Eating Disorders, Causes, Symptoms and Treatment

Eating disorders is phychological condition that involve extreme disturbances in eating behavior. Eating disorders are serious mental health disorders. They involve severe problems with your thoughts about food and your eating behaviours. You may eat much less or much more than you need.

Anorexia Nervosa self-induced starvation to a significant degree,

(1) a relentless drive for thinness or a morbid fear of fatness,

(2) the presence of medical signs and symptoms resulting from starvation. It is often associated with disturbances of body image-the perception that one is distressingly large despite obvious thinness.

Epidemiology of Eating Disorders

The most common age of onset is between 14 and 18 years. Anorexia Nervosa is estimated to occur in about 0.5% to 1% of adolescent girls. It occurs 10 to 20 times more often in females than in males.

The prevalence of young women with some symptoms of anorexia nervosa who do not meet the diagnostic criteria is estimated to be close to 5%.

It seems to be most frequent in developed countries, and it may be seen with greatest frequency among young women in professions that require thinness, such as modeling and ballet.

Causes Of Eating Disorders 

Biological, social, and psychological factors are implicated in the causes of anorexia nervosa.

Some evidence points to higher concordance rates in mono-zygotic twins than in dizygotic twins.

Major mood disorders are more common in family members than in the general population.

Biological factors.

Starvation results in many biochemical changes, some of which are also present in depression, such as hypercortisolemia and non suppression by dexamethasone. An increase in familial depression, alcohol dependence, or eating disorders has been noted.

Some evidence of increased anorexia nervosa. Neurobiologically, a reduction in 3-methoxy-4-hydroxyphenylglycol (MHPG) in urine and cerebrospinal fluid (CSF) suggests lessened norepinephrine turnover and activity.

Endogenous opioid activity appears lessened as a conse quence of starvation. In one positron emission tomography (PET) study, caudate nucleus metabolism was higher during the anorectic state than after weight gain.

Magnetic resonance imaging (MRI) may show volume deficits of gray matter during illness, which may persist during recovery. A genetic predisposition may be a factor.

Social factors

Patients with anorexia nervosa find support for their practices in society’s emphasis on thinness and exercise. Families of children who present with eating disorders, especially binge-eating or purging subtypes, may exhibit high levels of hostility, chaos, and isolation and low levels of nurturance and empathy.

Vocational and avocational interests interact with other vulnerability factors to increase the probability of developing eating disorders (i.e., ballet in young women and wrestling in high school boys).

Psychological and psychodynamic factors.

Patients with the disorder substitute their preoccupations, which are similar to obsessions, with eating and weight gain for other, normal adolescent pursuits. These patients typically lack a sense of autonomy and self-hood.

Diagnosis and clinical features.

The onset of anorexia nervosa usually occurs between the ages of 10 and 30 years. It is present when

(1) An individual voluntarily reduces and maintains an unhealthy degree of weight loss or fails to gain weight proportional to growth.

(2) An individual experiences an intense fear of becoming fat, has a relentless drive for thinness despite obvious medical starvation, or both.

(3) An individual experiences significant starvation-related medical symptomatology, often, but not exclusively abnormal reproductive hormone functioning, but also hypothermia, bradycardia, orthostasis, and severely reduced body fat stores.

(4) The behaviours and psychopathology are present for at least 3 months Obsessive-compulsive behavior, depression, and anxiety are other psychiatric symptoms of anorexia nervosa most frequently noted in the literature Poor sexual adjustment is frequently described in patients with the disorder.

Anorexia Nervosa patient often give a history of a few or no sexual experience and generally have low libido, whereas bulimia patients are often sexually active with a normal or high libido.

Very soon I will write on bulimia nervosa.

Type Of Eating Disorder

1. Restricting type (no binge eating)

Present in approximately 50% of cases. Food intake is highly restricted (usually with attempts to consume fewer than 300 to 500 calories per day and no fat grams), and the patient may be relentlessly and compulsively overactive, with overuse athletic injuries. Persons with restricting anorexia nervosa often have obsessive compulsive traits with respect to food and other matters.

2. Binge-eating/purging type

Patients alternate attempts at rigorous dieting with intermittent binge or purge episodes, with the binges, if present, being either subjective (more than the patient intended, or because of social pressure, but not enormous) or objective.

Purging represents a secondary compensation for the unwanted calories, most often accomplished by self-induced vomiting, frequently by laxative abuse, less frequently by diuretics, and occasionally with emetics. The suicide rate is higher than in those with the restricting type.

Pathology and laboratory examination

A complete blood count often reveals leukopenia with a relative lymphocytosis in emaciated patients with anorexia nervosa. If binge eating and purging are present, serum electrolyte determination reveals hypokalemic alkalosis.

Fasting serum glucose concentrations are often low during the emaciated phase, and serum salivary amylase concentrations are often elevated if the patient is vomiting.

The ECG may show ST-segment and T-wave changes, which are usually secondary to electrolyte disturbances; emaciated patients have hypo-tension a bradycardia. 

Differential diagnosis

1.Medical conditions and substance use disorders. Medical illness (e.g.. cancer, brain tumor, gastrointestinal disorders, drug abuse) that can account for weight loss.

2.Depressive disorder- Depressive disorders and anorexia nervosa have several features in common, such as depressed feelings, crying spell sleep disturbance, obsessive ruminations, and occasional suicidal thoughts.

However, generally a patient with a depressive disorder has decreased appetite, whereas a patient with anorexia nervosa claims to have normal appetite and feels hungry; only in the severe stages of anorexia nervosa do patients actually have a decreased appetite.

Also, in contrast to depressive agitation, the hyperactivity seen in anorexia nervosa is planned and ritualistic. The preoccupation with recipes, the caloric content of foods, and the preparation of gourmet feasts is typical with anorexia ner vosa not with depressive disorder.

In depressive disorders, patients have no intense fear of obesity or disturbance of body image. Comorbid major depression or dysthymia has been found in 50% of patients with anorexia.

3. Somatization disorder. Weight loss not as severe; no morbid fear becoming overweight; amenorrhea unusual.

4. Schizophrenia. Delusions about food (e.g., patients believe the food to be poisoned). Patients rarely fear becoming obese and are not as hyperactive.

5. Bulimia nervosa. Patient’s weight loss is seldom more than 15%. Bulimia nervosa develops in 30% to 50% of patients with anorexia nervosa with 2 years of the onset of anorexia.

Treatment Of Eating Disorders

Hospitalization. The first consideration in the treatment of anorexia ner. vosa is to restore patients’ nutritional state. Patients with anorexia nervosa who are 20% below the expected weight for their height are recommended for inpatient programs, and patients who are 30% below their expected weight require psychiatric hospitalization for 2 to 6 months.

Inpatient psychiatric programs for patients with anorexia nervosa generally use a combination of a behavioral management approach, individual psychotherapy, family education and therapy, and, in some cases, psychotropic medications.

Patients must become willing participants for treatment to succeed in the long run. After patients are discharged from the hospital, clinicians usually find it necessary to continue outpatient supervision of the problems identified in the patients and their families.

Psychotherapy Treatment 

Cognitive-behavioral therapy (CBT). Cognitive and behavioral therapy principles can be applied in both inpatient and outpatient settings.

Behavior therapy has been found effective for inducing weight gain; no large, c trolled studies of cognitive therapy with behavior therapy in patients with anorexia nervosa have been reported.

Patients are taught to monitor their food intake, their feelings and emotions, their binging and purging behaviors, and their problems in interpersonal relationships.

Patients are taught cognitive restructuring to identify automatic thoughts and to challenge their core beliefs. Problem solving is a specific method whereby patients learn how to think through and devise strategies to cope with their food-related and interpersonal problems. Patients’ vulnerability to rely on anorectic behavior as a means of coping can be addressed if they can learn to use these techniques effectively.

Dynamic Psychotherapy. Patients’ resistance may make the process difficult and painstaking. Because patients view their symptoms as constituting the core of their specialness, therapists must avoid excessive investment in trying to change their eating behavior.

The opening phase of the psychotherapy process must be geared to building a therapeutic alliance. Patients may experience early interpretations as though someone else were telling them what they really feel and thereby minimizing and invalidating their own experiences.

Therapists who empathize with patients’ points of view and take an active interest in what their patients think and feel, however, convey to patients that their autonomy is respected. Above all, psychotherapists must be flexible, persistent, and durable in the face of patients’ tendencies to defeat any efforts to help them.

Family Therapy. A family analysis should be done for all patients with anorexia nervosa who are living with their families, as a basis for a clinical judgment on what type of family therapy or counseling is advisable.

In some cases, family therapy is not possible; how ever, issues of family relationships can then be addressed in individual therapy. Sometimes, brief counseling sessions with immediate family members is the extent of family therapy required.

Pharmacotherapy. Some reports support the use of cyproheptadine (Periactin), a drug with antihistaminic and antiserotonergic properties, for patients with the restricting type of anorexia nervosa. Amitriptyline (Elavil) has also been reported to have some benefit.

Concern exists about the use of tricyclic drugs in low-weight, depressed patients with anorexia nervosa, who may be vulnerable to hypotension, cardiac arrhythmia, and dehydration.

Once an adequate nutritional status has been attained, the risk of serious adverse effects from the tricyclic drugs may decrease; in some patients, the depression improves with weight gain and normalized nutritional status.

Eating Disorder Not Otherwise Specified The text revision of the fourth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-IV-TR) diagnostic classification eating disorder not otherwise specified is a residual category used for eating disorders that do not meet the criteria for a specific eating disorder.

Binge-eating disorder that is, recurrent episodes of binge eating in the absence of the inappropriate compensatory behaviors characteristic of bulimia nervosa falls into this category. Such patients are not fixated on body shape and weight.

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