Eating disorders in

the USA






TABLE OF CONTENTS

Argument
Prcis
Introduction 1
Chapter I: Classification 2
Chapter II: Causes 3
Chapter III: Symptoms-complications 5
Chapter IV: Tests and diagnosis 6
Chapter V: Treatments and drugs 8
Chapter VI: Lifestyle and home remedies 9
Chapter VII: Coping and support 9
Conclusion 10
Bibliography









Argument
The reason why I have chosen this topic is to highlight a serious problem that today's
generation is facing: eating disorders. What aroused my interest for this topic was a
documentary I saw on television two years ago and which caught my attention. I could not
belive how serious the problem was as these eating disorders are rapidly taking on epidemic
proportions all aver the world, not only in the USA. Moreover, the documentary contained
shocking images that surprised me. I had never imagined that something like that could even
exist and I decided to do further research. I like to find out all sorts of new things, especially
if they will be helpful to me in the future and I think they will because I wish to follow the
Medical School. I found a lot of sites about these eating disorders that affected different
persons and radically changed both their psychics and bodies. There were also a lot of
interesting life stories with persons that suffered from eating disorders. Many of them
recovered, but those were the happy cases. These eating disorders are very dangerous if they
are not detected in time because they can cause even death.

Eating disorders are real, complex and devastating conditions that can have serious
consequences for health, productivity and relationships. In fact, these eating disorders are
mental diseases. Every person should be informed about them and the dangers they may be
exposed to. Society has changed over the years. People have another life-style, usually an
unhealthy one and they are more and more concerned about their appearance. The media has
a major role in peoples behavior nowadays. It promotes body perfection and this makes
many persons feel self-conscious and have a low opinion of their bodies. What is more,
people that have weight problems are usually rejected by the others and this is another serious
problem. People should learn to feel good about themselves and their body, to see the
difference between reality and fiction and to be more concerned about their health and life. In
addition to this, they should also learn how to become more tolerant with other people that
are different from them. Every person has something unique and every person should be
proud of who she/he is. People must learn to think positively and ignore things that can
influence them in a negative way.











Prcis
I have divided my paper into seven chapters.
The first chapter offers a classification of the eating disorders common in the USA, both
those recognised by doctors and those which are unfortunately not.
The second chapter deals with the factors that cause eating disorders.
In the third chapter I have tried to describe the symptoms and the complications that might
appear in these disorders.
Chapter four discusses how eating disorders are diagnosed based on signs and the tests that
are made by doctors.
Chapter five comprises treatments and drugs that help people recover from an eating disorder.
In the sixth chapter is presented the program of reabilitation for a person that suffered from
an eating disorder.
Chapter seven shows how treatment can be found anywhere, even in ones own house.





















Introduction

An eating disorder is an illness that causes serious disturbances to your everyday diet, such as
eating extremely small amounts of food or severely overeating. A person with an eating
disorder may have started out just eating smaller or larger amounts of food, but at some point,
the urge to eat less or more spiraled out of control. Severe distress or concern about body
weight or shape may also characterize an eating disorder.
Eating disorders frequently appear during the teen years or young adulthood but may also
develop during childhood or later in life. Common eating disorders include anorexia nervosa,
bulimia nervosa, and binge-eating disorder.
Eating disorders affect both men and women. It is unknown how many adults and children
suffer from other serious, significant eating disorders, including one category of eating
disorders called eating disorders not otherwise specified (EDNOS). EDNOS includes eating
disorders that do not meet the criteria for anorexia or bulimia nervosa. Binge-eating disorder
is a type of eating disorder called EDNOS which is the most common diagnosis among
people who seek treatment.
Eating disorders are real, treatable medical illnesses. They frequently coexist with other
illnesses such as depression, substance abuse, or anxiety disorders. Other symptoms,
described in the next section can become life-threatening if a person does not receive
treatment. People with anorexia nervosa are 18 times more likely to die early compared with
people of similar age in the general population.














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Chapter I: Classification

Currently recognized in medical manuals:
Anorexia nervosa (AN), characterized by refusal to maintain a healthy body weight, an
obsessive fear of gaining weight, and an unrealistic perception of current body weight.
However, some patients can suffer from anorexia nervosa unconsciously. These patients are
classified under "atypical eating disorders". Anorexia can cause menstruation to stop, and
often leads to bone loss, loss of skin integrity, etc. It greatly stresses the heart, increasing the
risk of heart attacks and related heart problems. The risk of death is greatly increased in
individuals with this disease. The most underlining factor researchers are starting to take
notice of is that it may not just be a vanity, social, or media issue, but it could also be related
to biological and or genetic components.
Bulimia nervosa (BN), characterized by recurrent binge eating followed by compensatory
behaviors such as purging (self-induced vomiting, excessive use of laxatives/diuretics, or
excessive exercise). Fasting and over-exercising may also be used as a method of purging
following a binge.
Eating disorders not otherwise specified (EDNOS) is an eating disorder that does not meet
the DSM-IV criteria for anorexia or bulimia. Examples can be a female who suffers from
anorexia but still has her period or someone who may be at a "healthy weight" but who has
anorexic thought patterns and behaviors; it can mean the sufferer equally participates in some
anorexic as well as bulimic behaviors (sometimes referred to as purge-type anorexia) or to
any combination of eating disorder behaviors that do not directly put them in a separate
category.
Binge eating disorder (BED) or 'compulsive overeating', characterized by binge eating,
without compensatory behavior. This type of eating disorder is even more common than
bulimia or anorexia. This disorder does not have a category of people in which it can develop.
In fact, this disorder can develop in a range of ages and is unbiased to classes.
Pica, characterized by a compulsive craving for eating, chewing or licking non-food items or
foods containing no nutrition. These can include such things as chalk, paper, plaster, paint
chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes. These
individuals cannot distinguish a difference between food and non-food items.
Not currently recognized in standard medical manuals:
Compulsive overeating (COE) characteristic of binge eating disorder, in which people tend to
eat more than necessary resulting in more stress. This is mainly caused by 'binge eating
disorder'.
Purging disorder, characterized by recurrent purging to control weight or shape in the absence
of binge eating episodes.
Rumination, characterized by involving the repeated painless regurgitation of food following
a meal which is then either re-chewed and re-swallowed, or discarded.
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Diabulimia, characterized by the deliberate manipulation of insulin levels by diabetics in an
effort to control their weight.
Food maintenance, characterized by a set of aberrant eating behaviors of children in foster
care.
Night eating syndrome, characterized by morning anorexia, evening polyphagia (abnormally
increased appetite for consumption of food (frequently associated with insomnia, and injury
to the hypothalamus).
Orthorexia nervosa, a term used by Steven Bratman to characterize an obsession with a
"pure" diet, in which people develop an obsession with avoiding unhealthy foods to the point
where it interferes with a person's life.
Drunkorexia, commonly characterized by purposely restricting food intake in order to reserve
food calories for alcoholic calories, exercising excessively in order to burn calories consumed
from drinking, and over-drinking alcohols in order to purge previously consumed food.
Pregorexia, characterized by extreme dieting and over-exercising in order to control
pregnancy weight gain. Under-nutrition during pregnancy is associated with low birth weight,
coronary heart disease, type 2 diabetes, stroke, hypertension, cardiovascular disease risk, and
depression.


Chapter II: Causes

There is no single cause for eating disorders. Although concerns about weight and body
shape play a role in all eating disorders, the actual cause of these disorders appears to involve
many factors, including those that are genetic and neurobiological, cultural and social, and
behavioral and psychological.
Genetic Factors
Research suggests that genetic factors may increase the likelihood of an
individual developing an eating disorder. Individuals with a first-degree relative
who has a history of an eating disorder are more likely than individuals without
such a relative, to themselves develop an eating disorder. In addition,
researchers have identified specific genes that influence hormones such as
leptin and ghrelin. Experts believe that as well as regulating feeding, these
hormones may influence the personality traits and behaviors that are associated
with anorexia and bulimia.
Influences at Home or at School
Existing research into the role of family in triggering an eating disorder is
largely cross-sectional, retrospective and unsubstantiated. However, it has been
suggested that parents behaviors may influence their childs eating habits. For
example, mothers who diet or worry excessively about their weight may trigger
their child to develop an abnormal attitude towards food, as may a father or
sibling who teases an individual about their weight or shape.
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Similarly, comments made by classmates in the school environment can influence a childs
attitude to eating habits and a parent or teachers high expectations of a childs performance
at school may also help lay the foundations for an eating disorder.
Personality and Character
People with eating disorders tend to share similar personality and behavioral traits such as
low self-esteem, perfectionism, approval seeking, dependency, and problems with self-
direction. In addition, specific personality disorders can increase the risk for developing
eating disorders, these include:
Avoidant Personality Disorder
People with this condition are typically perfectionist, emotionally and sexually inhibited,
nonrebellious and terrified of being criticized or humiliated.
Obsessive-Compulsive Personality Disorder
Individuals with this disorder may be perfectionist, morally rigid, or overly concerned with
rules and order.
Borderline Personality Disorder
This disorder is associated with self-destructive and impulsive behaviors.
Narcissistic Personality Disorder
Features of this disorder include an inability to comfort oneself or to empathize with others as
well as a need for admiration and oversensitivity to criticism or defeat.
Psychological Factors
Psychological conditions such as post-traumatic stress disorder, panic disorder, phobias and
depression have all been associated with abnormal eating habits, as have life stressors such as
job loss, divorce, or coping with bullying or a learning difficulty such as dyslexia. Stressful or
upsetting situations such as tight deadlines at work, school or university or experiencing the
death of a loved one are all examples of factors that may contribute to the development of an
eating disorder.
Body Image Disorders
Body image disorders such as body dysmorphic disorder, where an individual has a
distorted view of their body, or muscle dysmorphia which describes an obsession
with muscle mass, are often associated with anorexia or bulimia.
Cultural Pressures
The impact of the media in Western culture can fuel a desire for or obsession with
the idea of becoming thin. In the media, thinness or slimness is often equated with
success and popularity, which may cultivate and encourage the idea of being thin,
especially among young girls. However, the media also fiercely markets cheap and
calorific foods, which can cause confusion and stress. Pressure to become thin may also be
perceived by individuals who take part in competitive or athletic activities such as modelling,
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ballet or running. As a result, people can develop unrealistic expectations for their body
image and place an overemphasis on the importance of being thin.
Biologic Factors
A bodily system called the hypothalamic-pituitary-adrenal axis (HPA) may play an important
role in eating disorders.
The HPA releases regulators of appetite, stress and mood such as serotonin, norepinephrine,
and dopamine. Abnormalities of these chemical messengers are considered to play an
important role in eating disorders. Serotonin is important in the control of anxiety and
appetite while norepinephrine is a stress regulator and dopamine plays a role in reward-
seeking behavior. An imbalance of serotonin and dopamine may help to explain why people
with anorexia do not derive a sense of pleasure from food and other common comforts.

Chapter III: Symptoms-complications

Anorexia Nervosa
In anorexia nervosas cycle of self-starvation, the body is denied the essential nutrients it
needs to function normally. The body is forced to slow down all of its processes to conserve
energy, resulting in serious acute and long-term medical consequences including: abnormally
slow heart rate and low blood pressure; damage to the structure and function of the heart;
increased risk of heart failure and death; reduction of bone density (osteopenia and
osteoporosis) which results in dry, brittle bones; muscle loss and weakness; severe
dehydration, which can result in kidney failure; edema (swelling); fainting, fatigue, lethargy
and overall weakness; dry skin and hair, brittle hair and nails, hair loss; anemia (can lead to
fatigue, shortness of breath, increased infections, and heart palpitations); severe constipation;
prepubertal patients may have arrested sexual maturity and growth failure; drop in internal
body temperature, with subsequent growth of a downy layer of hair called lanugo, which is
the bodys effort to keep itself warm; amenorrhea (loss of menstrual cycle); infertility,
increased rates of miscarriage and other fetal complications.
Bulimia Nervosa
The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system. They
can lead to electrolyte and chemical imbalances in the body that affect the heart and other
major organ functions. While more common than anorexia, bulimia nervosa may be more
difficult for primary care physicians, school officials, parents and other loved ones to detect
because patients are often of normal weight and may be too embarrassed to directly reveal
their abnormal eating behaviors. Some of the health consequences of bulimia nervosa
include: severe dehydration and electrolyte imbalances (dangerous levels of sodium, calcium,
potassium and other minerals). This can lead to irregular heartbeats, possible heart failure and
death; chronically inflamed and sore throat; inflammation and possible rupture of the
esophagus; potential for gastric rupture; decalcification of teeth, enamel loss, staining, severe
tooth decay and gum disease as a result of repeated exposure to stomach acid; edema
(swelling); chronic irregular bowel movements, constipation and other gastrointestinal
problems; peptic ulcers and pancreatitis; swollen, enlarged salivary glands in the neck and
jaw area; acid reflux disorder; infertility, increased rates of miscarriage and other fetal
complications.
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Binge Eating Disorder
Binge eating disorder (BED) is much more prevalent than either anorexia or bulimia. BED
often results in many of the same health risks associated with clinical obesity yet people with
BED can be of normal weight. Some of the potential health consequences of BED include:
high blood pressure; high cholesterol levels; heart disease as a result of elevated triglyceride
levels; type II diabetes mellitus; obstructive sleep apnea; edema (swelling) kidney disease;
gall bladder disease; arthritis (degenerative) - caused by hormonal imbalances and vitamin
deficiencies as well as increased stress on the joints; infertility; various forms of cancer;
increased rates of irritable bowel syndrome (IBS), fibromyalgia and insomnia have also been
reported.
Eating Disorder Not Otherwise Specified (EDNOS)
Its a common misconception that the EDNOS diagnosis is not as serious or does not warrant
the same level of concern as the other eating disorder diagnoses discussed above. In reality,
all of the same medical problems can be experienced by those with EDNOS who are acting
on various eating disorder symptoms. In fact, recent research has actually shown that the
associated mortality rate for EDNOS exceeds the rates for both anorexia and bulimia.
Eating Disorders & Suicide
Suicide accounts for a significant number of eating disorder deaths. Those struggling with
eating disorders are more likely than individuals without eating disorders to think about
suicide and attempt suicide. The suicide rate for women with eating disorders is 58 times
greater than those without.

Chapter IV: Tests and diagnosis

Eating disorders are diagnosed based on signs, symptoms and eating habits. When doctors
suspect someone has an eating disorder, they typically run many tests or perform exams.
These can help pinpoint a diagnosis and also check for related complications. You may see
both a medical doctor and a mental health provider for a diagnosis.
Physical evaluations
These exams and tests generally include: physical exam that may include measuring height,
weight and body mass index; checking vital signs, such as heart rate, blood pressure and
temperature; checking the skin for dryness or other problems; listening to the heart and lungs;
and examining your abdomen; laboratory tests that may include a complete blood count, as
well as more-specialized blood tests to check electrolytes and protein, as well as liver, kidney
and thyroid function. A urinalysis also may be done and other studies such as X-rays that
may be taken to check for pneumonia or heart problems. Electrocardiograms may be done to
look for heart irregularities.
Psychological evaluations
In addition to a physical exam, people with eating disorders will have a thorough
psychological evaluation. Their doctor or mental health provider may ask them a number of
questions about their eating habits, beliefs and behavior. The questions may focus on their
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history of dieting, bingeing, purging and exercise. They will explore how you perceive your
body image and how you think others perceive your body image. They may also fill out
psychological self-assessments and questionnaires.
Diagnostic criteria
To be diagnosed with an eating disorder, you must meet criteria spelled out in the Diagnostic
and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric
Association. Each eating disorder has its own set of diagnostic criteria. Your mental health
provider will review your signs and symptoms to see if you meet the necessary diagnostic
criteria for a particular eating disorder. Some people may not meet all of the criteria but still
have an eating disorder and need professional help to overcome or manage it.

The diagnosis for Anorexia Nervosa are: restriction of energy intake relative to requirement,
leading to a significantly low body weight in the context of age, sex, developmental
trajectory, and physical health; intense fear of gaining weight or of becoming fat or persistent
behavior that interferes with weight gain, even though at a significantly low weight;
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 persistent lack of recognition of the
seriousness of the current low body weight.
The diagnosis for Bulimia Nervosa are: recurrent episodes of binge eating; recurrent
inappropriate compensatory behaviors (such as self-induced vomiting, misuse of laxatives,
fasting, or excessive exercise) in order to prevent weight gain; the binge eating and
inappropriate compensatory behaviors both occur, on average, at least 1x/week for 3 months;
self-evaluation is unduly influenced by body shape and weight; the disturbance does not
occur exclusively during episodes of anorexia nervosa
The diagnosis for Binge Eating Disorder are: recurrent episodes of binge eating; marked
distress regarding binge eating; the binge eating occurs, on average, at least 1x/week for 3
months; binge eating is not associated with the regular use of inappropriate compensatory
behavior and does not occur exclusively during the course of bulimia nervosa or anorexia
nervosa
Binge eating episodes are associated with three or more of the following: eating much more
rapidly than normal; eating large amounts of food when not feeling physically hungry; eating
until feeling uncomfortably full; eating alone because you are embarrassed by how much
you're eating; feeling disgusted with oneself, depressed, or very guilty after overeating.

Diagnostic examples of Eating Disorder Not Otherwise Specified
The Diagnostic & Statistical Manual (DSM-IV) currently lists six clinical examples of
EDNOS. Its important to note that this list in not exhaustive, and there are other situations
and variations of symptoms that would also warrant an EDNOS diagnosis: all criteria for
anorexia nervosa are met except the individuals has regular menstrual cycles; all criteria for
anorexia nervosa are met except that, despite significant weight loss, the individuals current
weight falls within the normal range; all criteria for bulimia nervosa are met except that binge
eating or purging behaviors occur less than twice per week or for fewer than three months; an
individual purges after eating small amounts of food while retaining a normal body weight;
repeatedly chewing and spitting out large amounts of food without swallowing; all criteria are
met for binge eating disorder.

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Chapter V: Treatments and drugs

Eating disorder treatment depends on your specific type of eating disorder. But in general, it
typically includes psychotherapy, nutrition education and medication. If your life is at risk,
you may need immediate hospitalization.
Psychotherapy
Individual psychotherapy can help you learn how to exchange unhealthy habits for healthy
ones. You learn how to monitor your eating and your moods, develop problem-solving skills,
and explore healthy ways to cope with stressful situations. Psychotherapy can also help
improve your relationships and your mood. A type of psychotherapy called cognitive
behavioral therapy is commonly used in eating disorder treatment, especially for bulimia
nervosa and binge-eating disorder. Group therapy also may be helpful for some people.
Family-based therapy is the only effective treatment for children and adolescents with eating
disorders. This type of therapy begins with the assumption that the person with the eating
disorder is no longer capable of making sound decisions regarding his or her health and needs
help from the family. An important part of family-based therapy is that your family is
involved in making sure that your child or other family member is following healthy-eating
patterns and is restoring weight. This type of therapy can help encourage support from
concerned family members.
Weight restoration and nutrition education
If you're underweight due to an eating disorder, the first goal of treatment will be to start
getting you back to a healthy weight. No matter what your weight, dietitians and other health
care providers can give you information about a healthy diet and help design an eating plan
that can help you achieve a healthy weight and instill normal-eating habits. If you have binge-
eating disorder, you may benefit from medically supervised weight-loss programs.
Hospitalization
If you have serious health problems or if you have anorexia and refuse to eat or gain weight,
your doctor may recommend hospitalization. Hospitalization may be on a medical or
psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may
offer day programs, rather than full hospitalization. Specialized eating disorder programs may
offer more intensive treatment over longer periods of time.
Medication
Medication can't cure an eating disorder. However, medications may help you control urges
to binge or purge or to manage excessive preoccupations with food and diet. Medications
such as antidepressants and anti-anxiety medications may also help with symptoms of
depression or anxiety, which are frequently associated with eating disorders.




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Chapter VI: 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.

Chapter VII: Coping and support
In addition to getting professional treatment for your eating disorder, you can also follow
these coping skills: boost your self-esteem; get involved in activities that interest you and that
are personally rewarding; these may include learning a new skill, developing a hobby or
participating in a social group in your church or community; be realistic; don't accept what
some of the media portray about what's a normal weight and what's an ideal body image;
resist the urge to diet or skip meals; dieting actually triggers unhealthy eating and makes it
difficult to cope with stress; remind yourself what a healthy weight is for your body,
especially at times when you see images that may trigger your desire to binge and purge;
don't visit websites that advocate or glorify eating disorders; these sites can encourage you to
maintain dangerous habits and can trigger relapses; identify troublesome situations that are
likely to trigger thoughts or behavior that may contribute to your eating disorder so that you
can develop a plan to deal with them; look for positive role models, even if they're not easy to
find; remind yourself that the ultrathin models or actresses showcased in popular magazines
often don't represent healthy bodies; acknowledge that you may not be the best judge of
whether your eating habits and weight are healthy; consider journaling about your feelings
and behaviors. Journaling can make you more aware of your feelings and actions, and how
they're connected.





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Conclusion
Eating disorders must be taken seriously. A person may fall into the trap of an eating disorder
without any intention of doing so. Once established, anorexia nervosa or bulimia nervosa can
seriously affect a person's life. Sometimes the outcome is a truly chronic illness or even,
rarely, death.
Its unfortunate, but in todays society, people have forgotten that its whats inside a person
that counts, not whats on the outside. We need to start loving and accepting each other for
who we are, not what we look like. If we learn to love and accept ourselves, we will also
begin to love our bodies, no matter what size we are. We also need to teach our children to be
proud of who they are. We need to remind them that people come in all shapes and sizes, and
we need to teach them to accept everyone for who they are. Parents need to also teach their
children the value of healthy eating and not send the message that being thin is important.
I would also like to stress the fact that diets dont work. Eating three healthy meals a day, a
few snacks and doing moderate exercise, will allow your body to go to its natural set point.
Its important to remember that no food will make you fat, as long as its eaten in moderation.
Stop buying those fashion magazines and diet products, and stop believing all the lies being
told to you by the fashion and diet industries. Instead, focus on learning to love and accept
yourself. No number on a scale and fitting into a smaller dress size will not make you happy.
Happiness can only come from within.

















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http://eatingdisorder.org
http://en.wikipedia.org/wiki/Eating_disorder
http://www.mayoclinic.org