Feeding and Eating Disorders II

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Overview – Feeding and Eating Disorders, Part 2

Feeding and Eating Disorders include a group of complex mental health conditions that can seriously impair health and social functioning. Eating disorders can manifest in various ways including ingesting either very small amounts or eating absolutely no food at all. They can affect every aspect of an individual’s daily life including physical, emotional, and relational health. Possibly 20 million women and 10 million men have suffered from a type of eating disorder at some time in their lives. These are often first identified in the adolescent years. Issues related to image, weight, and body shape that underlie eating disorders may begin at a much younger age. Estimates are that 40-60 percent of elementary school girls struggle with concern about body weight. 

Although the exact cause for eating disorders is not known, a variety of genetic, biological, behavioral, neurochemical, and environmental-socio-cultural factors likely play a part. Males with eating disorders tend to focus more on making their bodies larger and more muscular as opposed to women who seem to be more interested in making their bodies lighter and smaller. Adults in the United States with a history of eating disorders may be 5-6 times more likely to also have a history of suicidal behavior, compared with adults without an eating disorder. 

Feeding and Eating Disorders, Part 1, presented information on four types of disorders, one type each day for four days. These were:  

  1. Pica Feeding Disorder
  2. Rumination Feeding Disorder
  3. Avoidant/restrictive Feeding Disorder
  4. Unspecified Feeding and Eating Disorder

Feeding and Eating Disorders, Part 2, presents four additional types of eating disorders, one type each day for four days. These are:  

Anorexia Nervosa

Anorexia Nervosa is a serious psychological disorder characterized by a relentless drive for thinness with an extreme fear of gaining body weight associated with self-induced behaviors towards thinness. Many people with anorexia see themselves as overweight although they are, in fact, underweight. This may reflect a brain perception problem. Anorexia Nervosa may be diagnosed when an individual, during the last three months, has accomplished weight loss primarily through dieting, fasting, and/or excessive exercise. 

They may deny any problem with low weight. They may weigh themselves frequently, eat small amounts, or only eat certain foods, or exercise excessively. Complications may include osteoporosis, infertility, low blood pressure, heart damage, cessation of menstrual periods in females, abnormal blood counts, anemia, organ failure, irregular heart rhythms, brain damage, and death.

Many patients with Anorexia Nervosa and Bulimia Nervosa may have the same disease or at the least share many common features and can manifest one or the other and switch between them.

Bulimia Nervosa Disorder

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and recurrent inappropriate compensatory behaviors in order to prevent weight gain. These may include self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. Compensatory behaviors are attempts to undo the effects of binge eating. Bulimia nervosa has no known causes but can be influenced by various factors. 

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning as can cardiac arrest.

Binge Eating Disorder

Binge Eating Disorder involves frequent consumption of very large amounts of food with uncontrollable eating. It is the most common eating disorder. Binge eating, although less common than simply overeating, is much more severe. It can be defined as compulsive overeating that involves recurring episodes of eating more than necessary, in an abbreviated time frame, and with an accompanying lack of self-control. It is characterized by out-of-control eating during which Individuals will continue to eat long after their appetite has been satisfied or when they are not even hungry. Binge eating can lead to obesity, depression, substance abuse, coronary heart disease, diabetes type 2, and poor quality of life. The disorder can last several years or be lifelong. 

The binge eating is not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa Emotional and/or behavioral symptoms are associated with binge-eating disorder. 

An episode of binge eating is characterized by both of the following: 

  • Eating within a discrete period of time (e.g., any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  • A sense of lack of control over the individual’s eating during the episode (e.g., a feeling that one cannot stop eating or control what one is eating). 
Other Specified Feeding and Eating Disorder

Other Specified Feeding and Eating Disorder may be diagnosed when the feeding disorders and eating disorders are of clinical severity but do not meet diagnostic criteria for anorexia nervosa, bulimia nervosa, binge eating disorder, Pica, Rumination Disorder, and Avoidant/Restrictive food intake disorder. Although it is not as commonly known as other eating disorders, it can be just as devastating with similar medical consequences and severity of symptoms. 

In the DSM-5 diagnostic criteria for eating disorders, two main groups appear:

  • Threshold eating disorders (TED); anorexia nervosa, bulimia nervosa, and binge eating disorder)
  • Other Specified Feeding and Eating Disorders (OSFED). 

The International Journal of Eating Disorders published the results of a study that, in addition to calculating prevalence rates of these two groups, examined the degree to which they could be differentiated in terms of impairment and risk factors. The study findings suggest that Threshold Eating Disorders (TED) and Other Specified Feeding and Eating Disorders (OSFED) groups cannot be discriminated by prevalence or impairment or genetic risk factors.

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