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Anorexia Nervosa is an Eating Disorder characterized by an individual’s intense fear of gaining weight or becoming fat, even though the individual is underweight. Individuals refuse to maintain 85% of “normal” body weight and often experience panic as a result of minimum weight gain. Individuals suffering with Anorexia Nervosa “control” their environment by “controlling” their caloric intake, many times reducing their intake to less than 500 calories a day. Due to their decreased intake, individuals suffering with Anorexia will typically take on a “skeletal” appearance as their bodies deplete fat stores for energy. Prevalence rates of Anorexia Nervosa range from .10% to 1.0% but this statistic sadly, seems to be on the rise. With the constant bombardment of media images and focus and “glamorization” of stick thin beauty icons, the increase for the onset of Anorexia Nervosa between the ages of 15-24 is significant. Further, 86% of Eating Disorders are reported before the age of 20, while Anorexia Nervosa and Associated Disorders (ANAD) reports that 10% of Eating Disorders occur before the age of 10.Signs
Symptoms
Causes of Anorexia While the exact cause of Anorexia is not known, most clinicians believe the cause is multi-dimensional, involving cultural, genetic, personality, developmental and familial factors. Cultural factors related to Anorexia include the constant bombardment of media images portraying skeletal women as the epitome of beauty. These images may lead young girls to believe that being dangerously thin will bring happiness, beauty and control. The media messages may also lead young girls to have a distorted body image in which she perceives herself as “fat” unless she maintains the same emaciated look of those media images. While media images are daily and incessant, not all females develop Eating Disorders and therefore cannot account for the sole development of Anorexia. Studies have indicated there may be a genetic link to Eating Disorders. Many researchers believe there is an inherited predisposition to suffering with an Eating Disorder related to the neurochemistry in the brain. Twin studies have found that there is a highly increased risk of co-occurrence of Eating Disorders in identical twins. Identical twins share all of their genes while fraternal twins share just half of their genes. Based on this knowledge, researchers believe there is an inherited genetic component because studies have shown the risk is much higher in identical twins than it is in fraternal twins. In addition, levels of the neurotransmitter, serotonin, are significantly decreased in individuals suffering with Eating Disorders. Serotonin has also been found to be decreased in mood disorders such as depression leading researchers to believe there may be a link between mood disorders and eating disorders. Individuals suffering with Anorexia tend to share core personality characteristics. These characteristics include an obsession with perfectionism and exactness, harm avoidance and a dependence on external praise and rewards. These individuals tend to appear outwardly confident, competent and often highly accomplished; however, inwardly they suffer from pervasive feelings of inadequacy and ineffectiveness while also suffering with low self esteem. Individuals suffering with Anorexia tend to think in concrete terms and have rigid beliefs. They tend to think in “black and white”, “all or nothing” terms which they may integrate into their own perception of themselves. This dichotomous thinking leads individuals to think of themselves, others and relationships as all good or all bad. Given the typical onset in adolescence, a developmental component exists in Anorexia. Due to their core personality characteristics, individuals often experience difficulty meeting the social and emotional demands of the adolescent developmental phase. Individuals with shy and avoidant personalities have difficulty individuating from their families which may heighten and perpetuate the feelings of isolation from social circles. Further, the physical development experienced in adolescence distresses the individual suffering from Anorexia due to the deposition of fat in puberty. Although this change in weight distribution is a normal part of female development, these individuals psychologically suffer through this development due to their need for the “ideal” female body and may regress psychologically and physically from adolescence. This regression makes the individual ill prepared for meeting the social demands of adolescence and may experience issues separating from family, have interpersonal conflicts and difficulty meeting performance expectations. Families of individuals suffering from Anorexia sometimes describe the individual as the “perfect child” and consequently the families are surprised and confused to discover the illness. Families tend to be middle to upper class, financially successful and concerned with outward appearances including physical appearance and fitness. Some clinicians describe families of individuals with Anorexia as attending well to the child’s physical needs and highly valuing their child, yet are overprotective and over concerned. While being protective and concerned is part of good parenting, the level of protection and concern may actually limit the development of self autonomy and expression. The self denial of food intake may then be considered an expression of their control while still staying enmeshed in the family. Given the multidimensional nature of the causes of Anorexia, no one cause can be pinpointed and therefore treatment should also be multidimensional. Treatment should approach the areas of societal, personality, genetic, developmental and familial aspects on Anorexia not to isolate the sole cause but rather to uncover the individual’s specific areas of struggle in the above areas. The individual’s treatment plan should then incorporate and focus on these areas. Medical Complications With a mortality rate ranging between 6% and 20%, Anorexia Nervosa has the highest mortality rate of all psychiatric illnesses. The majority of the deaths stem from arrhythmias, fluid and electrolyte abnormalities and suicide. Individuals suffering from Anorexia starve their bodies of necessary calories that could cause damage to all vital organs such as the heart and brain. The individual’s pulse rate and blood pressure drop and lead to irregular heart rhythms or heart failure. In addition to these complications, individuals suffering from Anorexia may also experience:
Bulimia Nervosa is an Eating Disorder characterized by binge/purge cycles. A binge is defined as eating a large amount of food during a set period of time (e.g. 2 hours) during which the individual feels out of control and cannot stop the binge. The purge is aimed at controlling weight gain by “getting rid of the food”. This can be done through self induced vomiting, laxatives, suppositories, enemas, diuretics or syrup of ipecac. The individual may also engage in excessive exercise in order to burn the calories consumed in the binge. Individuals suffering with Bulimia will typically be of average or above average weight. While Eating Disorders are underreported, most clinicians and researchers report between 1.1 and 4.2% of females suffer from Bulimia during their lifetime. The occurrence of Bulimia in college age students may be considered at epidemic levels considering 19% to 30% of this age group display symptomatic behaviors. Further, an estimated 11% of high school students may suffer from Bulimia. Athletes are more susceptible to Eating Disorders due to their “appearance” focus that seems to play a key in success in their sport. Of the women involved in “appearance sports” (cross country, ballet, dancing, gymnastics, skating, cheerleading, modeling, etc) an estimated 62% have been reported to have Eating Disorders. Symptoms
Signs
Causes of Bulimia While the exact cause of Bulimia is not known, most clinicians believe the cause is multi-dimensional, involving cultural, genetic, personality, developmental and familial factors. Bulimia tends to occur in Westernized, industrialized societies where there is an abundance of food and where slimness defines beauty. Bulimia is very rarely found outside of this context and in fact, as immigrants assimilate into mainstream culture and obtain higher socioeconomic status, they also tend to develop higher rates of Eating Disorders. While culture and media images are not the sole cause of Bulimia, they both contribute to the development and continuance of the disorder. Studies have indicated there may be a genetic link to Eating Disorders. Many researchers believe there is an inherited predisposition to suffering with an Eating Disorder related to the neurochemistry in the brain. Twin studies have found that there is a highly increased risk of co-occurrence of Eating Disorders in identical twins. As the risk is much higher in identical twins than it is in fraternal twins, researchers believe there is an inherited genetic component to Eating Disorders. In addition, levels of the neurotransmitter, serotonin, are significantly decreased in individuals suffering with Eating Disorders. Serotonin has also been found to be decreased in mood disorders (such as depress ion) leading researchers to believe there may be a link between mood disorders and Eating Disorders. Individuals suffering with Bulimia tend to be more emotionally reactive, have disturbances in social functioning, and display depression and anxiety. If a personality disorder is diagnosed as a comorbid disorder, it tends to be of the cluster B (dramatic-erratic) type. While the individual tends to be emotionally reactive, they also tend to cope with emotion by avoidance. As binges tend to be triggered by emotional and stressful times, the speculation has been made by clinicians that binges actually divert attention from the painful or difficult emotion. The individual’s attention is narrowed to the specific cues (food involved in their binge) and attention to peripheral issues is minimized or avoided. In this way, Bulimia serves as an adaptive mechanism to protect the individual from those painful and difficult emotions. As adolescence is associated with many emotional changes, such as graduating from high school, leaving for college, relationship troubles, etc., Bulimia may serve to “protect” them from emotions they are ill-equipped to deal with. This concept is reinforced as the average onset of Bulimia is age 18. While there is no blame to be placed in the treatment process of Bulimia, certain familial tendencies and characteristics have been identified. Families of individuals suffering with Bulimia tend to be more disorganized and conflictive, are either overprotective or disengaged, have a history of alcoholism, physical or sexual abuse, Eating Disorders or weight consciousness. Due to the multi-faceted etiology, treatment of Bulimia also needs to be multidimensional. This treatment must incorporate and focus on the individual’s cognitions of themselves and their place in their family and society. Medical Complications Because individuals suffering from Bulimia are of average weight, their appearance isn’t as dramatic as those of individuals suffering with Anorexia and therefore it appears the urgency to seek treatment isn’t as extreme. However, medical complications are still experienced and the situation is a crisis, just as with Anorexia. The medical complications from Bulimia typically stem from the different methods of purging utilized by the individual including self induced vomiting, laxative abuse, diuretics, diet pills/appetite suppressants, and syrup of ipecac. Complications
Individuals suffering with Binge Eating Disorder often eat an unusually large amount of food and feel out of control during the binges. Individuals suffering with Binge Eating may also eat more quickly than usual during binge episodes, eat until they are uncomfortably full, eat when they are not hungry, eat alone because of embarrassment, or feel disgusted, depressed or guilty after overeating. Binge Eating Disorder is a relatively new diagnosis added to the Appendix of the DSM IV to stimulate more research. Due to the newer diagnosis, prevalence rates are underreported. Interestingly, 2% of individuals in the general population suffer from Binge Eating Disorder while 18%-46% of individuals in weight control programs (e.g. Weight Watchers, Jenny Craig, etc.) suffered from the disorder making it a common disorder in individuals who are overweight. Symptoms
Signs
Causes of Binge Eating While the exact cause of Binge Eating Disorder will vary from person to person, often there are contributing factors that stem from the individual’s past. Up to half of the individuals suffering from Binge Eating Disorder also suffer from depression but whether this is a cause or effect remains unclear. Binge Eating Disorder is outwardly very different than Anorexia and Bulimia in that the individual suffering from Binge eating is not focused on their body image and weight. However, inwardly, Binge Eating is very similar to Bulimia. Like individuals suffering from Bulimia, individuals suffering with Binge Eating Disorder realize their eating behaviors are abnormal and are ashamed of their actions. Binge Eating is also a response to negative emotions such as anger, sadness, anxiety, loneliness, and even boredom. Binge Eating Disorder tends to run in families and therefore, researchers are investigating the role of neurotransmitters in the development and maintenance of the disorder. Researchers are also investigating the role of genes in Binge Eating Disorder since the disorder occurs in several members of the same family. Medical Complications While some medical complications associated with Binge Eating Disorder may be minor, other complications can be quite serious and life threatening. Individuals suffering from Binge Eating Disorders are likely to be overweight and over the course of the disorder, become obese. While obesity can be a health problem in itself, it can also lead individuals to isolate from friends, family and social events which increases the feelings of sadness and loneliness; thereby creating a vicious cycle of Binge Eating and isolation. Individuals suffering with Binge Eating Disorder are at risk for:
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