Many kids ² particularly teens ² are concerned about how they look and can feel selfconscious about their bodies. This can be especially true when they are going through puberty, and undergo dramatic physical changes and face new social pressures. Unfortunately, for a growing proportion of kids and teens, that concern can grow into an obsession that can become an eating disorder. Eating disorders such as anorexia nervosa or bulimia nervosa cause dramatic weight fluctuation, interfere with normal daily life, and damage vital body functions. An eating disorder is marked by extremes. It is present when a person experiences severe disturbances in eating behavior, such as extreme reduction of food intake or extreme overeating, or feelings of extreme distress or concern about body weight or shape. A person with an eating disorder may have started out just eating smaller or larger amounts of food than usual, but at some point, the urge to eat less or more spirals out of control. Eating disorders are very complex, and despite scientific research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive. The two main types of eating disorders are anorexia nervosa and bulimia nervosa. A third category is "eating disorders not otherwise specified (EDNOS)," which includes several variations of eating disorders. Most of these disorders are similar to anorexia or bulimia but with slightly different characteristics. Binge-eating disorder, which has received increasing research and media attention in recent years, is one type of EDNOS.
Eating disorders are more common in women, in higher socioeconomic groups, and in the United States (compared with other developed countries).Bulimia nervosa and anorexia nervosa are the most common specific forms in the United States. Though primarily thought of as affecting females (an estimated 5±10 million being affected in the U.S.), eating disorders affect males as well (an estimated 1 million U.S. males being affected). Although eating disorders are increasing all over the world among both men and women, there is evidence to suggest that it is women in the Western world who are at the highest risk of developing them and the degree of westernization increases the risk.
Anorexia nervosa, Characterized by self-starvation and excessive weight loss, an obsessive fear of gaining weight, and an unrealistic perception of current body weight. 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 Bulimia nervosa (BN), characterized by recurrent binge eating followed by compensatory behaviors such as purging (self-induced vomiting, excessive use of
characterized by morning anorexia. and injury to the hypothalamus). plaster. starch. characterized by recurrent purging to control weight or shape in the absence of binge eating episodes. These can include such things as chalk. Diabulimia. characterized by binge eating. where it interferes with a person's life. it can mean the sufferer equally participates in some anorexic as well as bulimic behaviors (sometimes referred to as purge-type anorexia). These individuals cannot distinguish a difference between food and non food items. Pica. characterized by involving the repeated painless regurgitation of food following a meal which is then either re-chewed and re-swallowed. rust. chewing or licking non-food items or foods containing no nutrition. a term used by Steven Bratman to characterize an obsession with a "pure" diet. However. without compensatory behavior Compulsive overeating. Food maintenance.95% of patients with anorexia nervosa. characterized by a set of aberrant eating behaviors of children in foster care Eating disorders not otherwise specified (EDNOS) can refer to a number of disorders. they are becoming increasingly prevalent among young children. and cigarette ashes. characterized by the deliberate manipulation of insulin levels by diabetics in an effort to control their weight. or to any combination of Eating Disorder behaviors which do not directly put them in a separate category. characterized by a compulsive craving for eating. Eating disorders are more difficult to identify in young children because they are rarely suspected.
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laxatives/diuretics. someone who may be at a "healthy weight". paint chips. paper. Night Eating Syndrome. Binge eating disorder (BED) or compulsive overeating.
Studies indicate that eating disorders occur predominantly among girls and women. glue. are female. ice. coffee grounds. Rumination. and about 80% of patients with bulimia nervosa. evening polyphagia (abnormally increased appetite for consumption of food (frequently associated with insomnia. but who has anorexic thought patterns and behaviors. Orthorexia nervosa.
Many factors contribute to the risk of developing an eating disorder. The factors are as follows
Eating disorders occur most often in adolescents and young adults. or discarded. COE Purging disorder. or excessive exercise) Bulimics may also fast for a certain amount of time following a binge. baking soda. It can refer to a female individual who suffers from anorexia but still has her period.
Borderline Personality Disorder (BPD) is associated with selfdestructive and impulsive behaviors. although they may increase the risk for this disorder. Borderline Personalities. or preoccupied with rules and order). or both is also common in families of patients with eating disorders. Obsessive-compulsive personality defines certain character traits (being a perfectionist.Ethnic Factors
Most studies of individuals with eating disorders have been conducted using Caucasian middle-class females. reinforces their own belief that they are "no good". A number of other anxiety disorders have been associated with both bulimia and anorexia. including low self-esteem. It is not clear if emotional disorders. and any criticism. Obsessive-Compulsive Personality. including:
. and problems with self-direction. cause the eating disorders.
Living in any economically developed nation on any continent appears to pose a risk for eating disorders. including eating disorders. People with BPD tend to have other co-existing mental health problems. Within nations. no matter how slight. increase susceptibility to them. or share common biologic causes Other Anxiety Disorders. Specific psychiatric personality disorders may put people at higher risk for eating disorders. eating disorders also affect people of other races. This personality disorder has been strongly associated with a higher risk for anorexia. People with anorexia are extremely sensitive to failure. particularly obsessive-compulsive disorder (OCD). Narcissistic Personalities. Depression. anxiety. eating disorders can affect people of all socioeconomic levels.
People with eating disorders tend to share similar personality and behavioral traits. These traits should not be confused with the anxiety disorder called obsessive-compulsive disorder (OCD). However. morally rigid. dependency. Studies have also found that people with bulimia or anorexia are often highly narcissistic and tend to:
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Have an inability to soothe oneself Have an inability to empathize with others Have a need for admiration Be hypersensitive to criticism or defeat
Accompanying Emotional Disorders
Many patients with eating disorders experience depression and anxiety disorders.
Depression is common in people with eating disorders. anorexia postpones puberty. preoccupation with diet. depression often improves after anorexic patients begin to gain weight. bulimia). including the use of anabolic steroids. including use of diet pills. In young female athletes.
Body Image Disorders
Body Dysmorphic Disorder. for both anorexia and bulimia. and vomiting. and many exhibit symptoms of post-traumatic stress disorder (PTSD) -. It is characterized by periodic attacks of anxiety or terror (panic attacks). Many high school wrestlers use a method called weight-cutting for rapid weight loss. In addition. allowing them to retain a muscular boyish shape without the normal accumulation of fatty tissues in breasts and hips that may blunt their competitive edge. This process involves food restriction and fluid depletion by using steam rooms. to a lesser degree. Although male athletes are more apt to resume normal eating patterns once competition ends. It tends to occur in men who perceive themselves as being underdeveloped or "puny. Body dysmorphic disorder (BDD) involves a distorted view of one's body that is caused by social. Such individuals are prone to eating disorders and other unhealthy behaviors. studies show that the body fat levels of many wrestlers are still well below their peers during off-season and are often as low as 3% during wrestling season. Muscle Dysmorphia. diuretics.
Extreme eating disorder behaviors. It is often associated with anorexia or bulimia. saunas. because treating and relieving depression rarely cures an eating disorder. Male Athletes.y
Phobias. are reported more often in overweight than normal weight teenagers. Muscle dysmorphia is a form of body dysmorphic disorder in which the obsession involves musculature and muscle mass. laxatives. Panic disorder often follows the onset of an eating disorder. but it can also occur without any eating disorder." which results in excessive body building. Panic Disorder. and social problems.
. Many women with serious eating disorders report a past traumatic event. Excessive exercise is associated with many cases of anorexia (and. a trait common among people with eating disorders. Major depression is unlikely to be a cause of eating disorders. Post-Traumatic Stress Disorder. Female Athletes. psychologic. however. Many coaches and teachers compound the problem by overstressing calorie counting and loss of body fat. Social phobias. or possibly biologic factors.
Depression. are common in both types of eating disorders. in which a person is fearful about being humiliated in public. Phobias often precede the onset of the eating disorder. laxatives. Male wrestlers and lightweight rowers are also at risk for excessive dieting. and diuretics.
Excessive Physical Activity
Highly competitive athletes are often perfectionists.an anxiety disorder that occurs in response to life-threatening circumstances.
Poor parenting by both mothers and fathers has been implicated in eating disorders. Studies also show a higher-than-average risk for eating disorders in men and women in the military. including normal increased body fat. Family History of Addictions or Emotional Disorders. Although concerns about weight and body shape play a role in all eating disorders.
In general. Parents of people with
Negative Family Influences
Negative influences within the family may play a major role in triggering and perpetuating eating disorders. however.
Diabetes or Other Chronic Diseases
Eating disorders may be more common in teenagers with chronic illness. with careful planning.3% in the civilian female population. compared to 1 . four times as likely to intensively diet.Men and Women in the Military. Some recent research suggests an endocrinological link between obesity. Genetics and biologic factors may also play a role. Some studies have produced the following observations and theories regarding family influence. and eating disorders.
Parental Behaviors or Attitudes. the actual cause of these disorders appear to result from many factors. A study of eating behavior on one Army base reported that 8% of the women had an eating disorder. is a healthy practice for both adults and adolescents. including cultural and family pressures and emotional and personality disorders.
There is a greater risk for eating disorders and other emotional problems for girls who undergo early menarche and puberty. One study found that 40% of 9. while paternal criticism of weight can lead to bingeing and purging in young males.and 10-year-old girls trying to lose weight generally did so with the urging of their mothers. such as diabetes or asthma. diabetes. Studies report that people with either anorexia or bulimia are more likely to have parents with alcoholism or substance abuse than are those in the general population. vegetarianism. when the pressures experienced by all adolescents are intensified by experiencing these early physical changes. Vegetarian teens have been found to be twice as likely to diet frequently. and eight times as likely to use laxatives as their non-vegetarian peers. A maternal history of eating disorders can be a factor in development of eating disorders in young girls. Studies report. that vegetarianism in adolescence may be a risk factor for eating disorders in both males and females.
There is no single cause for eating disorders.
Researchers have identified specific chromosomes that may be associated with bulimia and anorexia. Studies have reported sexual abuse rates as high as 35% in women with bulimia. Obesity is a global epidemic. the media floods the public with attractive ads for consuming foods. Researchers have also pinpointed certain proteins such as brain-derived neurotrophic factor (BDNF). the brain chemical involved with both well-being and appetite. far more than are needed for good nutrition. advertisers heavily market weight-reduction programs and present anorexic young models as the paradigm of sexual desirability. especially "junk" foods
.S. Enough food is produced in the U. People with bulimia are more likely than average to have an obese parent or to have been overweight themselves during childhood. and child. Clothes are designed and displayed for thin bodies in spite of the fact that few women could wear them successfully. Some evidence has reported an association with genetic factors responsible for serotonin. regions on chromosome 10 have been linked to bulimia as well as obesity. to supply 3. One interesting anthropologic study reported the following observations:
During historical periods or in cultures where women are financially dependent and marital ties are stronger. possibly reflecting a cultural or economic need for greater reproduction.y
bulimia appear to be more likely to have psychiatric disorders than parents of patients with anorexia. and obesity). Twins had a tendency to share specific eating disorders (anorexia nervosa.
The most positive way for parents to influence their children's eating habits and to prevent weight problems and eating disorders is to have healthy eating habits themselves. the standard is toward being curvaceous. particularly bulimia. This protein may influence an individual's susceptibility to developing an eating disorder. woman. In particular. History of Abuse. Women with eating disorders.
Anorexia is eight times more common in people who have relatives with the disorder.800 calories every day to each man. the standard of female attractiveness tends toward thinness. appear to have a higher incidence of sexual abuse.
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On the one hand. On the other hand. Family History of Obesity.
The response of the media to the cultural drive for thinness and the overproduction of food both likely play major roles in triggering obesity and eating disorders. During periods or in cultures where female independence has been possible. bulimia nervosa. and some doctors believe that genetic factors are the root cause of many cases of eating disorders. and few people living in this over-fed and sedentary culture eat a meal guiltlessly.
The approach to food in Western countries is extremely problematic.
Many of these chemical changes are certainly a result of malnutrition or other aspects of eating disorders. but they also may play a role in perpetuating or even creating susceptibility to the disorders.Hormonal Abnormalities
Hormonal abnormalities are common in eating disorders and include chemical abnormalities in the thyroid. and areas related to stress.
PATHWAYS TO EATING DISORDER
WARNING SIGNS OF EATING DISORDERS
Preoccupied with food Preoccupied with weight Distorted body image Poor self-esteem Depression Mood swings Engages in binge eating Obsessive Exercise Abuse of diet aids Extreme weight loss Engages in purging Nutritional deficiencies Lack of self-control with food. and appetite. the reproductive regions. well-being.
excessive dieting) during the current episode of anorexia nervosa.g.binge eating purging type [e. The term is of Greek origin which means a lack of desire to eat.. with between 15 and 19 years old making up 40% of all cases.g.
The term anorexia nervosa was established in 1873 by Sir William Gull.
The subtypes of anorexia nervosa are . selfinduced vomiting or the misuse of laxatives.the restricting type (e. excessive dieting plus binge-eating (consuming large quantities of high calorie food at one time) and purging (e. It is often coupled with a distorted self image which may be maintained by various cognitive biasesthat alter how the affected individual evaluates and thinks about her or his body. Mayou and Geddes 2005). or enemas) . Anorexia nervosa and the associated malnutrition that results from self-
. The condition largely affects young adolescent women.g. food and eating. but deny themselves all but very small quantities of food.e. diuretics. the person has not regularly engaged in binge-eating or purging behavior (i. vomiting.. Approximately 90% of people with anorexia are female. or misuse of laxatives..3-1% in women and 0. one of Queen Victoria's personal physicians. diuretics.. some of which are listed below. The type and severity vary in each case and may be present but not readily apparent.ANOREXIA NERVOSA
Anorexia nervosa also known as simply Anorexia is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Anorexia nervosa is more prevalent in the upper social classes and it is declared to be rare in less developed countries (Gelder. and enemas)]
Signs and symptoms
A person with anorexia nervosa may exhibit a number of signs and symptoms. It is a serious mental illness with a high incidence of comorbidity and the highest mortality rate of any psychiatric disorder
Anorexia has an average prevalence of 0.1% in men for the diagnosis in developed countries. Persons with anorexia nervosa continue to feel hunger. but there are extreme cases of complete self-starvation. The average caloric intake of a person with anorexia nervosa is 600±800 calories per day.
loose-fitting clothes to cover weight loss if they have been confronted about their health and wish to hide it. neurodegenerative diseases and brain tumors which may mimic psychiatric disorders including anorexia nervosa. or cooking. body temperature lowers (hypothermia) in effort to conserve energy depression: may frequently be in a sad. to test for substance abuse. ipecac syrup. leukopenia. may engage in selfinduced vomiting.imposed starvation. fine hair grows on face and body obsession with calories and fat content preoccupation with food. while others will wear baggy clothing to hide what they see as an unattractive and overweight body. diet pills. may cook elaborate dinners for others but not eat themselves dieting despite being thin or dangerously underweight fear of gaining weight or becoming overweight rituals: cuts food into tiny pieces. chlorine and sodium and tests specific to liver and kidney function glucose tolerance test: Oral glucose tolerance test (OGTT) used to assess the body's ability to metabolize glucose. protein and electrolytes such as potassium. urinalysis: a variety of tests performed on the urine used in the diagnosis of medical disorders. hides or discards food purging: uses laxatives. refuses to eat around others. rapid. There are multiple medical conditions. strenuous exercise perception: perceives self to be overweight despite being told by others they are too thin becomes intolerant to cold: frequently complains of being cold due to loss of insulating body fat or poor circulation due to extremely low blood pressure. dramatic weight loss lanugo: soft. or water pills. becomes withdrawn and secretive clothing: some may wear baggy. such as viral or bacterial infections. recipes. and as an indicator of overall health ELISA: Various subtypes of ELISA used to test for antibodies to various viruses and bacteria such as Borrelia burgdoferi (Lyme Disease Western Blot Analysis: Used to confirm the preliminary results of the ELISA Chem-20: Chem-20 also known as SMA-20 a group of twenty separate chemical tests performed on blood serum. red blood cells and platelets used to assess the presence of various disorders such as leukocytosis. hormonal imbalances. can cause severe complications in every major organ system in the body. lethargic stat solitude: may avoid friends and family. Can be useful in detecting various disorders such as
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obvious. may run to the bathroom after eating in order to vomit and quickly get rid of the calories may engage in frequent. According to an in depth study conducted by psychiatrist Richard Hall as published in the Archives of General Psychiatry:
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Complete Blood Count (CBC): a test of the white blood cells. cheeks may become swollen due to enlargement of the salivary glands caused by excessive vomiting
The initial diagnosis should be made by a competent medical professional. Tests include cholesterol. thrombocytosis and anemia which may result from malnutrition.
A low BUN level may indicate the effects of malnutrition. Crohn's Disease Lh response to GnRH: Luteinizing hormone (Lh) response to gonadotropin-releasing hormone (GnRH): Tests the pituitary glands' response to GnRh a hormone produced in the hypothalumus. Test is used to diagnose parahypothyroidism.
Treatment for anorexia nervosa tries to address three main areas. PTH also controls the levels of calcium and phosphorus in the blood (homeostasis)
Anorexia nervosa is classified as an Axis I disorder in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV). kidney function. cirrhosis of the liver. High BUN/creatinine ratio can occur in severe hydration. Can be used to detect abnormalities such as those associated with pituitary tumors Upper GI Series: test used to assess gastrointestinal problems of the middle and upper intestinal tract] Thyroid Screen TSH. t4. bleeding disorders. Blood urea nitrogen (BUN) test: urea nitrogen is the byproduct of protein metabolism first formed in the liver then removed from the body by the kidneys. 1) Restoring the person to a healthy weight. 2) Treating the psychological disorders related to the illness. The BUN test is used primarily to test kidney function. protein deficiency. brain (CK-BB) and skeletal muscle (CK-MM). hypoglycemia and polycystic ovary syndrome Secritin-CCK Test: Used to assess function of pancreas and gall bladder Serum cholinesterase test: a test of liver enzymes (acetylcholinesterase and pseudocholinesterase) useful as a test of liver function and to assess the effects of malnutrition Liver Function Test: A series of tests used to assess liver function some of the tests are also used in the assessment of malnutrition.y y
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diabetes. 3) Reducing or eliminating behaviours or thoughts that originally led to the disordered eating. congestive heart failure. The DSM-IV should not be used by laypersons to diagnose themselves. published by The American Psychiatric Association. celiac disease rhabdomyolysis. thyroxine (T4). intestinal bleeding. Cushing's Syndrome.
. BUN-to-creatinine ratio: A BUN to creatinine ratio is used to predict various conditions. and triiodothyronine (T3) Parathyroid hormone (PTH) test: tests the functioning of the parathyroid by measuring the amount of (PTH) in the blood. acute kidney failure. t3 :test used to assess thyroid functioning by checking levels of thyroid-stimulating hormone (TSH). Central hypogonadism is often seen in anorexia nervosa cases Creatine Kinase Test (CK-Test): measures the circulating blood levels of creatine kinase an enzyme found in the heart (CK-MB). echocardiogram: utilizes ultrasound to create a moving picture of the heart to assess function electrocardiogram (EKG or ECG): measures electrical activity of heart can be used to detect various disorders such as hyperkalemia electroencephalogram (EEG): measures the electrical activity of the brain. A low BUN/creatinine can indicate a low protein diet. an insulinoma.
and executive functioning which leads to improved social functioning. including obsessional thoughts about food.Dietary y
Zinc supplementation has been shown in various studies to be beneficial in the treatment of AN even in patients not suffering from zinc deficiency. bipolar disorder. There are several approaches to cognitive-behavioral therapy". in the United States clinical trials are still being conducted by the National Institute of Mental Health on adolescents age 10-17 and
. Neuropsychological studies have shown that patients with AN have difficulties in cognitive flexibility. no participants worsened or lost weight even at 1-year follow-up. major depressive disorder (MDD). psychosocial history. There was reported rapid improvement in a case of severe AN treated with ethyl-eicosapentaenoic acid (E-EPA) and micronutrients. has shown promise in the treatment of AN" participants experienced clinically significant improvement on at least some measures. working memory.(MNT) also referred to as Nutrition Therapy is the development and provision of a nutritional treatment or therapy based on a detailed assessment of a person's medical history. and dietary history
Olanzapine: has been shown to be effective in treating certain aspects of AN including to help raise the body mass index and reduce obsessionality. Nutrition counseling Medical Nutrition Therapy.
Cognitive behavioral therapy (CBT) ± "The term 'cognitive-behavioral therapy (CBT) is a very general term for a classification of therapies with similarities. autism. CBT is an evidence based approach which in studies to date has shown to be useful in adolescents and adults with anorexia nervosa Acceptance and commitment therapy: A type of CBT. cognitive flexibility and planning. In studies conducted at Kings College and in Poland with adolescents CRT was proven to be beneficial in treating anorexia nervosa. and borderline personality disorder. by helping to increase weight gain Essential fatty acids:The omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been shown to benefit various neuropsychiatric disorders. physical examination. Accelerated cognitive decline and mild cognitive impairment (MCI) correlate with lowered tissue levels of DHA/EPA." Cognitive Remediation Therapy (CRT): is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention. and supplementation has improved cognitive function. DHA and EPA supplementation has been shown to be a benefit in many of the comorbid disorders of AN including: attention deficit/hyperactivity disorder (ADHD).
Bulimia nervosa is more common than anorexia. The median age of onset is 18.
Family therapy: The most effective form of therapy for adolescents with Anorexia is Family Therapy. and growth hormones Heart problems such as abnormal heart rhythm Electrolyte imbalance Fertility problems Bone density loss Anemia Neurological problems
The long term prognosis of anorexia is more on the favorable side. "separated family therapy" (SFT) in which parents and child attend therapy separately with different therapists
Complications of Anorexia Nervosa
Anorexia nervosa can increase the risk for serious health problems such as:
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Hormonal changes. fasting. There are various forms of family therapy that have been proven to work in the treatment of adolescent AN including "Conjoint family therapy" (CFT). in which the parents and child are seen together by the same therapist. including reproductive. Sufferers attempt to overcome these feelings in a number of ways. Mayou and Geddes 2005). another fifth of patients recover fully and three fifths of patients have a fluctuating and chronic course (Gelder. The most common form is defensive vomiting. and it usually begins early in adolescence. diuretics. enemas.Stanford University in subjects over 16 as a conjunctive therapy with Cognitive behavioral therapy. sometimes called purging. It is characterized by cycles of bingeing and purging. and over exercising are also common. The long-term prognosis of anorexia nervosa is changeable: a fifth of patients stay severely ill.
Bulimia nervosa is an eating disorder characterized by restraining of food intake for a period of time followed by an over intake or binging period that results in feelings of guilt and low self-esteem. and typically takes the following pattern:
. the use of laxatives. thyroid.
which may stop when the bulimic is interrupted by another person or the stomach hurts from overextension. cardiac arrest. (Binge eating involves consuming larger than normal amounts of food within a 2-hour period. and even death Esophagitis.)
There are two sub-types of bulimia nervosa:
Purging type : bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested.
Non-purging type : bulimics (approximately 6%±8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. followed by selfinduced vomiting or other forms of purging. which can lead to cardiac arrhythmia. vomiting. usually by purging. patients compensate. under the jaw line Peptic ulcers Calluses or scars on back of hands due to repeated trauma from incisors
. several times a day. They are then considered to have non-purging bulimia. (Some doctors believe that going through the cycle only once a week is sufficient for a diagnosis. diuretics. however. but as a secondary form of weight control. or both. Some studies have reported that patients with bulimia average about 14 episodes of binge-purging per week. in more serious cases. fail.) In response to the binges. in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat Gastroparesis or delayed emptying Constipation Infertility Enlarged glands in the neck. a patient must binge and purge at least twice a week for 3 months. excessive exercise.y
Bulimia is often triggered when young women attempt restrictive diets.) The cycle then swings back to bingeing and then to purging again. diet pills. To be diagnosed with bulimia. (Some patients with bulimia follow bingeing only with fasting and exercise. or inflammation of the esophagus Oral trauma. or taking laxatives.
Signs and symptoms
These cycles often involve rapid and out-of-control eating. or enemas. Patients then revert to severe dieting. Purging-type bulimics may also exercise or fast. or use laxatives. and react by binge eating. This cycle may be repeated several times a week or. using enemas. or drugs to reduce fluids. and may directly cause:
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Chronic gastric reflux after eating Dehydration and hypokalemia caused by frequent vomiting Electrolyte imbalance.
Research groups who have seen a relationship to seizure disorders have attempted treatment with phenytoin. carbamazepine. Cognitive behavioral therapy (CBT). Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy
BINGE EATING DISORDER
Binge eating disorder (BED) is the most common eating disorder in the United States affecting 3. Although it is not yet classified as a separate eating disorder. MAO inhibitors. By using CBT patients record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis (Gelder. all parties must work together to discuss. and bupropion.y
Constant weight fluctuations
Pharmacological Some researchers have hypothesized a relationship to mood disorders and clinical trials have been conducted with tricyclic antidepressants. which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (for example. BED usually leads to obesity although it can occur in normal weight individuals. lithium carbonate. it was first described in 1959 by psychiatrist and researcher Albert Stunkard as "Night Eating Syndrome" (NES). and valproic acid. alcohol and food. in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication. and limited clinical use of topiramate. fluoxetine. mianserin. Researchers have also reported positive outcomes when bulimics are treated in an addiction-disorders inpatient unit. have also been used. nomifensine. Mayou and Geddes 2005).
. He states in order for the therapy to work. Barker (2003) states that research has found 40-60% of patients using cognitive behaviour therapy to become symptom free. record and develop coping strategies. and the term "Binge Eating Disorder" was coined to describe the same binging-type eating behavior without the exclusive nocturnal component. Opiate antagonists naloxone and naltrexone. which block cravings for gambling.5% of females and 2% of males and is prevalent in up to 30% of those seeking weight loss treatment. trazodone. Barker (2003) claims by making people aware of their actions they will think of alternatives. Psychotherapy There are several empirically-supported psychosocial treatments for bulimia nervosa. cocaine. which blocks cravings for opiates. There has also been some research characterizing bulimia nervosa as an addiction disorder.
Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e. Binge eating usually leads to becoming overweight To be diagnosed as a binge eater.000 . soap. coal.) or an abnormal appetite for food ingredients (e. soil. owing to feelings of embarrassment about food. Feels disgusted. rather than consuming large amounts of food during binges
Signs and symptoms
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Periodically does not exercise control over consumption of food. raw rice. raw potato. salt). paper. ash.g. etc. may be helpful for some people. metal. feces. spoons. For these actions to be considered pica. Eats large amounts of food even when not really hungry. toothbrushes. flour. they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate
. dirt. depressed. It also teaches them how to change the way they act in tough situations. batteries. gum. sand. Eats an unusually large amount of food at one time. Drug therapy. Rapid weight gain. chalk.
There are several different ways to treat binge eating disorder. mucus.Bingeing without purging is characterized as compulsive overeating (binge eating) with the absence of bulimic behaviors. Eats until physically uncomfortable and nauseated due to the amount of food just consumed. Usually eats alone during binge eating episodes. far more than an average person would eat in the same amount of time. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. such as vomiting or laxative abuse (used to eliminate calories). Eats when depressed or bored. or guilty after binge eating. Often eats alone during periods of normal eating. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. pens and pencils. such as antidepressants. ice cubes.15. and/or sudden onset of obesity. Eats much more quickly during binge episodes than during normal eating episodes. a person typically has the following characteristics:
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Bingeing at least twice a week for 6 months Consuming 5.000 calories in one sitting Eating three meals a day plus frequent snacks Overeating continually throughout the day. in order to avoid discovery of the disorder.g.
Pica in children (usually only in young children or children with autism or another mental or developmental disorder) may be dangerous. a bird that is reputed to eat almost anything.. An initial approach often involves screening for and. In addition to poisoning. and family guidance approaches. and chore-based punishment Negative practice (nonedible object held against patient's mouth without allowing ingestion)
Treatment for pica varies based on the patient's category (e. child.] For pica that appears to be of psychotic etiology. with negative consequences if pica is attempted Visual screening. there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach.Meaning
The condition's name comes from the Latin word for magpie. with eyes covered for a short time after pica is attempted Aversive presentation. This is also true in animals.. contingent on pica being attempted: o oral taste (e. environmental. disposal of nonedible objects. previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out Behavior-based treatment options can be useful for developmentally disabled or mentally retarded individuals with pica. food. or psychotic) and may emphasize psychosocial.. Another risk of dirt-eating is the possible ingestion of animal feces and accompanying parasites. water mist in face) Physical restraint: o self-protection devices that prohibit placement of objects in the mouth o brief restraint contingent on pica being attempted Time-out contingent on pica being attempted Overcorrection. ammonia) o physical sensation (e. Pica is seen in all ages.g. pregnant. therapy and medication such as SSRIs have been used successfully However. not contingent on pica being attempted Differential reinforcement. small children. lemon) o smell sensation (e. There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetra-ethyl lead in gasoline (in some countries) or prior to the cessation of the use of contaminated oil (either used. if necessary. These may involve associating negative consequences with eating non-food items or good consequences with normal behavior. Pica is more common in women and children. treating any mineral deficiencies or other comorbid conditions. with positive reinforcement if pica is not attempted and consequences if pica is attempted Discrimination training between edible and inedible items. developmentally disabled. or containing toxic PCBs or dioxin) to settle dust. and those with developmental disabilities.g.g. or toys. particularly in pregnant women. with attempted pica resulting in required washing of self. and may be contingent on pica being attempted or initiated regardless of a pica attempt. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. A recent study classified nine such classes of behavioral intervention
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Presentation of attention.