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Eating Disorder (EDO)
Classification and external resources
ICD-10 F50.
ICD-9 307.5
MeSH D001068

An eating disorder is characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and emotional health. The causes of eating disorders are complex and not yet fully understood. Eating disorders are estimated to affect 5-10 million females and 1 million males in the United States.[1] Although not yet classified as separate disorder, binge eating disorder[2] is the most common eating disorder in the United States affecting 3.5% of females and 2% of males according to a study by Harvard affiliated McLean Hospital. Bulimia nervosa was the second most common followed by Anorexia nervosa.[3]

Contents

Statistics-Facts

  • Eating disorders affect all socioeconomic levels.[4]
  • 40% of 9- and 10-year-old girls are already trying to lose weight.[5]
  • Girls with ADHD are 5.6 times more likely to develop bulimia and 2.7 times more likely to develop anorexia nervosa[6][7]
  • Women who were raised in foster care are 7 times more likely to develop bulimia nervosa.[8]
  • Binge eating is the most common eating disorder in the United States affecting 3.5% of females and 2% of males, followed by bulimia nervosa then anorexia nervosa.[9]
  • Females with anorexia nervosa have a higher suicide rate than those with any other mental health disorder and the general population[10] up to 60 times higher according to one study[11]
  • Anorexia nervosa has the highest mortality rate of any psychiatric disorder.[12]
  • Anorexia nervosa although usually reported in white adolescent females affects all races and ages groups[13][14]
  • The mortality rate for anorexia nervosa is 4.0%, bulimia nervosa is 3.9% and 'eating disorder not otherwise specified' (EDNOS) which includes binge eating disorder is placed at 5.2%[15]
  • Males account for 5%-10% of anorexia nervosa cases[16] and 10%-15% of bulimia nervosa cases.[17]
  • An optimum healthy weight is calculated using the Body Mass Index

Causes

It is not known with certainty what causes eating disorders. It can be due to a combination of biological, psychological or environmental causes.

Biological

DNA ligase (shown here in color), encircles the double helix to repair a broken strand of human DNA.
  • Genetic: Numerous studies have been undertaken that show a possible genetic predisposition toward eating disorders.[18][19][20]
  • Biochemical:Eating behavior is a complex process controlled by the neuroendocrine system of which the Hypothalamus-pituitary-adrenal-axis (HPA axis) is a major component. Dysregulation of the HPA-axis has been associated with eating disorders,[21][22] such as irregularities in the manufacture, amount or transmission of certain neurotransmitters, hormones[23] or neuropeptides[24].
  • leptin and ghrelin; leptin is a hormone produced primarily by the fat cells in the body it has an inhibitory effect on appetite by inducing a feeling of saiety. Ghrelin is an appetite inducing hormone produced in the stomach and the upper portion of the small intestine. Circulating levels of both hormones are an important factor in weight control. While often associated with obesity both hormones and their respective effects have been implicated in the pathophysiology of anorexia nervosa and bulimia nervosa.[34]
  • immune system:studies have shown that a majority of patients with anorexia and bulimia nervosa have elevated levels of autoantibodies that affect hormones and neuropeptides that regulate appetite control and the stress response. There may be a direct correlation between autoantibody levels and associated psychological traits.[35][36]
Cerebral cortex of the human brain showing the 4 major lobes, below which are the cerebellum, pons, olive, and medulla oblongata
  • infection:PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Children with PANDAS "have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette's Syndrome, and in whom symptoms worsen following infections such as "Strep throat" and Scarlet Fever." (NIMH) There is a possibility that PANDAS may be a precipitating factor in the development of Anorexia nervosa in some cases, (PANDAS AN).[37]
  • lesions:studies have shown that lesions to the right frontal lobe or temporal lobe can cause the pathological symptoms of an eating disorder[38][39][40]
  • tumors:tumors in various regions of the brain have been implicated in the development of abnormal eating patterns.[41][42][43][44][45]
  • brain calcification: a study highlights a case in which prior calcification of the right thalumus may have contributed to development of anorexia nervosa.[46]
Homunculus.PNG
  • somatosensory homunculus; is the representation of the body located in the somatosensory cortex, first described by renowned neurosurgeon Wilder Penfield. The illustration was originally termed "Penfield's Homunculus", homunculus meaning little man. "In normal development this representation should adapt as the body goes through its pubertal growth spurt. However, in AN it is hypothesized that there is a lack of plasticity in this area, which may result in impairments of sensory processing and distortion of body image". (Bryan Lask, also proposed by VS Ramachandran)
  • Obstetric complications. There have been studies done which show maternal smoking, obstetric and perinatal complications such as maternal anemia, very pre-term birth (32<wks.), being born small for gestational age, neonatal cardiac problems, preeclampsia, placental infarction and sustaining a cephalhematoma at birth increase the risk factor for developing either anorexia nervosa or bulimia nervosa. Some of this developmental risk as in the case of placental infarction, maternal anemia and cardiac problems may cause intrauterine hypoxia, umbilical cord occlusion or cord prolapse may cause ischemia, resulting in cerebral injury, the prefrontal cortex in the fetus and neonate is highly susceptible to damage as a result of oxygen deprivation this has been shown to contribute to executive dysfunction, ADHD, and may affect personality traits associated with both eating disorders and comorbid disorders such as impulsivity, mental rigidity and obsessionality. The problem of perinatal brain injury, in terms of the costs to society and to the affected individuals and their families, is extraordinary." (Yafeng Dong, PhD) [47][48][49][50][51][52][53][54][55][56][57]

Psychological

Eating disorders are classified as Axis I[58] disorders in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV). Published by The American Psychiatric Association. There are various other psychological issues that may factor into eating disorders, some fulfill the criteria for a separate Axis I diagnosis or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Axis II disorders are subtyped into 3 "clusters", A, B and C.The causality between personality disorders and eating disorders has yet to be fully established.[59] Some people have a previous disorder which may increase their vulnerability to developing an eating disorder.[60][61][62] Some develop them afterwards.[63] The severity and type of eating disorder symptoms have been shown to affect comorbidity.[64] The DSM-IV should not be used by laypersons to diagnose themselves, even when used by professionals there has been considerable controversy over the diagnostic criteria used for various diagnoses, including eating disorders. There has been controversy over various editions of the DSM including the latest edition DSM-V due in May 2013.[65][66][67][68][69]

Personality traits

There are various childhood personality traits associated with the development of eating disorders.[84] During adolescence these traits may become intensified due to a variety of physiological and cultural influences such as the hormonal changes associated with puberty, stress related to the approaching demands of maturity and socio-cultural influences and perceived expectations, especially in areas that concern body image. Many personality traits have a genetic component and are highly heritable. Maladaptive levels of certain traits may be acquired as a result of anoxic or traumatic brain injury, neurodegenerative diseases such as Parkinson's disease, neurotoxicity such as lead exposure, bacterial infection such as Lyme disease or viral infection such as Toxoplasma gondii as well as hormonal influences. While studies are still continuing via the use of various imaging techniques such as fMRI; these traits have been shown to originate in various regions of the brain[85] such as the amygdala[86][87] and the prefrontal cortex[88] Disorders in the prefrontal cortex and the executive functioning system have have been shown to affect eating behavior.[89][90]

Environmental

William-Adolphe Bouguereau (1825-1905) - The Difficult Lesson (1884).jpg
Child maltreatment

Child abuse which encompasses physical, psychological and sexual abuse, as well as neglect has been shown by innumerable studies to be a precipitating factor in a wide variety of psychiatric disorders including eating disorders. Children who are subjugated to abuse may develop a disordered eating pattern in an effort to gain some sense of control or for a sense of comfort. Or they may be in an environment where the diet is unhealthful or insufficient.

Child abuse and neglect can cause profound changes in both the physiological structure and the neurochemistry of the developing brain. Children who as wards of the state were placed in orphanages or foster homes are especially susceptible to developing a disordered eating pattern. In a study done in New Zealand 25% of the study subjects in foster care exhibited an eating disorder. (Tarren-Sweeney M. 2006) An unstable home environment is detrimental to the emotional well-being of children, even in the absence of blatant abuse or neglect the stress of an unstable home can contribute to the development of an eating disorder.[139][140][141] [142][143][144][145][146][147]

Social isolation

Social isolation has been shown to have a deleterious effect on an individuals' physical and emotional well-being. Those that are socially isolated have a higher mortality rate in general as compared to individuals that have established social relationships. This effect on mortality is markedly increased in those with pre-existing medical or psychiatric conditions, this has been especially noted in cases of coronary heart disease. "The magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors." ( Brummett et al.)

Social isolation can be inherently stressful, depressing and anxiety provoking. In an attempt to ameliorate these distressful feelings an individual may engage in emotional eating in which food serves as a source of comfort. The loneliness of social isolation and the inherent stressors thus associated have been implicated as triggering factors in binge eating as well.[148][149][150][151]

Parental influence

Parental influence has been shown to be an intrinsic component in developing the eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape and eating patterns, the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders. As to the more subtle aspects of parental influence it has been shown that eating patterns are established in early childhood and that children should be allowed to decide when their appetite is satisfied as early as the age of two. A direct link has been proven between obesity and parental pressure to eat more.

Coercive tactics in regard to diet have not been proven to be efficacious in controlling a child's eating behavior. Affection and attention have been shown to affect the degree of a childs' finickiness and their acceptance of a more varied diet.[152] [153] [154][155][156][157]

Peer pressure

In various studies such as one conducted by The McKnight Investigators, peer pressure was shown to be a significant contributor to body image concerns and attitudes toward eating among subjects in their teens and early twenties.

Eleanor Mackey and co-author, Annette M. La Greca of the University of Miami, studied 236 teen girls from public high schools in southeast Florida. "Teen girls' concerns about their own weight, about how they appear to others and their perceptions that their peers want them to be thin are significantly related to weight-control behavior," says psychologist Eleanor Mackey of the Children's National Medical Center in Washington and lead author of the study. "Those are really important."

Dieting among adolescents was also reported to being influenced by peer behavior. With many of those individuals on a diet reporting that their friends also were dieting. The number of friends dieting and the number of friends who pressured them to diet also played a significant role in their own choices.[158] [159] [160][161]

Cultural pressure

There is a cultural emphasis on thinness which is especially pervasive in western society. There is an unrealistic stereotype of what constitutes beauty and the ideal body type as portrayed by the media, fashion and entertainment industries."The cultural pressure on women to be thin is an important predisposing factor for the development of eating disorders" (Bryan Lask, PhD) [162] [163]

Eating disorders in men

There has been an increasing rate of males suffering from various eating disorders including anorexia nervosa. There is a perceived stigma attached, as eating disorders are generally viewed as primarily affecting women. Among men the rates of eating disorders are higher in the gay and bi-sexual communities (Feldman & Meyer, 2007), yet it also affects heterosexual men. Despite the perceived stigma, some high profile male celebrities have publicised their struggles with eating disorders such as actor Dennis Quaid, who struggled with what he called "manorexia" for which he sought treatment. Quaid said his problems began when he went on a diet to lose forty pounds to play Doc Holliday in the movie "Wyatt Earp" in 1994. Billy Bob Thornton has also struggled with anorexia, once losing 59 lbs.Thomas Holbrook, M.D., is Clinical Director of the Eating Disorders Program at Rogers Memorial Hospital in Oconomowoc, Wisconsin despite being a psychiatrist specializing in eating disorders, he suffered from anorexia nervosa with compulsive exercising. At one time the 6-ft.-tall psychiatrist weighed just 135 lbs. "I was terrified," he says, "of being fat." His story has been chronicled in various publications including USA Today and People Magazine.

Signs

Anorexia-Bulimia

Anorexia nervosa (AN) is divided into two subtypes restrictive, which doesn't enage in purging behavior and purging type which does. Bulimia nervosa is divided into two subtypes purging and the less common; non purging. There is a tendency for diagnostic "crossover" in which symptoms change over time between the restricting and binge eating/purging anorexia nervosa subtypes and bulimia nervosa.[164][165] While anorexics are often underweight or below average body weight, bulimics range from a normal weight to even slightly above average weight.

Binge eating

Both bulimics and those with binge eating disorder (BED) engage in binge eating. Those with BED do not engage in any compensatory behavior e.g. they do not purge, use laxatives or engage in compulsive exercise. The binge eating is caused by emotional upset and not by hunger. During these episodes, those affected with BED will consume thousands of calories at once, often in one sitting. Because of the lack of purging, those with BED tend to be overweight or obese, even though persons of normal or average weight can be affected.

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder to affect women. Though often associated with obesity it can occur in normal weight individuals. PCOS has been associated with binge eating and bulimic behavior.[168][169][170][171][172][173]

Other eating disorders

Rumination Syndrome

Rumination Syndrome, is characterized by the repeated painless regurgitation of food following a meal which is then either re-chewed, re-swallowed or discarded. It is an under-diagnosed disorder possibly due to the fact that most physicians do not recognize the symptoms of the disorder. While often diagnosed in infants and developmently individuals it also occurs in adults of normal intelligence. An accurate clinical diagnosis is critical in making an accurate diagnosis. The Rome III Consensus Criteria for Rumination Syndrome varies for infants, adolescents and adults. [174][175][176]

Diabulimia

Diabulimia; not currently a recognized medical condition, is the deliberate manipulation of insulin including withholding shots, by individuals with Type 1 diabetes in an effort to control their weight.[177] Insulin is an anabolic hormone[178] that is involved in the metabolism of carbohydrates and lipids (fats).[179] It helps the body maintain muscle mass, it also encourages fat retention.[180]

The effects of withholding insulin can lead to severe complications[181] such as diabetic ketoacidosis. The long term effects can lead to the acceleration of diabetes related complications such as diabetic vasculopathy which may lead to limb amputation.[182][183]

Food Maintenance Syndrome

Food Maintenance Syndrome is characterized by a set of aberrant eating behaviors of children in foster care it is "a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity", it resembles "the behavioral correlates of Hyperphagic Short Stature". (Tarren-Sweeney M. 2006)[184] It is hypothesised that this syndrome is triggered by the stress and maltreatment these children are subjected to.

Female Athlete Triad

Female Athlete Triad is a syndrome in which eating disorders/disordered eating behavior, amenorrhoea/oligomenorrhoea and decreased bone mineral density (osteoporosis and osteoenia) are present. Not all patients exhibit all three components of the triad according to recent studies some may have only one or two which increases the difficulty of proper diagnosis and long-term morbidity. The full impact of this disorder may not be realized until menopause when the resultant bone loss is accelerated. The strict criteria for diagnosis have been amended by the American College of Sports Medicine in 2007. The diagnostic criteria are now ascertained on a continuous spectrum instead of the most severe presentation. Disordered eating has been replaced by "optimal energy availability" to "low energy availability with or without an eating disorder". Amenorrhea has been replaced by a spectrum ranging from normal menstruation (eumenorrhea) to "functional hypothalmic amenorrhea", in younger patients delayed primary menstruation may occur. Osteoporosis has been replaced by a spectrum ranging from optimal bone health to osteoporosis.[185][186][187]

Additional eating disorders

Symptoms-complications

Symptoms and complications vary according to the nature and severity of the eating disorder[188]

Diagnosis

The initial diagnosis should be made by a competent medical professional."The medical history is the most powerful tool for diagnosing eating disorders"( American Family Physician).[196] There are many medical disorders that mimic eating disorders and comorbid psychiatric disorders. All organic causes should be ruled out prior to a diagnosis of an eating disorder or any other psychiatric disorder is made. According to an in depth study conducted by psychiatrist Richard Hall as published in The Archives of General Psychiatry:

  • Medical illness often presents with psychiatric symptoms.
  • It is difficult to distinguish physical disorders from functional psychiatric disorders on the basis of psychiatric symptoms alone.
  • Detailed physical examination and laboratory screening are indicated as a routine procedure in the initial evaluation of psychiatric patients.
  • Most patients are unaware of the medical illness that is causative of their psychiatric symptoms.
  • The conditions of patients with medically induced symptoms are often initially misdiagnosed as a functional psychosis.[197]

Medical

PET scan of the human brain.

A consultation with a reputable medical professional who specializes in eating disorders is an indispensable part of both the diagnostic process and treatment. A complete medical and psychosocial history should be provided and a rational and formulaic approach to the diagnosis should be used. Neuroimaging using fMRI, MRI, PET and SPECT scans have been used to detect cases in which a lesion, tumor or other organic condition has been either the sole causative or contributory factor in an eating disorder."Right frontal intracerebral lesions with their close relationship to the limbic system could be causative for eating disorders,we therefore recommend performing a cranial MRI in all patients with suspected eating disorders"(Trummer M et.al.2002)","intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective".(O'Brien et.al.2001).[198][199]

Without visible images of neuropathology, psychiatric disorders have been a fertile ground for stigma and bizarre propositions, as evidenced by etiologic theories involving “schizophrenogenic”[200] and “refrigerator mothers". Neuroimaging will clearly establish psychiatric disorders as being “medical”, thereby bringing these disorders into the mainstream in terms of public attitude and, perhaps more importantly, funding for treating these problems.(Derryck H Smith, MD, Canadian Psychiatric Association) In addition to neuroimaging there are a variety of tests that may be performed to diagnosis and assess the effects of an eating disorder.

Psychological

After ruling out organic causes and the initial diagnosis of an eating disorder being made by a medical professional a trained mental health professional aids in the assessment and treatment of the underlying psychological components of the eating disorder and any comorbid psychological conditions. The clinician conducts a clinical interview and may employ various psychometric tests. Some are general in nature while others were devised specifically for use in the assessment of eating disorders. Some of the general tests that may be used are the Hamilton Depression Rating Scale[233] and the Beck Depression Inventory.[234] [235]

Differential diagnoses

Medical

According to a recent report issued in The Journal of the American Medical Association (JAMA), anywhere from 40,000 to 80,000 deaths in the U.S. are attributable to misdiagnosis in the hospital setting per year. Also in the U.S., deaths due to medical errors are higher than the numbers attributable to the 8th-leading cause of death. More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).[236]

[237] These figures do not factor in those misdiagnosed outside the hospital setting or for individuals who present with psychiatric symptoms and receive contraindicated i.e. wrong, mental health care predicated upon poor diagnostic procedure. On average, 32,000 Americans commit suicide per year. 77% had seen a physician and 30% had received mental health counseling in the year prior. In England alone independent of the rest of the United Kingdom an average of four psychiatric patients die, many from suicide and another three suffer serious physical harm each day while under the care of the National Health Service.[238][239][240]

  • acute pandysautonomia is one form of an autonomic neuropathy, which are a collection of various syndromes and diseases which affect the autonomic neurons of the autonomic nervous system (ANS). Autonomic neuropathies may be the result of an inherited condition or they may be acquired due to various premorbid conditions such as diabetes and alcoholism, bacterial infection such as Lyme disease or a viral illness. Some of the symptoms of ANS which may be associated with an ED include nausea, dysphagia, constipation, pain in the salivary glands early saiety. It also affects peristalsis in the stomach. ANS may cause emotional instability and has been misdiagnosed as various psychiatric disorders including hysterical neurosis and anorexia nervosa.[241]
  • Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare genetic disorder characterized by gastrointestinal dysmotility, severe cachexia progressive external ophthalmoplegia, post-prandial emesis (vomiting after eating), peripheral neuropathy, and diffuse leukoencephalopathy. Onset is prior to age 20 in 60% of cases. ""Miss A" was a 21-year-old Indian woman diagnosed as having treatment-resistant anorexia nervosa." It was subsequently proven to be MNGIE[242][243][244]
  • achalasia; There have been cases where achalasia, a disorder of the esophagus which affects peristalsis, has been misdiagnosed as various eating disorders including anorexia nervosa, bulimia nervosa, compulsive eating disorder and obesity related problems. It has been reported in cases where there is sub-clinical manifestation of anorexia nervosa and also in cases where the full diagnostic criteria AN has been met.[245]
  • superior mesenteric artery syndrome: (SMA) syndrome; "is a gastrointestinal disorder characterized by the compression of the third or transverse portion of the duodenum against the aorta by the superior mesenteric artery resulting in chronic partial, incomplete, acute or intermittent duodenal obstruction". It may occur as a complication of AN or as a differential diagnosis. There have been reported cases of a tentative diagnosis of AN, where upon treatment for SMA syndrome the patient is asymptomatic.[246][247]
    Borrelia burgdorferi
  • Lyme Disease is known as the "great imitator", as it may present as a variety of psychiatric or neurologic disorders including anorexia nervosa. "A 12 year old boy with confirmed Lyme arthritis treated with oral antibiotics subsequently became depressed and anorectic. After being admitted to a psychiatric hospital with the diagnosis of anorexia nervosa, he was noted to have positive serologic tests for Borrelia burgdorferi. Treatment with a 14 day course of intravenous antibiotics led to a resolution of his depression and anorexia; this improvement was sustained on 3 year follow-up."[248][249] Serologic testing can be helpful but should not be the sole basis for diagnosis. The Centers for Disease Control (CDC) issued a cautionary statement (MMWR 54;125) regarding the use of several commercial tests. Clinical diagnostic criteria has been issued by the CDC (CDC, MMWR 1997; 46: 531-535).
  • Addison's Disease; is a disorder of the adrenal cortex which results in decreased hormonal production. Addison's disease, even in subclinical form may mimic many of the symptoms of anorexia nervosa.[250]
  • Simmond's disease (organic hypopituitarism) – "A 20-year-old Japanese man with a hypothalamic tumor which caused hypopituitarism and diabetes insipidus was mistakenly diagnosed as anorexia nervosa because of anorexia, weight loss, denial of being ill, changes in personality, and abnormal behavior resembling the clinical characteristics of anorexia nervosa"(Hotta, M. 1999)
  • Celiac Disease is an inflammatory disorder triggered by peptides from wheat and similar grains which cause an immune reaction in the small intestine."information on the role of the gastrointestinal system in causing or mimicking eating disorders is scarce."(Leffler DA et.al.)[251]
  • Gastric adenocarcinoma is one of the most common forms of cancer in the world. Complications due to this condition have been misdiagnosed as an eating disorder.[252]
  • helicobacter pylori is a bacteria which causes stomach ulcers and gastritis and has been shown to be a precipitating factor in the development of gastric carcinomas. It also has an affect on circulating levels of leptin and ghrelin, two hormones which help regulate appetite. Upon successful treatment of helicobacter pylori associated gastritis in pre-pubertal children they showed "significant increase in BMI, lean and fat mass along with a significant decrease in circulating ghrelin levels and an increase in leptin levels" (Pacifico, L)."SUMMARY: H. pylori has an influence on the release of gastric hormones and therefore plays a role in the regulation of body weight, hunger and satiety,"(Weigt J, Malfertheiner P).[253][254]
  • Gall bladder disease which may be caused by inflammation, infection, gallstones, obstruction of the gallbladder or torsion of the gall bladder. Many of the symptoms of gall bladder disease may mimic anorexia nervosa (AN). Laura Daly, a woman from Missouri, suffered from an inherited disorder in which the gall bladder was not properly attached; the resultant complications led to multiple erroneous diagnoses of AN. Upon performance of a CCK test, standard imaging techniques are done with the patient lying prone, in this instance it was done with the patient in an upright position. The gall bladder was shown to be in an abnormal position having flipped over the liver. The gallbladder was removed and the patient has since recovered. The treatment was performed by William P. Smedley, M.D., F.A.C.S.in Pennsylvania.
  • colonic tuberculosis misdiagnosed as anorexia nervosa in a physician at the hospital where she worked. "This patient, who had severe wasting, was misdiagnosed as having anorexia nervosa despite the presence of other symptoms suggestive of an organic disease, namely, fever and diarrhea"(Madani, A 2002).[255]
  • Crohn's Disease: "We report three cases of young 18 to 25 year-old girls, initially treated for anorexia nervosa in a psychiatric department. Diagnosis of Crohn's disease was made within 5 to 13 years."(Blanchet C, Luton JP. 2002)"This disease should be diagnostically excluded before accepting anorexia nervosa as final diagnosis". (Wellmann W et al.)[256][257][258][259]
  • Insulinomas, are (pancreatic tumors) that cause an overproduction of insulin causing hypoglycemia. Various neurological deficits have been ascribed to this condition including misdiagnosis as an eating disorder.[260][261][262][263][264]
  • hypothyroidism, hyperthyroidism, hypoparathyroidism and hyperparathyroidism may mimic some of the symptoms of, can occur concurrently with, be masked by or exacerbate an eating disorder.[265][266][267][268][269][270][271][272]
  • Multiple sclerosis (Encephalomyelitis disseminata) is a progressive autoimmune disorder in which the protective covering (myelin sheath) of nerve cells is damaged as a result of inflammation and resultant attack by the bodies own immune system. In its initial presentation MS has been misdiagnosed as an eating disorder.[273]
  • cestodes (tapeworm) infestations can affect various regions of the human body including the gastrointestinal and neuroendocrine systems. While most of those infected are asymptomatic, infestations can cause psychiatric symptoms, epilepsy, megoblastic anemia, weight gain or loss.
    • Cysticercosis is an infection caused by the larval stage of the pork tapeworm (Taenia solium). The larval stage of T. solium can create cysts in various regions of the body including the brain (neurocysticercosis). Hypothalimic cysticercosis has been associated with obesity. Cysts may form in the bile and pancreatic ducts causing full or partial obstruction some of the symptoms may include weight loss, anorexia, or increased appetite.[274][275]
Differential diagnoses/ Comorbid medical disorders

There are multiple medical conditions which may misdiagnosed as a primary psychiatric disorder. These may have have a synergistic effect on conditions which mimic an eating disorder or on a properly diagnosed ED. They also may make it more difficult to diagnose and treat an ED.

  • Lupus: 19 psychiatric conditions have been associated with systemic lupus erythematosus (SLE), including depression and bipolar disorder.[276]
  • Toxoplasma seropositivity even in the absence of symptomatic toxoplasmosis has been linked to changes in human behavior and psychiatric disorders including those comorbid with eating disorders such as depression. In reported case studies the response to antidepressant treatment improved only after adequate treatment for toxoplasma.[277]
  • neurosyphilis;It is estimated that their may be up to one million cases of untreated syphyilis in the U.S. alone. "the disease can present with psychiatric symptoms alone, psychiatric symptoms that can mimic any other psychiatric illness". Many of the manifestations may appear atypical. Up to 1.3% of short term psychiatric admissions may be attributable to neurosyphilis, with a much higher rate in the general psychiatric population. Neurosyphilis like Lyme Disease has been given the appellation the "great imitator" for it may present in various ways such as depression and chronic alcoholism. (Ritchie, M Perdigao J,)[278]
  • dysautonomia a term used to describe a wide variety of autonomic nervous system (ANS) disorders may cause a wide variety of psychiatric symptoms including anxiety, panic attacks and depression. Dysautonomia usually involves failure of sympathetic or parasympathetic components of the ANS system but may also include excessive ANS activity. Dysautonomia can occur in conditions such as diabetes and alcoholism.
Differential diagnoses/Comorbid psychological disorders

There are separate psychological disorders which may be misdiagnosed as an eating disorder.

  • Emetophobia is an anxiety disorder characterized by an intense fear of vomiting. A person so afflicted may develop rigorous standards of food hygiene, such as not touching food with their hands. They may become socially withdrawn to avoid situations which in their perception may make them vomit. Many who suffer from emetophobia are diagnosed with anorexia or self-starvation. In severe cases of emetophobia they may drastically reduce their food intake.[279][280]
  • phagophobia is an anxiety disorder characterized by a fear of eating, it is usually initiated by an adverse experience while eating such as choking or vomiting. persons with this disorder may present with complaints of pain while swallowing.[281]
  • Body dysmorphic disorder (BDD) is listed as a somatoform disorder that affects up to 2% of the population. BDD is characterized by excessive rumination over an actual or perceived physical flaw. BDD has been diagnosed equally among men and women. While BDD has been misdiagnosed as anorexia nervosa, it also occurs comorbidly in 39% of eating disorder cases. BDD is a chronic and debilitating condition which may lead to social isolation, major depression and suicidal ideation and attempts. Neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe and left parietal lobe showing hemispheric imbalance in information processing. There is a reported case of the development of BDD in a 21 year old male following an inflammatory brain process. Neuroimaging showed the presence of new atrophy in the frontotemporal region.[282][283][284][285][286]

Treatment

Treatment varies according to type and severity of eating disorder. Usually more than one treatment option is utilized.[287] Some of the treatment methods are:

  • Cognitive Behavioral Therapy(CBT)[288][289][290] is an evidence based approach. The basic premise is that a person's thoughts cause their feelings and behaviors not external stimulus like other people, situations or events in a persons life. The rational is to change how a person thinks and reacts to a situation even if the situation itself does not change. CBT has been shown to be efficacious in the treatment of bulimia nervosa.
  • Family Therapy[292]
    • Maudsley Family Therapy; The Maudsley model of family-based treatment for anorexia nervosa, was developed in the 1980s (Dare, 1985), it utilizes a variety of family therapy models and is designed for use with adolescents 18 and under who are living with their families. It is an evidence based approach designed as an aggressive intervention within three years of the onset of anorexia nervosa and bulimia nervosa.[293][294]
  • Behavioral Therapy; focuses on gaining control and changing unwanted behaviors.[295]
  • Interpersonal Psychotherapy (IPT); "The current treatment of IPT was developed by the late Gerald Klerman and Myrna Weissman in the 1980s as a means of operationalising the interpersonal approach to psychotherapy for a series of treatment studies in depression conducted in the United States. Since that time it has been modified for a variety of other indications including Dysthymia, Bulimia Nervosa, Substance Misuse ,Somatization and depression in a variety of clinical settings. Preliminary studies in Anorexia Nervosa, Bipolar Disorder, PTSD and some anxiety disorders are underway. In each adaptation the fundamentals of the treatment manual are adhered to, however different components are emphasized." (International Society for Interpersonal Psychotherapy)[296]
  • Art Therapy; is the therapeutic use of art. The American Art Therapy Association describes art therapy "as a belief that individuals can resolve conflicts, develop interpersonal skills, and gain self-esteem and insight through the creative process of artistic self-expression".[297]
  • Nutrition counseling[298]
  • Medical Nutrition Therapy; Medical nutrition therapy (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, psychosocial history, physical examination, and dietary history.[299][300][301]
  • Medication; there are currently medications developed for use in obesity treatment such as Orlistat. To date there are none specifically designed for use in either anorexia or bulimia nervosa although olanzapine has shown promise in various studies for its' propensity to promote weight gain as well as the ability to ameliorate obsessional behaviors concerning weight gain. The Endocrine Research Project has conducted studies with cortisol supplements. Zinc supplements have been shown to be helpful as well.[302][303][304][305][306][307]
  • Self help and guided self help have been shown in various studies to be helpful in varying degrees including cost reduction for treatment in An, BN and BED.[308][309][310][311]
    • Self Help Groups; there are various support and self-help groups for eating disorders which may be helpful and can be used in conjunction with professional treatment. Both Eating Disorders Anonymous and Overeaters Anonymous are based on the traditional 12-step program pioneered in Alcoholics Anonymous. In some instances such as with BED, self help groups alone have been shown to be on par with individual therapy.[312][313]
  • Psychoanalysis is a non evidence based approach. While the psychoanalyst Hilde Bruch, the author of "The Golden Cage" helped bring anorexa nervosa to the public consciousness, the discipline has fallen into disrepute. "Alice Eagly, the chairwoman of the psychology department at Northwestern University, explained why: Psychoanalysis is “not the mainstream anymore” and so “we give it less weight.”".

    Psychoanalysis has been accused of having iatrogenic, i.e. harmful tendencies."Psychoanalysis is a great idea in personality, just as long as one is a male, who grew up in a two parent house, who had either a sister or female playmate at a very young age, with a great memory, and who has lots of money and no specific time frame in which one would like one's psychological problems cured." (Popkin, Nathan. NWU)."Psychoanalysis is a spurious, ineffective pseudoscience, Freud's legacy continues to inform a "therapeutic" tradition that destroys people's lives." (Frederick Crews).[314] In 2004 The French Institute of Health and Medical Research (INSERM) issued an official government funded report on three separate therapeutic approaches. The report was highly critical of the efficacy of psychoanalysis.[315][316]

Paying for treatment

Unfortunately getting the proper diagnosis and treatment for an eating disorder is expensive.[317][318] There are few studies on cost effectiveness of various treatment modalities and none on how a patients socioeconomic status affects treatment.[319] Patients with anorexia nervosa are often discharged early while still underweight due to limitations in health care coverage, which results in relapse and rehospitalization.[320]

  • In the United Kingdom there are about two dozen NHS eating disorders clinics. But quality and access to care depend upon the region the patient lives in. They are also subject to the NICE:guidelines There are several private clinics in the U.K., the average cost is £300 to £500 per day. Occasionally the NHS will cover this cost. The best source of information is the non-profit organization beat.[321][322]
  • In the United States the cost of in treatment is not always fully covered by private insurance. The National Eating Disorders Association provides information on how deal with insurance companies more effectively. Medicaid and Medicare do cover the cost of eating disorder treatment and they are accepted at various hospitals and some private clinics. Quality and accessibility to services vary by state. Some organizations such as The Manna Fund also offer private "scholarships" to help defray the cost.
  • In Canada the national health insurance program, often referred to as "Medicare", is composed of 13 provincial and territorial health insurance plans they share certain common features but not all, access and quality of care may be better in certain provinces and not all services are covered. The National Eating Disorder Information Centre (NEDIC) is a non-profit entity that provides information on resources.

Prognosis

Monarch Butterfly Pink Zinnia 1800px.jpg

There are varying estimates as to the prognosis of individual eating disorders as the criteria used to arrive at the respective conclusions vary. With increasing knowledge as to the causes of individual eating disorders and which treatment options prove to be the most efficacious, the remission rates and ultimately full recovery rates rise.

  • anorexia nervosa (AN);for AN the remission rate has been placed between 75%-83%, with varying estimates as to the full recovery rate. Dr. Walter Vandereycken a noted expert in the field chooses to be optimistic in his prognostic assessment and places the potential recovery rate at 70%.[323]
  • bulimia nervosa (BN); for BN the remission rate has been placed as high as 75%[324] In a 7.5 year follow-up study done by Herzog et al. at the Harvard Medical School the full recovery rate for BN was 74%, 99% of those with BN achieved at least partial recovery.[325]
  • binge eating disorder (BED); the outcomes of studies on BED treatment were predicated on the absence of binge eating episodes at 6mo. and 12mo. followup, the rate in this study was 51.7%. The reduction of binge eating episodes was 88.3%.[326]

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External links


Eating Disorder
Classification and external resources
ICD-10 F50.
ICD-9 307.5
MeSH D001068

An eating disorder is to eat, or avoid eating, in a manner which negatively affects both one's physical and mental health. Eating disorders are all encompassing. They affect every part of the person's life. According to the authors of Surviving an Eating Disorder, "feelings about work, school, relationships, day-to-day activities and one's experience of emotional well being are determined by what has or has not been eaten or by a number on a scale."[1] Anorexia nervosa and bulimia nervosa are the most common eating disorders generally recognized by medical classification schemes,[2] with a significant diagnostic overlap between the two.[3] Together, they affect an estimated 5-7% of females in the United States during their lifetimes.[4]There are several other eating disorders which are prevalent amongst certain demographics that are being investigated and defined - Rumination syndrome, Compulsive overeating, and Selective eating disorder.

Contents

Disorders

Anorexia nervosa

Anorexia nervosa is deliberate and sustained weight loss driven by a fear of distorted body image. It is a serious disorder that can lead to death.[5] It is not to be confused with anorexia, which is a symptomatic general loss of appetite or disinterest in food. DSM-IV characterizes anorexia nervosa as:
  • An abnormally low body weight (the suggested guideline ≤ 85% of normal for age and height, or BMI ≤ 17.5).
  • For postmenarcheal females, amenorrhea (the absence of three consecutive menstrual cycles).
  • An intense fear of gaining weight or becoming fat and a preoccupation with body weight and shape.[6]

The appearance of anorexia often occurs during adolescence, with 76% reporting onset of the disorder between the ages of 11 and 20.[7] It is about ten times more likely to occur with females than males.[5] The mortality rate for those diagnosed with anorexia nervosa is approximately 6%—the highest of any mental illness—with roughly half of those due to suicide.[8]

Anorexics have a distorted view of their body. Even when they are extremely thin, they see themselves as too fat.[5] Anorexics are commonly perfectionists, driven to succeed; yet they set unattainable standards of performance for themselves. When they fail to meet these standards, they look for a part of their lives they can control; food and weight become that “control” for them. Low self-esteem and constant self-criticism cause anorexics to constantly fear losing control, and even consuming a small amount of food could be considered a loss of control.[5]

Bulimia nervosa

Bulimia nervosa is a cyclical and recurring pattern of binge eating (uncontrolled bursts of overeating) followed by guilt, self-recrimination and overcompensatory behavior such as crash dieting, overexercising and purging to compensate for the excessive caloric intake.[5]

Bulimics often have "binge food," which is the food they typically consume during binges. Some describe their binge episodes as a physical high they feel, numbing out, going into auto-pilot, losing all control, immediate comfort, etc. The reasoning or triggers behind a binge may serve different purposes for different people. This binge episode leads the individual to feel guilt, shame, embarrassment, and complete failure. Bulimics try to regain control of themselves and the situation by purging the food (either by self-induced vomiting or using a laxative), making up for their mistake.[5] This leads to feeling famished and empty again, and therefore, another uncontrollable binge, followed by feeling powerless, and the vicious binge/purge cycle continues. Bulimics have extreme eating and exercising habits, instead of demonstrating moderation. This compulsive behavior is often echoed in similar destructive behavior such as sexual promiscuity, pathological lying, and shoplifting. Some bulimics not only struggle with the eating disorder, but these other harmful behaviors as well.

The appearance of bulimia nervosa often occurs during late adolescence or early adulthood.[5] 90 Percent of bulimics are women.[5] Roughly 70 percent of individuals who develop bulimia nervosa eventually recover.[5]

Compulsive exercising is a type of bulimia nervosa, where those afflicted exercise excessively in order to purge excess calories.[9][9] One that struggles with this disorder takes part of vigorous physical activity to the point that it is unhealthy and unsafe. It is often referred to as obligatory exercise or anorexia athletic. The individual usually feels compelled to exercise and has problems with anxiety and guilt until exercising. Someone that has compulsive exercising disorder will still force themselves to work out even when sick or injured. He or she will often calculate how much they have eaten and exercise on the amount of calories they have eaten and usually have low energy because of all the calories they have burned.[10] People who struggle with this disorder usually do it to have more control in their life. Praise is often given to the individual about how in shape he/she may look which gives that person more of a drive to continue to work out. Females most commonly have compulsive exercising disorder and measure their self worth through their performance. They often take out their emotions like anger, depression, or frustration when exercising by pushing their bodies to the limit.[11]

Rumination syndrome

Rumination Syndrome is a rarely diagnosed chronic eating disorder of unknown prevalence. Though classically described as an illness of infancy or people with cognitive disabilities, its effects on otherwise healthy adults and adolescents is gaining increasing awareness in the medical community. Patients of this disorder experience effortless post-prandial (after ingestion) regurgitation of meals without the smells and tastes associated with normal vomitting. There is no nausea or retching preceding the event. Rumination syndrome is often misdiagnosed as bulimia nervosa by doctors, due to the lack of awareness of the disorder, the similarity in symptoms, and the common teenage onset of the disorder.[12]

Orthorexia nervosa

Orthorexia nervosa is a recently discovered disease previously thought to be Anorexia. This type of disorder is an obsession with eating only healthy types of foods. This disorder derives from the drive to become pure, so that a sufferer begins to become obsessed with everything that he or she is consuming. Someone who struggles with orthorexia nervosa will do things like planning out their meals for the next day. This means that they will have a strict planned schedule of breakfast, lunch and dinner. Thinness often results due to the restricted types and amounts of food eaten, but is a side effect rather than an intended result. People who have orthorexia nervosa are often critical of what others eat, and usually isolate themselves from surroundings.[13]

Selective eating disorder

Selective Eating Disorder (SED) prevents the consumption of certain foods. Although it is often viewed as a phase of childhood that is generally overcome with age, one may continue to be afflicted with SED throughout his or her adult life. Those with the disorder eat a "highly limited range of foods" and are unlikely to try new foods, as well. When the disorder persists into middle childhood and adolescence, it can result in conflict, anxiety, and social avoidance.[14]

Sufferers of SED have an inability to eat certain foods based on texture or aroma. "Safe" foods may be limited to only certain types of food or even specific brands. Afflicted individuals may exclude whole food groups, such as fruits or vegetables.

Compulsive overeating

Obsessive Compulsive Overeating [OCO] (Also known as binge eating) is one of the most common mental disorders and is linked with Obsessive Compulsive Disorder (OCD). It involves the consumption of very large amounts of food in a short period of time. About 2 percent of all adults in the United States struggle with binge eating. People at any age can develop this particular disorder, but it is seen most in young adults. Clinical studies have continued to find that obese binge eaters have much higher levels of depression than other obese individuals that do not have a binge eating disorder.[15] The individual has feelings of disgust and guilt that lead to depression.

People that struggle with binge eating are likely to have alcohol problems and engage in impulsive behavior, such as not thinking before acting out.[citation needed] They do not feel that they can control themselves, are typically not close with their community, and have difficulty discussing their problems and feelings. They also have more health problems, a hard time sleeping at night, joint pain, muscle pains, menstrual problems, and headaches. Affected people often have suicidal thoughts, struggle digesting their food, and are stressed. People that have a binge eating disorder are usually ashamed and become very good at hiding the fact that they have it. They become so good at hiding that most people around them, including close friends and family members, do not even know about their disorder. ("Binge Eating Disorder", 2008)

Although it is not diagnosed very often, several factors can make it more difficult to diagnose than other eating disorders. Because COE is an eating disorder which is less commonly taught in school or talked about, a large amount of people who have the disorder just blame their weight on their binges and don't consider that there might be a psychological reason behind their binge eating, or are not even aware that the disorder exists altogether. One way to determine if a person has COE is by looking at their eating patterns. It is not uncommon in some that their food habits can be completely random: healthy foods a few days, attempted dieting or even crash dieting, which are followed by a relapse into binge eating. A very common misconception is that people who have COE do not know healthy eating habits or simply "don't know better," however, what makes this specifically an eating disorder is the addiction of eating large amounts of food and repeated relapsing in attempts to changing to healthy eating habits.[citation needed] Binge eating sometimes is because of a certain emotion (boredom, anger, sadness, etc.).

Causes

Environmental

Family and friends are very influential when it comes to eating disorders. The media may be a significant influence on eating disorders through its impact on values, norms, and image standards accepted by modern society.[16] The media sends a message that "thin is beautiful" in their choice of fashion models, which many young girls want to emulate.[5] Both society’s exposure to media and eating disorders have grown immensely over the past decade. Researchers and clinicians are concerned about the relationship between these two phenomena and finding ways to reduce the negative influence thin-ideal media has on women’s body perception and susceptibility to eating disorders. The dieting industry makes billions of dollars each year by consumers continually buying products in an effort to be the ideal weight. Hollywood displays an unrealistic standard of beauty that makes the public feel incredibly inadequate and dissatisfied and forces people to strive for an unattainable appearance.[17] This takes an enormous toll on one's self-esteem and can easily lead to dieting behaviors, disordered eating, body shame, and ultimately an eating disorder.[5] The surrounding culture in which an adolescent is raised greatly affects how they feel they are supposed to look, potentially contributing to an eating disorder.[5]

Biological

Patients with severe obsessive compulsive disorder, depression or bulimia were all found to have abnormally low serotonin levels.[18] Neurotransmitters such as serotonin, dopamine and norepinephrine are secreted by the intestines and central nervous system during digestion.[19]

Researchers have also found low cholecystokinin levels in bulimics. Cholecystokinin is a hormone that causes one to feel full and decreases eating. Low levels of this hormone are likely to cause a lack of satiative feedback when eating, which can lead to overeating. Another explanation researchers found for overeating is abnormalities in the neuromodulator peptides, neuropeptide Y and peptide YY. Both of these peptides increase eating and work with another peptide called leptin. Leptin is released by fat cells and is known to decrease eating. Research found the majority of people who overate produced normal amounts of leptin but they might have complications with the blood-brain barrier preventing an optimal amount to reach the brain.[19]

Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism.[19] High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus.[20] A study in London at Maudsley Hospital found that anorexics were found to have a large variation of serotonin receptors and a high level of serotonin.[21]

Many of these chemicals and hormones are associated with the hypothalamus in the brain.[22] Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level. Uher & Treasure (2005) performed a study researching brain lesions effects on eating disorders. They evaluated 54 formally published cases of eating disorders and brain damage. They found many correlations between eating disorders and damage to the hypothalamus. People with brain lesions in the hypothalamus had abnormal eating behaviors; unprovoked and self induced vomiting, over concern with becoming fat, cheating with eating, frequent sleepiness, depression, obsessive compulsive behavior and diabetes insipidus.[23]

While scientists have determined that there are possible biochemical or biological causes leading to eating disorders because certain chemicals which control hunger, appetite or digestions are out of balance, experts such as Dr. Edward J. Cumella, executive director of the Remuda Treatment Programs, states that there are three components to eating disorders: 1. The genetic component; 2. The unique environmental factors, such as personal experiences; and 3) The shared environmental factors, such as culture. According to Dr. Cumella, "Some people are born with a predisposition to having an eating disorder and there are genetic markers that can push a person in the direction of anorexia or bulimia...but it does not guarantee that a person will automatically suffer from an eating disorder. The environment - a person's life experience - still has to pull the trigger."[24]

Developmental etiology

Research from a family systems perspective indicates that eating disorders stem from both the adolescent's difficulty in separating from over-controlling parents, and disturbed patterns of communication. When parents are critical and unaffectionate, their children are more prone to becoming self-destructive and self-critical, and have difficulty developing the skills to engage in self-care giving behaviors. Such developmental failures in early relationships with others, particularly maternal empathy, impairs the development of an internal sense of self and leads to an over-dependence on the environment. When coping strategies have not been developed in the family system, food and drugs serve as a substitute.[25]

Trauma

Eating disorders should also be understood in the context of experienced trauma, with many eating problems beginning as survival strategies rather than vanity or obsession with appearance. According to sociologist Becky Thompson, eating disorders stemming from women of varying socio-economic status, sexual orientation and race, and finds that eating disorders and a disconnected relationship with one's body is commonly a response to environmental stresses, including sexual, physical, and emotional abuse, racism, and poverty. This reality is further detrimental for women of color and other minority women, since they are forced to live in a culture that embraces a narrowly defined conception of beauty: "people furthest from the dominant ideal of beauty, specifically women of color, may suffer the psychological effects of low self-esteem, poor body image, and eating disorders."[26]

Gender differences

"Frequent dieting and trying to look like persons in the media were independent predictors of binge eating in females of all ages. In males, negative comments about weight by fathers was predictive of starting to binge at least weekly."[27]

Exercise addiction is common in men and women, especially in those who suffer from eating disorders and obsessive-compulsive disorder. It is the result of a fear of becoming fat, and allowing their need to stay fit to overtake their lives. Exercise addicts are risking their health in order to get a "runner's high". [28] They are in search of the ideal body type and place the importance of exercise above the needs of their children, parents, friends and health.

In male and female sports there are different reasons to lose weight.[citation needed] For a female many of the eating disorders are for more dancing related sports such as poms, cheerleading, and many other forms of competitive forms of dance.[citation needed] While in many male predominant sports it is also necessary such as wrestling, mixed martial arts, and sports where weigh-ins are necessary.[citation needed] This puts a lot of stress on the male to make the cut leading to many of the eating disorders such as bulimia and anorexia nervosa.[original research?]

Education sources that we depend on don't always give us the accurate information on eating disorders. Eating disorders affect women and men but we don't recognize that fact.[original research?] Men suffer from a different type of eating disorders than women.[citation needed] They may not starve themselves[original research?] but sometimes they use drugs to bulk up. They have the pressure of being "strong, bulk, hot".[dubious ][original research?]"A survey published in Psychology Today reported that only 15% of men said that they are unhappy with their weight. Increasingly, men feel the same pressure that women feel to be attractive and slender. If these trends continue, the incidence rate for eating disorders among men will increase" (Pipher 16).

Pipher, Mary. Hunger pains: The moderns woman's tragic quest for thinness. New York: Ballantine Books, 1995.

Diagnosis

Clinically, eating disorders are evaluated using instruments such as the Questionnaire of Eating and Weight Patterns (QEWP), which has specialized versions for adolescents and parents (QEWP-A, and QEWP-P). In addition to evaluating eating patterns, these tests also diagnose depression.[29]

Notes

  1. ^ Siegel, Michaele, Brisman, Judith and Weinshel, Margot. Surviving an Eating Disorder. New York: Harper and Row Publishers. 1988.
  2. ^ "ICD-10: Behavioural syndromes associated with physiological disturbances and physical factors". World Health Organization. 2006-04-05. http://www.who.int/classifications/apps/icd/icd10online/?gf50.htm+f50. Retrieved on 2007-03-08. 
  3. ^ Milos, G; Spindler, A; Schnyder, U; Fairburn, C G (2005), "Instability of eating disorder diagnoses: prospective study", The British Journal of Psychiatry 187 (6): 573–578, doi:10.1192/bjp.187.6.573, PMID 16319411 
  4. ^ "Practice guidelines for the treatment of patients with eating disorders", American Journal of Psychiatry (American Psychiatric Association) 157 (1): 1–39, January 2000 .
  5. ^ a b c d e f g h i j k l Santrock, J. W. (2005). Nutrition and Eating Behavior. In Mike Ryan (Ed.). A Topical Approach to Life-Span Development, Fourth Edition (pp 156-157). New York City: McGraw-Hill.
  6. ^ American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (4th ed.). American Psychiatric Association. ISBN 0890420629. 
  7. ^ "Facts About Eating Disorders". National Association of Anorexia Nervosa and Associated Eating Disorders. http://www.anad.org/22385/index.html. Retrieved on 2008-03-15. 
  8. ^ Herzog, David B; Greenwood, Dara N; Dorer, David J; Flores, Andrea T; Ekeblad, Elizabeth R; Richards, Ana; Blais, Mark A; Keller, Martin B (2000), "Mortality in eating disorders: A descriptive study", International Journal of Eating Disorders 28 (1): 20–26, doi:10.1002/(SICI)1098-108X(200007)28:1<20::AID-EAT3>3.0.CO;2-X 
  9. ^ a b Barlow, David H; Durand, V Mark (July 2004), Abnormal Psychology: An Integrative Approach, Thomson Wadsworth, ISBN 0534633625 
  10. ^ Tiemeyer, 2008
  11. ^ Mary L. Gavin, 2007
  12. ^ Papadopoulos, Mimidis, V., K. (2007), "The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment", Journal of Postgraduate Medicine 53 (3): 203–206, ISSN 0022-3859 
  13. ^ "Eating Disorders", 2001
  14. ^ Clinical Child Psychology and Psychiatry, Vol. 6, No. 2, 257-270 (2001) (available at http://ccp.sagepub.com/cgi/content/short/6/2/257)
  15. ^ Susan Himes, 2005
  16. ^ Harrison, K; Cantor, J (1997), "The relationship between media consumption and eating disorders", Journal of Communication (Oxford University Press) 47 (1): 40–68, doi:10.1111/j.1460-2466.1997.tb02692.x 
  17. ^ Australian Idol Starlet: Shocking Anorexic Revelations
  18. ^ Long, Phillip W (1993). "Eating Disorders". National Institute of Mental Health. http://www.mentalhealth.com/book/p45-eat1.html. Retrieved on 2006-03-03. 
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References

  • Natenshon, Abigail, ed. (1999), When Your Child Has an Eating Disorder: A Step-By-Step Workbook for Parents and Other Caregivers, Jossey Bass, ISBN 0-7879-4578-1 
  • Thompson, K. J., ed. (2003), Body Image, Eating Disorders, and Obesity: An Integrative Guide for Assessment and Treatment, APA Books, ISBN 1-55798-726-2 
  • Agras, W. Steward (2004), "The consequences and costs of the eating disorders", The psychiatric clinics of North America 24 (2): 371, doi:10.1016/S0193-953X(05)70232-X 
  • Crow, S.; Praus, B; Thuras, P (1999), "Mortality from Eating Disorders—A 5- to 10-Year Record Linkage Study", International journal of eating disorders 26: 97, doi:10.1002/(SICI)1098-108X(199907)26:1<97::AID-EAT13>3.0.CO;2-D 
  • Crow, S; Nyman, J. (2004), "The Cost-Effectiveness of Anorexia Nervosa Treatment", International journal of eating disorders 35 (2): 155, doi:10.1002/eat.10258 
  • Lauer, C. J.; Krieg, J. C. (2004), "Sleep in eating disorders", Sleep Medicine Review 8 (2): 109, doi:10.1016/S1087-0792(02)00122-3 
  • Meads, C.; Gold, L.; Burls, A. (2001), "How effective is outpatient care compared to inpatient care for the treatment of Anorexia Nervosa? A systemic review", European eating disorders review 9 (4): 229, doi:10.1002/erv.406 
  • = Zeeck, A.; Herzog, T.; Hartman, A. (2004), "Day clinic or inpatient care for severe Bulimia Nervosa", European eating disorders review 12 (2): 79, doi:10.1002/erv.535 
  • Zipfel, S (2000), "Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study", Lancet (North American Edition) 355 (9205): 721 

External links


Simple English

Eating Disorder
Classification and other resource links
ICD-10 F50.
ICD-9 307.5
MeSH D001068

An eating disorder is when someone begins eating too much, or when someone begins to avoid eating. This affects one's mental and physical health. Anorexia nervosa and bulimia nervosa are two of the most common eating disorders today. Eating disorders affect 5-7% of American women, only a small percent of men are affected.

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