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Eating disorders are complex conditions characterized by abnormal eating behaviors and beliefs about eating, weight, and shape. There are three main types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. In addition, there are many types of eating disorder that have only some of the features required for a diagnosis of eating disorder. These are known as eating disorders not otherwise specified (EDNOS).
Nearly 10 million women and 1 million men currently suffer from anorexia and bulimia, while many millions more have binge eating disorder. Despite the prevalence of eating disorders in America, there is inadequate access to quality treatment, insurance coverage, and research funding. Couple that with misinformation about eating disorders and the stigma attached to victims and the need for more education, awareness, and advocacy programs becomes abundantly clear.
Anorexia nervosa is a potentially life-threatening eating disorder that is characterized by self-starvation and excessive weight loss. Sufferers have low self-esteem and often a tremendous need to control their emotions and surroundings.
Despite public opinion that people with anorexia nervosa are just preoccupied with food and excessive amounts of exercise, the reality is that the disorder is often triggered by a variety of deep conflicts. These include stress, anxiety, unhappiness, and the feeling that life is veering out of control. Their anorexia nervosa, however, is a negative and destructive way to deal with these powerful emotions.
Recent research findings show that there may be a genetic component to anorexia nervosa, which may mean that new treatments may be developed in the future to counteract a genetic predisposition to the eating disorder.
People with anorexia nervosa have extreme sensitivity about being fat or perceived as fat, or fears about becoming fat. Fearing that they may lose control over the amount of food they eat, they seek to control their emotions and their reactions to their emotions. Such obsessive control over weight and eating may lead sufferers of anorexia nervosa to believe that they don’t deserve to have any pleasure in life. Thus, they deprive themselves of situations that may result in any form of pleasure (including eating).
Symptoms of Anorexia Nervosa
Various symptoms of anorexia nervosa include:
• Intense fear of weight gain or being fat, even though the person may, in fact, be underweight
• Extreme resistance to maintaining body weight at or above a minimally normal weight for age and height
• Undue influence of weight or shape on self-evaluation, denial of the seriousness of low body weight, or disturbance in the experience of body weight or shape
• Loss of regular menstrual periods
Warning Signs of Anorexia Nervosa
Persons who display some or more of the following warning signs may be suffering from anorexia nervosa:
• Dramatic weight loss
• Preoccupation with food, calories, fat, grams, and dieting
• Refusal to eat certain foods, which may progress to refusal to eat whole categories of foods (such as not eating any carbohydrates)
• Frequent comments about being fat or overweight – despite weight loss
• Denying hunger
• Developing food rituals – such as eating foods in a certain order, compulsive chewing, constantly rearranging food on the plate
• Consistent excuses to avoid mealtimes or any situations involving food
• Adherence to a rigid, excessive exercise regimen – despite inclement weather, illness, injury or fatigue
• Withdrawal from usual activities and friends
Initial Treatment Efforts for Anorexia Nervosa
Weight loss and starvation can be life-threatening. Initial treatment efforts, therefore, need to focus on weight gain and the reestablishment of regular patterns of eating. Hospitalization is frequently required. Some individuals with anorexia nervosa have no evidence of medical problems. But since prolonged starvation affects most organ systems, a wide variety of medical problems may be present.
The long-term mortality from anorexia nervosa is estimated at between 5 and 10 percent, with most of the deaths attributed to starvation, cardiac events, or suicide.
Significant psychological issues may also be present, but these are generally attended to with intensive psychotherapy once the patient’s weight has been stabilized. Relapse rates for anorexia nervosa are high.
Bulimia nervosa, or bulimia, is another type of eating disorder in which the person consumes a great amount of food in a short period of time (binging) and then tries to prevent any weight gain from the food by getting rid of it (purging). Purging is accomplished by forced vomiting or taking laxatives (liquids or pills that accelerate the movement of food through the body and result in a bowel movement).
A bulimic individual feels incapable of controlling the amount of food he or she eats. A bulimic individual may also exercise excessively, consume very little or no food, and/or take pills to force frequent urination in order to prevent gaining weight.
People suffering from bulimia, unlike those with anorexia, may be of normal weight. But like anorectics, bulimics may fear becoming fat or gaining weight, be desperate to lose weight, and/or are very unhappy with their current body shape and size.
About 85 to 90 percent of bulimics are women, but bulimia affects men as well. Individuals from every walk of life can become bulimic. It is possible that people from different cultural backgrounds may develop eating disorders as a means of coping with culture clash – trying to live in two different worlds.
Causes of Bulimia Nervosa
While there is no single known cause of bulimia, several factors may play a part in whether or not a person becomes bulimic. These include:
• Family history – Women or girls whose mothers or sisters are bulimic may themselves become bulimic. In families where looks are considered important by parents, or the parents diet to maintain a certain weight and shape, or the parents criticize the children’s weight – the children may have a tendency to become bulimic or to develop an eating disorder.
• Cultural influences – Today’s society appears to place an inordinate emphasis on looking a certain way, to be thin, and to be flawless in every respect. Persons trying to measure up to certain so-called standards of beauty may develop an eating disorder.
• Stressful events or life changes – Certain events, including trauma, rape, accidents, and life changes (divorce, death of a loved one, loss of a job, etc.) can trigger a person’s eating disorder, including bulimia.
• Biological factors – Researchers are studying the link between genetic predispositions, and how hormones and chemicals may be factors in a person’s developing bulimia.
• Personality – Certain personality traits – moodiness, hopelessness, inability to control compulsive behavior or express anger – may contribute to a person’s developing bulimia. If an individual hates the way he or she looks and/or hates himself or herself, an eating disorder may develop.
Symptoms of Bulimia Nervosa
There are three primary symptoms of bulimia nervosa, according to the National Eating Disorders Association:
• Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior
• Regular use of inappropriate compensatory behaviors such as diuretic or laxative abuse, self-induced vomiting, fasting, and/or compulsive or obsessive exercise
• Extreme concern over body shape and weight
Warning Signs of Bulimia Nervosa
It’s sometimes difficult to tell if a person has bulimia nervosa, particularly since such individuals may be thin, overweight, or have a normal weight. In addition, since purging (throwing up) is done in private, it may be hard to tell if a person is truly bulimic. That said, there are warning signs of bulimia nervosa to look out for, including:
• Use of diet pills
• Taking pills to urinate or to have a bowel movement
• Going to the bathroom constantly after eating (to throw up)
• Excessive exercising, even when not feeling well or when tired
• Signs of throwing up, which include: swollen cheeks or jaw area, clear-looking teeth, broken blood vessels in the eyes, knuckle scrapes or calluses (from using fingers to force vomiting)
Also be on the lookout for other mental health conditions which may include depression, anxiety, and problems with substance abuse. Individuals suffering from bulimia nervosa may appear extremely sad, keep to themselves, and not want to socialize with friends.
Treatment for Bulimia Nervosa
A team of doctors, nutritionists, therapists, and other professionals is required in order to effectively treat an individual with bulimia nervosa. The patient needs to learn to develop health eating patterns and how to cope with thoughts and feelings. Effective treatment for bulimia utilizes a combination of options. Whether or not such treatment works depends upon the patient.
First and foremost, the doctor works to stop the patient from binging and purging. He or she may recommend that the patient receive nutritional advice in combination with psychotherapy – particularly cognitive behavioral therapy (CBT). CBT that has been tailored to treat bulimic patients has been shown to be effective in changing the binging and purging behavior and in establishing healthy eating attitudes. Such therapy may be on a one-on-one basis with a therapist or in group therapy.
The doctor may also prescribe medication to assist the patient in overcoming bulimia nervosa. Certain antidepressants, including fluoxetine (Prozac), which is the only FDA-approved medication for treating bulimia, may be prescribed for bulimic patients who also have anxiety and/or depression. Fluoxetine appears to help reduce the binge-eating and purging behavior, reduce the rate of relapse, and improve eating habits.
Binge Eating Disorder
Binge eating disorder is an eating disorder not otherwise specified (EDNOS), characterized by recurrent binge eating without the regular use of compensatory measures to counter binge eating. The prevalence of binge eating disorder is estimated at about 1 to 5 percent of the general population. The Weight Control Information Network, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), binge eating disorder is the most common eating disorder, affecting about 3 percent of all adults in the United States.
According to research, binge eating disorder affects more females than males. About 60 percent of persons struggling with binge eating disorder are female, and about 40 percent are male. These individuals may be of normal or heavier than average weight.
Although most obese people do not have binge eating disorder, people with binge eating disorder are often overweight or obese. It is more common in people who are severely obese. People who are obese and have binge eating disorder developed the eating disorder at a younger age than those without the disorder. These individuals lose and gain weight more often, a process known as “yo-yo dieting” or weight cycling.
Individuals with binge eating disorder often express shame, guilt, or distress over their eating behaviors. Binge eating disorder is often associated with depression.
Symptoms of Binge Eating Disorder
Binge eating disorder is characterized by:
• Frequent episodes of consuming large amounts of food within a short period of time
• Feeling out of control over the eating behavior
• Feeling disgusted or ashamed of the eating behavior
• Eating even when not hungry
• Eating in secret
Warning Signs of Binge Eating Disorder
In addition to the symptoms of binge eating disorder, there are several warning signs to look out for, including if the individual:
• Consumes large amounts of food when not actually hungry
• Eats much more rapidly than normal
• Eats to the point of being uncomfortably full
• Has a history of marked weight fluctuations
• Expresses shame, guilt, or disgust after eating
• Often feels depressed after eating
• Eats alone often out of feelings of embarrassment and shame
Treatment for Binge Eating Disorder
The treatment goals and strategies for binge eating disorder are similar to those for bulimia. These include reducing or eliminating the binge eating behavior, nutritional rehabilitation, psychosocial intervention, and medication management as required. Specific treatment aims include establishment of regular, non-binge meals, improving attitudes relating to the binge eating disorder, and resolution of co-occurring disorders such as anxiety and depression.
Getting Help is Critical for Persons with Eating Disorders
While there is no guarantee that an individual with an eating disorder can be successfully treated, there are greater chances of success with treatment than without. Eating disorders are both physically and psychologically destructive, and the individual suffering from an eating disorder should seek professional treatment as soon as possible. Experts say that early diagnosis and intervention offer the best likelihood of success. If eating disorders are not identified and treated in their early stages, they can become chronic, debilitating, and life-threatening.
It is important to remember that 80 to 90 percent of patients suffering from eating disorders respond to treatment. Of these, about half recover completely. Treatment should be coordinated, comprehensive, tailored to the individual’s needs, conducted in the least restrictive situation, and be comfortable and safe for the patient. The ultimate goal of treatment for an eating disorder is that patients learn how to live in a peaceful and healthful manner with themselves and with food.
Publications and sources for help include:
• Eating Disorders, a publication from the National Institute of Mental Health (NIMH) (http://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml)
• Binge-Eating Disorder, available through the Mayo Clinic (http://www.mayoclinic.com/health/binge-eating-disorder/DS00608)
• Academy for Eating Disorders (http://www.aedweb.org//AM/Template.cfm?Section=Home)
• National Eating Disorders Association (http://www.nationaleatingdisorders.org/)
• Body Image-Eating Disorders, WomensHealth.gov(http://www.womenshealth.gov/bodyimage/eatingdisorders/)
• Eating Disorder Foundation (http://eatingdisorderfoundation.org/EatingDisorders.htm)
--Suzannekane 21:58, 5 June 2010 (UTC)