Eating Disorders
Definition
Generally, eating disorders involve self-critical, negative
thoughts and feelings about appearance and food, and eating
behavior that harms normal body composition and functioning. A
person with anorexia nervosa typically starves herself to be
thin and experiences excessive weight loss. A person with
bulimia nervosa may experience weight fluctuations, but rarely
the low weight associated with anorexia. Bulimia nervosa is
characterized by binge-eating and purging. Both disorders may
also be characterized by compulsive exercise. Unfortunately,
many teens successfully hide these disorders from their families
for months or years.
People with binge-eating disorder experience frequent
episodes of out-of-control eating, with the same binge-eating
symptoms as those with bulimia. The main difference is that
individuals with binge-eating disorder do not purge their bodies
of excess calories. Therefore, many with the disorder are
overweight for their age and height. Feelings of self-disgust
and shame associated with this illness can lead to bingeing
again, creating a cycle of binge-eating.
Eating disorders involve serious disturbances in eating
behavior, such as extreme and unhealthy reduction of food intake
or severe overeating, as well as feelings of distress or extreme
concern about body shape or weight. Researchers are
investigating how and why initially voluntary behaviors, such as
eating smaller or larger amounts of food than usual, at some
point move beyond control in some people and develop into an
eating disorder. Studies on the basic biology of appetite
control and its alteration by prolonged overeating or starvation
have uncovered enormous complexity, but in the long run have the
potential to lead to new pharmacologic treatments for eating
disorders.
Compulsive exercising or over-exercising may be an offshoot
from eating disorders in teens, especially girls. Exercise in
moderation is the desired goal for teens. However, in extreme
cases, demands of activities such as sports, dance, or social
expectations, may lead to diets and exercise in unhealthy
amounts. Among other concerns, these teens may be more prone to
injuries as well as the complication of psychological issues.
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Symptoms
Anorexia danger signs include:
- Significant weight loss
- Continual dieting
- Feelings of fatness, even after weight loss
- Fear of weight gain
- Lack of menstrual periods
- Preoccupation with food, calories, nutrition, and/or
cooking
- Preference to eat in isolation
- Compulsive exercise
- binge-eating and purging
- Brittle hair or nails
- Depression
Anorexia nervosa occurs less frequently than bulimia though
the overall prevalence of both may be increasing.
Bulimia danger signs include:
- Uncontrollable eating
- Purging by strict dieting, fasting, vigorous exercise, or
vomiting
- Abuse of laxatives or diuretics to lose weight
- Frequent use of the bathroom after meals
- Reddened finger(s)
- Swollen cheeks
- Preoccupation with body weight
- Depression or mood swings
- Irregular menstrual periods
- Dental problems, such as tooth decay
- Heartburn or bloating
- Bulimia is probably more common in people of normal weight
Binge-eating danger signs include:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically
hungry
- Eating alone because of being embarrassed by how much one
is eating
- Feeling disgusted with oneself, depressed, or very guilty
after overeating
Other symptoms of binge-eating include:
- Recurrent episodes of binge-eating, characterized by
eating an excessive amount of food within a discrete period
of time and by a sense of lack of control over eating during
the episode
- Marked distress about the binge-eating behavior
- The binge-eating occurs, on average, at least 2 days a
week for 6 months
- The binge-eating is not associated with the regular use of
inappropriate compensatory behaviors (e.g., purging,
fasting, excessive exercise)
- Anorexia nervosa may be diagnosed with or without
binge-eating or purging
(American Psychiatric Association, 1994).
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Causes
Different types of emotional stress, such as depression
caused by a biological problem or difficulties adapting to
problems within the family, may lead to a disturbance in a child
or teen's relationship with nutrition.
Sometimes, problems at home (such as drug or alcohol abuse)
may be risk factors. The eating disorder may be the child's way
of coping with the problems encountered in her home life.
Some research suggests that media images contribute to the
rise in the incidence of eating disorders. Girls as well as boys
may try to emulate a media ideal by drastically restricting
their eating and compulsively exercising.
Though untrue in the recent past, current school of thought
generally agrees that there is no relationship between feeding
disorders of children (Pica, Rumination Disorder) and eating
disorders of adults (Morrison, 1995).
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Treatment
Eating disorders can be treated and a healthy weight
restored. The sooner these disorders are diagnosed and treated,
the better the outcomes are likely to be. Because of their
complexity, eating disorders require a comprehensive treatment
plan involving medical care and monitoring, psychosocial
interventions, nutritional counseling and, when appropriate,
medication management. At the time of diagnosis, the clinician
must determine whether the person is in immediate danger and
requires hospitalization.
Hospitalization occurs when a child, teen or adult is
severely malnourished. In-hospital treatment for eating
disorders lasts an average of 2 months, followed by outpatient
aftercare, which may last several more months.
The focus of treatment for eating disorders is helping
patients cope with their disordered eating behaviors and
thinking. Treatment includes medical supervision, nutritional
restoration, and behavioral therapy, which address beliefs about
body size, shape, eating, and foods.
Whatever the reason for the eating disorder, if parents and
children, for younger patients, can work together to understand
the problem, the results will be more favorable. Generally, the
earlier the intervention, the shorter the treatment period.
Treatment of anorexia calls for a specific program that
involves three main phases: (1) restoring weight lost to severe
dieting and purging; (2) treating psychological disturbances
such as distortion of body image, low self-esteem, and
interpersonal conflicts; and (3) achieving long-term remission
and rehabilitation, or full recovery. Early diagnosis and
treatment increases the treatment success rate. Use of
psychotropic medication in people with anorexia should be
considered only after weight gain has been established. Certain
selective serotonin reuptake inhibitors (SSRIs) have been shown
to be helpful for weight maintenance and for resolving mood and
anxiety symptoms associated with anorexia.
The acute management of severe weight loss is usually
provided in an inpatient hospital setting, where feeding plans
address the person's medical and nutritional needs. In some
cases, intravenous feeding is recommended. Once malnutrition has
been corrected and weight gain has begun, psychotherapy (often
cognitive-behavioral or interpersonal psychotherapy) can help
people with anorexia overcome low self-esteem and address
distorted thought and behavior patterns. Families are sometimes
included in the therapeutic process.
The primary goal of treatment for bulimia is to reduce or
eliminate binge-eating and purging behavior. To this end,
nutritional rehabilitation, psychosocial intervention, and
medication management strategies are often employed.
Establishment of a pattern of regular, non-binge meals,
improvement of attitudes related to the eating disorder,
encouragement of healthy but not excessive exercise, and
resolution of co-occurring conditions such as mood or anxiety
disorders are among the specific aims of these strategies.
Individual psychotherapy (especially cognitive-behavioral or
interpersonal psychotherapy), group psychotherapy that uses a
cognitive-behavioral approach, and family or marital therapy
have been reported to be effective. Psychotropic medications,
primarily antidepressants such as the selective serotonin
reuptake inhibitors (SSRIs), have been found helpful for people
with bulimia, particularly those with significant symptoms of
depression or anxiety, or those who have not responded
adequately to psychosocial treatment alone. These medications
also may help prevent relapse. The treatment goals and
strategies for binge-eating disorder are similar to those for
bulimia, and studies are currently evaluating the effectiveness
of various interventions.
People with eating disorders often do not recognize or admit
that they are ill. As a result, they may strongly resist getting
and staying in treatment. Family members or other trusted
individuals could be helpful in ensuring that the person with an
eating disorder receives needed care and rehabilitation. For
some people, treatment may be long term.
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