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 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."[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 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.[5] 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. [6]

Contents

[edit] 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.[7] 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.[8] 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.[9]

[edit] Anorexia nervosa

Main article: anorexia nervosa

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.[10]

Most anorexics become so as adolescents, with 76% reporting onset of the disorder between the ages of 11 and 20.[11] 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.[12]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.[13]

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.

[edit] Bulimia nervosa

Main article: bulimia nervosa

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.

[edit] Causes

[edit] Environmental

The media may be a significant influence on eating disorders through its impact on values, norms, and image standards accepted by modern society.[14] 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.[15] 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.

[edit] Biological

Patients with severe obsessive compulsive disorder, depression or bulimia patients were all found to have abnormally low serotonin levels.[16] Neurotransmitters such as serotonin, dopamine and norepinephrine are secreted by the intestines and central nervous system during digestion.[17]

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.[17]

Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism.[17] High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus.[18] 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.[19]

Many of these chemicals and hormones are associated with the hypothalamus in the brain.[20] Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level.[17]

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."[21]

[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.[22]

[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 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."[23]

[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."[24]

[edit] 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.[25]


[edit] References

  1. ^ Siegel, Michaele, Brisman, Judith and Weinshel, Margot. Surviving an Eating Disorder. New York: Harper and Row Publishers. 1988.
  2. ^ ICD-10: Behavioural syndromes associated with physiological disturbances and physical factors. World Health Organization (2006-04-05). Retrieved on 2007-03-08.
  3. ^ Milos, G; Spindler, A; Schnyder, U & Fairburn, C G (2005), “Instability of eating disorder diagnoses: prospective study”, The British Journal of Psychiatry 187 (6): 573-578 
  4. ^ “Practice guidelines for the treatment of patients with eating disorders”, American Journal of Psychiatry (American Psychiatric Association) 157 (1): 1-39, January 2000 .
  5. ^ http://www.healthyminds.org/factsheets/LTF-EatingDisorders.pdf Let's Talk Facts About Eating Disorders
  6. ^ http://www.anad.org
  7. ^ http://womenshealth.gov/bodyimage/kids/bodywise/bp/AtRisk.pdf At Risk: All Ethnic and Cultural Groups
  8. ^ http://www.empoweredparents.com/mini/t6.htm Fat Fears Create Stress in Young Children; Stress Levels Rise in Tweenies
  9. ^ Jablow, Martha > A Parent's Guide to Eating Disorders and Obesity New York: Dell Publishing, 1992.
  10. ^ (1994) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th, American Psychiatric Association. ISBN 0890420629. 
  11. ^ Facts About Eating Disorders. National Association of Anorexia Nervosa and Associated Eating Disorders. Retrieved on 2008-03-15.
  12. ^ Herzog, David B; Greenwood, Dara N; Dorer, David J; Flores, Andrea T; Ekeblad, Elizabeth R; Richards, Ana; Blais, Mark A & Keller, Martin B (2000), “Mortality in eating disorders: A descriptive study”, International Journal of Eating Disorders 28 (1): 20-26 
  13. ^ http://www.healthyminds.org/factsheets/LTF-EatingDisorders.pdf Let's Talk Facts About Eating Disorders
  14. ^ Harrison, K & Cantor, J (1997), “The relationship between media consumption and eating disorders”, Journal of Communication (Oxford University Press) 47 (1): 40-68 
  15. ^ Australian Idol Starlet: Shocking Anorexic Revelations
  16. ^ Long, Phillip W (1993). Eating Disorders. National Institute of Mental Health. Retrieved on 2006-03-03.
  17. ^ a b c d Kalat, James W (2006). Biological Psychology, 8th, Houston: Wadsworth Publishing. ISBN 0495090794. 
  18. ^ Long, Phillip W. (1993). Eating Disorders. Retrieved March 3, 2006, from the National Institute of Mental Health website: http://www.mentalhealth.com/book/p45-eat1.html
  19. ^ Yager, Joel & Anderson, Arnold E. (2005). Anorexia Nervosa. The New England Journal of Medicine, 353 (14), 1481-1488, Retrieved March 3, 2006, from Ovid web: http://mutex.gmu.edu:2076/gw1/ovidweb.cgi
  20. ^ Uher, R., & Treasure, J. (2005). Brain Lesions and Eating Disorders. Journal of Neurology, Neurosurgery, & Psychiatry, 76 (6). June 2005, pp 852-857.
  21. ^ http://my.webmd.com/content/article/48/39237.html Overcoming Eating Disorders
  22. ^ Weiner, Sydell (1998), “The Addiction of Overeating: Self-Help Groups as Treatment Models”, Journal of Clinical Psychology 54 (2): 163-167, ISSN 0021-9762 
  23. ^ Hall, C. I. (1995), “Asian Eyes: Body Image and Eating Disorders of Asian and Asian-American Women”, Eating Disorders (Taylor & Francis) 3 (1): 8-19 
  24. ^ "Risk Factors for Eating Disorders Vary by Gender: Rejecting media images, resilience to negative comments should be focus of prevention," Kevin McKeever, HealthDay, June 3, 2008.
  25. ^ Johnson, William G.; Grieve, Frederick G.; Adams, Christina D.; Sandy, Jamie (January 1998). "Measuring Binge Eating in Adolescents: Adolescent and Parent Versions of the Questionnaire of Eating and Weight Patterns". International Journal of Eating Disorders 26: 301. doi:10.1002/(SICI)1098-108X(199911)26:3<301::AID-EAT8>3.0.CO;2-M. ISSN 0276-3478. PMID 10441246. 
  • Natenshon, Abigail, ed. (1999), When Your Child Has an Eating Disorder: A Step-By-Step Workbook for Parents and Other Caregivers, Jossey Bass, ISBN 0-7879-4578-1 
  • Thompson, K. J., ed. (2003), Body Image, Eating Disorders, and Obesity: An Integrative Guide for Assessment and Treatment, APA Books, ISBN 1-55798-726-2 
  • Agras, W. Steward (2004), “The consequences and costs of the eating disorders”, The psychiatric clinics of North America 24 (2): 371 
  • Crow, S.; Praus, B & Thuras, P (1999), “Mortality from Eating Disorders—A 5- to 10-Year Record Linkage Study”, International journal of eating disorders 26: 97 
  • Crow, S & Nyman, J. (2004), “The Cost-Effectiveness of Anorexia Nervosa Treatment”, International journal of eating disorders 35 (2): 155 
  • Lauer, C. J. & Krieg, J. C. (2004), “Sleep in eating disorders”, Sleep Medicine Review 8 (2): 109 
  • Meads, C.; Gold, L. & Burls, A. (2001), “How effective is outpatient care compared to inpatient care for the treatment of Anorexia Nervosa? A systemic review”, European eating disorders review 9 (4): 229 
  • = Zeeck, A.; Herzog, T. & Hartman, A. (2004), “Day clinic or inpatient care for severe Bulimia Nervosa”, European eating disorders review 12 (2): 79 
  • Zipfel, S (2000), “Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study”, Lancet (North American Edition) 355 (9205): 721