rdwornit@lhup.edu

An eating disorder is a psychological disorder where an individual suffers delusions in regards to weight and food.   About 11 million people suffer from anorexia or bulimia in the United States alone.  It is estimated that another 25 million are suffering from binge eating disorder.  Imagine the amount of reports that go undetected due to the secretiveness of these disorders.

Anorexia nervosa is an psychological disorder that deals with lack of eating and excessive exercise.  People who are diagnosed try hard to make things in their life "perfect."  They like to have control and feel more in control with strict diet controls. 

• 90-95% of people who suffer from Anorexia are female.

• Anorexia has one of the highest death rates among psychological disorders.

• Anorexia usually develops in adolescence.

• 0.5-1% of women suffer from Anorexia in United States.

Diagnostic Material:

1. Resistance in maintaining body weight.

2. Fear of weight gain even though individual is underweight.

3. Lost of menstrual cycle in females.

4. Denial of low body weight and/ or disturbance of body shape or weight.

Warning Signs:

Bulimia Nervosa is a psychological disorder that deals with binge eating and then inappropriate ways of releasing food (purging).  These ways include vomiting, enemas, use of laxatives and diuretics, and excessive exercise.

• It is estimated that about 80% of bulimic patients are female.

• People suffering from bulimia are usually average weight.

• People suffering from bulimia usually are aware that they are endangering their health.

• Depression is associated with bulimia.

Diagnostic Material:

Warning Signs:

Binge eating disorder (BED) is repeated binge eating with no control and by taking no measures to make up for it.

• Estimated to affect 1-5% of people in the United States.

• BED affects females only slightly more than males.

• BED is associated with depression.

Diagnostic Material:

Warning Signs:

Dental Health Concerns:

Most people with an eating disorder decide to seek treatment based on problems with their teeth.  Dentists are sometimes the first to see the disorder.  Because of the acid in the vomit, 89% of bulimics suffer tooth erosion.  Lack of nutrition also causes destructive problems on the teeth.

• Symptoms that occur due to eating disorders are:

• Loss of tissue and erosion on teeth

• changes in teeth, such as brittle and discolored.

• Increased sensitivity to temperature.

• Dry mouth, cracked lips, and enlargement of the salivary glands.

• Tooth decay due to excessive tooth brushing.

Other Health Concerns:

Anorexics are lacking in essential nutrients due to the small amount of food intake.  Because these nutrients are needed to function properly, the body slows down all processes to conserve energy.

Consequences due to anorexia:

• Abnormally slow  heart rate and low blood pressure with an increase in risks of heart failure.*

• Osteoporosis.

• Muscle loss and weakness.

• Kidney failure due to dehydration.*

• Hair loss.*

• Growth of lanugos to keep the body warm.

• Liver failure.*

• Anemia.*

• Constipation.*

• Icy hands and feet.*

• Death from malnutrition.*

* occurs in both anorexics and bulimics

The digestive system is highly affected in bulimics due to the binging and purging.

Consequences due to bulimia:

• Potential for gastric rupture while purging.

• Inflammation and possible rupture of esophagus due to repeated vomiting.

• Peptic ulcers and pancreatitis.

BED is similar to the consequences of obesity.

Consequences due to binge eating:

• High blood pressure and cholesterol levels.

• Heart disease.

• Type II diabetes.

• Gallbladder disease.

• Increased risk of bowel, breast, and reproductive cancers.

Dieting is an attempt to lose weight by "healthy eating" or denying essential, well-balanced nutrients and calories that the body needs to function.

• The amount of money spent on dieting and diet products each year is about equivalent to the amount of money the government spends on education each year ($40 billion).

• Roughly, about 91% of women in college have dieted with 22% dieting quite often.

• About 40-60% of high school girls are dieting with about 46% of 9-11 year olds dieting.

• One study has found that roughly, 42% of first through third graders want to be thinner. 

• About 95% of dieters regain their weight within 5 years.

Dangers of dieting:

• "yo-yo" dieting- repeated cycles of gaining and losing weight.  Has been found to increase risks of heart disease and has negative impacts on metabolism.

• Dieting leaves out nutrients, needed by the body, which can lead to illness.

• Physical consequences such as weakness, dehydration, and electrolyte imbalances.

• Brain power consequences include slower reaction time, stress, anxiety, ect.

• Most eating disorders develop after someone has been dieting!

Orthorexia:

Orthorexia is an obsessive fixation with eating healthy causing severe weight loss.  Orthorexics are people who strive more for purity in eating habits rather than being thin, and stress over what type of food they are eating rather than how much they are eating.  People who suffer from this also have similar traits that are related to obsessive-compulsive disorder (OCD).  They worry excessively over strict meals and exercise to the point where they socially isolate themselves.

Disorder or Not?

So is this an eating disorder?  Some people believe that this is not a disorder of its own.  They consider it to be another name for anorexia.  Others believe that it should be considered an eating disorder because it is not dealing with food quantity, like anorexia, but food quality. 

Athletics:

The pressure to be thin is in athletics as well, especially in college.  The NCAA found in 1992 that 70% of the athletes, participating in their sponsored events, had an eating disorder within the previous two years.

Sports highly correlated with EDs:

• gymnastics

• figure skating

• dancing

• synchronized swimming

• track

• cross country

Amenorrhea:

Some female athletes suffer from amenorrhea (absence of menstruation).  This is also a symptom of eating disorders.  In a study that involved eleven division 1 schools, researchers found that there are higher rates of amenorrhea among cross country and gymnastics.  About 70% of these female athletes were found to have an eating disorder.

The Hypothalamus:

The hypothalamus, a part of the brain, plays a big part in hunger and satiety.  The ventromedial hypothalamus (VMH) controls satiety and the lateral hypothalamus (LH) controls hunger.  Studies have shown that lesions in the VMH result in hyperphagia (overeating) and lesions in the LH result in aphagia (undereating).   Some peptides that are involved in satiety include colecystokinin (CCK), glucagon, and somatostatin.  These peptides help to inform the body when to stop eating. 

Neurotransmitters and the hypothalamus:

Serotonin:

It has been found that people who suffer from anorexia have increased levels of serotonin and those who suffer from bulimia have decreased levels of serotonin. Dieting can also result in lowering serotonin levels, more in women than in men.  This may be one reason why women are more prevalent to eating disorders than men. 

Dopamine:

Both the hypothalamic-pituitary-adrenocortical (HPA) axis and the corticotrophin-releasing hormone (CRH) have an affect on eating disorders.  With reduced food intake and increased levels of exercise, the activity of the HPA and CRH increase.  The CRH then increases the levels of dopamine, which deals with rewarding behaviors.  The CRH also increases noradrenline, which deals with selective attention.  With an increase in both the dopamine and noradrenline, the person feels rewarded for behaviors and focuses more attention than usual on these rewards.  For example, a anorexic restricts food intake and exercises obsessively, activating her CRH and HPA levels.  This then increases the her levels of dopamine and noradrenline, thus bringing more attention to the rewards of her abnormal eating habits.

Leptin:

Leptin is responsible for letting the brain know whether the levels of energy, stored as fat, are low or not.  When leptin levels increase, the levels of energy in stored fat are low.  This also decreases thyroid hormone levels to decrease metabolic requirements and conserve energy. 

Leptin also has an affect on neuropeptide NPY, which regulates food intake and energy expenditure.  When leptin levels are low, energy stored as fat is high, and NPY increases to restrict the amount of food brought in as well as increasing the sympathetic nervous system and energy expenditure. 

Cocaine and amphetamine-related peptide (CART) and melanin concentrating hormone (MCH) are regulated by leptin.  CART inhibits food intake, is related to reward in the brain, and is responsible for the suppressed appetite in drug abusers.  MCH regulates skin color by affecting the melanosomes as well as helping to reduce food intake. 

Personality Traits:

There are psychological disorders that correlate with eating disorders.  Individuals who suffer from bulimia have similar traits to those who suffer from panic and impulse-control disorders such as borderline personality disorder and obsessive compulsive disorder.  Perfectionism and self-harming thoughts also coincide with eating disorders.

Genetics:

Heritability for anorexia is around 58-76% and for bulimia, 59-83%.  Individuals with relatives who have suffered an eating disorder are 7-12 times more likely to develop an eating disorder as compared with individuals with relatives who do not have any eating disorders.

In one study, looking for which genes would be involved in EDs, a linkage analysis in families who had at least two diagnosis of anorexia was performed.  A high link was found  on chromosome 1.  In another study, a linkage analysis was done in families who had a tie with bulimia.  They found a high link on the chromosome 10. 

Researchers also did twin studies using both identical and fraternal twins.  Because there are multiple genes and environmental factors that affect the outcome of an eating disorder, they has three pockets of variance.  These three were the effects of genes, the shared environment effects (how they were raised, religion), and the unique environmental effects (whether they played different sports).  The researchers found that the effects of genes was more predominate.  Shared environment was not as important but unique environment had a large affect as well. 

Body Image:

Body image is how an individual perceives a mirrored image of themselves.  This includes how you see your own appearance, memories, and ideas.  Its how you feel about your height, shape, and weight as well.  People with eating disorders develop a negative body image.  They tend to believe that they are overweight, even if they are severely underweight and distort their shape from what it really is.  A negative body image also consist of uncomfortable feelings of shame and self-consciousness.  About 80% of women are unhappy with their bodies.

Body image in the media:

The average height and weight of an American girl is 5'3" and 140 lbs.  The average height and weight for an American model is 5'11" and 119 lbs.  Why are they called models if they don't model the average woman?

Although the media doesn't cause eating disorders, it has a very strong affect on their developments.  42% of girls between the ages of six and eight, value thinness.  With a finding that 60% of middle school girls read at least one fashion magazine regularly, its no surprise.  Here are some other facts about the media's role in ED's:

• In women's magazines, there were about 10.5 times more weight loss advertisements appearing compared with men's magazines.

• 74% of exercise plans, in a magazine directed toward teenage girls, used the phrase " to become more attractive."

• 51% of the exercise plans, in the same magazine, stated that it was necessary to lose weight and burn calories.

• The average adolescent watches about 3-4 hours of TV. a day.

• 1 out of every 4 commercials are related to a message about attractiveness.

Famous people who died from EDs:

Karen Carpenter (musician)- Went on a water diet to lose weight and, as she put it, to appear more attractive.  Continued to diet even after losing 20 lbs, until her death at the age of 32.  She died of cardiac arrest due to anorexia and weighed only 80 lbs.  (pictured on left)

Christy Henrich (gymnast)- In 1988, Christy was told by a U.S. judge that she had to lose weight in order to make the Olympic team.  She died of multiple organ failure, as a result of anorexia, at the age of 22.  She weighed only 60 lbs. (pictured on right)

Heidi Guenther (ballet dancer)- After being told by a theatre company that at 5'5" in height and 96 lbs in weight she was too chunky, she developed an eating disorder.  She collapsed and died at the age of 22 due to complications from her eating disorder. (pictured on left)

Other famous  people who have suffered from EDs:

Paula Abdul (musician)
 

Nadia Comaneci (gymnast)
 

Susan Dey (actress)
 

Diana, Princess of Wales
 

Jane Fonda (actress)
 

Zina Garrison (tennis player)
 

Tracy Gold (actress from growing pains)
 

Daniel Johns (musician)
 

Gelsey Kirkland (ballet dancer)
 

Cathy Rigby (gymnast)
 

Joan Rivers (comedian)
 

Ally Sheedy (actress)

Victoria Beckham (Posh Spice of the spice girls)
 

Mary-Kate Olsen (actress)

Fiona Apple (musician)

and the lists goes on...

 

 

Because of both the physical and psychological effects of eating disorders, a variety of treatment must be applied.  Counseling is very important.  An important therapy that helps individuals with eating disorders is cognitive -behavioral therapy.  A nutritionist is also recommended to put the individual on a healthy diet.  Each and every person is different so each person will need different types of help.

Outpatient care involves group or family therapy and sometimes anti-depressant drugs.  Support groups and nutritional counseling also help.

Outpatient if:

Medically and psychiatrically stable

• no longer needs daily monitoring

• able to function in a normal society and continues to make progress

Inpatient care is when an eating disorder has led to life-threatening circumstances.  The patient may reside in a hospital or treatment center and is usually followed up on even after they have left to assure they are eating better.

Impatient if:

Medically and psychiatrically unstable

• depressed vital signs

• lab tests show acute risk

• complications due to medical problems

• symptoms worsening at a rapid rate

• suicidal

Tests that must be run:

• Complete blood count (CBC)

• urinalysis

• complete metabolic profile (glucose, blood urea, total protein, calcium, ect.)

• thyroid screen

• electrocardiogram (ECG)

Tests under special circumstances

15% or more below ideal body weight (IBW)

• X-ray

• complement 3 (C3)

• 24 creatinine clearence

• uric acid

20% or more below IBW

• echocardiogram

• brain scan

30% or more below IBW

• skin testing for immune functioning

To Get Help:

www.NationalEatingDisorders.org

A great website with lots of information and answers to any questions you might have.

Are you worried about a friend?

Individuals with eating disorders are usually unaware of their own problem.  It is very important for others to bring this problem into awareness for them.  If you are concern about them but unsure, talk to them about it.  Chances are, your instincts are right.  Just remember to be very supportive.  If they do need help, don't try and help them on your own. 

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