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Eating Disorders. Introduction
Eating Disorders. 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.
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.
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.
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.
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.
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.
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 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 selfassessments 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
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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.
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.
Medications
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.
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
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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.
Bibliography
http://www.ibuzzle.com
http://www.med.umich.edu/yourchild/topics/eatdisteen.htm
http://umm.edu/health/medical/reports/articles/eating-disorders
http://www.sciencedaily.com
http://eatingdisorder.org
http://en.wikipedia.org/wiki/Eating_disorder
http://www.mayoclinic.org
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