causes
• Recurrent episodes of binge eating, characterized by eating within a discrete period of
time—say, two hours—an amount of food substantially larger than most people
would eat.
• A feeling that one cannot stop eating or control what or how much one eats.
• Recurrent compensatory behavior in order to prevent weight gain, such as self-induced
vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; and
excessive exercise.
• Self-evaluation unduly influenced by body shape and weight
• This disturbance doesn't occur exclusively with anorexia nervosa.
Specific Types:
Purging type: regularly induced vomiting or misused laxatives, diuretics, or enemas.
Nonpurging type: other inappropriate compensatory behaviors, such as fasting or excessive
exercise, but not self-induced vomiting or the misuse of laxatives, diuretics, or
enemas.
Other symptoms include:
• chronically inflamed and sore throat
• swollen glands in the neck and below the jaw
• worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to
stomach acids
• acid reflux disorder (gastroesophageal reflux disorder, or GERD)
• intestinal distress and irritation from laxative abuse
• kidney problems from diuretic abuse severe dehydration from purging of fluids
1.3.Treatments
As with anorexia, treatment for bulimia often involves a combination of options and
depends on individual needs.
To reduce or eliminate binging and purging, a patient may undergo nutritional
counseling and psychotherapy, especially cognitive behavioral therapy, and be prescribed
medication. Some antidepressants, such as fluoxetine (brand name, Prozac)—the only
medication approved by the FDA for treating bulimia—may help patients who also suffer
from depression and anxiety. It also appears to help reduce binge-eating and purging as well
as the chance of relapse, and it can improve eating attitudes.
Cognitive behavioral therapy tailored to treat bulimia also has shown to be effective
in changing binging and purging behavior and improving attitudes towards eating. Therapy
may be done one on one or in a group.
Current Research
Unlike a neurological disorder, which generally can be pinpointed to a specific lesion on the
brain, an eating disorder likely involves abnormal activity distributed across brain systems.
With increased recognition that mental disorders are brain disorders, more researchers are
using tools from neuroscience, such as magnetic resonance imaging (MRI), to better
understand eating disorders and how those with a disorder process information, whether
they've recovered or are still in the throes of their illness.
Behavioral or psychological research on eating disorders is more complex and
challenging. New studies are currently underway to remedy the lack of information about
treatment. Researchers also are working to define the basic processes of the disorders, which
should help identify better treatments.
These and other questions may be answered in the future as scientists and doctors
think of eating disorders as medical illnesses with certain biological causes. Researchers are
studying behavioral questions, along with genetic and brain systems information, to
understand risk factors, identify biological markers and develop medications that can target
specific pathways that affect eating behavior. Finally, neuroimaging and genetic studies may
provide clues for individual responses to specific treatments.