Eating Disorders

Eating Disorders

An eating disorder is a complex compulsion to eat in a way which disturbs physical, mental, and psychological health. The eating may be excessive (compulsive over-eating); to limited (restricting); may include normal eating punctuated with episodes of purging; may include cycles of binging and purging; or may encompass the ingesting of non-foods. The best-known eating disorders are Anorexia nervosa and Bulimia nervosa. The most widely and rapidly spreading eating disorder is compulsive overeating or Binge eating disorder. The three most common eating disorders are anorexia, bulimia and binge eating disorder. All three have severe consequences to a person's immediate and long-term health and can cause death. There are numerous theories as to the causes and mechanisms leading to eating disorders.

Eating disorders are characterized by an abnormal obsession with food and weight. Eating disorders are much more noticed in women than in men due to the fact that men often don't seek help. Over 50% of the people with an eating disorder also have a problem with depression.In addition, some individuals have food phobias about what they can and cannot eat, which can be characterized as an eating disorder.

Anorexia
Anorexia nervosa is an eating disorder characterized by low body weight and body image distortion. Individuals with anorexia often control body weight by voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. It primarily affects young adolescent girls in the Western world and has a high mortality rate, with approximately 10% of people diagnosed with the condition eventually dying due to related factors.
Anorexia is a life threatening condition that can put a serious strain on many of the body's organs and physiological resources. A recent review of the scientific literature outlined a number of reliable findings in this area. Anorexia puts a particular strain on the structure and function of the heart and cardiovascular system, with slow heart rate (bradycardia) and elongation of the QT interval seen early on. People with anorexia typically have a disturbed electrolyte balance, particularly low levels of phosphate which has been linked to heart failure, muscle weakness, immune dysfunction, and ultimately, death. Those who develop anorexia before adulthood may suffer stunted growth and subsequent low levels of essential hormones (including sex hormones) and chronically increased cortisol levels. Osteoporosis can also develop as a result of anorexia in 38-50% of cases, as poor nutrition leads to the retarded growth of essential bone structure and low bone mineral density.

Furthermore, changes in brain structure and function are early signs of the condition. Enlargement of the ventricles of the brain is thought to be associated with starvation, and is partially reversed when normal weight is maintained. Anorexia is also linked to reduced blood flow in the temporal lobes, although as this finding does not correlate with current weight, it is possible that it is a risk trait, rather than an effect of starvation.

Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).Anorexia is characterized by intense fear of gaining weight or becoming fat. Also disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

There are two subtypes of anorexia:
Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)
Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

Effects of Anorexia
Extreme weight loss
Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia.
Growth of lanugo hair over the body
Abnormalities of mineral and electrolyte levels in the body
Zinc deficiency
Often a reduction in white blood cell count
Reduced immune system function
Body mass index less than 17.5 in adults, or 85% of expected weight in children
Possibly with pallid complexion and sunken eyes
Creaking joints and bones
Collection of fluid in ankles during the day and around eyes during the night
Constipation
Very dry/chapped lips due to malnutrition
Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities
In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet
headaches, due to malnutrition

Signs of Anorexia
Excessive exercise, food restriction
Fainting
Secretive about eating or exercise behaviour
Possible self-harm, substance abuse or suicide attempts
Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialised nations, particularly through the media. A classic study by Garner and Garfinkel demonstrated that those in professions where there is a particular social pressure to be thin (such as models and dancers) were much more likely to develop anorexia during the course of their career, and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss.

Although anorexia nervosa is usually associated with Western cultures, exposure to Western media is thought to have led to an increase in cases in non-Western counties. However, it is notable that other cultures may not display the same 'fat phobic' worries about becoming fat as those with the condition in the West, and instead may present with low appetite with the other common features.

There is a high-rate of child sexual abuse experiences in those who have been diagnosed with anorexia (up to 50% in those admitted to inpatient wards, with a lesser prevalence among people treated in the community). Although prior sexual abuse is not thought to be a specific risk factor for anorexia those who have experienced such abuse are more likely to have more serious and chronic symptoms.

Bulimia
Bulimia nervosa, more commonly known as bulimia, is an eating disorder. It is a condition in which the subject engages in recurrent binge eating followed by an intentional purging. This purging is done in order to compensate for the excessive intake of the food and to prevent weight gain. Purging typically takes the form of vomiting; inappropriate use of laxatives, enemas, diuretics or other medication; excessive physical exercise; or fasting.

Signs of Bulimia
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.

Patterns of bulimic cycles
The frequency of bulimic cycles will vary from person to person. Some will suffer from an episode every few months while others who are more severely ill may binge and purge several times a day. Some people may vomit automatically after they have eaten any food. Others will eat socially but may be bulimic in private. Some people do not regard their illness as a problem, while others despise and fear the vicious and uncontrollable cycle they are in.

Subtypes of bulimia
The specific subtypes of bulimia are distinguished by the way the bulimic relieves themself of the binge.

Purging type
The purging type involves self-induced vomiting, laxatives, diuretics, enemas, or ipecac, as a means of rapidly extricating the contents from their body. This type is generally more found, and can use one or more of the above methods.

Non-Purging Type
This type of bulimia is rarely found (occuring in only approximately 6%-8% of cases), as it is a less effective means of ridding the body of such a large number of calories. This type of bulimia involves engaging in excessive exercise or fasting following a binge in order to counteract the large amount of calories previously ingested. This is frequently observed in purging-type bulimics as well, however this method is, by definition, not their primary form of weight control following a binge.

Consequences of bulimia
Malnutrition
Dehydration
Electrolyte imbalance
Hyponatremia
Damaging of the voice
Vitamin and mineral deficiencies
Teeth erosion and cavities, gum disease
Sialadenosis (salivary gland swelling)
Potential for gastric rupture during periods of binging
Esophageal reflux
Irritation, inflammation, and possible rupture of the esophagus
Laxative dependence
Peptic ulcers and pancreatitis
Emetic toxicity due to ipecac abuse
Swelling of the face and cheeks, especially apparent in the lower eyelids due to the high pressure of blood in the face during vomiting.
Callused or bruised fingers
Dry or brittle skin, hair, and nails, or hair loss
Lanugo
Edema
Muscle atrophy
Decreased/increased bowel activity
Digestive problems that may be triggered, including Celiac, Crohn's Disease
Low blood pressure, hypotension
Orthostatic hypotension
High blood pressure, hypertension
Iron deficiency, anemia
Hormonal imbalances
Hyperactivity
Depression
Insomnia
Amenorrhea
Infertility
Polycystic Ovary Syndrome
High risk pregnancy, miscarriage, still-born babies
Diabetes
Elevated blood sugar or hyperglycemia
Ketoacidosis
Osteoporosis
Arthritis
Weakness and fatigue
Chronic Fatigue Syndrome
Cancer of the throat or voice box
Liver failure
Kidney infection and failure
Heart failure, heart arrhythmia, angina
Seizure
Paralysis
Potential death caused by heart attack or heart failure; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, perforated ulcer, depression and suicide.