Eating disorders are considered critical attitudes, emotions, and eating behaviors. Minimized food intake, overeating, and the perceptions of body image, weight, and shape are some examples. There can be contributing factors and influences that develop the idea of an eating disorder. There are three types of eating disorders, binge eating disorder, anorexia nervosa, and bulimia nervosa. The two most common forms are anorexia nervosa and bulimia nervosa. According to the National Eating Disorder Association, “25% of girls 12-18 years old were reported to be engaged in problematic food and weight behavior” And in men and boys, according to the website nimh.
nih.gov, “one in four preadolescent cases of Anorexia occurs in boys, and binge-eating disorder affects females and males about equally”.
While the causes aren’t concise, some contributions can be cultural, personal characteristics, stress events or life changes, family, peers, and media. Individuals of low self-esteem or feeling useless can be a big contribution. For most adolescents they tend to compare themselves to others and they can develop an eating disorder because of this aspect.
For example if their friends have an eating disorder they may develop one because they want to fit it. Some adolescents can develop an eating disorder from a stressful event such as; teasing, transition from middle school to high school, or a more traumatic event like rape. Families can even contribute to a teen developing an eating disorder. If parents are fighting a lot or may be considering divorce, this can be stressful and some adolescents handle it by not eating or induce vomiting as a means to obtain control over their parents in the household or gain back the attention.
If the adolescent seems to feel like their life is spiraling out of control, they may feel like an eating disorder is a way to gain that control back. Also family studies show that anorexia nervosa, bulimia nervosa, and binge eating disorders do run in families. The heritability of anorexia nervosa is around 60%, and of bulimia nervosa can be 28 and 80%. For binge eating disorder currently it is 41%. According to some studies conducted across countries eating disorders can be influenced by genetic factors. Another large contribution to eating disorders is our societal views. According to the National Eating Disorder Association, we develop these ideas, beliefs, and attitudes about what is acceptable according to our culture.
To put this into perspective if our culture says your beautiful when you skinny, then some people believe that if they’re not skinny, they aren’t beautiful. Essentially since girls are generally valued for their appearance, they are likely the ones to internalize this idea into their thought process. The media also plays a role in the cultural and societal acceptance. A couple of examples that are very common are models and movie stars. Most often models are in every magazine, on every billboard, and in most commercials. Even T.V. shows like America’s Next Top Model gives children at a young age what the idea of “beautiful” is. Most movie stars aren’t overweight, which generally can contribute to both males and females being self-conscious about what the ideal appearance should be.
There are three kinds of aspects that deal with the development of an eating disorder; behavioral, mental, and physical. The National Eating Disorder Association explains the more we focus on thoughts and feelings of our weight and how we look the more we may be missing out on life overall. When we focus on weight and body image, it can become an obsession, which can contribute to emotional and physical issues. The mental aspect of an eating disorder focuses on the opinion of yourself or your self- esteem. Self-esteem and body image both go hand in hand when it comes to one’s body. Eating disorders not only deal with the mental and behavioral aspects, but those of physical as well can contribute. Anorexia and Bulimia can lead to serious health problems such as kidney failure, heart problems, dehydration, and in excessive cases malnutrition, which can lead to death. A study by the National Association of Anorexia Nervosa and Associated Disorders reported that, “The mortality rate associated with Anorexia nervosa is twelve times higher than the death rate associated with all causes of death for females 15-24 years old.” Anorexia nervosa is an eating disorder in which results in thinness through starvation.
It has the highest mortality rate of any psychological disorder, although we know little about the causes of this disorder. Generally the standard cause of death includes both effects of starvation and suicide. This is disorder is also known as a visible eating disorder, because most are noticeably thin, although some hide their thinness with big clothes or wearing layers. During this time this individual is not maintaining a normal or healthy weight for their age, height, or gender. Anorexia nervosa tends to have two forms first being starvation or restricting. These individuals reduce their caloric intake and increase physical activity to maintain an abnormally low weight. When your body goes into starvation mode, it can alter your body. The second form is either binge eating, purging, or can be both.
When anorexia nervosa is in its early stage these behaviors were seen in over half of the individuals. During anorexia nervosa a person can come to weigh less than 85% of the ideal body weight. Anorexia tends to occur during early adolescence or 10-12 years old. People who suffer from anorexia suffer from not only physical illness, but psychiatric too. Some include cognitive impairment, body-checking, low self-esteem, self-absorption, ritualistic behaviors, extreme perfectionism, and self-consciousness. The two most common psychiatric illnesses with anorexia are depression and anxiety. Some physical symptoms that may occur or develop over time are electrolyte imbalances (sodium and potassium levels), osteoporosis (decreased bone density), lanugo hair, dry brittle hair, low body temperature, low blood pressure, slowed heart rate, growth retardation, bloating, constipation, fidgeting, and loss of tooth enamel and dentin, and dehydration.
However, the official diagnosis of anorexia nervosa in females requires the absence of menstruation (amenorrhea), for at least three consecutive months. The deficiency of menstruation is a normal response to starvation and weight loss and the body will then shut down the reproductive functions. Treatment plans of Anorexia nervosa often depend on the individual’s needs which may include medical care and supervision, nutritional counseling and therapy. If they have had severe weight loss, hospitalization is essential to get them back to an appropriate weight. This individual will need assistance in developing new patterns of thought process in their eating patterns. The earlier detected the less treatment necessary. Depending on the individual and the amount of time they have had the eating disorder; treatment can take a short or long period of time. Each person varies in the recovering process of the disorder.
According to the National Association of Anorexia Nervosa and Associated Disorders, “Only 1 in 10 men and women with eating disorders receive treatment. Only 35% of people that receive that treatment for eating disorders get treatment at a specialized facility for eating disorders.” Bulimia nervosa is an eating disorder that is characterized by a binge and purge pattern. Unlike Anorexia, people who have Bulimia can be at a normal weight range, but still have that fear of weight gain and they are generally very unhappy with their body image, shape, and size. It is also an invisible eating disorder, because individuals are usually of normal weight or over-weight. It can be difficult to place a caloric intake on a binge, but most agree around 1,000 calories is the minimum; however it can be up to 20,000 calories. Bulimia, unlike Anorexia, usually occurs during late adolescence or early adulthood, about 18-22 years old. These individuals persistently follow the pattern of binging in combination with some form of compensatory behavior, which is intended to reverse the effects of the binge or prevent weight gain.
Compensatory behaviors include actions such as; self-induced vomiting, misuse of laxatives, diuretics, or other agents, fasting, and excessive exercise. The behavior of Bulimia may not be obvious because they do it in secrecy, because they feel a sense of shame and sickness of what they did. This pattern of binging and purging most likely occurs several times a week. Some data addresses a theory that individuals born after 1960 are at greater risk for the disorder, because it is more of a “modern occurrence” than anorexia. Usually more common in urban areas which suggests that environmental exposure and social learning play a role in the development of this disorder. This disorder is 9 times more common in females than males. Coincidentally, people with Bulimia also have psychiatric and physical aspects. It is estimated that 80% of individuals with bulimia have another psychiatric disorder.
The psychiatric features are depression, anxiety, low self-esteem, extreme perfectionism, self-consciousness, irritability, impulsive spending, shoplifting, and may or may not have substance abuse problems, although the most common are anxiety disorders, major depression, substance use, and personality disorders. The two most common personality features those similar to those who have anorexia nervosa, perfectionism and low self-esteem. People with bulimia are likely to be more impulsive and have higher stimulus or sensation-seeking behavior. They also have a tendency to exhibit more erratic and impulsive traits. Some physical symptoms of bulimia include; dehydration, electrolyte imbalance, kidney problems, inflamed sore throat from purging, acid reflux, swollen parotid glands, gastrointestinal complications, irregular menstruation, constipation, bloating, sensitive and decaying teeth and tooth enamel from stomach acids. Like Anorexia the treatment for Bulimia is essential for the individual’s health. For Bulimia there are a few more options such as; reducing or ending the binging or purging pattern, nutritional counseling, and cognitive behavioral therapy, prescribing medication, and accessing reasons for the illness.
About 70% of people who have the disorder of Bulimia recover from it. According to the DSM the criteria is specific for anorexia nervosa and bulimia nervosa. However, most people who have eating disorders do not meet the criteria. There is a different way of diagnosing these particular individuals which is by the Eating Disorder Not Otherwise Specified (EDNOS). According to the textbook, Abnormal Psychology the “DSM-IV lists six examples of how the symptoms of EDNOS differ from those of the other disorders. Patients may have: 1. all features of anorexia nervosa except amenorrhea. 2. all features of anorexia nervosa except drastic weight loss. 3. all criteria for bulimia nervosa except frequency of binge eating or purging or duration of 3 months. 4. regular, inappropriate compensatory behavior after eating small amounts of food. 5. chewing and spitting out food (purging disorder). 6. binge eating disorder (binging without compensatory behavior.”
Binge eating disorder is characterized by regular binge eating behaviors, but without the compensatory behaviors. Binge eating disorder or BED is a recent addition to the DSM, and is not yet an official psychiatric disorder. Since it was a recent addition little is known about its morbidity and mortality. Some research indicates that a person can be ill with BED for approximately 14.4 years which may suggest that BED is not just a temporary stage. The two most common forms of psychiatric disorders are depression and anxiety like most other eating disorders. Of females 3.5% meet the criteria of BED and of males 2%. BED is also found in approximately 5 to 8% of obese individuals. Eating disorders in females and males as discussed are not generally similar. In anorexia nervosa women and girls are more common to have this disorder than men and boys, essentially the ratio being 9 to 1. Many different theories have been presented as to why it affects women more than men. The most efficient theory is believed to be the increased pressure on females to have the ideal appearance or the “perfection” of the female body. Even though bulimia nervosa is also approximately 9 to 1, women to men can be somewhat sex-biased.
Men tend to rely on nonpurging forms of compensatory behavior after binge eating, rather use excessive exercise. It is male athletes that feel pressured to remain thin and fit and focus on their weight and body shape excessively. For binge eating disorder the sex ratio is equally balanced. The developmental factors of eating disorders can assist in determining the causes as well. In anorexia nervosa it generally uncommon during childhood, although it is occurring increasingly. Bulimia nervosa is usually seldom conveyed before puberty. In anorexia nervosa the disorder itself and the associated symptoms can lead to isolation from peers and family. It can also have negative effects on the family emotionally and financially. The parents especially undergo extreme anxiety and struggle to understand why their children are doing this to themselves and their body. All this stress and financial difficulties with the expense of treatment can weaken or ruin a family’s functioning. For bulimia girls who develop mature figures earlier than their peers may develop disappointment, which can lead to earlier experimentation to design controlled eating and weight, which could very well increase the risk of an eating disorder.
Binge eating generally begins in late adolescence or early adulthood. There are many treatments for eating disorders, the treatment goals for individuals with anorexia nervosa, bulimia nervosa, and binge eating disorder differ somewhat, although there are some aspects in common. The treatment goal of anorexia nervosa are increased caloric intake and weight gain so later treatments for psychological aspects of this disorder can be dealt with more effectively. For bulimia nervosa the focus is on the normalization of eating, elimination of binge eating and purging, and improvement of the psychological aspects of the disorder as well. For binge eating disorder individuals who are overweight the goal is to elimination of binge eating and normalization of eating. Also either weight stabilization or weight loss can be effective. In anorexia nervosa inpatient treatment can be accomplished by having a disciplined team to succeed.
The first and most important step is weight restoration. Weight is generally not the only factor to consider some other crucial factors such as medical complications, suicide attempts or plans, failure to improve with outpatient treatment, interference with school, work, or family, and pregnancy. Inpatient treatment is very difficult for the patient and the family as the patient is feared of giving up the symptoms, essentially the patient could have developed a phobia of food. It is important for the doctor to create a safe environment to make the patient feel safe and to also obtain the patients trust to make the hospitalization a success. Biological treatments include medications to assist in the cure of the disorder or assist in decreased symptoms of the disorder. Medications prescribed for anorexia nervosa have shown to be ineffective currently. In bulimia nervosa fluoxetine (Prozac) has been known to decrease the core symptoms of binge eating and purging and associated psychological features such as depression and anxiety. The FDA approved the treatment of fluoxetine for the treatment of bulimia nervosa, but for no other eating disorders.
Although fluoxetine reduces the symptoms it is still not found to reduce or have permanent remission on long-lasting effects. A treatment that is necessary but not a sufficient intervention for all eating disorders is nutritional counseling. An additional treatment that helps individuals change their thinking patterns that contribute to their problem is cognitive-behavioral therapy or (CBT). Recovery rates with CBT wavy from 35-75% at five or more years of follow-up. For anorexia nervosa some evidence suggests that CBT may reduce relapse in adults after weight has been restored. However it’s unclear how effective CBT is with individuals who are extremely underweight. For bulimia nervosa the basis of CBT is self-monitoring. The individuals keep track of what they eat, the situation they were in, and their thoughts and feelings. CBT focuses extensively on relapse prevention for all eating disorders. It is also an effective treatment for a binge eating disorder.
Binge eating disorders may first be offered a help-book or an online cognitive-behavioral program online to use at their own pace. For the family theories of anorexia nervosa a family-based intervention is directed to change the dysfunction of the family. This therapy can assist the family in being around healthier and a place to have open communication. Some modern approaches to family therapy for anorexia nervosa include conjoint family therapy, separated family therapy, parent training, and the Maudsley method, which focuses on parental control of the initial stages of renutrion. The seven values include working with experts who know how to help you, working together as a family, to not blame your child or yourself for the problems you are having, focusing on the problem before you, not debating with your child about eating or weight-related concerns, knowing when to begin backing off, and taking care of yourself because you are the child’s best hope.
In conclusion I have discussed and explained the three types of eating disorders; anorexia nervosa, bulimia nervosa, and binge eating disorder. I explained what factors can contribute to the development of an eating disorder. I deliberated three aspects of eating disorders such as the mental, behavioral, and physical. The analyzed the three eating disorders and gave a definition for each. I gave various personalities and other psychological dysfunctions that can come along with eating disorders. I expressed the sex ratios and developmental factors of eating disorders and explained the contributing factors for each. Also in discussing the symptoms of eating disorders lastly I identified some treatments that can assist in reducing symptoms and essentially preventing relapse. Some treatments that were acknowledged are inpatient treatment, biological treatments, nutritional counseling, cognitive-behavioral therapy, and family-based interventions.
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