eating disorders

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EATING DISORDERS

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When most people hear of someone with an eating disorder they almost automatically assume the person has a problem with food.  Eating disorders are not a sign that a person has a problem with food, rather eating disorders are actually only the symptoms of underlying problems in that person's life.  With proper treatment, people can fully recover “ Eating disorders refer to a group of conditions characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health ”

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Specific eating disorders Anorexia nervosa (AN), characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity, etc. It greatly stresses the heart, increasing the risk of heart attacks and related heart problems. The risk of death is greatly increased in individuals with this disease. Bulimia nervosa (BN), characterized by recurrent binge eating followed by compensatory behaviors such as purging (self-induced vomiting, excessive use of laxatives/diuretics, or excessive exercise) Bulimics may also fast for a certain amount of time following a binge. Binge eating disorder (BED) or compulsive overeating, characterized by binge eating, without compensatory behavior. Purging disorder , characterized by recurrent purging to control weight or shape in the absence of binge eating episodes Rumination , characterized by involving the repeated painless regurgitation of food following a meal which is then either re-chewed and re-swallowed, or discarded. Diabulimia , characterized by the deliberate manipulation of insulin levels by diabetics in an effort to control their weight.

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Food maintenance , characterized by a set of aberrant eating behaviors of children in foster care . Eating disorders not otherwise specified (EDNOS) can refer to a number of disorders. It can refer to a female individual who suffers from anorexia but still has her period, someone who may be at a "healthy weight", but who has anorexic thought patterns and behaviors, it can mean the sufferer equally participates in some anorexic as well as bulimic behaviors (sometimes referred to as purge-type anorexia), or to any combination of Eating Disorder behaviors which do not directly put them in a separate category. Pica , characterized by a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition. These can include such things as chalk, paper, plaster, paint chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes. These individuals cannot distinguish a difference between food and non food items. Night Eating Syndrome , characterized by morning anorexia, evening polyphagia (abnormally increased appetite for consumption of food (frequently associated with insomnia , and injury to the hypothalamus ). Orthorexia nervosa , a term used by Steven Bratman to characterize an obsession with a "pure" diet, where it interferes with a person's life.

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Anorexia nervosa ‘‘ Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight ’’ A person with Anorexia starve her or him self so she or he can be skinny. Signs of anorexia nervosa O bvious, rapid, dramatic weight loss L anugo : soft, fine hair grows on face and body O bsession with calories and fat content Preoccupation with food , recipes ,or cooking ; may cook elaborate dinners for others but not eat themselves D ieting despite being thin or dangerously underweight F ear of gaining weight or becoming overweight

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Purging: uses laxatives , diet pills , ipecac syrup , or water pills ; may engage in self-induced vomiting ; may run to the bathroom after eating in order to vomit and quickly get rid of the calories May engage in frequent, strenuous exercise Perception : perceives self to be overweight despite being told by others they are too thin Becomes intolerant to cold: frequently complains of being cold due to loss of insulating body fat or poor circulation due to extremely low blood pressure; body temperature lowers ( hypothermia ) in effort to conserve energy R ituals: cuts food into tiny pieces; refuses to eat around others; hides or discards food Russell's sign :scarring of the knuckles from placing fingers down the throat to induce vomiting Russell's sign scarring on knuckles due to sticking fingers down throat to force vomiting Chilblains , also known as Perniosis.

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Miss A —” pictured in 1866 and in 1870 after treatment. She was one of the earliest Anorexia nervosa case studies. From the published medical papers of Sir William Gull . Possible medical complications of anorexia nervosa C onstipation Diarrhoea E lectrolyte imbalance C avities T ooth loss C ardiac arrest Amenorrhea O steoporosis O steopenia H yponatremia Hypokalemia O ptic neuropathy B rain atrophy Leukopenia Miss A—” pictured in 1866 and in 1870 after treatment. She was one of the earliest Anorexia nervosa case studies. From the published medical papers of Sir William Gull

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Complete Blood Count Urinalysis ELISA Western Blot Analysis G lucose tolerance test Secritin-CCK Test Serum cholinesterase test Liver Function Test Creatine Kinase Test Blood urea nitrogen (BUN)test BUN-to-creatinine ratio Echocardiogram E lectrocardiogram Electroencephalogram Upper GI Series Thyroid Screen Parathyroid hormone test N euroimaging Medical Tests used in the Diagnosis and Assessment of Anorexia Nervosa

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Treatment : Treatment for anorexia nervosa tries to address three main areas. Restoring the person to a healthy weight; Treating the psychological disorders related to the illness Reducing or eliminating behaviors or thoughts that originally led to the disordered eating. Diet and Nutrition Zinc supplementation has been shown in various studies to be beneficial in the treatment of AN even in patients not suffering from zinc deficiency, by helping to increase weight gain. Essential fatty acids :The omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been shown to benefit various neuropsychiatric disorders. There was reported rapid improvement in a case of severe AN treated with ethyl -eicosapentaenoic acid (E-EPA) and micronutrients . DHA and EPA supplementation has been shown to be a benefit in many of the comorbid disorders of AN including: attention deficit/hyperactivity disorder (ADHD), autism, major depressive disorder (MDD),bipolar disorder, and borderline personality disorder. Accelerated cognitive decline and mild cognitive impairment (MCI) correlate with lowered tissue levels of DHA/EPA, and supplementation has improved cognitive function.

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Cognitive behavioral therapy (CBT) – "The term 'cognitive-behavioral therapy (CBT) is a very general term for a classification of therapies with similarities. There are several approaches to cognitive-behavioral therapy". CBT is an evidence based approach which in studies to date has shown to be useful in adolescents and adults with anorexia nervosa. Cognitive Behavioral Therapies : Rational Emotive Behavior Therapy Dialectical behavior therapy Rational Behavior Therapy Cognitive Therapy Nutrition counseling 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. Medication : Olanzapine has been shown to be effective in treating certain aspects of AN including to help raise the body mass index and reduce obsessionality, including obsessional thoughts about food Psychotherapy/Cognitive remediation

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BULIMIA NERVOSA “ Bulimia nervosa is an eating disorder characterized by restraining of food intake for a period of time followed by an over intake or binging period that results in feelings of guilt and low self-esteem. ” A person with bulimia eats a lot of food in a short amount of time. this is called binging. Binging can cause feelings of shame and guilt. So, the person tries to "undo" the binge by getting rid of the food by throwing it up.

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Signs and symptoms Chronic gastric reflux after eating Dehydration and hypokalemia caused by frequent vomiting Electrolyte imbalance, which can lead to cardiac arrhythmia, cardiac arrest, and even death\ Esophagitis, or inflammation of the esophagus Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat Gastroparesis or delayed emptying Constipation Infertility Enlarged glands in the neck, under the jaw line Peptic ulcers Calluses or scars on back of hands due to repeated trauma from incisors

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There are two sub-types of bulimia nervosa: Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac ) to rapidly remove food from the body before it can be digested, or use laxatives , diuretics , or enemas . Non-purging type bulimics (approximately 6%–8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Treatment : Tricyclic antidepressants,MAO inhibitors, mianserin, fluoxetine , lithium carbonate, nomifensine, trazodone, and bupropion. Research groups who have seen a relationship to seizure disorders have attempted treatment with phenytoin, carbamazepine, and valproic acid. Opiate antagonists naloxone and naltrexone, which block cravings for gambling, have also been used. There has also been some research characterizing bulimia nervosa as an addiction disorder, and limited clinical use of topiramate , which blocks cravings for opiates, cocaine, alcohol and food.Researchers have also reported positive outcomes when bulimics are treated in an addiction-disorders inpatient unit.

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Psychotherapy There are several empirically-supported psychosocial treatments for bulimia nervosa. Cognitive behavioral therapy (CBT), which involves teaching clients to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of "forbidden foods") has demonstrated efficacy both with and without concurrent antidepressant medication. By using CBT patients record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis (Gelder, Mayou and Geddes 2005). Barker (2003) states that research has found 40-60% of patients using cognitive behaviour therapy to become symptom free. He states in order for the therapy to work, all parties must work together to discuss, record and develop coping strategies. Barker (2003) claims by making people aware of their actions they will think of alternatives. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy . Maudsley Family Therapy a.k.a. Family Based Treatment (FBT), developed at the Maudsley Hospital in London for the treatment of anorexia nervosa (AN) has been shown to have positive results for the treatment of bulimia nervosa. FBT has been shown through empirical research to be the most efficacious treatment of AN for patients under the age of eighteen and within three years of onset of illness. The studies to date using FBT to treat BN have been promising. Some researchers have also claimed positive outcomes in hypnotherapy treatment

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Binge eating disorder ( BED ) Binge eating disorder is characterized by consuming large quantities of food in a very short period of time until the individual is uncomfortably full. Binge eating disorder is much like bulimia except the individuals do not use any form of purging (i.e. vomiting, laxatives, fasting, etc.) following a binge. Individuals usually feel out of control during a binge episode, followed by feelings of guilt and shame. Many individuals who suffer with binge eating disorder use food as a way to cope with or block out feelings and emotions they do not want to feel. Individuals can also use food as a way to numb themselves, to cope with daily life stressors, to provide comfort to themselves or fill a void they feel within. Like all eating disorders, binge eating is a serious problem but can be overcome through proper treatment

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Signs : Periodically does not exercise control over consumption of food. Eats an unusually large amount of food at one time, far more than an average person would eat in the same amount of time. Eats much more quickly during binge episodes than during normal eating episodes. Eats until physically uncomfortable and nauseated due to the amount of food just consumed. Eats when depressed or bored. Eats large amounts of food even when not really hungry. Usually eats alone during binge eating episodes, in order to avoid discovery of the disorder. Often eats alone during periods of normal eating, owing to feelings of embarrassment about food. Feels disgusted, depressed, or guilty after binge eating. Rapid weight gain, and/or sudden onset of obesity.

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Causes : No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder, whether binge eating disorder causes depression, or whether the two have a common cause, is not known for sure. The trigger point can be emotion such as happiness, anger, sadness or boredom. Impulsive behavior and certain other emotional problems can be more common in people with binge eating disorder. However, many people also claim that bingeing occurs regardless of their mood. It is also unclear whether dieting and binge eating are related. Some studies show that about half of all people with binge eating disorder had binge episodes before they started to diet.

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Researchers also say that binge eating disorder is more common among competitive athletes such as swimmers or gymnasts whose body form is regularly on public display. Affected athletes in these sports tend to compare their own bodies in a negative way with those of their teammates. There is a research into how brain chemicals and metabolism affect binge eating disorder, but this study is in its early stages . Treatment : People with binge eating disorder, whether or not they want to lose weight, should seek help from health professionals including physicians, nutritionists, psychiatrists, psychologists, clinical social workers or by attending 12-step Overeaters Anonymous meetings. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. Although mental health professionals may be attuned to the signs of binge eating disorders, most physicians do not raise the question, either because they are uninformed about the condition or too embarrassed to ask about it. Because it is not a recognized psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders , it is difficult to obtain insurance reimbursement for treatments.

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There are several different ways to treat binge eating disorder. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy , such as antidepressants, may be helpful for some people. Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program to improve health and to build self-esteem, as well as counselling to pinpoint the root of the psychological problems triggering their binge episodes, might be the best choice. “ A clinical trial in Helsinki is investigating the use of intra-nasal naloxone for binge eating disorder, using the same approach as the highly successful Sinclair Method for alcohol addiction. Results of this trial are expected in 2011. ”

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“ Although eating disorders are increasing all over the world among both men and women, there is evidence to suggest that it is women in the Western world who are at the highest risk of developing them and the degree of westernization increases the risk. While these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining. All eating disorders require professional help The consequences of eating disorders can be severe, including death..So proper treatment can be highly effective for many of the specific types of eating disorder. Encouraging healthy, realistic attitudes toward weight and diet may be helpful. Sometimes, talk therapy can help for these disorders. ” Conclusion:

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