Eating Disorders

Eating Disorders: Facts About Eating Disorders and the Search for Solutions

Introduction

Anorexia Nervosa

Bulimia Nervosa

Binge-Eating Disorder

Treatment Strategies

Research Findings and Directions

References

 

There are many different factors included with eating, such as one’s appetite, the food available, family, peer, and cultural practices, and attempts at voluntary control. Today’s fashion trends, sale campaigns for special foods, activities and professions all influence people to diet to achieve a body weight that is leaner than needed for their health. This can cause eating disorders amongst many who are influenced by this  factors, the experience feelings of distress or extreme concern about their body shape or weight. When suffering from an eating disorder the person experiences serious disturbances in their eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating.

Uncovering Answers to Eating Disorders

There are a lot of questions to how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, have move beyond control for some people, resulting in the development of an eating disorder. Researchers are investigating further into these questions and have uncovered complexities in regards to the basic biology of appetite control and its alteration by prolonged overeating or starvation. This research has lead to pharmaceutical advances as treatment for these eating disorders.

Eating Disorders are a True Medical Illness

Many think that eating disorders are caused by a lack of will power or a behavioral problem, they are wrong. Eating disorders are true medical illnesses that can be treated professionally. For many this illness is a maladaptive pattern of eating that has taken over, making it difficult for the individual to stop without treatment.

Types of Eating Disorders

There are two main types of eating disorders: anorexia nervosa and bulimia nervosa. There is also a third that has been suggested been approved as a formal psychiatric diagnosis; binge-eating disorder.

When Eating Disorders Occur

It is common for an eating disorders to develop during adolescence or early adulthood. However some suffer an their onset  of an eating disorder during childhood or later in adulthood. Many eating disorders co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders. The majority of those suffering from eating disorders are females. A small percentile of male suffer from eating disorders. According to research an estimate of 5 to 15 percent of people with anorexia or bulimia and 35 percent of people with binge-eating disorders are males.

Health Risks

People who suffer from eating disorders often are in poor physical health due to complications. Many suffer from serious heart conditions and kidney failure which may lead to death. People with eating disorders often will be malnourished, some may even have dental disease. It is important to recognition of eating disorders as real and treatable diseases before the persons health is at risk.


Anorexia Nervosa

Anorexia Nervosa is a common eating disorder with 0.5 to 3.7 percent of females world wide suffering from it in their life time. It is common for those with anorexia nervosa to be resistant to maintaining body weight at or above the normal weight for their height and age. People suffering from eating disorders suffer from an intense fear of gaining weight or becoming fat, even though they are underweight. They see themselves differently than others, their in complete denial that they are underweight. It is not uncommon for women with anorexia nervosa to have infrequent or absent menstrual periods.

People suffering from anorexia nervosa see themselves as overweight even though they are dangerously thin. Their perception of themselves is altered and their eating becomes an obsession as a way to control their weight. When suffering from this disease their eating habits are unusual because the avoid food and meals, they will only eat certain foods and in small quantities, they will carefully weigh out their food and portion it so that they are unable put on weight. People with anorexia may obsessively check their body weight. Many use certain unhealthy techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics.

The outcome of anorexia nervosa varies with the individual. Some are able to reach full recovery from a single episode of anorexia. Others suffer fluctuating patterns of weight gain and relapse. Unfortunately there are some that experience a chronically deteriorating course of illness over many years.

Anorexia posses a dangerous risk on the person health and life. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. Those who are battling anorexia and loose their lives is commonly because of complications, such as cardiac arrest or electrolyte imbalance, and suicide.


Bulimia Nervosa

Bulimia Nervosa affects 1.1 percent to 4.2 percent of females within their life time. Many who suffer from bulima have 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. After their binge eating they will preform certain behaviors in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise. On average this will occur at least twice a week for 3 months. Their self-evaluation is unduly influenced by body shape and weight.

People with bulimia nervosa typically weigh within the normal range for their age and health because of the compensatory behavior that follows the binge-eating episodes. Just as those who suffer from anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often feeling disgusted and ashamed when they binge, yet relieved once they purge, they will hide these behaviors from others.


Binge-Eating Disorder

Binge-Eating disorder effects an approximately 2 percent to 5 percent of Americans. It is common for those who binge-eat to have recurrent episodes, 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. People who binge eat are eating much more rapidly than normal, they may eating until feeling uncomfortably full and often eating large amounts of food when not feeling physically hungry. Many people with binge-eating disorder will eat alone because of being embarrassed by how much they are eating. They are left feeling disgusted with themselves, depressed, or very guilty after overeating. It is common for binge eating occurs, on average, at least 2 days a week for 6 months.

People with binge-eating disorder are frequently out-of-control eating. This behavior is similar to those who suffer from Bulimia with the main difference being that people with binge-eating disorder do not purge their bodies of excess calories. This is why many with the disorder are overweight for their age and height. They will often repeat their binge-eating actions due to feelings of self-disgust and shame, creating a cycle of binge eating.


Treatment Strategies

It is possible for a person who is suffering from an eating disorder to be treated and restored to a healthy weight. It is important to diagnoses these diseases as soon as possible to provide the person with the best outcome. Eating disorders are complex and require a comprehensive treatment plan that involves medical care and monitoring, psychosocial interventions, nutritional counseling and pharmaceutical management. There are many health risks associated with eating disorders and some may require hospitalization, this will be determined by a clinician upon intake.

Anorexia Treatment

There are three phases involved with treatment for anorexia:

  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
  3. Achieving long-term remission and rehabilitation, or full recovery

The persons success rate is greatly increased with early diagnosis. They may be prescribed a psychotropic medication after they have gained weight as a way of controlling this behavior. Certain selective serotonin reuptake inhibitors (SSRIs) have too shown to be beneficial for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

Those suffering from eating disorders will often require an inpatient program. They require a program that provides feeding plans that are designed to address the person’s medical and nutritional needs. In some cases, intravenous feeding is recommended. Once weight gain has begun and the malnutrition treated, often cognitive-behavioral or interpersonal psychotherapy (forms of psychotherapy) can help them to overcome anorexia, low self-esteem and address distorted thought and behavior patterns. Family members are often included in the therapeutic process.

Bulimia Treatment

The goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To do so the person requires nutritional rehabilitation, psychosocial intervention, and medication management. Treatment will allow the person to establishment a pattern of regular, non-binge meals, and to improve their attitude towards this eating disorder. They will be encouraged to take part in healthy but not excessive exercise. They will receive treatment for co-occurring conditions such as mood or anxiety disorders.

Effective Treatment Options for Bulimia

  • Individual psychotherapy  cognitive-behavioral
  • interpersonal psychotherapy
  • group psychotherapy
  • family or marital therapy
  • Psychotropic medications

Most people who suffer from eating disorders are in denial or simply do not recognize that they are ill. Many will resist getting and staying in treatment. Friends and family can help to ensure that person that receiving this care and rehabilitation will help them to feel better and overcome their eating disorder. It is not uncommon that many require long term treatment to overcome their eating disorder.


Research Findings and Directions

Research is contributing to advances in the understanding and treatment of eating disorders.

  • NIMH-funded scientists and others continue to research the effectiveness of psychosocial interventions, medications, and the combination of these treatments in hopes of improving outcomes for people with eating disorders.
  • Research on interrupting the binge-eating cycle has shown that once a structured pattern of eating is established, the person experiences less hunger, less deprivation, and a reduction in negative feelings about food and eating. The two factors that increase the likelihood of binging—hunger and negative feelings—are reduced, which decreases the frequency of binges.
  • Several family and twin studies are suggest that anorexia and bulimia is hereditary, and researchers are working to uncover genes that confer susceptibility to these disorders. Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses. If scientist are able to identify these susceptibility genes they will be able to improvements to treatment for eating disorders.
  • Other studies are investigating the neurobiology of emotional and social behavior relevant to eating disorders and the neuroscience of feeding behavior.
  • Scientists have learned that both appetite and energy expenditure are regulated by a highly complex network of nerve cells and molecular messengers called neuropeptides. These and future discoveries will provide potential targets for the development of new pharmacological treatments for eating disorders.
  • Further insight is likely to come from studying the role of gonadal steroids. Their relevance to eating disorders is suggested by the clear gender effect in the risk for these disorders, their emergence at puberty or soon after, and the increased risk for eating disorders among girls with early onset of menstruation.

References

1American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 2000; 157(1 Suppl): 1-39.

2American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.

3Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of Medicine, 1999; 340(14): 1092-8.

4Andersen AE. Eating disorders in males. In: Brownell KD, Fairburn CG, eds. Eating disorders and obesity: a comprehensive handbook. New York: Guilford Press, 1995; 177-87.

5Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, Devlin M, Mitchell J, Hasin D, Horne RL. Binge eating disorder: its further validation in a multisite study. International Journal of Eating Disorders, 1993; 13(2): 137-53.

6Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry, 1995; 152(7): 1073-4.

7Bruce B, Agras WS. Binge eating in females: a population-based investigation. International Journal of Eating Disorders, 1992; 12: 365-73.

8Agras WS. Pharmacotherapy of bulimia nervosa and binge eating disorder: longer-term outcomes. Psychopharmacology Bulletin, 1997; 33(3): 433-6.

9Wilfley DE, Cohen LR. Psychological treatment of bulimia nervosa and binge eating disorder. Psychopharmacology Bulletin, 1997; 33(3): 437-54.

10Apple RF, Agras WS. Overcoming eating disorders. A cognitive-behavioral treatment for bulimia and binge-eating disorder. San Antonio: Harcourt Brace & Company, 1997.

11Strober M, Freeman R, Lampert C, Diamond J, Kaye W. Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes. American Journal of Psychiatry, 2000; 157(3): 393-401.

12Walters EE, Kendler KS. Anorexia nervosa and anorexic-like syndromes in a population-based female twin sample. American Journal of Psychiatry, 1995; 152(1): 64-71.

13Kaye WH, Lilenfeld LR, Berrettini WH, Strober M, Devlin B, Klump KL, Goldman D, Bulik CM, Halmi KA, Fichter MM, Kaplan A, Woodside DB, Treasure J, Plotnicov KH, Pollice C, Rao R, McConaha CW. A search for susceptibility loci for anorexia nervosa: methods and sample description. Biological Psychiatry, 2000; 47(9): 794-803.

14Frank GK, Kaye WH, Altemus M, Greeno CG. CSF oxytocin and vasopressin levels after recovery from bulimia nervosa and anorexia nervosa, bulimic subtype. Biological Psychiatry, 2000; 48(4): 315-8.

15Elias CF, Kelly JF, Lee CE, Ahima RS, Drucker DJ, Saper CB, Elmquist JK. Chemical characterization of leptin-activated neurons in the rat brain. Journal of Comparative Neurology, 2000; 423(2): 261-81.

16Devlin MJ, Walsh BT, Katz JL, Roose SP, Linkei DM, Wright L, Vande Wiele R, Glassman AH. Hypothalamic-pituitary-gonadal function in anorexia nervosa and bulimia. Psychiatry Research, 1989; 28(1): 11-24.

17Flanagan-Cato LM, King JF, Blechman JG, O’Brien MP. Estrogen reduces cholecystokinin-induced c-Fos expression in the rat brain. Neuroendocrinology, 1998; 67(6): 384-91.


This publication was originally written by Melissa Spearing, Office of Communications and Public Liaison, National Institute of Mental Health (NIMH). Rewritten by Kristin Nichols. Expert assistance was provided by NIMH Director Steven E. Hyman, M.D., and NIMH staff members Bruce N. Cuthbert, Ph.D., Regina Dolan-Sewell, Ph.D., Benedetto Vitiello, Ph.D., Clarissa K. Wittenberg, and Constance Burr. Editorial assistance was provided by Margaret Strock and Lisa D. Alberts, also NIMH staff members.

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