Eating Disorders

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Eating Disorders

NIH - Medical Encyclopedia Anorexia nervosa

"Anorexia nervosa is an eating disorder characterized by refusal to stay at even the minimum body weight considered normal for the person's age and height. Other symptoms of the disorder include an intense fear of weight gain and distorted body image. Inadequate eating or excessive exercising results in severe weight loss (see also bulimia and intentional weight loss). The exact cause of anorexia nervosa is not known, but social attitudes towards body appearance, as well as family factors, are believed to play a role in its development. The condition usually occurs in adolescence or young adulthood. It is more common in women, affecting 1-2% of the female population and only 0.1-0.2% of males.

Symptoms

• Weight loss of 15% or greater below the expected weight • Inappropriate use of laxatives, enemas, or diuretics (water pills) in an effort to lose weight • Self-imposed food intake restrictions, often hidden • Absence of menstruation • Skeletal muscle atrophy • Loss of fatty tissue • Low blood pressure • Dental cavities may be present with self-induced vomiting • Blotchy or yellow skin • Depression may be present in addition to the eating disorder • Most individuals with anorexia nervosa refuse to recognize that they have an eating disorder (denial).

Anorexia nervosa is a serious and potentially deadly medical condition. By some estimates, it leads to death in 10% of cases. Experienced treatment programs have a two-thirds success rate in restoring normal weight, but relapse is common. Women who develop this eating disorder at an early age have a better chance of complete recovery. Most people with anorexia will continue to prefer a lower body weight and be preoccupied with food and calories to some extent, however. Weight management may be difficult, and long-term treatment may be necessary to help maintain a healthy body weight. "

Highlighted Article

Outcomes of eating disorders: A systematic review of the literature. (Int J Eat Disord. 2007)

"... reviewed evidence on factors associated with outcomes among individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) … RESULTS: At follow up, individuals with AN were more likely than comparisons to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders. Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced. The only consistent factor across studies relating to worse BN outcomes was depression."  

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Eating Disorders

General Information

NEWS:

Anorexia May Be More Common Than Thought "Anorexia nervosa is more common than previously thought, according to a study of more than 3,000 Finnish women born between 1975 and 1979. The study, by Finnish and American researchers, also found that, in many cases, anorexia symptoms come and go. The researchers found that about 2.2 percent of young women suffered from severe anorexia nervosa, while up to 5 percent of the women suffered at least some degree of anorexic symptoms (self starvation and obsessive anxiety about weight) sometime during their lifetime. Symptoms of anorexia nervosa usually appeared between ages 10 and 25, while the peak of illness onset was between ages 15 and 19. "

Anorexia may represent an addiction

Binge Eating Tops Other Eating Disorders: Survey " Binge eating tops the list of eating disorders affecting Americans, with the first-ever national survey on eating disorders finding it much more prevalent than either anorexia or bulimia. Binge eating -- a condition where people undergo frequent, uncontrolled eating binges without purging -- affects 3.5 percent of women and 2 percent of men during their lifetime. The condition is strongly linked to obesity. "

Bulimia symptoms impair daily function "Women and men with symptoms of bulimia may find that their eating problems take a heavy toll on their daily lives, a new study suggests. In a survey of more than 3,000 Australians, researchers found that bulimia symptoms -- including binge eating, purging and fasting -- were not uncommon among women and men. What's more, these symptoms impaired day-to-day activities in both sexes, the study authors report in the International Journal of Eating Disorders. Bulimia is often described as a "binge-purge" eating disorder because many affected individuals go through cycles of excessive eating followed by purging -- through vomiting or abusing laxatives and diuretics. However, there are also non-purging forms of bulimia, in which people exercise excessively or fast to counter their binge-eating episodes. "

Eating Disorders In Adolescents

Eating Disorders: A Midlife Crisis for Some Women "Anorexia and bulimia used to be considered health problems that afflicted teenage girls. But doctors are finding that a growing number of older women are now being diagnosed with some sort of eating disorder."

Menstruation key to bone rebuilding in anorexics "Adequate nutrition can rebuild bone mass in women with anorexia, but the restoration of normal menstrual periods appears to be necessary for fully normal bone metabolism to be recovered, a new study shows."

More body fat means better recovery for anorexics "For women recovering from anorexia nervosa, achieving a normal percentage of body fat seems to indicate that they have a good chance of beating the disease long-term. In a study of anorexic women who had regained their normal weight, those with the most body fat relative to their total weight were the least likely to relapse, Dr. Laurel E. S. Mayer and colleagues found. "These data suggest that restoring body fat to normal levels may be integral to recovery," Mayer, of Columbia University in New York City, and her team write in the June issue of the American Journal of Psychiatry."

More women over 30 battling eating disorders "Most of the women in this age group who seek treatment have had the problem for years, said Dr. Donald McAlpine, director of an eating disorders clinic at Mayo Clinic in Rochester, Minn. “The epidemiology is pretty clear that anorexia and bulimia both peak in the late teens, early 20s,” yet “a lot of (patients) continue to be symptomatic right on through to middle life.” People who study eating disorders suggest several reasons there might be more women over 30 seeking treatment for what is typically a young woman’s problem: growing public awareness, social pressure to be thin and an aging group of baby boomers. "

Parental Involvement Key to Battling Bulimia "When parents were involved in a treatment program, the percentage of teens able to abstain from the eating disorder's binge-purge pattern after six months doubled."

ARTICLES:

Eating Disorders: Facts to Know

PAS 2007: Anorexia Nervosa in Adolescents

Starvation of the Spirit "Farnsworth: ‘I have seldom come across a truly honest article about the emotional and mental burden of anorexia and bulimia.’"

JOURNAL ARTICLES:

A randomized trial on the efficacy of a 2-month tube feeding regimen in anorexia nervosa: A 1-year follow-up study. (Clin Nutr. 2007) "CONCLUSION: CEN is helpful in malnourished AN patients for weight restoration, without hindrance on the eating behavior therapy nor inducing a more rapid relapse."

A study of bone density change in patients with anorexia nervosa. (Eur Eat Disord Rev. 2007)

A two-stage epidemiologic study on prevalence of eating disorders in female university students in Mexico. (Eur Eat Disord Rev. 2007)

An empirical study of the typology of bulimic symptoms in young Portuguese women. (Int J Eat Disord. 2007) “CONCLUSION:: In the community, three natural patterns exist: binge eating plus compensatory behaviors, binge eating only, and purging in the absence of binge eating. These results have implications for future revisions of eating disorders nosology.”

Androgen deficiency: association with increased anxiety and depression symptom severity in anorexia nervosa. (J Clin Psychiatry. 2007) "CONCLUSIONS: Our data suggest that low androgen levels may contribute to anxiety, depression, and eating-disordered thinking and behavior in women with anorexia nervosa and form the basis for future studies to investigate the effectiveness of androgen replacement therapy."

Anorexia nervosa and autism spectrum disorders: Guided investigation of social cognitive endophenotypes. (Psychol Bull. 2007)

Are obsessive-compulsive personality traits associated with a poor outcome in anorexia nervosa? A systematic review of randomized controlled trials and naturalistic outcome studies. (Int J Eat Disord. 2007)

Attention-deficit/hyperactivity disorder (ADHD) and binge eating. (Nutr Rev. 2007)

Body image in patients with eating disorders and their mothers, and the role of family functioning. (Compr Psychiatry. 2007)

Bone cross-sectional geometry in adolescents and young women with anorexia nervosa: a hip structural analysis study. (Osteoporos Int. 2007) "CONCLUSIONS: Anorexia nervosa sufferers had decreased resistance to axial (CSA) and bending loads (Z) compared with healthy controls. Differences in strength properties were significant even when adjusted for lean mass, suggesting that not only decreased mechanical loading, but also known metabolic differences are likely responsible for deficits in bone strength in these patients."

Bone mineral density in adolescent girls with early onset of anorexia nervosa. (Clin Nutr. 2007) "CONCLUSIONS: Early diagnosis may prevent bone loss in AN patients. Protein intake and moderate physical activity seem to be useful to maintain an adequate bone mineral status."

Bulimia nervosa. (Am Fam Physician. 2007)

Cause and treatment of anorexia nervosa. (Physiol Behav. 2007) "This hypothesis is supported by the observations of the effects of a 6 month long period of semi-starvation on healthy human volunteers, which demonstrated not only the emergence of psychiatric symptoms but also the reduction in eating rate which is typical of anorexia nervosa patients. On this framework training anorexic patients how to eat may be a useful intervention. We report that anorexic patients, either with a body mass index <14 or >15.5 display the same pattern of eating behavior, with a low level of intake, a slow eating rate and a high level of satiety. They also have the same, high level of psychiatric symptoms, including obsessive compulsive symptoms. Training patients to eat more food at a progressively higher rate reverses these symptoms and patients remain free of symptoms during an extended period of follow-up. It is suggested that the pattern of eating behavior mediates between the starved condition and the psychopathology of anorexia nervosa."

Childhood experiences of being bullied and teased in the eating disorders. (Eur Eat Disord Rev. 2007)

Clinical, Psychological and Personality Features Related to Age of Onset of Anorexia Nervosa. (Psychopathology. 2007)

Comorbidity and high-risk behaviors in treatment-seeking adolescents with bulimia nervosa. (Int J Eat Disord. 2007)

Co-morbidity and disorder-related distress and impairment in purging disorder. (Psychol Med. 2007)

Comparison of obese men and women with binge eating disorder seeking weight management. (Eat Weight Disord. 2007) "CONCLUSIONS: Our results suggest that while obese men and women with BED who present for weight management are very similar, males had fewer previous attempts at weight loss, possibly related to their less pronounced body dissatisfaction or fewer help-seeking behaviors as compared to females. Our results also support findings of substantial comorbidity among obesity, BED, mood and anxiety disorders, and metabolic syndrome in weight loss seeking populations, in men as well as women."

Core beliefs and social anxiety in the eating disorders. (Eat Weight Disord. 2007)

Depressive and manic-hypomanic spectrum psychopathology in patients with anorexia nervosa. (Compr Psychiatry. 2007)

[Detection of adolescents at risk of suffering eating disorders.] (Aten Primaria. 2007)

Disordered eating: young women's search for control and connection. (J Child Adolesc Psychiatr Nurs. 2007)

Does percent body fat predict outcome in anorexia nervosa? (Am J Psychiatry. 2007) "CONCLUSIONS: In recently weight-restored women with anorexia nervosa, lower percent body fat was associated with poor long-term outcome."

Eating Disorders and Substance Abuse in Canadian Men and Women: A National Study (Eating Disorders 2007) "Alcohol interference and amphetamine use were associated with the risk for an eating disorder in both women and men. In the women sample only, risk for an eating disorder was associated with illicit drug use, dependence and interference, as well as with the number of substance classes used. The study findings support the importance of developing assessment instruments and treatment strategies that address the co-occurrence of eating disorders and substance use for both women and men."

Eating disorders in adolescents. (Aust Fam Physician. 2007)

[Eating disorders in children and adolescents. First results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).] (Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007)

Eating disorders symptoms in pregnancy: A longitudinal study of women with recent and past eating disorders and obesity. (J Psychosom Res. 2007) "CONCLUSIONS: Women with a recent ED continued to have some ED symptoms in pregnancy, albeit fewer compared to before pregnancy. Although at a lower level, women with a past history of ED also had ED symptoms in pregnancy. Screening for ED symptoms during pregnancy may provide a useful opportunity for engagement in treatment and to reduce behaviors that might be detrimental to the foetus."

Emotional awareness among eating-disordered patients: the role of narcissistic traits. (Eur Eat Disord Rev. 2007)

Exercise behaviours and feelings in eating disorder and non-eating disorder groups. (Eur Eat Disord Rev. 2007)

Heart failure in anorexia nervosa: case report and review of the literature. (Eat Weight Disord. 2007) "DISCUSSION: If shortness of breath occurs in AN it may be a symptom of heart failure. The diagnosis is further suggested by increased jugular venous pressure, increasing shortness of breath on exertion, and pulmonary crepitations at the bases of the lungs on physical examination. The chest x-ray usually shows pulmonary venous redistribution, the electrocardiogram may be normal, and the echocardiogram should document a reduced left ventricular ejection fraction. Standard medical therapy for heart failure should be started. In addition, a history of ipecac use should be taken, deficiencies should be corrected, and weight restoration can reverse cardiac abnormalities."

Impulse control disorders in women with eating disorders. (Psychiatry Res. 2007)

I'm not as slim as that girl: Neural bases of body shape self-comparison to media images. (Neuroimage. 2007)

Links between eating disorder symptom severity and psychiatric comorbidity. (Eat Behav. 2007)

Loss of control over eating reflects eating disturbances and general psychopathology. (Behav Res Ther. 2007)

Malnutrition induces dissociated changes in lymphocyte count and subset proportion in patients with anorexia nervosa. (Int J Eat Disord. 2007)

Obsessive-compulsive and eating disorders: Comparison of clinical and personality features. (Psychiatry Clin Neurosci. 2007) "Although some obsessive-compulsive and eating disorder patients share common traits (e.g. some personality traits especially between OCD and AN), both disorders seem to be clinically and psychopathologically different."

Outcomes of eating disorders: A systematic review of the literature. (Int J Eat Disord. 2007) "RESULTS:: At followup, individuals with AN were more likely than comparisons to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders. Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced. The only consistent factor across studies relating to worse BN outcomes was depression."

Overvaluation of shape and weight in binge eating disorder. (J Consult Clin Psychol. 2007)

Personality disorders in 545 patients with eating disorders. (Eur Eat Disord Rev. 2007)

Personality subtypes in adolescents with eating disorders: validation of a classification approach. (J Child Psychol Psychiatry. 2007)

Predictive value of alexithymia in patients with eating disorders: A 3-year prospective study. (J Psychosom Res. 2007) "CONCLUSIONS: The results of this study indicate that difficulty in identifying feelings can act as a negative prognostic factor of the long-term outcome of patients with eating disorders. Professionals should carefully monitor emotional identification and expression in patients with eating disorders and develop specific strategies to encourage labeling and sharing of emotions."

Predictors of late menarche and adult height in children with anorexia nervosa. (Clin Endocrinol (Oxf). 2007) "Conclusion The intensity of the disease affects the timing of menarche but not adult height in most patients. Hospitalization, despite often being an effective means of managing AN, does not reduce the impact of AN on growth."

Prevalence and correlates of eating disorders in Latinos in the United States. (Int J Eat Disord. 2007) "RESULTS:: Latinos have elevated rates of any binge eating and binge eating disorder but low prevalence of anorexia nervosa and bulimia nervosa. The US born and those living a greater percentage of their lifetime in the US evidenced higher risk for certain eating disorders while severe obesity and low levels of education were significant correlates. Rates of treatment utilization were exceedingly low. CONCLUSION:: Standard eating disorder criteria may not be appropriate for understanding psychological morbidity of eating disorders for Latinos, particularly less acculturated Latinos, due to cultural differences in the presentation of eating disorder symptoms."

Prevalence of eating disorders among adolescent and young adult scholastic population in the region of Madrid (Spain). (J Psychosom Res. 2007) "RESULTS: ED prevalence was 3.43%. Prevalence estimations were as follows: 5.34% for females: 2.72% for eating disorders not otherwise specified (EDNOS), 2.29% for bulimia nervosa (BN), and 0.33% for anorexia nervosa (AN); and 0.64% for males: 0.48% for EDNOS, 0.16% for BN, and 0.00% for AN. Some demographic factors that were shown to be associated with ED included the following: sex, age, single child, single-parent families, and father or mother's death."

Prevalence of Eating Disorders and Psychiatric Comorbidity among Children and Adolescents. (Indian Pediatr. 2007) "The prevalence of eating disorders was 1.25% Psychogenic vomiting was the commonest eating disorders and anorexia nervosa the emerging eating disorder. The most common co-morbidities were depression, intellectual disability, and dissociative disorder."

Prospective associations between depressive symptoms and eating disorder symptoms among adolescent girls. (Int J Eat Disord. 2007) "CONCLUSION:: Adolescent girls with high levels of eating-related pathology appear to be at risk for later depression."

Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa. (Child Psychiatry Hum Dev. 2007) "Mood disorders (60.4%) were most commonly identified, followed by the category anxiety disorders without obsessive-compulsive disorders (OCD) (25.7%), OCD (16.8%) and substance use disorders (7.9%). Two specific diagnoses differed across the two subtypes of AN. Substance use disorder was 18 times, and the category anxiety disorder without OCD was three times as likely to co-occur with AN binge-eating disorder and purging type than with AN restricting type. Clinicians should be alerted to the particularly high rate of psychiatric comorbidities in adolescents suffering from AN."

Recurrent binge eating (RBE) and its characteristics in a sample of young women in Germany. (Eur Eat Disord Rev. 2007)

Risk of major adverse perinatal outcomes in women with eating disorders. (Br J Psychiatry. 2007)

Screening for childhood eating disorders in primary care. (Prim Care Companion J Clin Psychiatry. 2007) "Conclusion: Fast-paced appointments and patients who withhold information compromise identification of eating disorders in pediatric and adolescent medicine practices. Barriers to detection highlight the need for enhanced professional and parent education, practical changes in screening tools and processes, and more frequent appointments when risk factors are present."

Self-injurious behavior and attempted suicide in purging bulimia nervosa: Associations with psychiatric comorbidity. (J Affect Disord. 2007)

Self-oriented perfectionism in eating disorders. (Int J Eat Disord. 2007)

Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts. (Eur Psychiatry. 2007) "CONCLUSIONS: Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors."

The co-morbidity of eating disorders and anxiety disorders: a review. (Eur Eat Disord Rev. 2007) "RESULTS: Of the empirical studies undertaken, it is clear that anxiety disorders are significantly more frequent in subjects with eating disorders than the general community. Researchers have shown that often anxiety disorders pre-date eating disorders, leading to a suggestion that early onset anxiety may predispose individuals to developing an eating disorder."

[The eating disorders in sports - sport in eating disorders.] (Orv Hetil. 2007)

The experience of 'feeling fat' in women with anorexia nervosa, dieting and non-dieting women: an exploratory study. (Eur Eat Disord Rev. 2007)

The interaction between eating disorders and celiac disease: an exploration of 10 cases. (Eur J Gastroenterol Hepatol. 2007) " Our findings suggest that clinicians treating patients with eating disorders or celiac disease should be aware of both conditions to provide optimum care."

The pursuit of thinness: an outcome study of anorexia nervosa. (Singapore Med J. 2007)

[The significance of perfectionism in eating disorders. A comparative study.] (Tijdschr Psychiatr. 2007)

The use of multiple purging methods as an indicator of eating disorder severity. (Int J Eat Disord. 2007)

Understanding bulimia. (Aust Fam Physician. 2007)

Unintentional onset of anorexia nervosa. (Eat Weight Disord. 2007) "CONCLUSIONS: We postulate that inadvertent weight loss may be as powerful a trigger as intentional dieting to initiating anorexia nervosa in predisposed individuals; self-induced weight loss may not be a necessary precursor to anorexia nervosa."

Why do normal weight young women look for diet-therapy? Findings from a pilot study in a clinical and non-clinical population. (Eat Weight Disord. 2007)

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