Eating Disorders

What is eating disorders?

Eating disorders are serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder.

The eating disorders are classified to three main groups of anorexia nervosa, bulimia and binge-eating disorders. These conditions are serious disturbances in eating behavior and body image. Individuals with eating disorders are often concerned about weight, body shape and body image.

There are two subtypes of anorexia nervosa: a restrictive subtype and binge-purge subtype.

  • Restrictive: People with the restrictive subtype of anorexia nervosa place severe restrictions on the amount and type of food they consume.
  • Binge-Purge: People with the binge-purge subtype of anorexia nervosa also place severe restrictions on the amount and type of food they consume. In addition, they may have binge eating and purging behaviors (such as vomiting, use of laxatives and diuretics, etc.).

What are the risk factors of eating disorders?

Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Researchers are using the latest technology and science to better understand eating disorders. Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women.

There is a large body of clinical research describing the multiple functions of eating disorder behaviours. For instance, patients describe anorexia nervosa as providing a sense of control, a means of avoiding painful experiences, and a way of feeling special or different. Dominant themes expressed by patients with BN include bingeing and purging to avoid or manage emotions, and a method for staying slim. Both groups describe the disorder as a guardian, a friend, or as a means to increase attractiveness (Gale et al., 2006).

What are the presenting disorders of eating disorders?

Anorexia nervosa

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of only certain foods. Anorexia nervosa has the highest mortality rate of any mental disorder. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.

Symptoms include:

  • Extremely restricted eating
  • Extreme thinness (emaciation)
  • A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
  • Intense fear of gaining weight
  • Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

  • Thinning of the bones (osteopenia or osteoporosis)
  • Mild anemia and muscle wasting and weakness
  • Brittle hair and nails
  • Dry and yellowish skin
  • Growth of fine hair all over the body (lanugo)
  • Severe constipation
  • Low blood pressure, slowed breathing and pulse
  • Damage to the structure and function of the heart
  • Brain damage
  • Multiorgan failure
  • Drop in internal body temperature, causing a person to feel cold all the time
  • Lethargy, sluggishness, or feeling tired all the time
  • Infertility

Bulimia nervosa

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.

Symptoms include:

  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging of fluids
  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to stroke or heart attack

Binge-eating disorder

People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms include:

  • Eating unusually large amounts of food in a specific amount of time
  • Eating even when you’re full or not hungry
  • Eating fast during binge episodes
  • Eating until you’re uncomfortably full
  • Eating alone or in secret to avoid embarrassment
  • Feeling distressed, ashamed, or guilty about your eating
  • Frequently dieting, possibly without weight loss

What are the health impacts of eating disorders?

  • Anemia
  • Damage to bone and muscles and joints
  • Poor immune system
  • Infertility
  • Hair loss
  • Damage to nails
  • Bad mood
  • Poor memory
  • Anxiety and depression
  • Easily tired
  • Low energy
  • Heart diseases
  • Poor sex drive
  • Abnormal periods in women
  • feeling cold
  • Low blood pressure
  • Constipation

What laboratory work ups might be requested?

The following laboratory work ups might be requested to investigate the health effects of eating disorders on your body:

  • CBC
  • Electrolytes
  • Vitamin B12, B1
  • Calcium and vitamin D
  • TSH
  • Serum Phosphate
  •  Serum magnesium

Diagnostic tests

  • ECG to monitor for arrhythmia and QTC prolngation

How are eating disorders managed?

The eating disorders are notoriously challenging to treat due to high levels of ambivalence about
change. Many patients, especially adolescents, experience negative consequences of their eating disorder but nevertheless avoid treatment because they fear that recovery will result in more costs than benefits.

Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment. Treatment plans are tailored to individual needs and may include one or more of the following:

  • Individual, group, and/or family psychotherapy
  • Medical care and monitoring
  • Nutritional counseling
  • Medications

Psychotherapies

Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression.

References

  • https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
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