anorexia and bulimia are about more that just losing weight or being thin. the causes and symptoms anorexia and bulimia. Compare and cantrast the two disorders. why are self-induced vomiting, diuretics, laxatives, diet pills, "natural" diet supplements or excessive exercising are not only dangerous and unhealthy ways to lose weight but can, if overused, be life-threatening. Here is a great informative website, not sure what your question is based off, but the best thing to do is do your own research, this site will be a great start for you.
http://www.myeatingdisorder.com
Good luck
Toni Lynne :) what this? Is this a test or something....? This sounds a bit like an essay question for school. How about researching yourself? Do your own homework. Bulimia
nervosa, commonly known as bulimia, is an eating disorder. It is a psychological condition in which the subject engages in recurrent binge eating followed by an intentional purging. This purging is done in order to compensate for the excessive intake of the food and to prevent weight gain. Purging typically takes the form of vomiting; inappropriate use of laxatives, enemas, diuretics or other medication; and excessive physical exercise. New research suggests that some sufferers may have a hormonal imbalance of testosterone; however, this research is in its early stages. The word bulimia comes from the the Latin (b奴l墨mia) from the Greek 尾慰蠀位峥懳嘉刮?(boul墨mia), ravenous hunger, compounded from 尾慰蠀蟼 (bous), ox + 位峥懳嘉肯?(l墨mos), hunger.
Contents [hide]
1 DSM-IV-TR criteria
2 History of bulimia nervosa
3 Causes
4 Environmental factors
5 Definition
6 Subtypes of bulimia
7 Consequences of bulimia nervosa
8 Diagnosis
9 Related psychological disorders
10 Differences between anorexia nervosa and bulimia nervosa
11 Treatment of bulimia nervosa
12 Mortality risk
13 At-risk groups
14 Prevention
15 See also
16 References
17 External links
[edit] DSM-IV-TR criteria
The following five criteria should be met for a patient to be diagnosed with bulimia nervosa:[1]
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a fixed period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.
[edit] History of bulimia nervosa
Bulimia nervosa was first described by Gerald Russell in 1977 while he worked at the Royal Free Hospital, London. Bulimia nervosa has been recognized as an autonomous eating disorder by the American Psychiatric Association since 1980 [2]. The word 鈥渂ulimia鈥?is Latin, getting its roots from the Greek word 鈥渂oulimia鈥?which directly translates to mean 鈥渆xtreme hunger鈥?[3].
[edit] Causes
Bulimia is often less about food, and more to do with deep psychological issues and profound feelings of lack of control. Binge/purge episodes can be severe, sometimes involving rapid and out of control feeding that can stop when the sufferers "are interrupted by another person" or when their stomach hurts from over-extension. This cycle may be repeated several times a week or, in serious cases, several times a day.[4] Sufferers can often "use the destructive eating pattern to gain control over their lives"[5].
Environmental factors
The disorder is more prevalent in Caucasian groups, but is becoming a rising problem in the African American and Hispanic communities. Women account for 90% of the patients that suffer from the disorder. There are higher rates of eating disorders in groups involved in activities that put an emphasis on thinness and body type (such as gymnastics, dance and cheerleading, figure skating, and other sports and activities in which a slender body is believed to be most appealing).
Definition
An eating disorder, common especially among young women of normal or nearly normal weight, that is characterized by episodic binge eating and followed by feelings of guilt, depression, and self-condemnation. It is often associated with measures taken to prevent weight gain, such as self-induced vomiting, the use of laxatives, dieting, or fasting.
The specific subtypes of bulimia are distinguished by the way the bulimic relieves themselves of the binge.
Purging type
The purging type involves self-induced vomiting, laxatives, diuretics, tapeworms, enemas, or ipecac, as a means of rapidly extricating the contents from their body. This type is generally more found, and can use one or more of the above methods. [8]
Non-Purging Type
This type of bulimia is rarely found (occurring in only approximately 6%-8% of cases), as it is a less effective means of ridding the body of such a large number of calories. This type of bulimia involves engaging in excessive exercise or fasting following a binge in order to counteract the large amount of calories previously ingested. This is frequently observed in purging-type bulimics as well, however this method is, by definition, not their primary form of weight control following a binge. [9]
[edit] Consequences of bulimia nervosa
Bulimia can result in following health problems:
Malnutrition
Dehydration
Electrolyte imbalance (Can lead to Cardiac Arrest, which can also result in brain damage by stroke)
Hyponatremia
Damaging of the voice
Vitamin and mineral deficiencies
Teeth erosion and cavities, gum disease
Sialadenosis (salivary gland swelling)
Potential for gastric rupture during periods of binging
Esophageal reflux
Irritation, inflammation, and possible rupture of the esophagus
Laxative dependence
Peptic ulcers and pancreatitis
Emetic toxicity due to ipecac abuse
Swelling of the face and cheeks, especially apparent in the lower eyelids due to the high pressure of blood in the face during vomiting.
Callused or bruised fingers
Dry or brittle skin, hair, and nails, or hair loss
Lanugo
Edema
Muscle atrophy
Decreased/increased bowel activity
Digestive problems that may be triggered, including Celiac, Crohn's Disease
Low blood pressure, hypotension
Orthostatic hypotension
High blood pressure, hypertension
Iron deficiency, anemia
Hormonal imbalances
Hyperactivity
Depression
Insomnia
Amenorrhea
Infertility
Polycystic Ovary Syndrome
High risk pregnancy, miscarriage, still-born babies
Diabetes
Elevated blood sugar or hyperglycemia
Ketoacidosis
Osteoporosis
Arthritis
Weakness and fatigue
Chronic Fatigue Syndrome
Cancer of the throat or voice box
Liver failure
Kidney infection and failure
Heart failure, heart arrhythmia, angina
Seizure
Paralysis
Potential death caused by heart attack or heart failure; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, perforated ulcer, depression and suicide.
Diagnosis
As mentioned earlier, all six of the criteria listed in the DSM are required for a classic diagnosis of bulimia nervosa. However, these symptoms are often difficult to spot, especially since, unlike anorexia nervosa, in order to be classified as bulimic the person must be of normal or higher weight. Likewise, the person is less likely to drop a significant amount of weight on a continual basis as does the anorexic, making the physical symptoms less noticeable, despite the fact that internal bodily functions are suffering. Because this disorder carries a great deal of shame, the bulimic will desperately try to hide their symptoms from family and friends. This disorder is more likely to span over a lifetime unnoticed, causing a great deal of isolation and stress for the suffering individual. Despite the frequent lack of obvious physical symptoms, bulimia nervosa has proven to be fatal, as malnutrition takes a serious toll on every organ in your body. If any of the symptoms above are noticed one should consult with a doctor or psychologist for further assistance
Related psychological disorders
It is not uncommon that a patient with bulimia nervosa will also have some anxiety or mood disorder as well. Most commonly associated with bulimia is the incidence of anxiety, one study noted this in 75% of bulimic patients. Also prominent in bulimic patients are mood disorders, most commonly depression as well as substance abuse issues. However recent research suggest that depression is a consequence of the eating disorder itself, rather than the other way around. [11]. They are also more likely to attempt suicide, and engage in impulsive behaviors.
Differences between anorexia nervosa and bulimia nervosa
The main criteria differences involve weight, as an anorexic must technically be classified as underweight (defined as a BMI < 18.5, though to be diagnosed with anorexia, the patient generally must have a BMI of less than 17.5). Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation. Another criterion which must usually be met is amenorrhea, the loss of a female's menstrual cycle not caused by the normal cessation of menstruation during menopause for a period of three months. Generally the anorexic does not engage in regular binging and purging sessions, though they may occur. In the rare instance that this is observed, that is, the patient binges and purges as well as fails to maintain a minimum weight, they are classified as a purging anorexic, due to the underweight criterion being met and cessation of menstruation. [12] Characteristically, those with bulimia nervosa feel more shame and out of control with their behaviors, as the anorexic meticulously controls their intake, a symptom that calms their anxiety around food as s/he feels s/he has control of it, na茂ve to the notion that it, in fact, controls him/her. For this reason, the bulimic is more likely to admit to having a problem, as they do not feel they are in control of their behavior. The anorexic is more likely to believe they are in control of their eating and much less likely to admit to needing help, or that a problem even exists in the first place. Similarly, both anorexics and bulimics have an overpowering sense of self that is determined by their weight and their perceptions of it. They both place all their achievements and successes as the result of their body, and for this reason are often depressed as they feel they are consistently failing to achieve the perfect body. For the bulimic, because s/he cannot achieve the low weight s/he feels physically that s/he is a failure and this outlook infiltrates into all aspects of her/his life. The anorexic cannot see that s/he is truly underweight and is constantly working towards a goal that s/he will never meet. Because of this misconception s/he will never be thin enough, and therefore will be always working towards this unattainable goal. S/he too allows this failure at achieving the 鈥減erfect body鈥?to define her/his self worth. As both the anorexic and bulimic never feel satisfaction in the more important part of their lives, depression often accompanies these disorders
[edit] Treatment of bulimia nervosa
Treatment is most effective when it is implemented early on in the development of the disorder. Unfortunately, since this disorder is often easier to hide and less physically noticeable, diagnosis and treatment often come when the disorder has already become a static part of the patient鈥檚 life. Historically, those with bulimia were often hospitalized to end the pattern and then released as soon as the symptoms had been relieved. However, this is now infrequently used, as this only addresses the surface of the problem, and soon after discharge the symptoms would often reappear as severe, if not worse, than when they had originally been.
There are several residential treatment centers which offer long term support, counseling, and symptom interruption. The most popular form of treatment for the disorder involves some form of therapy, often group psychotherapy or cognitive behavioral therapy. Anorexics and bulimics typically go through the same types of treatments and are members of these same treatment groups. This is because anorexia and bulimia often go hand in hand, and it is not unlikely that one has at some point participated in both. Some refer to this as "symptom swapping". These forms of therapy address both the underlying issues which cause the patient to engage in these behaviors, as well as the actual food symptoms. In combination with therapy, many psychiatrists will prescribe anti-depressants or anti-psychotics. Anti-depressants come in different forms, and the most promising drug to respond to bulimia has been Prozac. In a study done with 382 bulimia patients those who took between 20-60 mg of the drug reduced their symptoms from 45% to 67%, respectively. However it is quite possible that several other drugs could be more effective. Often insurance companies will not pay for other drugs for the patient until he or she has tried Prozac, because it has some positive outcome results.
Anti-psychotics are also used, but in smaller doses than are used for treating schizophrenia. With an eating disorder, the patient perceives reality differently and has difficulty grasping what it is like to eat normally. Unfortunately, since this disorder has only recently been recognized by the DSM, long-term outcomes of people with the disorder are unknown. Current research indicates that up to 30% of patients rapidly relapse, while 40% are chronically symptomatic.
The rate in which the patient receives treatment is the most important factor affecting prognosis. Those who receive treatment early on for the disorder have the highest and most permanent recovery rates.
Dr Sabine Naess茅n, from the Karolinska Institute, has discovered that some female patients suffer from a hormonal imbalance of testosterone and respond to a course of contraceptive pill containing oestrogen, resulting in a reduction of the symptoms of bulimia nervosa. This research is in its early stages and further studies will be required to determine the efficacy and application of such a treatment.
Mortality risk
Eating disorders have one of the highest death rates of all mental illnesses. The Eating Disorders Association (UK) estimates a 10% mortality rate. An 18% mortality rate has been suggested for Anorexia Nervosa.[1] In addition to the risk of suicide, 鈥渄eath can occur after severe binging in bulimia nervosa as well鈥?[14] For perspective, these death rates are higher than those of some forms of cancer.
However, the mortality rate related to bulimia is quite low, when compared to anorexia nervosa.
At-risk groups
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Risk factors for bulimia are similar to those of other eating disorders, such as anorexia nervosa:
those of age 10 through to 25 (though typically bulimia tends to start in late teens or early 20s)
athletes
students who are under heavy workloads
those who have suffered traumatic events in their lifetime such as child abuse and sexual abuse
those positioned in the higher echelons of the socioeconomic scale.
the highly intelligent and/or high-achievers.
perfectionists
Although the above are considered to be the groups at highest risk, the disorder can occur in people of all ages and both sexes. The numbers of male sufferers and bulimics in their thirties, forties, and beyond may not be accurately reported due to the shame that often coincides with the behaviors. Additionally, in the case of older persons with the disease, symptoms may have continued untreated for several years or decades, which results in the behaviors becoming increasingly ingrained and more difficult to confront.
There can be a popular assumption that eating disorders are 鈥榝emale diseases鈥? but the illnesses do not discriminate based on gender, and males can also suffer from them: 鈥渆ven if only 5% of sufferers are male, hundreds of thousands of young men are affected鈥tudies have been conducted within the homosexual subculture, and have also focused on males who suffer from anorexia and bulimia. These point to a direct connection between gender identity conflict and eating disorder in males but not in females. This does not indicate that only gender-conflicted males suffer from eating disorders, but there is a tendency for eating disorders in males to go unrecognised or undiagnosed, due to reluctance among males to seek treatment for these stereotypically female conditions."
Prevention
Currently, there is no known way to prevent the onset of bulimia nervosa. Less social and cultural emphasis on physical perfection might help, but it is difficult to make sweeping societal changes. And, as stressed earlier, the best method for preventing the progression of this disorder is early intervention by contacting your medical health professional and receiving psychotherapy. Adults have an immeasurable impact on their children, and focusing on developing a healthy lifestyle is key to raising healthy children in all aspects of life. Teaching children to adopt a healthy diet as a way of life and incorporating fun activities into their day will allow this to become second nature to them. Children should also be taught an emphasis on their internal characteristics and qualities rather than the external focus so much of society and the media tend to focus on. Action is the best method of teaching, and curtailing your own self-criticism and behavior will reflect substantially on your children鈥檚 impressions of themselves [15].
Early results from the Karolinska Institutet suggests that one possible treatment is to take a course of birth control pills containing oestrogen to offset a possible over production of the male hormone testosterone. This appears to alleviate some of the symptoms however further research is needed
Anorexia
Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. Individuals with anorexia often control body weight by voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. It primarily affects young adolescent girls in the Western world. Anorexia nervosa is a complex condition, involving psychological, neurobiological, and sociological components.[1]
Anorexia is a life-threatening condition that can put a serious strain on many of the body's organs and physiological resources;[2] it has one of the highest mortality rates of any psychiatric condition, with approximately 10% of people diagnosed with the condition eventually dying due to related factors.[3] Anorexia puts a particular strain on the structure and function of the heart and cardiovascular system, with slow heart rate (bradycardia) and elongation of the QT interval seen early on. People with anorexia typically have a disturbed electrolyte balance, particularly low levels of phosphate, which has been linked to heart failure, muscle weakness, immune dysfunction, and ultimately death. Those who develop anorexia before adulthood may suffer stunted growth and subsequent low levels of essential hormones (including sex hormones) and chronically increased cortisol levels. Osteoporosis can also develop as a result of anorexia in 38-50% of cases,[4] as poor nutrition leads to the retarded growth of essential bone structure and low bone mineral density. Anorexia does not harm everybody the same way. For example, evidence suggests that the results of the disease in adolescents may differ from those in adults.[2]
Changes in brain structure and function are early signs of the condition. Enlargement of the ventricles of the brain is thought to be associated with starvation, and is partially reversed when normal weight is regained.[5] Anorexia is also linked to reduced blood flow in the temporal lobes, although since this finding does not correlate with current weight, it is possible that it is a risk trait rather than an effect of starvation.[6]
Contents [hide]
1 Terminology
2 Diagnosis and clinical features
2.1 Presentation
2.1.1 Psychological
2.1.2 Emotional
2.1.3 Interpersonal and social
2.1.4 Physical
2.1.5 Behavioural
2.2 Diagnostic issues and controversies
3 Causes and contributory factors
3.1 Physiological factors
3.1.1 Genetic factors
3.1.2 Neurobiological factors
3.1.2.1 Nutritional factors
3.2 Psychological factors
3.2.1 Social and environmental factors
4 Prognosis
5 Incidence, prevalence and demographics
6 Treatment
7 See also
8 References
9 External links
9.1 Support organizations and information
9.2 Media stories and reports
10 Further reading
Terminology
The term anorexia is of Greek origin: an (privation or lack of) and orexis (appetite) thus meaning a lack of desire to eat.[7]
A person who is suffering from anorexia nervosa is referred to as anorexic' or (less commonly) as 'an anorectic'. "Anorectic" is the noun form, whereas "anorexic" is the adjectival form.
The term "anorectic" can also refer to any drug that suppresses appetite.
"Anorexia nervosa" is frequently shortened to "anorexia" in both the popular media and scientific literature. This is technically incorrect, as strictly speaking "anorexia" refers to the medical symptom of reduced appetite.
In popular culture, and especially with anorexics themselves, the term is often shortened to "ana" to avoid sounding clinical and impersonal. "Pro-ana" groups often use the terms "ana" and "mia" (referring to bulimia nervosa) to describe their conditions, as it has less negative connotations than the full medical term.
Diagnosis and clinical features
The most commonly used criteria for diagnosing anorexia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD).
Although biological tests can aid the diagnosis of anorexia, the diagnosis is based on a combination of behaviour, reported beliefs and experiences, and physical characteristics of the patient. Anorexia is typically diagnosed by a clinical psychologist, psychiatrist or other suitably qualified clinician.
Notably, diagnostic criteria are intended to assist clinicians, and are not intended to be representative of what an individual sufferer feels or experiences in living with the illness.
The full ICD-10 diagnostic criteria for anorexia nervosa can be found here, and the DSM-IV-TR criteria can be found here.
To be diagnosed as having anorexia nervosa, according to the DSM-IV-TR, a person must display:
Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
Intense fear of gaining weight or becoming fat.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
In postmenarcheal, premenopausal females (women who have had their first menstrual period but have not yet gone through menopause), amenorrhea (the absence of at least three consecutive menstrual cycles).
Or other eating related disorders.
Furthermore, the DSM-IV-TR specifies two subtypes:
Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas)
Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).
The ICD-10 criteria are similar, but in addition, specifically mention: i) ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics); ii) physiological features, including "widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhoea and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion"; and iii) if the onset is before puberty, development is delayed or arrested.
Presentation
There are a number of features, that although not necessarily diagnostic of anorexia, have been found to be commonly (but not exclusively) present in those with this eating disorder.[8][1]
Psychological
Distorted body image
Poor insight
Self-evaluation largely, or even exclusively, in terms of their shape and weight
Pre-occupation or obsessive thoughts about food and weight
Perfectionism
OCD (obsessive compulsive disorder)
Emotional
Low self-esteem and self-efficacy
Clinical depression or chronically low mood
Intense fear about becoming overweight
Moodiness or 'mood swings'
Interpersonal and social
Poor or deteriorating school performance, however in some anoretics this is not present due to their perfectionistic tendencies
Withdrawal from previous friendships and other peer-relationships
Deterioration in relationships with the family
Physical
Extreme weight loss
Endocrine disorder, leading to cessation of periods in girls (amenorrhea)
Starvation symptoms, such as reduced metabolism, slow heart rate (bradycardia), hypotension, hypothermia and anemia
Growth of lanugo hair over the body
Abnormalities of mineral and electrolyte levels in the body
Zinc deficiency
Often a reduction in white blood cell count
Reduced immune system function
Body mass index less than 17.5 in adults, or 85% of expected weight in children
Possibly with pallid complexion and sunken eyes
Creaking joints and bones
Collection of fluid in ankles during the day and around eyes during the night
Constipation
Very dry/chapped lips due to malnutrition
Poor circulation, resulting in common attacks of 'pins and needles' and purple extremities
In cases of extreme weight loss, there can be nerve deterioration, leading to difficulty in moving the feet
Headaches, due to malnutrition
Thinning of the hair
Nails become more brittle
Constantly feeling "cold"
Bruise easily
Dry skin
Behavioural
Excessive exercise, food restriction
Fainting
Secretive about eating or exercise behaviour
Possible self-harm, substance abuse or suicide attempts
Very sensitive to references about body weight
Become very angry when forced to eat "forbidden" foods
Diagnostic issues and controversies
The distinction between the diagnoses of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS) is often difficult to make in practice and there is considerable overlap between patients diagnosed with these conditions. Furthermore, seemingly minor changes in a patient's overall behaviour or attitude (such as reported feeling of 'control' over any bingeing behaviour) can change a diagnosis from 'anorexia: binge-eating type' to bulimia nervosa. It is not unusual for a person with an eating disorder to 'move through' various diagnoses as his or her behavior and beliefs change over time.[8]
Additionally, it is important to note that an individual may still suffer from a health- or life-threatening eating disorder (e.g., subclinical anorexia nervosa or EDNOS: eating disorder, not otherwise specified) even if one diagnostic sign or symptom is still present. For example, a substantial number of patients diagnosed with EDNOS meet all criteria for diagnosis of anorexia nervosa, but lack the three consecutive missed menstrual cycles needed for a diagnosis of anorexia.[1]
Feminist writers such as Susie Orbach and Naomi Wolf have criticised the medicalisation of extreme dieting and weight-loss as locating the problem within the affected women, rather than in a society that imposes concepts of unreasonable and unhealthy thinness as a measure of female beauty.
Causes and contributory factors
It is clear that there is no single cause for anorexia and that it stems from a mixture of social, psychological and biological factors. Current research is commonly focused on explaining existing factors and uncovering new causes. However, there is considerable debate over how much each of the known causes contributes to the development of anorexia. In particular, the contribution of perceived media pressure on women to be thin has been especially contentious.[9]
Physiological factors
Genetic factors
Family and twin studies have suggested that genetic factors contribute to about 50% of the variance for the development of an eating disorder[10] and that anorexia shares a genetic risk with clinical depression.[11] This evidence suggests that genes influencing both eating regulation, and personality and emotion, may be important contributing factors.
Several rodent models of anorexia have been developed which largely involve subjecting the animals to various environmental stressors or using gene knockout mice to test hypotheses about the effects of certain genes on related behaviour.[12] These models have suggested that the hypothalamic-pituitary-adrenal axis may be a contributory factor, although the models have been criticised as food is being limited by the experimenter and not the animal, and these models cannot take into account the complex cultural factors known to affect the development of anorexia nervosa.
Neurobiological factors
There are strong correlations (but not proven causation) between the neurotransmitter serotonin and various psychological symptoms such as mood, sleep, emesis (vomiting), sexuality and appetite. A recent review of the scientific literature has suggested that anorexia is linked to a disturbed serotonin system,[13] particularly to high levels at areas in the brain with the 5HT1A receptor - a system particularly linked to anxiety, mood and impulse control. Starvation has been hypothesised to be a response to these effects, as it is known to lower tryptophan and steroid hormone metabolism, which, in turn, might reduce serotonin levels at these critical sites and, hence, ward off anxiety. In contrast, studies of the 5HT2A serotonin receptor (linked to regulation of feeding, mood, and anxiety), suggest that serotonin activity is decreased at these sites. One difficulty with this work, however, is that it is sometimes difficult to separate cause and effect, in that these disturbances to brain neurochemistry may be as much the result of starvation, than continuously existing traits that might predispose someone to develop anorexia. There is evidence, however, that both personality characteristics (such as anxiety and perfectionism) and disturbances to the serotonin system are still apparent after patients have recovered from anorexia,[14] suggesting that these disturbances are likely to be causal risk factors.
Recent studies also suggest anorexia may be linked to an autoimmune response to melanocortin peptides which influence appetite and stress responses.[15]
Nutritional factors
Zinc deficiency causes a decrease in appetite -- which could degenerate in anorexia nervosa (AN). Appetite disorders, in turn, cause malnutrition and, notably, inadequate zinc nutriture. The use of zinc in the treatment of anorexia nervosa has been advocated since 1979 by Bakan. At least 5 trials showed that zinc improved weight gain in anorexia. A 1994 randomized, double-blind, placebo-controlled trial showed that zinc (14 mg per day) doubled the rate of body mass increase in the treatment of AN.[16] Deficiency of other nutrients such as tyrosine and tryptophan (precursors of the monoamine neurotransmitters norepinephrine and serotonin, respectively), as well as vitamin B1 (thiamine) could contribute to this phenomenon of malnutrition-induced malnutrition.[16]
Psychological factors
There has been a significant amount of work into psychological factors that suggests how biases in thinking and perception help maintain or contribute to the risk of developing anorexia.
Anorexic eating behavior is thought to originate from feelings of fatness and unattractiveness[17] and is maintained by various cognitive biases that alter how the affected individual evaluates and thinks about their body, food and eating.
One of the most well-known findings is that people with anorexia tend to over-estimate the size or fatness of their own bodies. A recent review of research in this area suggests that this is not a perceptual problem, but one of how the perceptual information is evaluated by the affected person.[18] Recent research suggests people with anorexia nervosa may lack a type of overconfidence bias in which the majority of people feel themselves more attractive than others would rate them. In contrast, people with anorexia nervosa seem to more accurately judge their own attractiveness compared to unaffected people, meaning that they potentially lack this self-esteem boosting bias.[19]
People with anorexia have been found to have certain personality traits that are thought to predispose them to develop eating disorders. High levels of obsessionality (being subject to intrusive thoughts about food and weight-related issues), restraint (being able to fight temptation), and clinical levels of perfectionism (the pathological pursuit of personal high-standards and the need for control) have been cited as commonly reported factors in research studies.[20]
It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia nervosa in the sufferer. Clinical depression, obsessive compulsive disorder, substance abuse and one or more personality disorders are the most likely conditions to be comorbid with anorexia, and high-levels of anxiety and depression are likely to be present regardless of whether they fulfill diagnostic criteria for a specific syndrome.[21]
Research into the neuropsychology of anorexia has indicated that many of the findings are inconsistent across studies and that it is hard to differentiate the effects of starvation on the brain from any long-standing characteristics. Nevertheless, one reasonably reliable finding is that those with anorexia have poor cognitive flexibility[22] (the ability to change past patterns of thinking, particularly linked to the function of the frontal lobes and executive system).
Other studies have suggested that there are some attention and memory biases that may maintain anorexia.[23] Attentional biases seem to focus particularly on body and body-shape related concepts, making them more salient for those affected by the condition, and some limited studies have found that those with anorexia may be more likely to recall related material than unrelated material.
Fairburn and colleagues psychological model of anorexiaAlthough there has been quite a lot of research into psychological factors, there are relatively few theories which attempt to explain the condition as a whole.
Fairburn and colleagues have created a 'transdiagnostic' model,[24] in which they aim to explain how anorexia, as well as related disorders such as bulimia nervosa and ED-NOS, are maintained. Their model is developed with psychological therapies, particularly cognitive behaviour therapy, in mind, and so suggests areas where clinicians could provide psychological treatment.
Their model is based on the idea that all major eating disorders (with the exception of obesity) share some core types of psychopathology which help maintain the eating disorder behaviour. This includes clinical perfectionism, chronic low self-esteem, mood intolerance (inability to cope appropriately with certain emotional states) and interpersonal difficulties.
Social and environmental factors
Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialised nations, particularly through the media. A recent epidemiological study of 989,871 Swedish residents indicated that gender, ethnicity and socio-economic status were large influences on the chance of developing anorexia, with those with non-European parents among the least likely to be diagnosed with the condition, and those in wealthy, white families being most at risk.[25] A classic study by Garner and Garfinkel demonstrated that those in professions where there is a particular social pressure to be thin (such as models and dancers) were much more likely to develop anorexia during the course of their career,[26] and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss.[27]
Although anorexia nervosa is usually associated with Western cultures, exposure to Western media is thought to have led to an increase in cases in non-Western counties. However, it is notable that other cultures may not display the same 'fat phobic' worries about becoming fat as those with the condition in the West, and instead may present with low appetite with the other common features.[28]
There is a high rate of child sexual abuse experiences in those who have been diagnosed with anorexia (up to 50% in those admitted to inpatient wards, with a lesser prevalence among people treated in the community). Although prior sexual abuse is not thought to be a specific risk factor for anorexia (although it is a risk factor of mental illness in general), those who have experienced such abuse are more likely to have more serious and chronic symptoms.[29]
The Internet has enabled anorexics and bulimics to contact and communicate with each other outside of a treatment environment, with much lower risks of rejection by mainstream society. A variety of websites exist, some run by sufferers, some by former sufferers, and some by professionals. The majority of such sites support a medical view of anorexia as a disorder to be cured, although some people affected by anorexia have formed online pro-ana communities that reject the medical view and argue that anorexia is a 'lifestyle choice', using the internet for mutual support, and to swap weight-loss tips.[30] Such websites were the subject of significant media interest, largely focusing on concerns that these communities could encourage young women to develop or maintain eating disorders, and many were taken offline as a result.[31]
Prognosis
Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with approximately 10% of those who are diagnosed with the disorder eventually dying due to related causes.[3] The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition.[32] A recent review suggested that less than one-half recover fully, one-third improve, and 20% remain chronically ill.[33]
Incidence, prevalence and demographics
The majority of research into the incidence and prevalence of anorexia has been done in Western industrialized countries, so results are generally not applicable outside these areas. However, recent reviews[34][35] of studies on the epidemiology of anorexia have suggested an incidence of between 8 and 13 cases per 100,000 persons per year and an average prevalence of 0.3% using strict criteria for diagnosis. These studies also confirm the view that the condition largely affects young adolescent females, with females aged between 15 and 19 making up 40% of all cases. Furthermore, the majority of cases are unlikely to be in contact with mental health services. As a whole, about 90% of people with anorexia will be female.[1]
Treatment
The first line treatment for anorexia is usually focused on immediate weight gain, especially with those who have particularly serious conditions that require hospitalization. In particularly serious cases, this may be done as an involuntary hospital treatment under mental health law, where such legislation exists. In the majority of cases, however, people with anorexia are treated as outpatients, with input from physicians, psychiatrists, clinical psychologists and other mental health professionals.
A recent clinical review has suggested that psychotherapy is an effective form of treatment and can lead to restoration of weight, return of menses among female patients, and improved psychological and social functioning when compared to simple support or education programmes.[36] However, this review also noted that there are only a small number of randomised controlled trials on which to base this recommendation, and no specific type of psychotherapy seems to show any overall advantage when compared to other types. Family therapy has also been found to be an effective treatment for adolescents with anorexia[37] and in particular, a method developed at the Maudsley Hospital is widely used and found to maintain improvement over time.[38]
It is important to note that many recovering underweight persons (who are more or less forced against their will into recovery by parents or other relatives) often harbour a hateful dislike for those who they feel to be robbing them of their treasured emaciation. Often when well-meaning friends or relatives compliment the recoveree on how much healthier they look, the recoveree's mind replaces "healthy" with "fat."
Drug treatments, such as SSRI or other antidepressant medication, have not found to be generally effective for either treating anorexia,[39] or preventing relapse[40] although it has also been noted that there is a lack of adequate research in this area. It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression.
Supplementation with 14mg/day of zinc is recommended as routine treatment for anorexia nervosa due to a study showing a doubling of weight regain after treatment with zinc was began. The mechanism of action is hypothesized to be an increased effectiveness of neurotransmission in various parts of the brain, including the amygdala, after adequate zinc intake begins resulting in increased appetite.[41]
There are various non-profit and community groups that offer support and advice to people who have anorexia, or are the carer of someone who does. Several are listed in the links below and may provide useful information for those wanting more information or help on treatment and medical care.
See also
History of anorexia nervosa
Adi Barkan (photographer who has campaigned against use of anorexic models)
Anorexia (symptom)
Body dysmorphic disorder
Bulimia nervosa
Binge eating disorder
Cachexia
Calorie restriction
Defensive vomiting
Eating disorder
Eating disorder not otherwise specified
Muscle dysmorphia ('reverse' anorexia nervosa)
Orthorexia nervosa
Pro-ana
Female body shape
Malnutrition
Refeeding syndrome
Body image I'm not doing your homework for you..nice try though. |
