Eating disorder

An eating disorder is a complex compulsion to eat, or not eat, in a way which disturbs physical and mental health. Often the symptoms can seem as extreme, or as extensions of culturally acceptable behavior and preoccupations. The eating may be excessive (compulsive over-eating); too 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 most commonly known eating disorders are Anorexia nervosa and Bulimia nervosa. The most widely and rapidly spreading eating disorder is compulsive overeating or Binge eating disorder. These are also the three most common eating disorders. All three can cause severe, immediate and long-term health issues and can cause death. There are numerous theories as to the causes and mechanisms leading to eating disorders.

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Types

• Anorexia nervosa
• Starvation diet
• Binge eating disorder
• Bulimia nervosa
• Diabulimia
• Eating disorder not otherwise specified
• Orthorexia
• Hyperphagia
• Rumination
• Pica
• Night eating syndrome

Eating disorders such as Anorexia, Bulimia, and Binge Eating disorder are characterized by extreme emotions, attitudes and behaviors surrounding weight and food issues, and a disconnected understanding of one’s body. Eating disorders are also a gendered health issue, affecting women at a disproportionate rate than men. Of the 5 million people reported to suffer from eating disorders in the United States, 4 million are women and 1 million are men (The National Association of Anorexia Nervosa and Associated Disorders). Even within this statistic are a wide range of women with varied backgrounds and life experiences. In order to fully understand eating disorders, like any disease, the prevalence must be understood within the context of social and cultural factors, including age, race, gender, sexual orientation and socio-economic class.

It is commonly understood that eating disorders can be attributed to the pressure society puts an women to be thin, and men to be 'bulked up'. This can lead to pressure on women to be 'picture perfect.' Eating disorders prevail when these unattainable goals and cultural standards become internalized and necessary for survival and success. Researchers who study eating-disordered thoughts and behaviors suggest that the media, advertising, women's magazines in particular and the rise of the diet industry that commodifies the body, may play a role in triggering these practices [1]. Interestingly, as women's empowerment has increased, so has the prevalence of eating disorders, since thinness has become a necessity for the modern woman, representing beauty, self-control, achievement and success. ^[1] Thinness has also become an answer to the "modern woman dilemma," where women are torn between conflicting and contradictory roles - you can do anything and be anything, but must also be beautiful. Thinness for the new women, combines qualities of self control, competition and success with qualities required from the conflicting traditional woman, i.e. attractiveness, weakness and helplessness.^[2] While the media is a powerful force of influence, sending messages about the body and how it should look, it is not the only element influencing the development of eating disorders.

Anorexia Nervosa

The American Psychiatric Association [2] defines anorexia nervosa as the presence of an abnormally low body weight (15% below normal body weight for age and height), the intense fear of gaining weight or becoming fat, disturbance and preoccupation with body weight and shape, and amenorrhea (the absence of three consecutive menstrual cycles). Anorexia can be life-threatening as victims commonly refuse to eat and drastically lose weight in which causes the lack of nutrients within the their body. Anorexics are commonly perfectionists, driven to succeed; yet they set unattainable standards of performance for themselves. When they fail to meet these standards, they look for a part of their lives they can control; food and weight become that “control” for them. Low self-esteem and constant self-criticism cause anorexics to constantly fear losing control, and even consuming a small amount of food could be considered a loss of control [3]. One thousand women die of anorexia nervosa each year, and millions more suffer from the destructive physical complications [4].

Bulimia Nervosa

Bulimia nervosa is characterized by the recurrent episodes of bingeing (eating large quantities of food over short periods of time) followed by attempts to compensate for the excessive caloric intake by such purging behaviors as self-induced vomiting, laxative abuse, severe restrictive dieting or fasting, or excessive exercise ^[3]. Bulimics often have "binge food," which is the food they typically consume during binges. Some have described their binge episodes as a physical high they feel, numbing out, going into auto-pilot, losing all control, immediate comfort, etc. The reasoning or triggers behind a binge may serve different purposes for different people. This binge episode leads the individual to feel guilt, shame, embarrassment, and complete failure. Bulimics try to regain control of themselves and the situation by purging the food – making up for their mistake. This leads to feeling famished and empty again, and therefore, another uncontrollable binge, followed by feeling powerless, and the vicious binge/purge cycle continues. Bulimics have extreme eating and exercising habits, instead of demonstrating moderation. This compulsive behavior is often echoed in similar destructive behavior such as sexual promiscuity, pathological lying, and shoplifting. Some bulimics not only struggle with the eating disorder, but these other harmful behaviors as well.

Binge-Eating Disorder

This is often referred to as Compulsive Overeating. Binge-eating disorder is similar to bulimia in the recurrent episodes of bingeing; however, binge-eaters do not engage in any purging behavior or attempt to rid themselves of the food in any way ^[4]. Binges often take place in secret, when the person is alone, since feelings of shame and disgust often accompany the binge. Binge eaters typically eat very rapidly, hide food, and stuff themselves to the point of feeling sick. Some binge eaters may eat to fill an emotional void or spiritual emptiness they feel, in a desperate effort to be satisfied. This is called emotional eating, which is a coping mechanism for stress, depression, anxiety, anger, and many other negative emotions.

Patients with eating disorders may also have a comorbid diagnosis of, mood disorder, severe mental depression,^[5] Obsessive compulsive disorder, Body dysmorphic disorder, Bipolar disorder, self-harm^[6] personality disorders and substance abuse disorders. Sexual abuse is also frequently reported among those with eating disorders. Women with eating disorders show poorer eating self-efficacy, psychological distress, disinhibition, low self-esteem, less helpful coping strategies, more frequent sensations of hunger, and less cognitive restraint when compared to control groups.^[7]

Some psychologists also classify a syndrome called orthorexia as an eating disorder, or, more properly, "disordered eating" - the person is overly obsessed with the consumption of what they see as the 'right' foods for them, to the point that their nutrition and quality of life suffers (although due to cultural and political factors which influence food choices, this idea is considered controversial by some). In addition, some individuals have food phobias about what they can and cannot eat, which can be characterized as an eating disorder. The UK broadcaster BBC Three have shown a series called Freaky Eaters that deals with such topics.

Somewhat qualitatively different from those conditions previously mentioned is pica, or the habitual ingestion of inedibles, such as dirt, wood, hair, etc.

The American Psychiatric Association recognizes eating disorders.

Causes and mechanisms

Environmental factors

The media may be a significant influence on eating disorders through its impact on values, norms, and image standards accepted by modern society ^[8]. Both society’s exposure to media and eating disorders have grown immensely over the past decade. Researchers and clinicians are concerned about the relationship between these two phenomena and finding ways to reduce the negative influence thin-ideal media has on women’s body perception and susceptibility to eating disorders. The dieting industry makes billions of dollars each year by consumers continually buying products in an effort to be the ideal weight. Hollywood displays an unrealistic standard of beauty that makes the public feel incredibly inadequate and dissatisfied and forces people to strive for an unattainable appearance. This takes an enormous toll on one's self-esteem and can easily lead to dieting behaviors, disordered eating, body shame, and ultimately an eating disorder.

Family Relationships

Many studies have found that women lack control over their bodies ^[9]. Especially in conditions of criticism and coercive parental control during childhood, women use food refusal to gain autonomy and control over their environment. Many studies have showed that many women who experienced physical or sexual abuse as a child end up with eating disorders as a method of punishing oneself due to the feeling of being worthless, or to strive to be “good enough” so they can finally receive the love and acceptance they lacked during childhood. Women may have developed low self-esteem and poor body image, but they can find achievement in abiding by food rules; they gain a sense of control and independence in being disciplined and avoiding "bad" food. These distorted thoughts are correlated with perfectionism and obsessiveness, giving women a false sense of control when, in reality, the eating disorder has totally consumed them.

Biological/Genetic factors

Research has shown that many people who suffer from an eating disorder are highly correlated with having depression and obsessive compulsive disorder. Depressed, obsessive compulsive and bulimic patients were found to have lower than normal serotonin levels ^[10]. Neurotransmitters, such as serotonin, dopamine, and norepinephrine, are released as you eat ^[11].

Researchers have also found low cholecystokinin levels in bulimics. Cholecystokinin is a hormone that causes one to feel full and decreases eating ^[12]; ^[13]. People who are lacking this hormone are more likely to lack feeling satisfaction while eating which can lead to binge eating. Another explanation researchers found for over eating is abnormalities in the neuromodulator peptides, neuropeptide Y and peptide YY ^[14]; ^[15]. Both of these peptides increase eating and work with another peptide called leptin. Leptin is released by fat cells and is known to decrease eating. Research found the majority of people who overate produced normal amounts of leptin but they might have complications with the blood-brain barrier preventing an optimal amount to reach the brain ^[16].

Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism ^[17]. High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus ^[18]. A study in London at Maudsley Hospital found that anorexics were found to have a large variation of serotonin receptors and a high level of serotonin ^[19]

Many of these chemicals and hormones are associated with the hypothalamus in the brain ^[20].Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level ^[21]. Uher & Treasure (2005) performed a study researching brain lesions effects on eating disorders. They evaluated 54 formally published cases of eating disorders and brain damage. They found many correlations between eating disorders and damage to the hypothalamus. People with brain lesions in the hypothalamus had abnormal eating behaviors; unprovoked and self induced vomiting, over concern with becoming fat, cheating with eating, frequent sleepiness, depression, obsessive compulsive behavior and diabetes insipidus ^[22]

Addiction

The same personality factors that place individuals at risk for substance abuse are often found in individuals with eating disorders. With addiction and eating disorders there is a need to discharge affective experience through action rather than feeling or being able to talk about them, an inability to regulate tension, the need for immediate gratification, poor impulsive control, and a fragile sense of self. Often in those with eating disorders and substance abuse problems drugs or alcohol is used in attempts to avoid binge eating. Similarly, those with eating disorders may deny their problem or attempt to keep it a secret, much like addicts try to conceal their drug and alcohol usage. Similar to genetic components of addiction, there is a large genetic component to body type.^[7]

Developmental etiology

Research from a family systems perspective indicates that eating disorders stem from both the adolescent's difficulty in separating from over-controlling parents, and disturbed patterns of communication. When parents are critical and unaffectionate, their children are more prone to becoming self-destructive and self-critical, and have difficulty developing the skills to engage in self-care giving behaviors. Such developmental failures in early relationships with others, particularly maternal empathy, impairs the development of an internal sense of self and leads to an over-dependence on the environment. When coping strategies have not been developed in the family system, food and drugs serve as a substitute.^[7][23]

A Response to Trauma

Eating Disorders should also be understood in the context of experienced trauma, with many eating problems beginning as survival strategies rather than vanity or obsession with appearance. According to sociologist Becky Thompson, eating disorders stemming from trauma are actually, "sensible acts of self-preservation in response to myriad injustices including racism, sexism, homophobia, classism, the stress of acculturation and emotion, physical and sexual abuse. ^[24] In her book A Hunger So Wide and So Deep, Thompson interviews eighteen women of varying socio-economic status, sexual orientation and race, and finds that eating disorders and a disconnected relationship with ones body is commonly a response to environmental stresses, including sexual, physical, and emotional abuse, racism, and poverty. This reality is further detrimental for women of color and other minority women, since they are forced to live in a culture that embraces a narrowly defined conception of beauty: "people furthest from the dominant ideal of beauty, specifically women of color, may suffer the psychological effects of low self-esteem, poor body image, and eating disorders." ^[25] For minority women, being part of multiple subordinate groups, often silenced by mainstream media and culture, compounds the likelihood that injustice and oppression will be played out within the body, as social injustice is internalized and eating disorders develop as a way to cope with the stress.

References

Journal references

• Agras, W. Steward, MD (2004). "The consequences and costs of the eating disorders". The psychiatric clinics of North America 24 (2): 371.: An excellent current article on the consequences of eating disorders, the costs to families and institutions.

• Crow, S., Praus, B., and Thuras, P. (1999). "Mortality from Eating Disorders—A 5- to 10-Year Record Linkage Study". International journal of eating disorders 26: 97.

• Crow, S., Nyman, J. (2004). "The Cost-Effectiveness of Anorexia Nervosa Treatment". International journal of eating disorders 35 (2): 155.

• Lauer, C.J., Krieg, J.C. (2004). "Sleep in eating disorders". Sleep Medicine Review 8 (2): 109.

• Meads, C., Gold, L., and Burls, A. (2001). "How effective is outpatient care compared to inpatient care for the treatment of Anorexia Nervosa? A systemic review". European eating disorders review 9 (4): 229.

• Zeeck, A., Herzog, T., and Hartman, A. (2004). "Day clinic or inpatient care for severe Bulimia Nervosa". European eating disorders review 12 (2): 79.

• Zipfel, S., et al (2000). "Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study". Lancet (North American Edition) 355 (9205): 721.

Book references

• Abigail Natenshon, editor (1999). When Your Child Has an Eating Disorder: A Step-By-Step Workbook for Parents and Other Caregivers. Jossey Bass. ISBN 0-7879-4578-1. 

• Thompson, K. J., editor (2003). Body Image, Eating Disorders, and Obesity: An Integrative Guide for Assessment and Treatment. APA Books. ISBN 1-55798-726-2.