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Eating Disorders


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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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