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Introduction
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Introduction
Eating disorders are complex diseases
and not just a condition that can be treated with willpower. There
are many different types of eating disorders and all are detrimental
to ones health if not taken seriously. Eating disorders
arise out of the combination of genetic, sociological, and psychological
factors. The most well known ones are listed below.
Genetic
Many researchers believe that there is an inherited predisposition
to having an eating disorder. Studies have shown that the co-occurrence
of eating disorders among identical twins is greater than the
co-occurrence among fraternal twins. Since identical twins are
genetically more similar than fraternal twins, this would support
an inherited component. Other research on the genetic component
of eating disorders has focused on neurochemistry. Researchers
have found that the neurotransmitters serotonin and neuroepinephrine
are significantly decreased in acutely ill patients suffering
from Anorexia and Bulimia Nervosa. These neurotransmitters also
function abnormally in individuals afflicted with depression.
This leads some researchers to believe there may a link between
these two disorders. Besides creating a sense of physical and
emotional satisfaction, the neurotransmitter serotonin also produces
the effect of feeling full and having had enough food.
Other brain chemicals have also been explored for their possible
role in eating disorders. Individuals with eating disorders have
been shown to have a higher than normal level of the hormones
vasopressin and cortisol. Both these hormones are normally released
in response to physical and possible emotional stress, and may
contribute to some of the dysfunction seen in eating disordered
individuals. Other research has found high levels of the neuropeptide-Y
and peptide-YY to be elevated in individuals suffering from Anorexia
and Bulimia. These chemicals have been shown to stimulate eating
behavior in laboratory animals. The hormone cholecystokinin (CCK)
has been found to be low in women with Bulimia and has caused
laboratory animals to feel full and stop eating.
Sociological
Environmental conditions reinforce the practice of an eating disorder.
We live in a society that reinforces the idea to be happy and
successful we must be thin. Today, you cannot read a magazine
or newspaper, turn on the television, listen to the radio, or
shop at the mall without being assaulted with the message that
fat is bad. During adolescence, a particularly vulnerable time
to the development of an eating disorder, the influence of peers
becomes important. Self monitoring and comparing ourselves to
others becomes central to our psyche. Peer teasing and pressures
to conform to the norm are common in the background of eating
disorder individuals. As our bodies developed and changed, how
others and we reacted to these changes influenced our eventual
body acceptance. Other societal issues include dysfunctional families,
sexual abuse, physical abuse, domineering coaches and controlling
relationships.
Psychological
The practice of an eating disorder can be viewed as a survival
mechanism. Just as an alcoholic uses alcohol to cope, a person
with an eating disorder can use eating, purging or restricting
to deal with feelings and emotions that may otherwise seem overwhelming.
Through the practice of the eating disorder, the individual may
feel a sense of partial control over their seemingly uncontrollable
life. Some of the underlying issues that are associated with an
eating disorder include low self-esteem, depression, feelings
of loss of control, feelings of worthless, identity concerns,
family communication problems and an inability to cope with emotions.
The practice of an eating disorder may be an expression of something
that the eating disordered individual has found no other way of
expressing.
Through the interaction of the various components an eating disorder
can be developed.
SIGNS & SYMPTOMS
Individuals suffering from eating disorders may be unaware that
they have a disorder or may have difficulty asking for help. Below
are some "danger signs" to help determine if you or
a loved one could be at risk for having an eating disorder. If
three or more of the following symptoms apply to you or a loved
one please contact us. You or your loved one may be at risk of
having an eating disorder.
· Thoughts about "feeling fat"
· Fear of gaining weight
· Feelings of loss of control when eating
· Weight determines self-esteem
· Body image obsession
· Guilt or shame after eating
· Repeated attempts at dieting
· Eating large amounts of food in a short period
of time
· Self-consciousness or embarrassment about eating
· Sneaking food
· Lying about eating habits
· Restrictive eating
· Self-induced vomiting
· Laxative abuse
· Diuretic abuse
· Use of diet pills
· Use of Ipecac
· Compulsive exercise
· Eating to relieve stress or depression
· Perfectionism
· Eating when not hungry
· Eating sensibly in front of others and then making
up for it when alone
· Depression
· Low body weight
· Embarrassment about body weight
· Low self-esteem
· Difficulty identifying or expressing feelings
· Strict dieting
· Fasting
· Menstrual irregularities
· Gastrointestinal complaints
PREVALENCE
Each year, millions of people in the United States succumb to
potentially life-threatening eating disorders. Estimates of people
afflicted with Anorexia Nervosa and Bulimia Nervosa in the United
States range from 2% to 6%. This implies that between 5 and 16
million people suffer from these disorders. Approximately 90%
of those afflicted with these disorders are women. The potentially
fatal disease, Anorexia Nervosa, occurs within the population
at approximately .5% to 2%. Estimates for the occurrence of Bulimia
Nervosa range between 1% to 4% of the population. Although eating
disorders can affect people of all ages, 86% of individuals afflicted
with these disorders report the onset before the age of 20. The
occurrence of eating disorders among college age women can almost
be considered epidemic. Between 19% and 30% of this age group
display bulimic behavior. The current trend is that eating disorders
are affecting younger and younger individuals. It is estimated
that currently 11% of high school students may have a diagnosable
eating disorder. Athletes and dancers may face a greater risk
for developing an eating disorder. In ballet, for example, success
may depend on the attainment of a wiry and extremely thin body
type. For athletes, particularly women in "appearance sports"
which include gymnastics and figure skating, appearance also seems
to play a key role in success. Of females who participate in these
types of athletic activities, as well as track and cross-country,
62% have been reported to have eating disorders.
Course and Outcome of Eating
Disorders
The onset for Anorexia Nervosa and Bulimia Nervosa is usually
during late adolescence or early adulthood. The illnesses usually
begin following a stressful life event. Many eating disordered
individuals feel out of control with their life and through the
practice of the eating disorder get a false sense of control.
They often went through a period of being overweight and being
teased or felt left out because of their weight. Their first attempts
at weight loss were often met with success and positive comments
from their family and peers. Of individuals with eating disorders,
77% usually practice their eating disorders between 1 and 15 years.
Eating disorders are among the deadliest mental disorders with
up to 10% succumbing to death as a result of starvation, cardiac
arrest, or suicide. Eating disorders are most successfully treated
with early diagnosis. For anorexics that receive treatment, 40%
recover completely, 40% make only partial recovery, and 20% have
chronic problems. For bulimics, 50% recover completely, 35% have
some bulimic episodes, and 15% still have chronic problems with
their bulimia.
MEDICAL COMPLICATIONS IN ALL BODY SYSTEMS
The following is a list of possible medical
complications that accompany Eating Disorders. If left untreated
the physical complications from practicing an eating disorder
can become life threatening.
CARDIOVASCULAR
Slow pulse
Low blood pressure
Electrocardiogram abnormalities
Hypovolemia
Myocardiopathy and CHF (especially with use of ipecac)
CHEMISTRIES
Uric acid elevated
Cholesterol is abnormal (elevated or depressed)
Carotene is elevated
Deficiencies of trace minerals
Low blood glucose
Hypochloremic metabolic alkalosis
DENTAL AND MOUTH
Increased dental caries
Highly sensitive teeth from gingival deterioration
Pyorrhea
Lacerations and contusions of the oral cavity from use of objects
to induce emesis
Tooth Loss
Erosion of enamel
Altered bite
Bleeding gums
Oral sensitivity
DERMATOLOGIC
Dry skin
Loss of subcutaneous tissues and fat in general
Scars (such as on knuckles due to inducing emesis)
Fine lanugo hair
Acrocyanosis
EFFECTS ON BRAIN AND CNS
Lack of REM sleep
Affected hypothalamus (lower body temperature, loss of shivering
response, cold intolerance, and malfunction of entire temperature
regulating system) due to chronic malnutrition
EEG abnormalities
ENDOCRINE
T-3 deficiency (leading to bradycardia, sluggish reflexes, dry
skin, cold intolerance, hypercarotenemia, and various abnormalities
of the hair)
Abnormal calcium levels and symptoms
Hypogonadism
Partial diabetes insipidus condition and the inability to concentrate
urine normally
Addisons disease or hyperaldosteronism
FLUID AND ELECTROLYTE ABNORMALITIES
Effects of resultant metabolic alkalosis, potassium and chloride
deficiencies
Electrolyte Imbalance
Skeletal muscle weakness
Diminished reflexes
Abnormal gastrointestinal motility
Cramps
Paresthesia
Polyuria and oliguria
Nocturia
CNS abnormalities
Constipation
Cardial effects (conduction abnormalities, irregular rhythms and
sudden death)
Impaired kidney function
Emotional lability and lassitude
Potassium increase due to diuretic abuse causing cardiac abnormalities
Depletion of sodium (hyponatremia)
Dehydration
Hyponatremia
Edema
GASTROINTESTINAL
Abdominal pain, bloating, and fullness
Esophageal perforations and lacerations (Mallory-Weiss Syndrome)
Irritable bowel syndrome
Ulceration of the bowel
Malabsorption of nutrients leading to hypoproteinemia, hypoalbuminemia
and calcium deficiency
Fatty infiltration of the liver
Pancreatitis
Exacerbation of hemorrhoids
Esophagitis
Melanosis coli
Gastritis
Gastric ulceration
Intestinal injury
GYNECOLOGIC
Menstrual irregularity
Amenorrhea
Infertility
Atrophic vaginitis and loss of sexual appetite
Breast atrophy
HEMATOLOGIC ABNORMALITIES
Anemia
Leukopernia
Thrombocytopenia
Bone marrow may be deficient or hypocellular
OPHTHALMOLOGIC
Transient blurred vision
Dark circles, puffiness under the eyes
ORTHOPEDIC AND MUSCULOSKELETAL
Osteoporosis
Loss of muscle mass leading to muscular weakness
PULMONARY
Aspiration pneumonia
RENAL
Prerenal and renal azotemia due to diminished renal pertusion
and chronic dehydration
Tubular and collecting system abnormalities due to electrolyte
abnormality
Predisposition to renal stones
Kidney failure
MISCELLANEOUS
Bacterial and fungal infections
Bilateral parotid gland swelling
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
ANOREXIA NERVOSA
Anorexia Nervosa is a disorder where
the main characteristic is the restriction of food and the refusal
to maintain a minimal normal body weight. Most Anorexics lose
weight by restricting their food intake. Anorexics may start by
limiting or excluding foods that they perceive as having high
fat or caloric content.
Once the disorder of Anorexia Nervosa takes hold, the individual
usually ends up with an extremely restrictive diet that is sometimes
limited to only a small number of foods. Additional methods of
weight loss for Anorexics can include vomiting, laxative abuse,
diuretic abuse, insulin abuse, chew-spitting, and excessive exercise.
For individuals suffering from Anorexia Nervosa, any actual gain
or even perceived gain of weight is met with intense fear of becoming
fat. With Anorexia Nervosa, weight loss usually does not lesson
the fear, and in fact, the fear often increases following the
weight loss. Not only is there a true feeling of fear, but also
once in the grasp of the disorder, Anorexics experience body image
distortions. Most individuals suffering from Anorexia have an
overall feeling of being overweight.
Some Anorexics have an understanding that they are thin, but are
concerned that parts of their bodies are fat. Those areas of the
body usually representing maturity or sexuality including the
buttocks, hips, thighs, and breasts are visualized by the Anorexic
as being fat. An individual with Anorexia Nervosa will often obsessively
check their body size and weight through frequent weighing, measuring,
pinching, and viewing themselves in a mirror.
With Anorexia self-esteem and self worth is tied directly to the
Anorexic's body shape and weight. For an Anorexic, weight loss
is viewed as a success, a sign of extraordinary self-discipline,
and control over life. Conversely, any real or perceived weight
gain is seen as a personal failure and loss of control for the
Anorexic.
For some Anorexics, weight loss is so severe there is a loss of
menstruation. Medical complications for individuals with Anorexia
Nervosa can be severe and even life threatening. Some of the more
common potential medical complications include emaciation, bradycardia,
hypotension, hypothermia, impaired renal functioning and gastrointestinal
problems. For a complete list of potential medical problems for
Anorexia Nervosa, visit our Medical Complications page.
If Anorexia Nervosa is left untreated, it can be fatal.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
BULIMIA NERVOSA
Bulimia Nervosa is a disorder where the main characteristics are
binge eating and compensatory behaviors in order to prevent weight
gain. Bulimics are caught in the devastating and addictive binge-purge
cycle.
For individuals suffering from Bulimia Nervosa, the binge can
be seen as a reward within itself and a way to cope with daily
stresses and feelings. Bulimic binges usually consist of a larger
than normal quantity of food, that typically are high in caloric
intake. For individuals with Bulimia Nervosa, the binge eating
usually occurs in secrecy and rarely in the presence of others.
The types of food vary but are often sweet and/or high in fat
content. Some binges are planned in advance by the Bulimic, but
generally they are impulsive. Triggers for binges in Bulimia Nervosa
include dysphoric mood, interpersonal stressors, boredom, prolonged
dieting, and body image dissatisfaction.
The binge eating in Bulimia Nervosa may temporarily numb the negative
feelings, but this state is quickly followed by feelings of failure.
The Bulimic is often ashamed of their binges and views the Bulimic
behavior as a loss of control and a reason for low self-esteem.
This is why it is often hard for Bulimics to come forward and
seek help.
Individuals suffering from Bulimia Nervosa follow their binge-eating
behavior with compensatory behaviors in an attempt to counteract
the binge episodes. The most common form of compensatory behavior
for individuals suffering from Bulimia Nervosa is vomiting. The
Bulimic usually induces vomiting directly following the binge.
For the Bulimic, the act of purging may temporarily reduce the
feeling of fullness and reduce their fear of weight gain from
the binge. Some individuals with Bulimia Nervosa even look forward
to the purging behavior as they enjoy the feeling of release the
purging behavior temporarily affords.
Other compensatory behaviors that individuals with Bulimia Nervosa
use in an attempt to prevent weight gain include use of laxatives,
enemas, diuretics, diet pills, ipecac, strict diets, fasts, insulin
abuse, chew-spitting, and vigorous exercise.
Bulimics, like Anorexics, are also obsessively involved with their
body shape and weight. An individual with Bulimia Nervosa will
often obsessively check their body size and weight through frequent
weighing, measuring, pinching, and viewing themselves in a mirror.
For the Bulimic, the individual's self worth is directly tied
to their body shape and weight.
Some of the common potential medical complications of practicing
Bulimia Nervosa include cardiac arrhythmias, esophageal tears,
electrolyte disturbances, gastrointestinal problems, and dental
problems. For a complete list of potential medical problems for
Bulimia Nervosa, visit our Medical Complications page.
The medical complications of Bulimia Nervosa can be severe and
like Anorexia, if left untreated can become life threatening.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
COMPULSIVE OVEREATERS
Compulsive Overeaters are often
caught in the vicious cycle of binge eating and depression. With
Compulsive Overeating food is used as a coping mechanism to deal
with uncomfortable feelings. Many Compulsive Overeaters speak
of using the Compulsive Overeating episodes as a way to numb all
that is going on around them. The amount of food eaten and duration
can vary greatly for a Compulsive Overeater.
For many individuals suffering from Compulsive Overeating, binges
may not be able to be broken into specific episodes but rather
days where the individual eats more than normal throughout the
day. Triggers for Compulsive Overeating include depression, anxiety,
interpersonal stressors, boredom, prolonged dieting, and body
image dissatisfaction.
Compulsive Overeating may temporarily relieve the stress of these
unwanted feelings, but for the Compulsive Overeater the overeating
episodes are unfortunately followed by feelings of guilt, shame,
disgust, and further depression. For the Compulsive Overeater,
episodes of Compulsive Overeating usually occur in secret and
any evidence is often hidden from others.
It is not uncommon for Compulsive Overeaters to eat normally or
even restrictively in front of others and then make up for eating
less by Compulsively Overeating in private at a later time. Compulsive
Overeating late at night, when others are asleep or frequenting
fast food restaurants and convenience stores alone, can also be
common. Many Compulsive Overeaters even have a secret stash of
junk food hidden for their personal use.
Similar to Anorexics and Bulimics, Compulsive Overeaters are constantly
struggling and unhappy with their weight. With Compulsive Overeating,
the number read on the scale often determines how the Compulsive
Overeater feels about themselves. Constant dieting and restricting
food becomes a way of life for the Compulsive Overeater.
Each new diet is tried in hope that it will be the one that works
to combat the Compulsive Overeating. At first, there may even
be some weight loss success for the Compulsive Overeater with
the diet, but unfortunately in most cases each diet ends in failure
and all the lost weight is regained. Thus continues the devastating
cycle for the Compulsive Overeater.
Medical complications from the Compulsive Overeating behavior
can be severe and even life threatening for Compulsive Overeaters.
Diabetes, hypertension and cardiac problems are just a few of
the dangerous complications of Compulsive Overeating.
Like Anorexia Nervosa and Bulimia Nervosa, Compulsive Overeating
is a disease and cannot be cured with willpower alone.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
NIGHT EATING SYNDROME
Night Eating Syndrome is a disorder where the affected individual
wakes multiple times during the night and is unable to fall back
asleep unless they eat something. Foods eaten during the binge
are often high caloric in content and unhealthy. The night eating
behavior seems totally beyond the effected individual's control.
For these individuals, 35% or more of their calories are eaten
after dinnertime. Following the night binge, the person is often
not hungry in the morning. Individuals suffering from Night Eating
Syndrome are often caught in the vicious cycle of binge eating
during the night and eating less during the day. Triggers for
Night Eating Syndrome include depression, anxiety, interpersonal
stressors, boredom, prolonged dieting, and body image dissatisfaction.
Night eating may temporarily relieve the stress of these unwanted
feelings, but for the night eater these episodes are unfortunately
followed by feelings of guilt, shame, disgust, and further depression.
For the person suffering from Night Eating Syndrome, the eating
episodes usually occur in secret and any evidence is often hidden
from others. Similar to Anorexics, Bulimics, and Compulsive Overeaters,
individuals suffering from Night Eating Syndrome are often struggling
and unhappy with their weight. It is estimated that up to one
percent of the population may be suffering from Night Eating Syndrome.
Like Anorexia Nervosa Bulimia Nervosa, and Compulsive Overeating,
Night Eating Syndrome is a disease and cannot be cured with willpower
alone.
It is not your fault and you are not alone, there is help out
there waiting for you.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Resources:
http://www.eatingdisordersanonymous.org
http://familydoctor.org/277.xml
http://www.nimh.nih.gov/publicat/eatingdisorders.cfm
http://www.onlyeatingdisorders.com
http://www.girlpower.gov/girlarea/bodywise/eatingdisorders/index.htm
http://www.troubledwith.com/parentingteens/EatingDisorders.cfm