INTRODUCTION Eating is controlled by many factors; including appetite, food availability, family, peer, and cultural practices, and

attempts at voluntary control (Agras, 1992). Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends, sales campaigns for special foods, and in some activities and professions. Eating disorders involve serious disturbances in eating behaviour, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight (Attia, Haiman, Walsh & Flater, 1998). Researchers are investigating how and why initially voluntary behaviours, such as eating smaller or larger amounts of food than usual, at some point move beyond control in some people and develop into an eating disorder. Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity, but in the long run have the potential to lead to new pharmacologic treatments for eating disorders. Medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa. A third type, binge-eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis (Attia et al, 1998). Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood. 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 which may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important. Females are much more likely than males to develop an eating disorder, only an estimated 5 to 15

percent of people with anorexia or bulimia and an estimated 35 percent of those with bingeeating disorder are male(Agras, 1992). BINGE EATING DISORDER Almost everyone overeats from time to time, taking an extra helping at Thanksgiving dinner, for example, or downing dozens of cookies during a late-night study session. But if overeating is a regular and uncontrollable habit, you may be suffering from binge eating disorder.

Binge eaters use food to cope with stress and other negative emotions, but their compulsive overeating just makes them feel worse. Binge eating disorder is more common than bulimia and anorexia and affects a significant number of men as well as women (Beglin & Fairburn, 1992). Binge eating disorder is treatable, however, and with the right help and support, you can learn to control your binge eating.

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. The symptoms of binge eating disorder usually begin in late adolescence or early adulthood, often after a major diet (Beglin et al, 1992) .A binge eating episode typically lasts around two hours, but some people binge on and off all day long. Binge eaters often eat even when theyre not hungry and continue eating long after theyre full. They may also gorge themselves as fast as they can while barely registering what theyre eating or tasting.

key features of binge eating disorder are:

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Frequent episodes of uncontrollable binge eating. Feeling extremely distressed or upset during or after bingeing.

Unlike bulimia, there are no regular attempts to make up for the binges through vomiting, fasting, or over-exercising (Bachar, Latzer, Kreitler, & Berry, 1999).

People with binge eating disorder struggle with feelings of guilt, disgust, and depression. They worry about what the compulsive eating will do to their bodies and beat themselves up for their lack of self-control. They desperately want to stop binge eating, but feel like they cant.

The binge eating cycle

Binge eating may be comforting for a brief moment, but then reality sets back in, along with regret and self-loathing. Binge eating often leads to weight gain and obesity, which only reinforces compulsive eating. The worse a binge eater feels about themselves and their appearance, the more they use food to cope. It becomes a vicious cycle: eating to feel better, feeling even worse, and then turning back to food for relief (Bachar et al, 1999).

Signs and symptoms of binge eating disorder

People with binge eating disorder are embarrassed and ashamed of their eating habits, so they often try to hide their symptoms and eat in secret. Many binge eaters are overweight or obese, but some are of normal weight.

Behavioural symptoms of binge eating and compulsive overeating

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Inability to stop eating or control what youre eating Rapidly eating large amounts of food Eating even when youre full Hiding or stockpiling food to eat later in secret

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Eating normally around others, but gorging when youre alone Eating continuously throughout the day, with no planned mealtimes

Emotional symptoms of binge eating and compulsive overeating Feeling stress or tension that is only relieved by eating Embarrassment over how much youre eating Feeling numb while bingeinglike youre not really there or youre on auto-pilot. Never feeling satisfied, no matter how much you eat Feeling guilty, disgusted, or depressed after overeating Desperation to control weight and eating habits

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Effects of binge eating disorder Binge eating leads to a wide variety of physical, emotional, and social problems. People with binge eating disorder report more health issues, stress, insomnia, and suicidal thoughts than people without an eating disorder. Depression, anxiety, and substance abuse are common side effects as well. But the most prominent effect of binge eating disorder is weight gain.

Obesity and binge eating

Over time, compulsive overeating usually leads to obesity. Obesity, in turn, causes numerous medical complications, including:

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Type 2 diabetes Gallbladder disease High cholesterol

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Certain types of cancer Osteoarthritis Joint and muscle pain

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High blood pressure Heart disease

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Gastrointestinal problems Sleep apnea

Causes of binge eating and compulsive overeating

Generally, it takes a combination of things to develop binge eating disorder including a person's genes, emotions, and experience.

Biological causes of binge eating disorder

Biological abnormalities can contribute to binge eating. For example, the hypothalamus (the part of the brain that controls appetite) may not be sending correct messages about hunger and fullness. Researchers have also found a genetic mutation that appears to cause food addiction. Finally, there is evidence that low levels of the brain chemical serotonin play a role in compulsive eating.

Social and cultural causes of binge eating disorder

Social pressure to be thin can add to the shame binge eaters feel and fuel their emotional eating. Some parents unwittingly set the stage for binge eating by using food to comfort, dismiss, or reward their children. Children who are exposed to frequent critical comments about their bodies and weight are also vulnerable, as are those who have been sexually abused in childhood.

Psychological causes of binge eating disorder

Depression and binge eating are strongly linked (Anstine & Grinenko, 2000). Many binge eaters are either depressed or have been before; others may have trouble with impulse control and managing and expressing their feelings. Low self-esteem, loneliness, and body

dissatisfaction may also contribute to binge eating.

Binge eating and stress

One of the most common reasons for binge eating is an attempt to manage unpleasant emotions such as stress, depression, loneliness, fear, and anxiety (Anstine et al, 2000). When you have a bad day, it can seem like food is your only friend. Binge eating can temporarily make feelings such as stress, sadness; anxiety, depression, and boredom evaporate into thin air. But the relief is only very fleeting.

Anorexia Nervosa Eating disorder Anorexia nervosa is the best known of the three disorders. By definition, anorexia nervosa is the inability to maintain body weight at or above the minimum of the normal weight range for height and body build. People suffering from this disorder are chronically underweight, yet harbour deep anxieties about becoming fat. They have an intense and irrational fear of being overweight, or even of being a normal weight (Babyak, 2000). No amount of argument or logic can change this mind set. In anorexia, the destructiveness of the eating disorder is denied. Starving is seen as essential to maintaining competence and self-esteem. The prevalence of anorexia nervosa is not known because many people with the disorder are not aware they have a problem. While people with anorexia come from all cultures and socioeconomic backgrounds, the majority of reported cases are females from white, middleclass backgrounds(Beglin et al, 1992). Adolescent girls are the highest-risk group for becoming anorexic, and females in general are the more susceptible. Males, however, are not immune to the problem. It is believed that five to ten percent of people with anorexia are males. Anorexia nervosa has serious consequences. In adults, it has one of the highest

mortality rates of any psychiatric disorder. One in ten patients will either commit suicide or die as a result of malnutrition. Even those less affected can face serious health concerns, in part, because the disorder usually surfaces during adolescence when the bodys nutritional demands are high. Adolescents with anorexia frequently encounter problems with menstruation, a weakened immune system, stomach and heart problems, and chemical imbalances in the brain which can increase depression and anxiety levels. Approximately half of all people with anorexia nervosa also engage in somebulimicbehaviour.

Etiology

The etiology of AN remains incompletely understood. Although not disorder-specific, common risk factors across eating disorders include sex, race or ethnicity, childhood eating and gastrointestinal problems, elevated shape and weight concerns, negative self-evaluation, sexual abuse and other adverse events, and general psychiatric comorbidity. Although serotonin has received considerable research attention, given the interrelatedness of neurotransmitter function, other neurotransmitter systems, most notably dopamine, are also implicated in this disorder. The ultimate understanding of AN etiology will likely include main effects of both biological and environmental factors as well as their interactions and correlations.

Symptoms of Anorexia Nervosa Behavioural:

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Eats very little, and usually only from a narrow selection of food considered safe. Refuses to maintain a minimal, normal body weight for age and height.

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Harbours an intense fear of weight gain, regardless of low weight. Develops rituals around food intake. Perceives self as being fat, even when critically underweight. May perceive dieting to be the highest form of self control, and equate successful dieting with personal success.

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Undertakes rigid and excessive exercise regimes. Eats a restrictive diet, even when underweight. Shops for groceries and prepare food for others, but avoids eating. Pays a lot of attention to creating and maintaining records like meal plans and calorie journals.

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Continually weighs and measures food. Hoards food. For example, hides food in a locker or knapsack. Exhibits significant weight loss in the absence of any related illness. Wears layers of loose fitting clothing to hide the body. Withdraws from social activities and becomes immersed in highly physical, repetitive activities such as working out, running, cycling or roller-blading.

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Sets unrealistically high goals and constantly strives for perfection. Demonstrates an unwillingness or inability to eat which becomes a consistent focus of attention from family and friends.

Demonstrates changes in behaviour, such as increased activity levels, that appear incongruent with the students personality.

Cognitive:
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Preoccupied with food. Conversations, school projects, artwork, etc. May revolve around food themes.

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Has difficulty concentrating. Appears indecisive or, conversely, exhibits rigid black-and-white thinking. Makes comments about being overweight or expresses a belief that thinness equates to happiness.

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Considers self fat, but does not appear to be so. Places a premium on self-control.

Emotions:
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Appears anxious, depressed, angry, irritable, defiant, and stubborn or displays intense mood swings.

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Expresses feelings of inadequacy, worthlessness, anxiety and loneliness. Demonstrates feelings of low self-esteem through radical change in attire, body language or social relations.

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Tends to be withdrawn and appears isolated. Demonstrates inflexibility and resists changes to routines. Expresses a fear of weight gain. Expresses feelings of failure with less than perfect school grades/marks. Associates feelings of shame or guilt with eating disorders when taking part in a class discussion on the topic.

Denies anything is wrong. Becomes sullen, angry or defensive when concern is expressed.

Physical:
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Weight loss is noticeable, often over a short period of time. Appears unusually thin, with little muscle or fat.

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Complains of ongoing stomach problems, muscle cramps or tremors. Skin is unusually dry or scaly, and yellow or grey in colour. Fine hair growth on face or body. Dull, brittle or thinning hair. Engages in binge eating, eating large quantities of food over short periods of time. Appears chronically tired. Constantly complains of feeling cold. Suffers unusually severe dental problems. Experiences loss of menstrual periods. Younger females may experience a delay in the onset of menses.

Bulimia Nervosa Often confused with anorexia nervosa, bulimia nervosa is actually a distinct eating disorder. People with bulimia go through behaviour cycles marked by binge eating followed by purging through self-induced vomiting or use of laxatives. Some other behaviours of people with bulimia are excessive exercising or fasting. Like people with anorexia, those with bulimia are obsessed with their weight and body image. They set unreasonably strict diets. When they do not maintain these diets, they fall into episodes of intense eating followed by purging. These episodes typically occur in secret, in order to avoid criticism from family and peers. Unlike students with anorexia, students with bulimia are more likely to acknowledge their behaviour. Despite acknowledging the consequences of the behaviour, they will not use this knowledge to initiate change, but rather use the behaviours to confirm their own negative self-image. People with bulimia tend to be average weight to overweight, because of their episodes of intense eating. They may, however, go through periods of time when they are

underweight. They may also suffer both the physical and mental effects of chronically poor nutrition, including stomach and cardiovascular problems, damage to the immune system, and depression. They are at risk for rupture of the oesophagus, inflamed throat, and other side-effects from self-induced vomiting. While researchers still do not have a clear understanding of the long-term effects of bulimia, some believe the mortality rate for bulimia is as high as it is for anorexia. They do agree that bulimia is a more widespread eating disorder. It is estimated that as many as three percent of North American females suffer from bulimia nervosa. Etiology Historically, like AN, BN has been conceptualized as having sociocultural origins. Substantial familial aggregation of BN has been reported.Twin studies reveal a moderate to substantial contribution of additive genetic factors (between 54 percent and 83 percent) and unique environmental factors to BN. Linkage analyses have identified areas on chromosome 10p that may be implicated in BN. Numerous candidate genes have been studied for their role in risk for the disorder. Ongoing biological studies suggest fundamental disturbances in serotonergic function in individuals with BN.80,84 The ultimate understanding of the etiology of BN and of other disturbances that contribute to the development of inappropriate responses to satiety clues will most likely include main effects of both biological and environmental factors as well as their interactions and correlations.

What is meant by bingeing and purging? If you have bulimia nervosa you feel as if your whole life is taken over by the need to either eat excessively and chaotically or to physically get rid of what you have eaten. For most people these two needs alternate - usually with the need to purge immediately following a period of bingeing.

Bingeing A binge is almost always carried out in secret, alone and usually at home. Some people plan binges very carefully and have foods which they use regularly either because they need no preparation, are easy to eat or easy to expel. Other binges can happen on the spur of the moment and any available food even raw food - is used. Bingeing is a frantic activity and usually makes the person with bulimia nervosa feel completely out of control. Many people know some time in advance that they will binge on a particular day or at a certain time usually because they know they will be alone. A great deal of thought can go into what food will be consumed and in what order. Some people think that their problem may become obvious if they regularly buy large quantities of food in the same places and so part of the planning process will also involve identifying which shops to use. The binge almost always takes place as soon as the person gets home. The food which has just been bought is eaten frantically as quickly as possible - and usually only stops when all of the food has been eaten or when so much has been consumed that it is causing extreme discomfort. Sometimes the need for bingeing can be triggered unexpectedly. This may occur, for example, because of an upsetting or unsettling event, as a result of anxiety about money, work or relationships or through being suddenly and unexpectedly alone. Some people find themselves eating almost anything which is immediately available. This may mean having dozens of pieces of toast, taking left-overs from the fridge or from dirty plates or even eating seemingly inedible foods such as frozen peas, raw pasta or whole slabs of butter. Bingeing can also happen when people are not at home although some privacy is needed if very large amounts of food are eaten in a short space of time. Sometimes the binge will start with other people and then be continued in private. Someone may eat a `normal meal with others and then binge in private. This may be because they feel they have already let themselves consume more calories than they had intended and that they have therefore lost control.

Purging With bulimia nervosa, bingeing is almost always followed by a feeling of overwhelming guilt and panic. Not only does the bingeing result in physical discomfort, but it also leaves people feeling disgusting and ashamed. They may feel fat, unattractive and terrified by the thought of how much weight they will gain as a result of all the calories they have consumed. There is an immediate need to rid the body of all the food which has just been crammed in to it. For some people this will mean self induced vomiting. Many people also use laxatives either as well as or instead of vomiting. People who plan their bingeing often plan their abuse of laxatives and will take large numbers of them before starting to eat. This means that they know while they are eating that the process of purging has already begun. Other people embark on a period of extreme fasting or start exercising strenuously in order to burn off the calories they have consumed.

Symptoms Behavioural:
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Eats a large amount of food over a short period of time. Engages in purging or other inappropriate compensatory behaviours after eating, including: self-induced vomiting, fasting, excessive exercise and/or the misuse of laxatives or diuretics.

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Eats in private or is secretive about eating behaviours. Often eats a restrictive diet. Prefers high-fat, high-carbohydrate and high-sugar junk foods during bing

episodes.
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Frequently uses the bathroom for extended periods of time after eating. Engages in acting out behaviours, such as shoplifting, binge spending, alcohol or drug use and/or sexual promiscuity.

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Shows a marked decline in school attendance patterns. Often appears socially outgoing, but on close examination, relationships may tend to be superficial.

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Sets high goals and constantly strives for perfection. Often appears to be of average weight or overweight. Cognitive:

Is preoccupied with food. Conversations, school projects or artwork may revolve around food themes.

Has difficulty concentrating, appears indecisive or, conversely, exhibits rigid blackand-white thinking.

Makes comments about being overweight or expresses a belief in the importance of self-control when it comes to eating habits.

Expresses fears about intimacy in personal relationships.

Affective:
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Appears anxious, depressed, angry, irritable, defiant or stubborn, or displays intense mood swings.

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Expresses feelings of inadequacy, worthlessness, anxiety and loneliness. Demonstrates feelings of low self-esteem through appearance, attire, body language or social relations.

Expresses a fear of weight gain.

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Expresses feelings of failure with less than perfect school grades/marks. Associates feelings of shame or guilt with eating disorders when taking part in a class discussion on the topic.

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Expresses fears about intimacy in personal relationships. Feels dependent on others for approval and appreciation, relying on others to determine self-worth.

Physical:
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Exhibits broad fluctuations in weight. Has dental problems, broken blood vessels under the eyes, bags under the eyes, or throat problems. These are physical conditions that can be caused by self -induced vomiting.

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Complains of dehydration, fainting spells, dizziness, hand tremors or blurred vision. Suffers from ongoing stomach problems. Engages in binge eating, eating large quantities of food over short periods of time. Experiences loss of, or irregular, menstrual periods.

COUNSELLING IMPLICATIONS How the counsellor can help involves three components :
o restoring the person to a healthy weight; o treating the psychological issues related to the eating disorder; and o reducing or eliminating behaviours or thoughts that lead to disordered eating,

and preventing relapse (Kasper, 2002).

According to (Agras, Telch, Arnow, Eldredge, Detzer, Henderson & Marnell 1995), the use of medications, such as antidepressants, antipsychotics or mood stabilizers, may be modestly effective in treating patients with eating disorder by helping to resolve mood and anxiety symptoms that often co-exist with it. In addition, no medication has shown to be effective during the critical first phase of restoring a patient to healthy weight. Overall, it is unclear if and how medications can help patients conquer eating disorder, but research is ongoing. Different forms of psychotherapy, including individual, group and family-based, can help address the psychological reasons for the illness. Some studies suggest that family-based therapies in which parents assume responsibility for feeding their afflicted adolescent are the most effective in helping a person with eating disorder improve eating habits and moods. Shown to be effective in case studies and clinical trials, this particular approach is discussed in some guidelines and studies for treating eating disorders in younger, non-chronic patients eight Others have noted that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia patients is more effective than just psychotherapy.Agras et al (1995) posits that, the effectiveness of a treatment depends on the person involved and his or her situation. However, research into novel treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder (Kasper, 2002).

There are many group options, including self-help support groups and more formal therapy groups.

Group therapy - Group therapy sessions are led by a trained psychotherapist, and may cover everything from healthy eating to coping with eating disorder.

Support groups Support groups for eating disorders are led by trained volunteers or

health professionals. Group members give and receive advice and support each other.

Eating disorder can be successfully treated in therapy (Agras, 1992). Therapy can teach you how to exchange unhealthy habits for newer healthy ones, monitor your eating and moods, and develop effective stress-busting skills.

Three types of therapy are particularly helpful in the treatment of eating disorders

(Agras, 1992):

Cognitive-behavioural therapy focuses on the dysfunctional thoughts and behaviours involved in binge eating. One of the main goals is for you to become more self-aware of how you use food to deal with emotions. Cognitive-behavioural therapy for eating disorders also involves education about nutrition, healthy weight loss, and relaxation techniques.

Interpersonal psychotherapy - focuses on the relationship problems and interpersonal issues that contribute to eating disorder. Therapist will help improve your communication skills and develop healthier relationships with family members and friends. As you learn how to relate better to others and get the emotional support you need, the unhealthy way of eating becomes more infrequent.

Dialectical behaviour therapy combines cognitive-behavioural techniques with mindfulness meditation. The emphasis of therapy is on teaching unhealthy eaters how to accept themselves, tolerate stress better, and regulate their emotions. Therapist will also address unhealthy attitudes you may have about eating, shape, and weight. Dialectical behaviour therapy typically includes both individual treatment sessions and weekly group therapy sessions.

The therapist can advice friends and family of unhealthy eaters to try to listen without

judgment and make sure the person knows you care.

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Counsellors or therapists can also advice loved ones of unhealthy eaters that, they feel bad enough about themselves and their behaviour already. Lecturing, getting upset, or issuing ultimatums to them will only increase stress and make the situation worse. Instead, make it clear that you care about the persons health and happiness and youll continue to be there for him or her.

Also loved ones can be advised by counsellors to set good examples by eating healthily, exercising, and managing stress without food

Medications for binge eating disorder

Medication is not a cure for eating disorder (Agras, 1992). A number of medications may be useful in helping to treat eating disorder symptoms as part of a comprehensive treatment program that includes therapy, group support, and proven self-help techniques.

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Appetite suppressants Topamax Antidepressants.

CONCLUSION Though addressing the topic of eating disorders is not an easy one, it may be among the most important health facilities tackle. As Babyak (2000) points out, someone suffering from an eating disorder is lonely and isolated. Though approaching these people may be difficult and thankless, and they may be in denial, they may also be waiting for someone to notice and help them.