More people are diagnosed with eating disorders than before, perhaps because of the importance attached to thinness in society and the constant concern about it. The eating disorders involve genetic, biological, psychosocial and environmental. In North America, the most common eating disorders are anorexia nervosa, bulimia nervosa and binge eating. More women than men suffer from an eating disorder.
Anorexia Nervosa is a psychiatric disorder where the person limits their food consumption or adopts behaviors to prevent weight gain, because of an intense fear of becoming fat or obese. In fact, people with anorexia are almost always underweight or normal when the disorder first appears. Anorexia usually occurs between adolescence and early adulthood; the average age at the beginning is 18 years old. Women are more often anorexic than men. According to current statistics, 9 out of 1000 women and 3 out of 1000 men will be diagnosed with anorexia during their lifetime. However, the diagnostic criteria were modified in 2013 to be less restrictive; the proportions given would therefore be an underestimate, according to these new criteria.
Bulimia is an eating disorder that is characterized by repeated, uncontrollable or compulsive episodes of excessive consumption of food, followed by inappropriate actions to get rid of the foods eaten. More often than not, the person seeks to purge the stomach by inducing vomiting or by resorting to laxatives, enemas or diuretics. The disorder is sometimes called bulimic hyperplasia syndrome. Some people do not use a purge. Rather, they gorge themselves (and consume up to 20,000 calories in one meal), and then try to compensate by adopting behaviors such as fasting or excessive exercise.
Bulimia usually occurs in late adolescence or at maturity, but may occur sooner or later. As in the case of anorexia, the median age at onset of bulimia is 18 years. Bulimia, too, affects more women than men, about 3 times more in the course of life.
Binge eating is characterized by the same uncontrollable urges to eat excessively as bulimia, but without the behaviors to purge after an episode of frenzy. The disorder is distinct from being overweight or obese. Previously, clinicians classified all eating disorders that did not meet the criteria for anorexia or bulimia in the category “Eating Disorders Not Elsewhere Specified”. Since 2013, binge eating has been recognized as a distinct disorder.
Eating disorders are generally considered to have a psychological origin. However, like depression, schizophrenia, and manic depressive psychosis, it is currently attributed to various causes, including genetics and functional changes in the brain. People with anorexia and bulimia are concerned about their physical appearance, weight and diet. They also have a false perception of their own body pattern, and are very afraid of gaining weight and being obese.
Although the onset of eating disorders is related to certain cultural factors, these disorders seem to come from multiple causes. The role of parents and the contribution of the family environment to eating disorders have been much debated. Genetic and hormonal factors seem to play an important role. People with an eating disorder would be genetically predisposed to this disease. Those with a family history of depression, alcoholism, obesity or eating disorders are at increased risk for anorexia nervosa and bulimia nervosa. In addition, there appears to be a relationship between diet-related behaviors (such as diets and excessive fasting) and neurological and hormonal systems, such as hunger.
Symptoms and Complications
People with anorexia nervosa may look seriously emaciated to the point where the ribs are sometimes visible under the skin due to malnutrition. Other common symptoms of anorexia are:
- Dryness and flaking of the skin;
- Hair loss
- Loss of consciousness or weakness
- Inability to concentrate
- Intolerance to cold;
- A loss of fat mass;
- Low blood pressure
- Menstruation too distant or absent;
- A pathological fear of obesity and weight gain;
- Slow or irregular heartbeat.
If anorexia appears before the onset of puberty, the sexual development of girls will be interrupted and the onset of their first period will be delayed. Severe anorexia causes a state of chronic malnutrition which has harmful effects on the body, especially on the bones, the thyroid, the heart and the digestive and reproductive systems. Anorexia can be deadly. Half of those who die of anorexia commit suicide and the other half die of medical complications.
Some people with bulimia can lose weight episodically, while others maintain normal weight, and may even be overweight. In some cases, the menstrual cycle may be disrupted and interrupted, but menstruation usually continues. Some of the possible symptoms of bulimia include:
- Dehydration (due to overuse of laxatives or frequent voluntary vomiting);
- Caries and dental erosion (due to acids contained in voluntary vomiting);
- Low blood pressure
- Swelling of the salivary glands in the cheeks (evoking mumps);
- Abnormal hormone levels
- Problems with the stomach and esophagus;
- Irregular heartbeat
Constant vomiting can lead to various complications, including esophageal inflammation (known as oesophagitis) and severe dental problems. In the most acute cases, constant bleeding can lead to heart damage. People who suffer from bulimia may also have a history of anorexia or obesity. They may also suffer from psychological disorders, such as depression, anxiety disorder, social phobias and panic-related disorders, or addictions such as alcoholism or drug addiction.
Like people with bulimia, those who suffer from binge eating have episodes of excessive food consumption, but without compensatory behaviors thereafter. Here are some symptoms of binge eating:
- Consume more food in a given period of time than most people in such circumstances;
- Experience a lack of control over excessive food consumption during an episode;
- Eat until feeling heavy stomach or faster than normal;
- Eat large amounts of food even if there is no hunger;
- To eat alone or in secret because of the discomfort caused by the amount of food consumed;
- Have feelings of depression, guilt or self-loathing after an episode.
The signs and symptoms revealed by a physical examination, and a detailed medical or personal history, are generally sufficient for the physician to diagnose eating disorders. In the case of an anorexic patient, continued weight loss from light or normal weight, obsessive exercise, gradual refusal of food, decreased school performance or work productivity, and depression should raise suspicions.
Blood tests reveal abnormalities in hormone levels that help rule out other disorders that cause similar symptoms. There is no precise diagnostic test; the diagnosis of eating disorders is therefore established following a clinical evaluation.
Treatment and Prevention
People who suffer from anorexia rarely seek treatment and do not want it, since they do not recognize it and their problem do not admit it. It is often family members and friends who notice the eating disorder and encourage the person to be treated.
Normally, anorexia does not go away by itself: sufferers must receive medical treatment and rely on specialized help to recover. The main obstacle to the treatment of anorexia is the patient’s refusal to undergo treatment.
The primary goal of the treatment is to allow the person to regain a normal weight. In general, people who suffer from anorexia do not consider their behavior abnormal or dangerous, and it is therefore very difficult to convince them and encourage them to refuel normally. In severe cases, when the person is in a state of emaciation, hospitalization is often necessary.
Individual and family counseling is normally part of the treatment plan. This assumes a cognitive-behavioral approach therapy that allows the patient to be rehabilitated with respect to body pattern, weight management, normal eating habits, nutrition, and the effects of dietary deficiency. Drug therapy with medications such as antidepressants is only useful for treating related disorders such as depression or obsessive-compulsive disorder (OCD).
Bulimic people rarely have to be hospitalized. They are usually treated with a combination of drugs and cognitive-behavioral therapy. Antidepressants are often prescribed in hopes of reducing cravings and uncontrolled hyperplasia. Psychotherapy is used to educate and educate about their eating habits and to eliminate misconceptions about body pattern and weight. Family and group therapies, which are often recommended for the treatment of bulimia, are effective.
Some people who suffer from binge eating avoid getting treatment because their condition makes them uncomfortable. Others do not perceive binge eating as a real health problem and therefore do not seek care. Most of the time, the treatment consists of a psychotherapy that helps the person to recognize the triggers of his frenzy and to adopt coping strategies to avoid giving in to his urge to eat.
Most people who have an eating disorder will recover through treatment. However, the recovery process can take a long time and some people may relapse. If your symptoms reappear, it is important to seek help.
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