Eating Disorder

Anomalous eating habits involving too less or too much dietary intake that may lead to physical or mental harm to an individual is known as Eating Disorders.

Classification of Eating Disorders

According to Walsh and Sysko (2009) Eating Disorders are most commonly classified into three categories

Anorexia nervosa (AN)

Bulimia nervosa (BN)

Atypical eating disorder or Eating disorders not otherwise specified (EDNOS)

Anorexia Nervosa is a medical condition associated with exceptionally low food intake, less bodyweight and an apprehension of increase in the body weight in the affected person. The affected person usually exhibit transition from severe limitation to the binge eating behavior.

Bulimia Nervosa is a medical condition in which the effected individual binges on food and his repeated episodes of eating become out of his control. Hence, this disease is associated with obesity in the affected person. (Marcus and Wildes, 2009) Later on, the individual try to counteract this behavior by utilizing different methods like vomiting or taking laxatives in order to avoid weight gain. But, the reverse practice (a move from binge eating into eating limitation) is less common.

Atypical eating disorder or EDNOS includes modifications of above mentioned disorders, but with sub-threshold indicators. This disorder possesses major medical severity that does not fulfil the indicative criteria for anorexia nervosa or bulimia nervosa both. More than half of the cases of eating disorders fall into this category. (Thomas, Vartanian and Brownell, 2009)

Current Theoretical Perspectives mental disorder

The description of the central control of appetite can be used to acquire an in-depth knowledge of eating disorders. An easy way is to understand three components of nervous system. Foremost is the Homoeostatic System which is mainly controlled by the brain stem and hypothalamus that incorporate peripheral metabolic markers with details from the gastrointestinal tract to influence levels of appetite, fullness, and autonomic nervous activity. Then there is Drive System, that holds distributed neural circuitry in the mesolimbic cortex and striatum that has conducting inputs from sense organs and neural constituents that are involved in processes of learning and remembrance. (Thomas, Vartanian and Brownell, 2009) This system records the reward associated with food intake and is involved in the impulse to hunt for food and consume. Finally, there exists self-regulation system, within which a kind of let say top down control contextualizes hunger within life objectives, significance, and meaning.

Anomalous variations in these systems may lead to risk of developing or developing and sustaining eating disorders. A theory advocates that these disorders may occur due to persistent deficits in self-regulatory systems. In addition, eating disorder patterns influence the drive system, for instance, a boost in binge eating has found to be associated with subsequent food limitation, gastric drainage (vomiting), anxiety, and discontinuation of highly appetizing food- and some animals with a craving for food. (Pallister and Waller 2008) It was observed that binge eating may even follow intervals of food withdrawal. Furthermore, they had a tendency to go back to their previous eating habits after some time, and may exhibit cross-tolerance towards cocaine and alcohol. (Calero-Elvira, Krug, Davis, Lopez, Fernandez-Aranda, Treasure, 2009) These behavioral changes take place due to the changes in the levels of dopamine and upload (chemical transmitters). Lastly, the reaction to alterations in patterns of food consumption of the putative homoeostatic system may develop other eating disorders like, anorexia nervosa which is often linked with creating slimness, but the case is other way round for bulimia nervosa or binge eating disorder.

Treatment of Eating Disorders

Medical complications

Eating disorders mostly develop in adulthood, but the highest occurrence has been observed between 10 and 19 years of age, that may result in disturbing optimum growth and development. (Walsh and Sysko, 2009) Majority of path physiological complications associated with eating disorders may reverse with improving dietary habits or discontinue anomalous dietary and purging behaviors. (Eddy, Dorer, Franko, Tahilani, Thompson-Brenner and Herzog, 2008) Nevertheless, a number of physical damages may prove to be life-threatening, like extreme vomiting or laxative and diuretic abuse may lead to electrolyte imbalance in the body. (Calero-Elvira, Krug, Davis, Lopez, Fernandez-Aranda, Treasure, 2009) Moreover, nutritional insufficiency augments the possibility of developing cardiac arrhythmias and repeated infections. Symptoms of increased health risk are indicators of the extent to which an immediate professional consultation or inpatient handling, or both, are needed mainly in individuals with a recent and severe onset.

Possibly the greatest controversy related to eating-disorder management is the treatment of binge-eating disorder. (Marcus and Wildes, 2009) People with binge-eating disorder exhibit varying attitudes towards eating, shape and weight, together with mood swings like depression and behavior disorders. Since binge-eating disorder encompass both weight and eating-disorder problems, experts of both the obesity and eating-disorders fields identify disease management goals in their own way. On one hand, eating-disorders specialists recommend binge-eating is best cured by conventional eating-disorder approaches, like providing emotional support to the patient may lead to stop bingeing, improve their confidence and body acceptance. Same is correct for underlying psychological problems associated with obesity such as depression and nervousness.

Conversely, specialists of obesity recommend curing obesity first. They think it is useless or sometimes impossible to handle psychological problems without treating obesity. However, some eating disorder experts believe, since the disease is complex, there are several ways to treat it. For instance, studies reveal that cognitive behavioral therapy is beneficial for treating depression and bulimia both, interpersonal therapy helps cure depression, and behavioral weight-loss management helps cure obesity.

The complications in anorexia nervosa develop slowly and gradually and mostly develop an overall therapeutic condition rather than specific. Hence, these are rectified gradually and orally, through administration of food supplements, multiple minerals and multivitamins. In the course of first 3-7 days, an easily digestible food measuring approximately 5-10 kcal/kg per day together with thiamine and vitamin B co-strong in small meals is given to the patient. (Thomas, Vartanian and Brownell, 2009)

Meals containing large quantities of phosphorus (eg, dairy products) are recommended to the severely malnourished individuals, that diminishes the onset of refeeding syndrome. Food administration by tube is seldom required. Mostly the treatment intends to develop an increase of 250 g and 450 g weight in outpatients in a week, and approximately 1 kg in those treated in hospital.

Few strategies to develop weight change like vomiting or diuretics abuse, laxatives, or caffeinated and fizzy drinks may lead to electrolyte imbalance or under or over hydration. (Marcus and Wildes, 2009) Severe conditions may lead to acute renal failure. Oral administration is mostly the foremost and most preferred way of management; nevertheless the treatment is decided after a complete medical checkup and assessment of risk. Constant vomiting and Persistent hypokalaemia needs rectification to correct an imbalance of calcium and magnesium. This can be achieved through Proton-pump inhibitors that reduce gastric acid secretion and metabolic alkalosis and assist in potassium reservation in the body.

Some therapeutic effects of eating disorders can be irremediable or possess after effects on well-being, mainly those involving the skeleton, brain and the reproductive system. Some long-term complications include growth retardation, Dental problems and osteoporosis.

Anorexia nervosa has found to be associated with reduced fertility, miscarriage and maternity rate in women. (Eddy, Dorer, Franko, Tahilani, Thompson-Brenner and Herzog, 2008) Anorexia nervosa may also cause a decreased birth weight of infants; similarly it is higher in children of mothers having bulimia nervosa. Moreover, such conditions may augment risk for prenatal problems and feeding complication that may affect growth in infants. Hence, both infertile and expected women should be screened and treated if diagnosed with eating disorders to maximize the well-being of upcoming generations.

References

Calero-Elvira A, Krug I, Davis K, Lopez C, Fernandez-Aranda F, Treasure J. (2009) Meta-analysis on drugs in people with eating disorders. 17: 243-59.

Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB. (2008) Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. American Journal of Psychiatry; 165: 245-50.

Marcus MD, Wildes JE. (2009) Obesity: is it a mental disorder? International Journal of Eating Disorder; published online July 16. DOI:10.1002/eat.20725.

Pallister E, Waller G. (2008) Anxiety in the eating disorders: understanding the overlap. Clinical Psychology Revised 2008; 28: 366-86.

Thomas JJ, Vartanian LR, Brownell KD. (2009) The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychological Journal; 135: 407-33.

Walsh BT, Sysko R. (2009) Broad categories for the diagnosis of eating disorders (BCD-ED): an alternative system for classification. International Journal of Eating Disorder, published online July 31. DOI:10.1002/eat.20722.

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