EATING DISORDER

An 'eating disorder' is a complex compulsion to eat, or not eat, in a way which disturbs physical and mental health. The eating may be excessive (compulsive over-eating); too limited (restricting); may include normal eating punctuated with episodes of purging; may include cycles of binging and purging; or may encompass the ingesting of non-foods. The most heard about eating disorders are Anorexia nervosa and Bulimia nervosa. The most widely and rapidly spreading eating disorder is compulsive overeating or Binge eating disorder. These are also the three most common eating disorders. All three have severe consequences to a person's immediate and long-term health and can cause death. There are numerous theories as to the causes and mechanisms leading to eating disorders.

Contents

Types

Causes and mechanisms

Addiction

Developmental etiology

External links

References

Journal references

Book references

Online references

Types

★ Anorexia nervosa

★ Starvation diet

★ Binge eating disorder

★ Bulimia nervosa

★ Diabulimia

★ Eating disorder not otherwise specified

★ Orthorexia

★ Hyperphagia

★ Rumination

★ Pica

★ Night eating syndrome
Eating disorders are characterized by an abnormal obsession with food and weight. Eating disorders are much more noticed in women than in men. This can be attributed to the fact that society is seen to put an emphasis on women to be thin, and men to be 'bulked up'. This can lead to pressure on women to be 'picture perfect', and an eating disorder prevails as a result of stress of not being able to reach unattainable goals related to this 'picture perfect' ideal. Also, it can be due to the fact that men are less likely to seek help.
Patients with eating disorders may also have a comorbid diagnosis of, mood disorder, severe mental depression,^[1] Obsessive compulsive disorder, Body dysmorphic disorder, Bipolar disorder, self-harm^[2] personality disorders and substance abuse disorders. Sexual abuse is also frequently reported among those with eating disorders. Women with eating disorders show poorer eating self-efficacy, psychological distress, disinhibition, low self-esteem, less helpful coping strategies, more frequent sensations of hunger, and less cognitive restraint when compared to control groups.^[3]
Some psychologists also classify a syndrome called orthorexia as an eating disorder, or, more properly, "disordered eating" - the person is overly obsessed with the consumption of what they see as the 'right' foods for them, to the point that their nutrition and quality of life suffers (although due to cultural and political factors which influence food choices, this idea is considered controversial by some). In addition, some individuals have food phobias about what they can and cannot eat, which can be characterized as an eating disorder. The UK broadcaster BBC Three have shown a series called Freaky Eaters that deals with such topics.
Somewhat qualitatively different from those conditions previously mentioned is pica, or the habitual ingestion of inedibles, such as dirt, wood, hair, etc.
The American Psychiatric Association recognizes eating disorders.

Causes and mechanisms

Environmental factors have a large influence on developing eating disorders but more research is being performed on hormonal imbalances, brain lesions and their effects on eating disorders. Research has shown that many people who suffer from an eating disorder are highly correlated with having depression and obsessive compulsive disorder. Depressed, obsessive compulsive and bulimic patients were found to have lower than normal serotonin levels ^[4]. Neurotransmitters, such as serotonin, dopamine, and norepinephrine, are released as you eat ^[5].
Researchers have also found low cholecystokinin levels in bulimics. Cholecystokinin is a hormone that causes one to feel full and decreases eating ^[6]; ^[4]. People who are lacking this hormone are more likely to lack feeling satisfaction while eating which can lead to binge eating. Another explanation researchers found for over eating is abnormalities in the neuromodulator peptides, neuropeptide Y and peptide YY ^[6]; ^[4]. 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 ^[6].
Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism ^[11]. High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus ^[4]. 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 ^[13]
Many of these chemicals and hormones are associated with the hypothalamus in the brain ^[14].Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level ^[15]. 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 ^[14]

Addiction

The same personality factors that place individuals at risk for substance abuse are often found in individuals with eating disorders. With addiction and eating disorders there is a need to discharge affective experience through action rather than feeling or being able to talk about them, an inability to regulate tension, the need for immediate gratification, poor impulsive control, and a fragile sense of self. Often in those with eating disorders and substance abuse problems drugs or alcohol is used in attempts to avoid binge eating. Similarly, those with eating disorders may deny their problem or attempt to keep it a secret, much like addicts try to conceal their drug and alcohol usage. Similar to genetic components of addiction, there is a large genetic component to body type.

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.^[17]

External links

★ National Institute of Mental Health: Eating Disorders: A detailed booklet that describes symptoms, causes, and treatments, with information on getting help and coping.

★ NEDIC National Eating Disorder Information Centre

★ ANAD National Association of Anorexia Nervosa and Associated Disorders

★ Medline Plus eating disorder info and links

★ [1]The Joy Project: A non-profit organization that aims to provide information, support, and resources for people affected by eating disorders while bridging the gap between the professional ED treatment community and those affected by eating disorders.

References

1. The relationship between depression and eating disorders
2. Comorbities of eating disorders
3. The Efficacy of Overeaters Anonymous in Fostering Abstinence in Binge-Easting Disorder and Bulimia Nervosa, , Kerri-Lynn Murphy, Kriz, Virginia Polytechnic Institute and State University, 2002,
4. Long, Phillip W. (1993). Eating Disorders. Retrieved March 3, 2006, from the National Institute of Mental Health website: http://www.mentalhealth.com/book/p45-eat1.html
5. Kalat, James W. (2004). Biological Psychology (8th ed.). Houston: New Leaf Publishing Services
6. Kalat, James W. (2004). Biological Psychology (8th ed.). Houston: New Leaf Publishing Services, p. 316
7. Long, Phillip W. (1993). Eating Disorders. Retrieved March 3, 2006, from the National Institute of Mental Health website: http://www.mentalhealth.com/book/p45-eat1.html
8. Kalat, James W. (2004). Biological Psychology (8th ed.). Houston: New Leaf Publishing Services, p. 316
9. Long, Phillip W. (1993). Eating Disorders. Retrieved March 3, 2006, from the National Institute of Mental Health website: http://www.mentalhealth.com/book/p45-eat1.html
10. Kalat, James W. (2004). Biological Psychology (8th ed.). Houston: New Leaf Publishing Services, p. 316
11. Kalat, James W. (2004). Biological Psychology (8th ed.). Houston: New Leaf Publishing Services, p. 366
12. Long, Phillip W. (1993). Eating Disorders. Retrieved March 3, 2006, from the National Institute of Mental Health website: http://www.mentalhealth.com/book/p45-eat1.html
13. Yager, Joel & Anderson, Arnold E. (2005). Anorexia Nervosa. The New England Journal of Medicine, 353 (14), 1481-1488, Retrieved March 3, 2006, from Ovid web: http://mutex.gmu.edu:2076/gw1/ovidweb.cgi
14. Uher, R., & Treasure, J. (2005). Brain Lesions and Eating Disorders. Journal of Neurology, Neurosurgery, & Psychiatry, 76 (6). June 2005, pp 852-857.
15. Kalat, James W. (2004). Biological Psychology (8th ed.). Houston: New Leaf Publishing Services, p. 90
16. Uher, R., & Treasure, J. (2005). Brain Lesions and Eating Disorders. Journal of Neurology, Neurosurgery, & Psychiatry, 76 (6). June 2005, pp 852-857.
17. The Addiction of Overeating: Self-Help Groups as Treatment Models, , Sydell, Weiner, Journal of Clinical Psychology, 1998

Journal references

★ The consequences and costs of the eating disorders, Agras, W. Steward, MD, , , The psychiatric clinics of North America, 2004 : An excellent current article on the consequences of eating disorders, the costs to families and institutions.

★ Mortality from Eating Disorders—A 5- to 10-Year Record Linkage Study, Crow, S., Praus, B., and Thuras, P., , , International journal of eating disorders, 1999

★ The Cost-Effectiveness of Anorexia Nervosa Treatment, Crow, S., Nyman, J., , , International journal of eating disorders, 2004

★ Sleep in eating disorders, Lauer, C.J., Krieg, J.C., , , Sleep Medicine Review, 2004

★ How effective is outpatient care compared to inpatient care for the treatment of Anorexia Nervosa? A systemic review, Meads, C., Gold, L., and Burls, A., , , European eating disorders review, 2001

★ Day clinic or inpatient care for severe Bulimia Nervosa, Zeeck, A., Herzog, T., and Hartman, A., , , European eating disorders review, 2004

★ Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study, Zipfel, S., et al, , , Lancet (North American Edition), 2000

Book references

★ When Your Child Has an Eating Disorder: A Step-By-Step Workbook for Parents and Other Caregivers, Abigail Natenshon, editor, , , Jossey Bass, 1999,

★ Body Image, Eating Disorders, and Obesity: An Integrative Guide for Assessment and Treatment, Thompson, K. J., editor, , , APA Books, 2003,

Online references

★ Article on psychological treatments for eating disorders