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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
Binge eaters often eat even when they¶re not hungry and continue eating long after they¶re full.A binge eating episode typically lasts around two hours. BINGE EATING DISORDER Almost everyone overeats from time to time. you can learn to control your binge eating. But if overeating is a regular and uncontrollable habit. . They may also gorge themselves as fast as they can while barely registering what they¶re eating or tasting. however. but some people binge on and off all day long. but their compulsive overeating just makes them feel worse. you may be suffering from binge eating disorder. The symptoms of binge eating disorder usually begin in late adolescence or early adulthood. Binge eaters use food to cope with stress and other negative emotions.percent of people with anorexia or bulimia and an estimated 35 percent of those with bingeeating disorder are male(Agras. Binge eating disorder is more common than bulimia and anorexia and affects a significant number of men as well as women (Beglin & Fairburn. 1992). 1992) . taking an extra helping at Thanksgiving dinner. key features of binge eating disorder are: y y Frequent episodes of uncontrollable binge eating. for example. Feeling extremely distressed or upset during or after bingeing. Binge eating disorder is treatable. 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. and with the right help and support. or downing dozens of cookies during a late-night study session. 1992). often after a major diet (Beglin et al.
but then reality sets back in. or over-exercising (Bachar. Binge eating often leads to weight gain and obesity. The worse a binge eater feels about themselves and their appearance. They worry about what the compulsive eating will do to their bodies and beat themselves up for their lack of self-control. the more they use food to cope. there are no regular attempts to ³make up´ for the binges through vomiting. but some are of normal weight. Latzer. People with binge eating disorder struggle with feelings of guilt. & Berry. so they often try to hide their symptoms and eat in secret.y Unlike bulimia. They desperately want to stop binge eating. It becomes a vicious cycle: eating to feel better. along with regret and self-loathing. 1999). and then turning back to food for relief (Bachar et al. feeling even worse. disgust. 1999). but feel like they can¶t. Kreitler. Behavioural symptoms of binge eating and compulsive overeating y y y y Inability to stop eating or control what you¶re eating Rapidly eating large amounts of food Eating even when you¶re full Hiding or stockpiling food to eat later in secret . The binge eating cycle Binge eating may be comforting for a brief moment. fasting. Signs and symptoms of binge eating disorder People with binge eating disorder are embarrassed and ashamed of their eating habits. Many binge eaters are overweight or obese. which only reinforces compulsive eating. and depression.
including: y y y Type 2 diabetes Gallbladder disease High cholesterol y y y Certain types of cancer Osteoarthritis Joint and muscle pain . and suicidal thoughts than people without an eating disorder. or depressed after overeating Desperation to control weight and eating habits y y y y y y Effects of binge eating disorder Binge eating leads to a wide variety of physical.y y Eating normally around others. Depression. in turn. insomnia. disgusted. emotional. causes numerous medical complications. no matter how much you eat Feeling guilty. But the most prominent effect of binge eating disorder is weight gain. anxiety. and social problems. but gorging when you¶re 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 you¶re eating Feeling numb while bingeing²like you¶re not really there or you¶re on auto-pilot. Never feeling satisfied. Obesity and binge eating Over time. and substance abuse are common side effects as well. compulsive overeating usually leads to obesity. Obesity. stress. People with binge eating disorder report more health issues.
loneliness. For example. Finally. 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. Low self-esteem. and experience. others may have trouble with impulse control and managing and expressing their feelings. emotions. the hypothalamus (the part of the brain that controls appetite) may not be sending correct messages about hunger and fullness. there is evidence that low levels of the brain chemical serotonin play a role in compulsive eating. Researchers have also found a genetic mutation that appears to cause food addiction.y y High blood pressure Heart disease y y Gastrointestinal problems Sleep apnea Causes of binge eating and compulsive overeating Generally. Children who are exposed to frequent critical comments about their bodies and weight are also vulnerable. it takes a combination of things to develop binge eating disorder ² including a person's genes. Psychological causes of binge eating disorder Depression and binge eating are strongly linked (Anstine & Grinenko. Some parents unwittingly set the stage for binge eating by using food to comfort. and body . or reward their children. 2000). Biological causes of binge eating disorder Biological abnormalities can contribute to binge eating. dismiss. Many binge eaters are either depressed or have been before. as are those who have been sexually abused in childhood.
Males. are not immune to the problem. depression. 2000). When you have a bad day. loneliness. By definition. anxiety. and boredom evaporate into thin air. anorexia nervosa is the inability to maintain body weight at or above the minimum of the normal weight range for height and body build. the majority of reported cases are females from white.dissatisfaction may also contribute to binge eating. the destructiveness of the eating disorder is denied. But the relief is only very fleeting. It is believed that five to ten percent of people with anorexia are males. Binge eating can temporarily make feelings such as stress. In adults. 1992). Binge eating and stress One of the most common reasons for binge eating is an attempt to manage unpleasant emotions such as stress. and females in general are the more susceptible. Starving is seen as essential to maintaining competence and self-esteem. While people with anorexia come from all cultures and socioeconomic backgrounds. They have an intense and irrational fear of being overweight. it has one of the highest . People suffering from this disorder are chronically underweight. or even of being a normal weight (Babyak. Anorexia nervosa has serious consequences. In anorexia. depression. it can seem like food is your only friend. however. yet harbour deep anxieties about becoming fat. 2000). Anorexia Nervosa Eating disorder Anorexia nervosa is the best known of the three disorders. fear. Adolescent girls are the highest-risk group for becoming anorexic. middleclass backgrounds(Beglin et al. No amount of argument or logic can change this mind set. The prevalence of anorexia nervosa is not known because many people with the disorder are not aware they have a problem. and anxiety (Anstine et al. sadness.
in part. Etiology The etiology of AN remains incompletely understood. Even those less affected can face serious health concerns. stomach and heart problems. Although not disorder-specific. a weakened immune system. given the interrelatedness of neurotransmitter function. other neurotransmitter systems. are also implicated in this disorder. Symptoms of Anorexia Nervosa Behavioural: y y Eats very little. Although serotonin has received considerable research attention.mortality rates of any psychiatric disorder. Approximately half of all people with anorexia nervosa also engage in some³bulimic´behaviour. One in ten patients will either commit suicide or die as a result of malnutrition. . Refuses to maintain a minimal. normal body weight for age and height. because the disorder usually surfaces during adolescence when the body¶s nutritional demands are high. and usually only from a narrow selection of food considered ³safe. and chemical imbalances in the brain which can increase depression and anxiety levels. elevated shape and weight concerns. The ultimate understanding of AN etiology will likely include main effects of both biological and environmental factors as well as their interactions and correlations. common risk factors across eating disorders include sex. most notably dopamine. race or ethnicity. and general psychiatric comorbidity. childhood eating and gastrointestinal problems. negative self-evaluation. Adolescents with anorexia frequently encounter problems with menstruation. sexual abuse and other adverse events.
Cognitive: y Preoccupied with food. and equate successful dieting with personal success. . that appear incongruent with the student¶s personality. Perceives self as being fat. Exhibits significant weight loss in the absence of any related illness. running. For example.y y y y Harbours an intense fear of weight gain. Shops for groceries and prepare food for others. Develops rituals around food intake. artwork. May perceive dieting to be the highest form of self control. such as increased activity levels. y y Sets unrealistically high goals and constantly strives for perfection. y Demonstrates changes in behaviour. regardless of low weight. Pays a lot of attention to creating and maintaining records like meal plans and calorie journals. even when critically underweight. repetitive activities such as working out. May revolve around food themes. y y y y y Continually weighs and measures food. school projects. Withdraws from social activities and becomes immersed in highly physical. Hoards food. Conversations. Wears layers of loose fitting clothing to hide the body. y y y y Undertakes rigid and excessive exercise regimes. cycling or roller-blading. etc. even when underweight. Eats a restrictive diet. but avoids eating. hides food in a locker or knapsack. Demonstrates an unwillingness or inability to eat which becomes a consistent focus of attention from family and friends.
Demonstrates feelings of low self-esteem through radical change in attire. Becomes sullen. Emotions: y Appears anxious. irritable. angry or defensive when concern is expressed. defiant. worthlessness. Associates feelings of shame or guilt with eating disorders when taking part in a class discussion on the topic. body language or social relations. conversely. and stubborn or displays intense mood swings. exhibits rigid ³black-and-white´ thinking. Places a premium on self-control. Expresses feelings of failure with less than perfect school grades/marks. Appears indecisive or. depressed. y y Expresses feelings of inadequacy.y y y Has difficulty concentrating. angry. Physical: y y Weight loss is noticeable. anxiety and loneliness. Appears unusually thin.´ but does not appear to be so. y Denies anything is wrong. often over a short period of time. y y y y y Tends to be withdrawn and appears isolated. Demonstrates inflexibility and resists changes to routines. y y Considers self ³fat. with little muscle or fat. Makes comments about being overweight or expresses a belief that thinness equates to happiness. . Expresses a fear of weight gain.
Experiences loss of menstrual periods. in order to avoid criticism from family and peers. Younger females may experience a delay in the onset of menses. brittle or thinning hair. When they do not maintain these diets. Constantly complains of feeling cold. They set unreasonably strict diets. Some other behaviours of people with bulimia are excessive exercising or fasting. they fall into episodes of intense eating followed by purging. People with bulimia go through behaviour cycles marked by binge eating followed by purging through self-induced vomiting or use of laxatives. muscle cramps or tremors. and yellow or grey in colour. They may. they will not use this knowledge to initiate change. Despite acknowledging the consequences of the behaviour. go through periods of time when they are . eating large quantities of food over short periods of time. Fine hair growth on face or body. because of their episodes of intense eating.y y y y y y y y y Complains of ongoing stomach problems. Appears chronically tired. but rather use the behaviours to confirm their own negative self-image. These episodes typically occur in secret. People with bulimia tend to be average weight to overweight. Engages in binge eating. Suffers unusually severe dental problems. Dull. students with bulimia are more likely to acknowledge their behaviour. Like people with anorexia. those with bulimia are obsessed with their weight and body image. bulimia nervosa is actually a distinct eating disorder. Unlike students with anorexia. however. Bulimia Nervosa Often confused with anorexia nervosa. Skin is unusually dry or scaly.
inflamed throat.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. BN has been conceptualized as having sociocultural origins. They may also suffer both the physical and mental effects of chronically poor nutrition. damage to the immune system. and other side-effects from self-induced vomiting. For most people these two needs alternate . They do agree that bulimia is a more widespread eating disorder. Substantial familial aggregation of BN has been reported.usually with the need to purge immediately following a period of bingeing. Linkage analyses have identified areas on chromosome 10p that may be implicated in BN. It is estimated that as many as three percent of North American females suffer from bulimia nervosa.Twin studies reveal a moderate to substantial contribution of additive genetic factors (between 54 percent and 83 percent) and unique environmental factors to BN. . While researchers still do not have a clear understanding of the long-term effects of bulimia.80.underweight. They are at risk for rupture of the oesophagus. some believe the mortality rate for bulimia is as high as it is for anorexia. Ongoing biological studies suggest fundamental disturbances in serotonergic function in individuals with BN. Etiology Historically. 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. including stomach and cardiovascular problems. like AN. and depression. Numerous candidate genes have been studied for their role in risk for the disorder.
Someone may eat a `normal¶ meal with others and then binge in private. taking left-overs from the fridge or from dirty plates or even eating seemingly inedible foods such as frozen peas.Bingeing A binge is almost always carried out in secret. Other binges can happen on the spur of the moment and any available food ± even raw food .is used. The food which has just been bought is eaten frantically as quickly as possible . 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. Some people find themselves eating almost anything which is immediately available. . are easy to eat or easy to expel. work or relationships or through being suddenly and unexpectedly alone. Sometimes the binge will start with other people and then be continued 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. 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. because of an upsetting or unsettling event. raw pasta or whole slabs of butter. This may mean having dozens of pieces of toast. 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. as a result of anxiety about money. The binge almost always takes place as soon as the person gets home. Sometimes the need for bingeing can be triggered unexpectedly. This may occur. Some people plan binges very carefully and have foods which they use regularly either because they need no preparation. A great deal of thought can go into what food will be consumed and in what order.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. Bingeing is a frantic activity and usually makes the person with bulimia nervosa feel completely out of control. alone and usually at home. for example.
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.Purging With bulimia nervosa. y y y Eats in private or is secretive about eating behaviours. including: self-induced vomiting. Many people also use laxatives either as well as or instead of vomiting. unattractive and terrified by the thought of how much weight they will gain as a result of all the calories they have consumed. Other people embark on a period of extreme fasting or start exercising strenuously in order to burn off the calories they have consumed. but it also leaves people feeling disgusting and ashamed. They may feel fat. Prefers high-fat. Not only does the bingeing result in physical discomfort. high-carbohydrate and high-sugar ³junk´ foods during bing . Engages in purging or other inappropriate compensatory behaviours after eating. Often eats a restrictive diet. People who plan their bingeing often plan their abuse of laxatives and will take large numbers of them before starting to eat. excessive exercise and/or the misuse of laxatives or diuretics. fasting. bingeing is almost always followed by a feeling of overwhelming guilt and panic. This means that they know while they are eating that the process of purging has already begun. Symptoms Behavioural: y y Eats a large amount of food over a short period of time.
Engages in ³acting out´ behaviours. anxiety and loneliness. y y Shows a marked decline in school attendance patterns. appears indecisive or. worthlessness. y Makes comments about being overweight or expresses a belief in the importance of self-control when it comes to eating habits. Cognitive: y Is preoccupied with food. . Often appears to be of average weight or overweight. y Has difficulty concentrating. but on close examination. angry. relationships may tend to be superficial. Often appears socially outgoing. Conversations. binge spending. irritable. defiant or stubborn. conversely. exhibits rigid ³blackand-white´ thinking.episodes. y Expresses a fear of weight gain. alcohol or drug use and/or sexual promiscuity. body language or social relations. y Expresses fears about intimacy in personal relationships. y y Sets high goals and constantly strives for perfection. y y Frequently uses the bathroom for extended periods of time after eating. Affective: y Appears anxious. depressed. school projects or artwork may revolve around food themes. such as shoplifting. attire. or displays intense mood swings. y y Expresses feelings of inadequacy. Demonstrates feelings of low self-esteem through appearance.
. relying on others to determine self-worth. Associates feelings of shame or guilt with eating disorders when taking part in a class discussion on the topic. Has dental problems. fainting spells. Suffers from ongoing stomach problems. Experiences loss of. Engages in binge eating. dizziness. 2002). or irregular. These are physical conditions that can be caused by self -induced vomiting. menstrual periods. COUNSELLING IMPLICATIONS How the counsellor can help involves three components : o restoring the person to a healthy weight. and preventing relapse (Kasper. and o reducing or eliminating behaviours or thoughts that lead to disordered eating. or throat problems. Feels dependent on others for approval and appreciation.y y Expresses feelings of failure with less than perfect school grades/marks. y y Expresses fears about intimacy in personal relationships. o treating the psychological issues related to the eating disorder. eating large quantities of food over short periods of time. ³bags´ under the eyes. broken blood vessels under the eyes. y y y y Complains of dehydration. Physical: y y Exhibits broad fluctuations in weight. hand tremors or blurred vision.
Different forms of psychotherapy. There are many group options.Group therapy sessions are led by a trained psychotherapist. 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. Telch. y Group therapy . 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. Eldredge. may be modestly effective in treating patients with eating disorder by helping to resolve mood and anxiety symptoms that often co-exist with it. the use of medications. this particular approach is discussed in some guidelines and studies for treating eating disorders in younger. However. y Support groups ± Support groups for eating disorders are led by trained volunteers or . but research is ongoing. Shown to be effective in case studies and clinical trials. antipsychotics or mood stabilizers. Overall. Detzer. can help address the psychological reasons for the illness. the effectiveness of a treatment depends on the person involved and his or her situation. and may cover everything from healthy eating to coping with eating disorder. Arnow.Agras et al (1995) posits that. including individual. it is unclear if and how medications can help patients conquer eating disorder. such as antidepressants. 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. 2002). including self-help support groups and more formal therapy groups. group and family-based. In addition. Henderson & Marnell 1995). no medication has shown to be effective during the critical first phase of restoring a patient to healthy weight.According to (Agras.
The emphasis of therapy is on teaching unhealthy eaters how to accept themselves. Therapist will also address unhealthy attitudes you may have about eating. y The therapist can advice friends and family of unhealthy eaters to try to listen without . 1992). Cognitive-behavioural therapy for eating disorders also involves education about nutrition. shape. and weight. Three types of therapy are particularly helpful in the treatment of eating disorders (Agras. As you learn how to relate better to others and get the emotional support you need. y Interpersonal psychotherapy . Therapist will help improve your communication skills and develop healthier relationships with family members and friends. Therapy can teach you how to exchange unhealthy habits for newer healthy ones. 1992): y Cognitive-behavioural therapy ±focuses on the dysfunctional thoughts and behaviours involved in binge eating. healthy weight loss. monitor your eating and moods. Dialectical behaviour therapy typically includes both individual treatment sessions and weekly group therapy sessions. Group members give and receive advice and support each other. y Dialectical behaviour therapy ±combines cognitive-behavioural techniques with mindfulness meditation.health professionals.focuses on the relationship problems and interpersonal issues that contribute to eating disorder. Eating disorder can be successfully treated in therapy (Agras. and regulate their emotions. tolerate stress better. the unhealthy way of eating becomes more infrequent. and relaxation techniques. One of the main goals is for you to become more self-aware of how you use food to deal with emotions. and develop effective stress-busting skills.
judgment and make sure the person knows you care. y y y Appetite suppressants Topamax Antidepressants. make it clear that you care about the person¶s health and happiness and you¶ll continue to be there for him or her. 1992). and proven self-help techniques. they feel bad enough about themselves and their behaviour already. exercising. y Also loved ones can be advised by counsellors to set good examples by eating healthily. it may be among the most important health facilities tackle. CONCLUSION Though addressing the topic of eating disorders is not an easy one. getting upset. A number of medications may be useful in helping to treat eating disorder symptoms as part of a comprehensive treatment program that includes therapy. and they may be in denial. y Counsellors or therapists can also advice loved ones of unhealthy eaters that. Lecturing. and managing stress without food Medications for binge eating disorder Medication is not a cure for eating disorder (Agras. . Though approaching these people may be difficult and thankless. group support. they may also be waiting for someone to notice and help them. Instead. or issuing ultimatums to them will only increase stress and make the situation worse. As Babyak (2000) points out. someone suffering from an eating disorder is lonely and isolated.
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