EATING DIORDER

Eating Disorder Statistics

PREVALENCE

• It is estimated that 8 million Americans have an eating disorder – seven million women and one million men
• One in 200 American women suffers from anorexia
• Two to three in 100 American women suffers from bulimia
• Nearly half of all Americans personally know someone with an eating disorder (Note: One in five Americans suffers from mental illnesses.)
• An estimated 10 – 15% of people with anorexia or bulimia are males

MORTALITY RATES

• Eating disorders have the highest mortality rate of any mental illness
• A study by the National Association of Anorexia Nervosa and Associated Disorders reported that 5 – 10% of anorexics die within 10 years after contracting the disease; 18-20% of anorexics will be dead after 20 years and only 30 – 40% ever fully recover
• The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females 15 – 24 years old.
• 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems

ACCESS TO TREATMENT

• Only 1 in 10 people with eating disorders receive treatment
• About 80% of the girls/women who have accessed care for their eating disorders do not get the intensity of treatment they need to stay in recovery – they are often sent home weeks earlier than the recommended stay
• Treatment of an eating disorder in the US ranges from $500 per day to $2,000 per day. The average cost for a month of inpatient treatment is $30,000. It is estimated that individuals with eating disorders need anywhere from 3 – 6 months of inpatient care. Health insurance companies for several reasons do not typically cover the cost of treating eating disorders
• The cost of outpatient treatment, including therapy and medical monitoring, can extend to $100,000 or more

ADOLESCENTS

• Anorexia is the 3rd most common chronic illness among adolescents
• 95% of those who have eating disorders are between the ages of 12 and 25
• 50% of girls between the ages of 11 and 13 see themselves as overweight
• 80% of 13-year-olds have attempted to lose weight

RACIAL AND ETHNIC MINORITIES

• Rates of minorities with eating disorders are similar to those of white women
• 74% of American Indian girls reported dieting and purging with diet pills
• Essence magazine, in 1994, reported that 53.5% of their respondents, African-American females were at risk of an eating disorder
• Eating disorders are one of the most common psychological problems facing young women in Japan.

CELEBRITIES WHO HAVE SUFFERED WITH EATING DISORDERS:

Paula Abdul

Justine Batemen

Karen Carpenter

Nadia Comaneci

Susan Dey

Jane Fonda

Tracey Gold

Elton John

Jamie Lynn-Sigler

Cherry Boone O’Neill

Barbara Niven

Alexandra Paul

Princess Di

Lynn Redgrave

Kathy Rigby

Joan Rivers

Jeannine Turner

Understanding Statistics on Eating Disorders

It is important to make sure that you understand the meaning of any eating disorder statistic you may read, and how it can be used.
Look at the research from which the statistics come:

What kind of questions did the researchers ask?
• How was information gathered?
• Who did they ask?
• Do the researchers have a bias?
• Is there a different explanation for the results?

The statistics NEDIC uses are gathered from peer-reviewed articles in highly regarded journals. We provide these statistics to draw attention to the core issues involved in eating disorders. Our aim is to influence those policymakers, funding organizations and individuals who are committed to making a difference in our society through the expansion of prevention and intervention services.
Statistics are also useful in initiating discussion on eating disorders, and in encouraging people to help work toward the healing, health and well-being of everyone affected by an eating problem.
Please Note: The following statistics have been compiled from specific research studies and papers as cited. These statistics may not be applicable to other groups. 

Prevalence of Eating Disorders

According to a 2002 survey, 1.5% of Canadian women aged 15 – 24 years had an eating disorder.
Government of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada 2006.

The prevalence of anorexia and bulimia is estimated to be 0.3% and 1.0% among adolescent and young women respectively. Prevalence rates of anorexia and bulimia appear to increase during the transition from adolescence to young adulthood.
Hoek, H. W. (2007). Incidence, prevalence and mortality of anorexia and other eating disorders. Current Opinion in Psychiatry 19(4), 389-394.

Lifetime prevalence rates for AN, BN, and BED tend to be higher among women than in men.
- Lifetime prevalence of AN = 0.9% in women and 0.3% in men
- Lifetime prevalence of BN = 1.5% in women and 0.5% in men
- Lifetime prevalence of BED found to be 3.5% in women and 2.0% in men
The average lifetime duration of BN is found to be approximately 8.3 years.
Hudson, J. I., Hiripi, E., Pope, H. G. & Kessler, R. C. (2007). The Prevalence and Correlates of
Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-358.

AN has the highest mortality rate of any psychiatric illness – it is estimated that 10% of individuals with AN will die within 10 years of the onset of the disorder.
Sullivan, P. (2002). Course and outcome of anorexia nervosa and bulimia nervosa. In Fairburn, C. G. & Brownell, K. D. (Eds.). Eating Disorders and Obesity (pp. 226-232). New York, New York: Guilford.

Eating Disorders in Males

Four percent of boys in grades nine and ten reported anabolic steroid use in a 2002 study, showing that body preoccupation and attempts to alter one’s body are issues affecting both men and women.
Boyce, W. F. (2004). Young people in Canada: their health and well-being. Ottawa, Ontario: Health Canada.

The fashion industry has long dictated that female models be tall and waif-like; however, male models are now facing increasing pressure to slim down and appear more androgynous, in order to book top fashion jobs.
Trebay, G. (2008, February 7). The Vanishing Point. The New York Times.
Retrieved from http://www.nytimes.com/2008/02/07/fashion/shows/07DIARY.html?pagewanted=1

Children and Adolescents

Children learn (unhealthy) mainstream attitudes towards food and weight at a very young age. In a study of five-year-old girls, a significant proportion of girls associated a diet with food restriction, weight-loss and thinness.
Abramovitz, B. A. & Birch, L. L. (2000). Five-year-old girls’ ideas about dieting are predicted by their mothers’ dieting. Journal of the American Dietetic Association, 100 (10), 1157-1163.

According to a 2002 survey, 28% of girls in grade nine and 29% in grade ten engaged in weight-loss behaviours.
Boyce, W. F. (2004). Young people in Canada: their health and well-being. Ottawa, Ontario: Health Canada

Thirty-seven percent of girls in grade nine and 40% in grade ten perceived themselves as too fat. Even among students of normal-weight (based on BMI), 19% believed that they were too fat, and 12% of students reported attempting to lose weight.
Boyce, W. F., King, M. A. & Roche, J. (2008). Healthy Living and Healthy Weight. In Healthy Settings for Young People in Canada. 

In a survey of adolescents in grades 7-12, 30% of girls and 25% of boys reported teasing by peers about their weight. Such teasing has been found to persist in the home as well - 29% of girls and 16% of boys reported having been teased by a family member about their weight.
Eisenberg, M. E. & Neumark-Sztainer, D. (2003). Associations of Weight-Based Teasing and Emotional Well-Being Among Adolescents. Archives of Pediatrics & Adolescent Medicine, 157(6), 733-738.

Body-based teasing can have a serious impact on girls’ attitudes and behaviours. According to one study, girls who reported teasing by family members were 1.5 times more likely to engage in binge-eating and extreme weight control behaviours five years later.
Neumark-Sztainer, D. R., Wall, M. M., Haines, J. I., Story, M. T., Sherwood, N. E., van den Berg, P. A. (2007). Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents. American Journal of Preventative Medicine, 33(5), 359-369.

Overweight and obese children are more likely to be bullied than their normal-weight peers. For example:
- In a survey of 11 – 16 year-olds, 10% of normal-weight children reported being bullied, compared to 15% of overweight and 23% of obese children
-Obese girls were 2.7 times more likely than normal weight girls to be verbally bullied on a regular basis and 3.4 times more likely to be excluded from group activities
Janssen, I., Craig, W. M., Boyce, W. F. & Pickett, W. (2004). Associations Between Overweight and Obesity With Bullying Behaviours in School-Age Children. Pediatrics, 113(5), 1187-1194.

In a study of 14 – 15 year old adolescents, girls who engaged in strict dieting practices:
-Were 18 times more likely to develop an ED within six months than non-dieters
-Had almost a 20% chance of developing an ED within one year
Girls who dieted moderately were five times more likely to develop an ED within 6 months than non-dieters.
Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B. & Wolfe, R. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. British Medical Journal, 318, 765-768.

In childhood (5-12 years), the ratio of girls to boys diagnosed with AN or BN is 5:1, whereas in adolescents and adults, the ratio is much larger – 10 females to every male.
Public Health Agency of Canada. Canadian Paediatric Surveillance Program, 2003 Results.

Dieting and the Diet Industry

Dieting for weight loss is often associated with weight gain, due to the increased incidence of binge-eating
Field, A. E., Austin, S. B., Taylor, C. B., Malpeis, S., Rosner, B., Rockett, H. R., Gillman, M. W. & Colditz, G. A. (2003). Relation between dieting and weight change among preadolescents and adolescents. Pediatrics, 112(4), 900-906,
Stice, Cameron, R. P., Killen, J. D., Hayward, C. & Taylor, C. B. (1999). Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. Journal of Consulting and Clinical Psychology, 67, 967-974.

Adolescent girls who diet are at 324% greater risk for obesity than those who do not diet.
(Stice et al., 1999).

Special Populations

A survey of British models found that 50% believe that AN and BN are significant problems amongst models. In addition, 70% of models perceive a trend for thinner models over the last five years.
British Fashion Council. The Report of the Model Health Inquiry, September 2007. Retrieved from

According to a Norwegian study, elite athletes demonstrate significantly higher rates of EDs compared to population controls. In one study, 20% of elite female athletes met the criteria for having an ED, compared to 9% of female controls. In men, 8% of elite male athletes met the criteria for having an ED, compared to 0.5% of male controls.

Female athletes competing in aesthetic sports (e.g. dance, gymnastics and figure skating) were found to be at the highest risk for EDs. Athletes competing in weight-class and endurance sports were also at elevated risk for EDs.
Sungot-Borgen, J. & Torstveit, M.K. (2004). Prevalence of Eating Disorders in Elite Athletes is Higher Than in the General Population. Clinical Journal of Sport Medicine, 14(1), 25-32.

Dieting and obesity/weight loss

Findings from Project EAT (population-based study of approximately 5000 teens):
- More than 1/2 of girls and 1/3 of boys engage in unhealthy weight control behaviors (e.g., fasting, vomiting, laxatives, skipping meals, or smoking to control appetite)
- Higher weight and overweight teens are more likely to engage in both binge-eating and unhealthy weight control than normal weight teens.
In fact, 20% of overweight girls and 6% of overweight boys report using laxatives, vomiting, diuretics, and diet pills (Neumark-Sztainer, Story, Hannan, Perry, & Irving, 2002).
Cogan, J. C., Smith, J. P. & Maine, M. D. (2008). The risks of a quick fix: A case against mandatory body mass index reporting laws. Eating Disorders: The Journal of Treatment & Prevention, 16, 2-13.
Neumark-Sztainer, D., Story, M., Hannan, P. J., Perry, C. L. & Irving L. M. (2002). Weight- Related Concerns and Behaviors Among Overweight and Nonoverweight Adolescents. Archives of Pediatrics and Adolescent Medicine, 156(2), 171-178.

Body dissatisfaction and weight change behaviours have been shown to predict later physical and mental health difficulties, including weight gain and obesity on the one hand (Field et al., 2003; Neumark-Sztainer et al., 2006), and the development of eating disorders (EDs) on the other (Le Grange & Loeb, 2007).
Field, A. E., Austin, S. B., Taylor, C. B., Malspeis, S., Rosner, B., Rockett, H. R., Gillman, M. W., & Colditz, G.A. (2003). Relation between dieting and weight change among preadolescents and adolescents. Pediatrics, 112, 900-906.
Neumark-Sztainer, D., van den Berg, P., Hannan, PJ., & Story, M. (2006). Self-weighing in adolescents: helpful or harmful: longitudinal associations with body weight changes and disordered eating. Journal of Adolescent Health, 39, 811-818.
Le Grange, D., & Loeb, KL. (2007). Early identification and treatment of eating disorders: prodrome to syndrome. Early Intervention in Psychiatry, 1, 27-39.

Understanding Brief Reports on Research

Brief reports on research are often found in the media. They can be useful because they tell us about new research. Based on this information, we can find out more about the issue under study.
On the other hand, brief reports on research can also be misleading if they:

• Are taken out of context.
• Leave out many of the researchers' comments that explain or change the meaning of the results.
• Ignore links or conflicts of interest between the researchers and a particular industry.

It is important to see these short reports as opportunities to highlight issues rather than as complete and dependable sources of information

Source: Nedic

EATING DIORDER

ABOUT EATING DISORDER ANONYMOUS

Eating Disorders Anonymous (EDA) is a fellowship of individuals who share their experience, strength and hope with each other that they may solve their common problems and help others to recover from their eating disorders. People can and do fully recover from having an eating disorder. In EDA, we help one another identify and claim milestones of recovery. The only requirement for membership is a desire to recover from an eating disorder. There are no dues or fees for EDA membership. We are self-supporting through our own contributions. EDA is not allied with any sect, denomination, politics, organization or institution. EDA does not wish to engage in any controversy. We neither endorse nor oppose any causes. Our primary purpose is to recover from our eating disorders and to carry this message of recovery to others with eating disorders. In EDA, we try to focus on the solution, not the problem. Solutions have to do with recognizing life choices and making them responsibly. Diets and weight management techniques do not solve our thinking problems. EDA endorses sound nutrition and discourages any form of rigidity around food.

*balance ___ not abstinence ___ is our goal. *

In EDA, recovery means living without obsessing on food, weight and body image. In our eating disorders, we sometimes felt like helpless victims. Recovery means gaining or regaining the power to see our options, to make careful choices in our lives. Recovery means rebuilding trust with ourselves, a gradual process that requires much motivation and support. As we learn and practice careful self-honesty, self-care and self-expression, we gain authenticity, perspective, peace and empowerment. 

Source:General Service Board of EDA, Inc.

Eating Disorder

EATING DISORDER


Eating disorders refer to a group of conditions characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and emotional health, binge eating disorder, bulimia nervosa, anorexia nervosa being the most common specific forms in the United States.^[1] Though primarily thought of as affecting females (an estimated 5–10 million being affected in the U.S.), eating disorders affect males as well (an estimated 1 million U.S. males being affected).^[2][3][4] Although eating disorders are increasing all over the world among both men and women, there is evidence to suggest that it is women in the Western world who are at the highest risk of developing them and the degree of westernization increases the risk. ^[5]
The reason for eating disorders is poorly known, but, it might involve other conditions and situations. One study showed that girls with ADHD have a greater chance of getting an eating disorder than those not affected by ADHD.^[6][7] One study showed that foster girls are more likely to develop bulimia nervosa.^[8] Some also think that peer pressure and idealized body-types seen in the media are also a significant factor. However, research shows that for some people there is a genetic reason why they may be prone to developing an eating disorder.^[9]
While proper treatment can be highly effective for many of the specific types of eating disorder, the consequences of eating disorders can be severe, including death^[10][11][12] (whether from direct medical effects of disturbed eating habits or from comorbid conditions such as suicidal thinking).^[13][14]

Contents [hide] 1 Specific eating disorders 2 Causes 2.1 Biological 2.2 Psychological 2.2.1 Personality traits 2.2.2 Environmental 2.2.2.1 Child maltreatment 2.2.2.2 Social isolation 2.2.2.3 Parental influence 2.2.2.4 Peer pressure 2.2.2.5 Cultural pressure 2.2.3 In men 3 Symptoms-complications 4 Diagnosis 4.1 Medical 4.2 Psychological 4.3 Differential diagnoses 5 Treatment 6 See also 7 References 8 Bibliography 9 External links

Specific eating disorders

• Anorexia nervosa (AN), characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity, etc. It greatly stresses the heart, increasing the risk of heart attacks and related heart problems. The risk of death is greatly increased in individuals with this disease. ^[15]
• Bulimia nervosa (BN), characterized by recurrent binge eating followed by compensatory behaviors such as purging (self-induced vomiting, excessive use of laxatives/diuretics, or excessive exercise).
• Binge eating disorder (BED), characterized by binge eating, without compensatory behavior. ^[16]
• Purging disorder, characterized by recurrent purging to control weight or shape in the absence of binge eating episodes
• Rumination, characterized by involving the repeated painless regurgitation of food following a meal which is then either re-chewed and re-swallowed, or discarded.
• Diabulimia, characterized by the deliberate manipulation of insulin levels by diabetics in an effort to control their weight.
• Food maintenance, characterized by a set of aberrant eating behaviors of children in foster care.^[17]
• Eating disorders not otherwise specified (EDNOS) can refer to a number of disorders. It can refer to a female individual who suffers from anorexia but still has her period, someone who may be at a "healthy weight", but who has anorexic thought patterns and behaviors, it can mean the sufferer equally participates in some anorexic as well as bulimic behaviors (sometimes referred to as purge-type anorexia), or to any combination of Eating Disorder behaviors which do not directly put them in a separate category.
• Pica, characterized by a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition. These can include such things as chalk, paper, plaster, paint chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes.
• Night Eating Syndrome, characterized by morning anorexia, evening polyphagia (abnormally increased appetite for consumption of food (frequently associated with insomnia, and injury to the hypothalamus).
• Orthorexia Nervosa, characterized by obsession with a "pure" diet, where it interferes with a person's life. It becomes a way of life filled with chronic concern for the quality of food being consumed. When the person suffering with orthorexia slips up from wavering from their "perfect" diet, they may resort to extreme acts of further self-discipline, including even stricter regimens and fasting.

Several of the above mentioned disorders, such as diabulimia, food maintenance syndrome and orthorexia nervosa, are not currently recognized as mental disorders in any of the medical manuals, such as the ICD-10^[18] or the DSM-IV.^[19]

Causes

The exact cause of Eating Disorders is unknown. However, it is believed to be due to a combination of biological, psychological an/or environmental abnormalities. A common belief is that "Genetics loads the gun, environment pulls the trigger."^{[citation needed]} This, in other words, means that some people are born with a predisposition to it, which can be brought to the surface pending on environment and reactions to it. Many men and women with eating disorders suffer also from body dysmorphic disorder, altering the way a person sees themselves.^{[citation needed]}

 Biological

• Genetic: Numerous studies have been undertaken that show a possible genetic predisposition toward eating disorders as a result of Mendelian inheritance.^[20][21][22]
• Epigenetics: Epigenetic mechanisms are means by which environmental effects alter gene expression via methods such as DNA methylation; these are independent of and do not alter the underlying DNA sequence. They are heritable, but also may occur throughout the lifespan, and are potentially reversible. Dysregulation of dopaminergic neurotransmission due to epigenetic mechanisms has been implicated in various eating disoders.^[23]

"We conclude that epigenetic mechanisms may contribute to the known alterations of ANP homeostasis in women with eating disorders."^[24][25]

• Biochemical: Eating behavior is a complex process controlled by the neuroendocrine system of which the Hypothalamus-pituitary-adrenal-axis (HPA axis) is a major component. Dysregulation of the HPA axis has been associated with eating disorders,^[26][27] such as irregularities in the manufacture, amount or transmission of certain neurotransmitters, hormones^[28] or neuropeptides^[29] and amino acids such as homocysteine, elevated levels of which are found in AN and BN as well as depression.^[30]
  • serotonin: a neurotransmitter involved in depression also has an inhibitory effect on eating behavior.^{[31][32][33][34][35]}
  • norepinephrine is both a neurotransmitter and a hormone; abnormalities in either capacity may affect eating behavior.^[36][37]
  • dopamine: which in addition to being a precursor of norepinephrine and epinephrine is also a neurotransmitter which regulates the rewarding property of food.^[38][39]
• leptin and ghrelin: leptin is a hormone produced primarily by the fat cells in the body; it has an inhibitory effect on appetite by inducing a feeling of saiety. Ghrelin is an appetite inducing hormone produced in the stomach and the upper portion of the small intestine. Circulating levels of both hormones are an important factor in weight control. While often associated with obesity, both hormones and their respective effects have been implicated in the pathophysiology of anorexia nervosa and bulimia nervosa.^[40]
• immune system: studies have shown that a majority of patients with anorexia and bulimia nervosa have elevated levels of autoantibodies that affect hormones and neuropeptides that regulate appetite control and the stress response. There may be a direct correlation between autoantibody levels and associated psychological traits.^[41][42]
• infection: PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Children with PANDAS "have obsessive-compulsive disorder (OCD) and/or tic disorders such as Tourette syndrome, and in whom symptoms worsen following infections such as "strep throat" and scarlet fever." (NIMH) There is a possibility that PANDAS may be a precipitating factor in the development of anorexia nervosa in some cases, (PANDAS AN).^[43]
• lesions: studies have shown that lesions to the right frontal lobe or temporal lobe can cause the pathological symptoms of an eating disorder.^[44][45][46]
• tumors: tumors in various regions of the brain have been implicated in the development of abnormal eating patterns.^{[47][48][49][50][51]}
• brain calcification: a study highlights a case in which prior calcification of the right thalumus may have contributed to development of anorexia nervosa.^[52]
• somatosensory homunculus: is the representation of the body located in the somatosensory cortex, first described by renowned neurosurgeon Wilder Penfield. The illustration was originally termed "Penfield's Homunculus", homunculus meaning little man. "In normal development this representation should adapt as the body goes through its pubertal growth spurt. However, in AN it is hypothesized that there is a lack of plasticity in this area, which may result in impairments of sensory processing and distortion of body image". (Bryan Lask, also proposed by VS Ramachandran)
• Obstetric complications: There have been studies done which show maternal smoking, obstetric and perinatal complications such as maternal anemia, very pre-term birth (32<wks.), being born small for gestational age, neonatal cardiac problems, preeclampsia, placental infarction and sustaining a cephalhematoma at birth increase the risk factor for developing either anorexia nervosa or bulimia nervosa. Some of this developmental risk as in the case of placental infarction, maternal anemia and cardiac problems may cause intrauterine hypoxia, umbilical cord occlusion or cord prolapse may cause ischemia, resulting in cerebral injury, the prefrontal cortex in the fetus and neonate is highly susceptible to damage as a result of oxygen deprivation which has been shown to contribute to executive dysfunction, ADHD, and may affect personality traits associated with both eating disorders and comorbid disorders such as impulsivity, mental rigidity and obsessionality. The problem of perinatal brain injury, in terms of the costs to society and to the affected individuals and their families, is extraordinary. (Yafeng Dong, PhD)^{[53][54][55][56][57][58][59][60][61][62][63]}

 Psychological

Eating disorders are classified as Axis I^[64] disorders in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV) published by the American Psychiatric Association. There are various other psychological issues that may factor into eating disorders, some fulfill the criteria for a separate Axis I diagnosis or a personality disorder which is coded Axis II and thus are considered comorbid to the diagnosed eating disorder. Axis II disorders are subtyped into 3 "clusters", A, B and C. The causality between personality disorders and eating disorders has yet to be fully established.^[65] Some people have a previous disorder which may increase their vulnerability to developing an eating disorder.^[66][67][68] Some develop them afterwards.^[69] The severity and type of eating disorder symptoms have been shown to affect comorbidity.^[70] The DSM-IV should not be used by laypersons to diagnose themselves, even when used by professionals there has been considerable controversy over the diagnostic criteria used for various diagnoses, including eating disorders. There has been controversy over various editions of the DSM including the latest edition, DSM-V, due in May 2013.^{[71][72][73][74][75]}

Comorbid Disorders

Axis I	Axis II
depression[76]	obsessive compulsive personality disorder[77]
substance abuse, alcoholism[78]	borderline personality disorder[79]
anxiety disorders[80]	narcissistic personality disorder[81]
obsessive compulsive disorder[82][83]	histrionic personality disorder[84]
Attention-deficit hyperactivity disorder[85][86][87][88]	avoidant personality disorder[89]

Personality traits

There are various childhood personality traits associated with the development of eating disorders.^[90] During adolescence these traits may become intensified due to a variety of physiological and cultural influences such as the hormonal changes associated with puberty, stress related to the approaching demands of maturity and socio-cultural influences and perceived expectations, especially in areas that concern body image. Many personality traits have a genetic component and are highly heritable. Maladaptive levels of certain traits may be acquired as a result of anoxic or traumatic brain injury, neurodegenerative diseases such as Parkinson's disease, neurotoxicity such as lead exposure, bacterial infection such as Lyme disease or viral infection such as Toxoplasma gondii as well as hormonal influences. While studies are still continuing via the use of various imaging techniques such as fMRI; these traits have been shown to originate in various regions of the brain^[91] such as the amygdala^[92][93] and the prefrontal cortex^[94] Disorders in the prefrontal cortex and the executive functioning system have been shown to affect eating behavior.^[95][96]

 Environmental

Child maltreatment

Child abuse which encompasses physical, psychological and sexual abuse, as well as neglect has been shown by innumerable studies to be a precipitating factor in a wide variety of psychiatric disorders, including eating disorders. Children who are subjugated to abuse may develop a disordered eating in an effort to gain some sense of control or for a sense of comfort. Or they may be in an environment where the diet is unhealthy or insufficient. Child abuse and neglect can cause profound changes in both the physiological structure and the neurochemistry of the developing brain. Children who, as wards of the state, were placed in orphanages or foster homes are especially susceptible to developing a disordered eating pattern. In a study done in New Zealand 25% of the study subjects in foster care exhibited an eating disorder (Tarren-Sweeney M. 2006). An unstable home environment is detrimental to the emotional well-being of children, even in the absence of blatant abuse or neglect the stress of an unstable home can contribute to the development of an eating disorder.^{[97][98][99][100][101][102][103][104][105]}

Social isolation

Social isolation has been shown to have a deleterious effect on an individuals' physical and emotional well-being. Those that are socially isolated have a higher mortality rate in general as compared to individuals that have established social relationships. This effect on mortality is markedly increased in those with pre-existing medical or psychiatric conditions, and has been especially noted in cases of coronary heart disease. "The magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors." (Brummett et al.)
Social isolation can be inherently stressful, depressing and anxiety provoking. In an attempt to ameliorate these distressful feelings an individual may engage in emotional eating in which food serves as a source of comfort. The loneliness of social isolation and the inherent stressors thus associated have been implicated as triggering factors in binge eating as well.^{[106][107][108][109]}

 Parental influence

Parental influence has been shown to be an intrinsic component in developing the eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape and eating patterns, the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders. As to the more subtle aspects of parental influence it has been shown that eating patterns are established in early childhood and that children should be allowed to decide when their appetite is satisfied as early as the age of two. A direct link has been proven between obesity and parental pressure to eat more.
Coercive tactics in regard to diet have not been proven to be efficacious in controlling a child's eating behavior. Affection and attention have been shown to affect the degree of a childs' finickiness and their acceptance of a more varied diet.

Peer pressure

In various studies such as one conducted by The McKnight Investigators, peer pressure was shown to be a significant contributor to body image concerns and attitudes toward eating among subjects in their teens and early twenties.
Eleanor Mackey and co-author, Annette M. La Greca of the University of Miami, studied 236 teen girls from public high schools in southeast Florida. "Teen girls' concerns about their own weight, about how they appear to others and their perceptions that their peers want them to be thin are significantly related to weight-control behavior," says psychologist Eleanor Mackey of the Children's National Medical Center in Washington and lead author of the study. "Those are really important."
According to one study, 40% of 9- and 10-year-old girls are already trying to lose weight.^[116] Such dieting is reported to being influenced by peer behavior, with many of those individuals on a diet reporting that their friends also were dieting. The number of friends dieting and the number of friends who pressured them to diet also played a significant role in their own choices.^{[117][118][119][120]}

[edit] Cultural pressure

There is a cultural emphasis on thinness which is especially pervasive in western society. There is an unrealistic stereotype of what constitutes beauty and the ideal body type as portrayed by the media, fashion and entertainment industries. "The cultural pressure on men and women to be "[perfect]" is an important predisposing factor for the development of eating disorders" (Bryan Lask, PhD).

 In men

It is estimated that 8 million people in the United States are suffering from an Eating Disorder, and of that number 10% are men. Professionals suggest that the percentage suffering that are men is much higher, but because of the old fashioned idea that this illness strikes only women, few men come forward to find the help they deserve.
To date, the evidence suggests that the gender bias of clinicians means that diagnosing either bulimia or anorexia in men is less likely despite identical behavior. Men are more likely to be diagnosed as suffering depression with associated appetite changes than receive a primary diagnosis of an eating disorder.
In addition, there may often be shrouds of secrecy because of the lack of therapy groups and treatment centers offering groups specifically designed for men. They may feel very alone at the thought of having to sit in a group of women, to be part of a program designed for women, and even at the prospect that a treatment facility will turn them down because of their sex.
Men who participate in low-weight oriented sports such as jockeys, wrestlers and runners are at an increased risk of developing an Eating Disorder such as Anorexia or Bulimia. The pressure to succeed, to be the best, to be competitive and to win at all costs, combined with any non-athletic pressures in their lives (relationship issues, family problems, abuse, etc.) can help to contribute the onset of their disordered eating.
It is not uncommon for men suffering with an Eating Disorder to also suffer with alcohol abuse and/or substance abuse simultaneously (though many women also suffer both disordered eating and substance abuse problems, combined). This may be due to the addictive nature of their psychological health, combined with the strong images put out by society of men's overindulgence in alcohol.
There may also be a link between ADHD, with male sufferers of Anorexia, Bulimia, and self-injury. More research is still needing to be done in this area.
For all those who suffer, men and women alike, there are many possible co-existing psychological illnesses that can be present, including depression, anxiety, PTSD, self-injury behaviors, substance abuse, OCD, borderline personality disorder, and Multiple Personality Disorders.
It is important to remember is that most of the underlying psychological factors that lead to an Eating Disorder are the same for both men and women; low self-esteem, a need to be accepted, depression, anxiety, an inability to cope with emotions & personal issues, and other existing psychological illnesses. All of the physical dangers and complications associated with being the sufferer of an Eating Disorder are the same. A great number of the causes are the same or very similar (family problems, relationship issues, alcoholic/addictive parent, abuse, societal pressure). Most of all, it is important to remember that all people with eating disorders deserve to find recovery, happiness, and self-love on the other side.

 Symptoms-complications

Symptoms and complications vary according to the nature and severity of the eating disorder:^[123]

Possible Symptoms and Complications of Eating Disorders

acne	xerosis	amenorrhoea	tooth loss, cavities
constipation	diarrhea	water retention and/or edema	lanugo
telogen effluvium	cardiac arrest	hypokalemia	death
osteoporosis[124]	electrolyte imbalance	hyponatremia	brain atrophy[125][126]
pellagra[127]	scurvy	kidney failure	suicide[128][129][130]

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women. Though often associated with obesity it can occur in normal weight individuals. PCOS has been associated with binge eating and bulimic behavior.

Diagnosis

The initial diagnosis should be made by a competent medical professional. "The medical history is the most powerful tool for diagnosing eating disorders"(American Family Physician).^[137] There are many medical disorders that mimic eating disorders and comorbid psychiatric disorders. All organic causes should be ruled out prior to a diagnosis of an eating disorder or any other psychiatric disorder is made.

 Medical

The diagnostic workup typically includes complete medical and psychosocial history and follows a rational and formulaic approach to the diagnosis. Neuroimaging using fMRI, MRI, PET and SPECT scans have been used to detect cases in which a lesion, tumor or other organic condition has been either the sole causative or contributory factor in an eating disorder. "Right frontal intracerebral lesions with their close relationship to the limbic system could be causative for eating disorders, we therefore recommend performing a cranial MRI in all patients with suspected eating disorders" (Trummer M et al. 2002), "intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective".(O'Brien et al. 2001

 Psychological

Eating Disorder Specific Psychometric Tests

Eating Attitudes Test	SCOFF questionnaire
Body Attitudes Test	Body Attitudes Questionnaire
Eating Disorder Inventory	Eating Disorder Examination Interview

After ruling out organic causes and the initial diagnosis of an eating disorder being made by amedical professional, a trained mental health professional aids in the assessment and treatment of the underlying psychological components of the eating disorder and any comorbid psychological conditions. The clinician conducts a clinical interview and may employ various psychometric tests. Some are general in nature while others were devised specifically for use in the assessment of eating disorders. Some of the general tests that may be used are the Hamilton Depression Rating Scale^[146] and the Beck Depression Inventory.^[147][148]

 Differential diagnoses

There are a variety of medical conditions which may be misdiagnosed as an eating disorder such as Lyme disease which is known as the "great imitator", as it may present as a variety of psychiatric or neurologic disorders including anorexia nervosa.^[149][150]

• Addison's Disease is a disorder of the adrenal cortex which results in decreased hormonal production. Addison's disease, even in subclinical form may mimic many of the symptoms of anorexia nervosa.^[151]
• gastric adenocarcinoma is one of the most common forms of cancer in the world. Complications due to this condition have been misdiagnosed as an eating disorder.^[152]
• helicobacter pylori is a bacterium which causes stomach ulcers and gastritis and has been shown to be a precipitating factor in the development of gastric carcinomas. It also has an effect on circulating levels of leptin and ghrelin, two hormones which help regulate appetite. Upon successful treatment of helicobacter pylori associated gastritis in pre-pubertal children they showed "significant increase in BMI, lean and fat mass along with a significant decrease in circulating ghrelin levels and an increase in leptin levels" (Pacifico, L)."SUMMARY: H. pylori has an influence on the release of gastric hormones and therefore plays a role in the regulation of body weight, hunger and satiety,"(Weigt J, Malfertheiner P).^[153][154]
• hypothyroidism, hyperthyroidism, hypoparathyroidism and hyperparathyroidism may mimic some of the symptoms of, can occur concurrently with, be masked by or exacerbate an eating disorder.^{[155][156][157][158][159][160][161][162]}

There are multiple medical conditions which may be misdiagnosed as a primary psychiatric disorder. These may have a synergistic effect on conditions which mimic an eating disorder or on a properly diagnosed ED. They also may make it more difficult to diagnose and treat an ED.

• Lupus: 19 psychiatric conditions have been associated with systemic lupus erythematosus (SLE), including depression and bipolar disorder.^[163]
• Toxoplasma seropositivity: even in the absence of symptomatic toxoplasmosis, toxoplasma gondii exposure has been linked to changes in human behavior and psychiatric disorders including those comorbid with eating disorders such as depression. In reported case studies the response to antidepressant treatment improved only after adequate treatment for toxoplasma.^[164]
• neurosyphilis: It is estimated that there may be up to one million cases of untreated syphyilis in the US alone. "The disease can present with psychiatric symptoms alone, psychiatric symptoms that can mimic any other psychiatric illness". Many of the manifestations may appear atypical. Up to 1.3% of short term psychiatric admissions may be attributable to neurosyphilis, with a much higher rate in the general psychiatric population. Neurosyphilis like Lyme disease has been given the appellation the "great imitator" for it may present in various ways such as depression and chronic alcoholism. (Ritchie, M Perdigao J,)^[165]
• dysautonomia: a term used to describe a wide variety of autonomic nervous system (ANS) disorders may cause a wide variety of psychiatric symptoms including anxiety, panic attacks and depression. Dysautonomia usually involves failure of sympathetic or parasympathetic components of the ANS system but may also include excessive ANS activity. Dysautonomia can occur in conditions such as diabetes and alcoholism.

There are separate psychological disorders which may be misdiagnosed as an eating disorder.

• Emetophobia is an anxiety disorder characterized by an intense fear of vomiting. A person so afflicted may develop rigorous standards of food hygiene, such as not touching food with their hands. They may become socially withdrawn to avoid situations which in their perception may make them vomit. Many who suffer from emetophobia are diagnosed with anorexia or self-starvation. In severe cases of emetophobia they may drastically reduce their food intake.^[166][167]
• phagophobia is an anxiety disorder characterized by a fear of eating, it is usually initiated by an adverse experience while eating such as choking or vomiting. Persons with this disorder may present with complaints of pain while swallowing.^[168]
• Body dysmorphic disorder (BDD) is listed as a somatoform disorder that affects up to 2% of the population. BDD is characterized by excessive rumination over an actual or perceived physical flaw. BDD has been diagnosed equally among men and women. While BDD has been misdiagnosed as anorexia nervosa, it also occurs comorbidly in 39% of eating disorder cases. BDD is a chronic and debilitating condition which may lead to social isolation, major depression and suicidal ideation and attempts. Neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe and left parietal lobe showing hemispheric imbalance in information processing. There is a reported case of the development of BDD in a 21 year old male following an inflammatory brain process. Neuroimaging showed the presence of a new atrophy in the frontotemporal region.^{[169][170][171][172][173]}

[edit] Treatment

Treatment varies according to type and severity of eating disorder, and usually more than one treatment option is utilized.^[174] Some of the treatment methods are:

• Cognitive behavioral therapy (CBT),^{[175][176][177]} which postulates that an individual's feelings and behaviors are caused by their own thoughts instead of external stimuli such as other people, situations or events; the idea is to change how a person thinks and reacts to a situation even if the situation itself does not change.
  • Acceptance and commitment therapy: a type of CBT^[178]
  • Dialectical behavior therapy, another form of CBT^[179]
  • Cognitive Remediation Therapy (CRT), a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning.
• Family therapy including "conjoint family therapy" (CFT), "separated family therapy" (SFT) and Maudsley Family Therapy.^[185][186]
• Behavioral therapy: focuses on gaining control and changing unwanted behaviors.
• Interpersonal psychotherapy (IPT)
• Music Therapy
• Recreation Therapy
• Art therapy
• Nutrition counseling^[190] and Medical nutrition therapy^{[191][192][193]}
• Medication: Orlistat is used in obesity treatment. Olanzapine seems to promote weight gain as well as the ability to ameliorate obsessional behaviors concerning weight gain. zinc supplements have been shown to be helpful, and cortisol is also being investigated.^{[194][195][196][197][198][199]}
• Self help and guided self help have been shown to be helpful in AN, BN and BED;this includes support groups and self-help groups such as Eating Disorders Anonymous and Overeaters Anonymous.
• Psychoanalysis
• Inpatient care

There are few studies on the cost-effectiveness of the various treatments.Treatment can be expensive; due to limitations in health care coverage, patients hospitalized with anorexia nervosa may be discharged while still underweight, resulting in relapse and rehospitalization.
Prognosis estimates are complicated by non-uniform criteria used by various studies, but for AN, BN, and BED, there seems to be general agreement that full recovery rates are in the 50% to 85% range, with larger proportions of patients experiencing at least partial remission.

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