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Documentary about tablets in psychological diseases treatment.

Documentary about tablets in psychological diseases treatment

Eating disorders










Eating Disorders
By Jaclyn Kong (5sc3)

Eaing Disorders Are So Common In America That 1 Or 2 Out Of Every 100 Students Will Struggle With One.
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     Eating Disorders Are More Than Just Going On A Diet To Lose Weight Or Trying To Make Sure You Exercise Every Day. They're Extremes In Eating Behavior — The Diet That Never Ends And Gradually Gets More Restrictive, For Example. Or The Person Who Can't Go Out With Friends Because He Or She Thinks It's More Important To Go Running To Work Off A Piece Of Candy.
    The Most Common Types Of Eating Disorder Are Anorexia Nervosa And Bulimia Nervosa (Usually Called Simply "Anorexia" And "Bulimia"). But Other Food-Related Disorders, Like Binge Eating Disorders, Body Image Disorders, And Food Phobias, Are Showing Up More Frequently Than They Used To.






Anorexia

   People With Anorexia Have An Extreme Fear Of Weight Gain And A Distorted View Of Their Body Size And Shape. As A Result, They Can't Maintain A Normal Body Weight. Some People With Anorexia Restrict Their Food Intake By Dieting, Fasting, Or Excessive Exercise. They Hardly Eat At All — And The Small Amount Of Food They Do Eat Becomes An Obsession.

   Other People With Anorexia Do Something Called Binge Eating And Purging, Where They Eat A Lot Of Food And Then Try To Get Rid Of The Calories By Forcing Themselves To Vomit, Using Laxatives, Or Exercising Excessively.


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Bulimia

     Bulimia Is Similar To Anorexia. With Bulimia, A Person Binge Eats (Eats A Lot Of Food) And Then Tries To Compensate In Extreme Ways, Such As Forced Vomiting Or Excessive Exercise, To Prevent Weight Gain. Over Time, These Steps Can Be Dangerous.
    To Be Diagnosed With Bulimia, A Person Must Be Binging And Purging Regularly, At Least Twice A Week For A Couple Of Months. Binge Eating Is Different From Going To A Party And "Pigging Out" On Pizza, Then Deciding To Go To The Gym The Next Day And Eat More Healthfully. People With Bulimia Eat A Large Amount Of Food (Often Junk Food) At Once, Usually In Secret. The Person Typically Feels Powerless To Stop The Eating And Can Only Stop Once He Or She Is Too Full To Eat Any More. Most People With Bulimia Then Purge By Vomiting, But May Also Use Laxatives Or Excessive Exercise.


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   Although Anorexia And Bulimia Are Very Similar, People With Anorexia Are Usually Very Thin And Underweight But Those With Bulimia May Be A Normal Weight Or Even Overweight.

Binge Eating Disorder
    This eating disorder Is Similar To Anorexia And Bulimia Because A Person Binges Regularly On Food (More Than Three Times A Week). But, Unlike The Other Eating Disorders, A Person With Binge Eating Disorder Does Not Try To "Compensate" By Purging The Food.
    Anorexia, Bulimia, And Binge Eating Disorder All Involve Unhealthy Eating Patterns That Begin Gradually And Build To The Point Where A Person Feels Unable To Control Them.

Anorexia And Bulimia: What To Look For
    Sometimes A Person With Anorexia Or Bulimia Starts Out Just Trying To Lose Some Weight Or Hoping To Get In Shape. But The Urge To Eat Less Or To Purge Spirals Out Of Control.
    People With Anorexia Or Bulimia Frequently Have An Intense Fear Of Being Fat Or Think That They Are Fat When They Are Not. A Person With Anorexia May Weigh Food Before Eating It Or Compulsively Count The Calories Of Everything. When It Seems "Normal" Or "Cool" To Do Things Like Restrict Food Intake To An Unhealthy Level, It's A Sign That A Person Has A Problem.
   So How Do You Know If A Person Is Struggling With Anorexia Or Bulimia? You Can't Tell Just By Looking At Someone. A Person Who Loses A Lot Of Weight May Have Another Health Condition Or May Be Losing Weight Through Healthy Eating And Exercise.
Here Are Some Signs That A Person May Have Anorexia Or Bulimia:
Anorexia
1. Becomes Very Thin, Frail, Or Emaciated
2. Obsessed With Eating, Food, And Weight Control
3. Weighs Herself Or Himself Repeatedly
4. Counts Or Portions Food Carefully
5. Only Eats Certain Foods, Avoiding Foods Like Dairy, Meat, Wheat, Etc. (Of Course
6. Lots Of People Who Are Allergic To A Particular Food Or Are Vegetarians Avoid Certain Foods)
7. Exercises Excessively
8. Feels Fat
9. Withdraws From Social Activities, Especially Meals And Celebrations Involving Food
10. May Be Depressed, Lethargic (Lacking In Energy), And Feel Cold A Lot

Bulimia

1. Fears Weight Gain
2. Intensely Unhappy With Body Size, Shape, And Weight
3. Makes Excuses To Go To The Bathroom Immediately After Meals
4. May Only Eat Diet Or Low-Fat Foods (Except During Binges)
5. Regularly Buys Laxatives, Diuretics, Or Enemas
6. Spends Most Of His Or Her Time Working Out Or Trying To Work Off Calories
7. Withdraws From Social Activities, Especially Meals And Celebrations Involving Food

What Causes Eating Disorders?
     No One Is Really Sure What Causes Eating Disorders, Although There Are Many Theories About Why People Develop Them. Many People Who Develop An Eating Disorder Are Between 13 And 17 Years Old. This Is A Time Of Emotional And Physical Changes, Academic Pressures, And A Greater Degree Of Peer Pressure. Although There Is A Sense Of Greater Independence During The Teen Years, Teens Might Feel That They Are Not In Control Of Their Personal Freedom And, Sometimes, Of Their Bodies. This Can Be Especially True During Puberty.
For Girls, Even Though It's Completely Normal (And Necessary) To Gain Some Additional Body Fat During Puberty, Some Respond To This Change By Becoming Very Fearful Of Their New Weight. They Might Mistakenly Feel Compelled To Get Rid Of It Any Way They Can.
   When You Combine The Pressure To Be Like Celeb Role Models With The Fact That During Puberty Our Bodies Change, It's Not Hard To See Why Some Teens Develop A Negative View Of Themselves.

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      Many People With Eating Disorders Also Can Be Depressed Or Anxious, Or Have Other Mental Health Problems Such As Obsessive-Compulsive Disorder (OCD). There Is Also Evidence That Eating Disorders May Run In Families. Although Part Of This May Be Our In Genes, It's Also Because We Learn Our Values And Behaviors From Our Families.
Sports And Eating Disorders
     Athletes And Dancers Are Particularly Vulnerable To Developing Eating Disorders Around The Time Of Puberty, As They May Want To Stop Or Suppress Growth (Both Height And Weight).Coaches, Family Members, And Others May Encourage Teens In Certain Sports — Such As Gymnastics, Ice-Skating, And Ballet — To Be As Thin As Possible. Some Athletes And Runners Are Also Encouraged To Weigh Less Or Shed Body Fat At A Time When They Are Biologically Destined To Gain It.

Effects Of Eating Disorders

     Eating Disorders Are Serious Medical Illnesses. They Often Go Along With Other Problems Such As Stress, Anxiety, Depression, And Substance Use. People With Eating Disorders Also Can Have Serious Physical Health Problems, Such As Heart Conditions Or Kidney Failure. People Who Weigh At Least 15% Less Than The Normal Weight For Their Height May Not Have Enough Body Fat To Keep Their Organs And Other Body Parts Healthy. In Severe Cases, Eating Disorders Can Lead To Severe Malnutrition And Even Death.
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   With Anorexia, The Body Goes Into Starvation Mode, And The Lack Of Nutrition Can Affect The Body In Many Ways:
1. A Drop In Blood Pressure, Pulse, And Breathing Rate
2. Hair Loss And Fingernail Breakage
3. Loss Of Periods
4. Lanugo Hair — A Soft Hair That Can Grow All Over The Skin
5. Lightheadedness And Inability To Concentrate
6. Anemia
7. Swollen Joints
8. Brittle Bones
With Bulimia, Constant Vomiting And Lack Of Nutrients Can Cause These Problems:

1. Constant Stomach Pain
2. Damage To A Person's Stomach And Kidneys
3. Tooth Decay (From Exposure To Stomach Acids)
4. "Chipmunk Cheeks," When The Salivary Glands Permanently Expand From Throwing Up So Often
5. Loss Of Periods
6. Loss Of The Mineral Potassium (This Can Contribute To Heart Problems And Even Death)
7.A Person With Binge Eating Disorder Who Gains A Lot Of Weight Is At Risk Of 8.Developing Diabetes, Heart Disease, And Some Of The Other Diseases Associated With Being overweight.

     The Emotional Pain Of An Eating Disorder Can Take Its Toll, Too. When A Person Becomes Obsessed With Weight, It's Hard To Concentrate On Much Else. Many People With Eating Disorders Become Withdrawn And Less Social. People With Eating Disorders Might Not Join In On Snacks And Meals With Their Friends Or Families, And They Often Don't Want To Break From Their Intense Exercise Routine To Have Fun.
    People With Eating Disorders Often Spend A Lot Of Mental Energy On Planning What They Eat, How To Avoid Food, Or Their Next Binge, Spend A Lot Of Their Money On Food, Hide In The Bathroom For A Long Time After Meals, Or Make Excuses For Going On Long Walks (Alone) After A Meal.

Treatment For Eating Disorders
    Fortunately, People With Eating Disorders Can Get Well And Gradually Learn To Eat Normally Again. Eating Disorders Involve Both The Mind And Body. So Medical Doctors, Mental Health Professionals, And Dietitians Will Often Be Involved In A Person's Treatment And Recovery.
   Therapy Or Counseling Is A Critical Part Of Treating Eating Disorders — In Many Cases, Family Therapy Is One Of The Keys To Eating Healthily Again. Parents And Other Family Members Are Important In Helping A Person See That His Or Her Normal Body Shape Is Perfectly Fine And That Being Excessively Thin Can Be Dangerous.
   If You Want To Talk To Someone About Eating Disorders And You Don't Feel As Though You Can Approach A Parent, Try Talking To A Teacher, A Neighbor, Your Doctor, Or Another Trusted Adult. Remember That Eating Disorders Are Very Common Among Teens. Treatment Options Depend On Each Person And Their Families, But Many Options Are Available To Help You Overcome An Eating Disorder. Therapy Can Help You Feel In Charge Again And Learn To Like Your Body, Just As It Is.
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Defining Characteristics Of Binge Eating Disorder:
     Binge Eating Disorder Is A Relatively Recently Recognized Disorder (It Is Sometimes Referred To As Compulsive Overeating).  Some Researchers Believe It Is The Most Common Of The Eating Disorders Affecting Millions Of Americans. Similar To Bulimia Nervosa, Those With Binge Eating Disorder Frequently Consume Large Amounts Of Food While Feeling A Lack Of Control Over Their Eating. However, This Disorder Is Different From Bulimia Nervosa Because People With Binge Eating Disorder Usually Do Not Purge (I.E. Vomiting, Laxatives, Excessive Exercise, Etc) Their Bodies Of The Excess Food They Consume During A Binge Episode. 
Diagnostic Criteria: DSM-IV
A. Recurrent Episodes Of Binge Eating. An Episode Is Characterized By:
1. Eating A Larger Amount Of Food Than Normal During A Short Period Of Time (Within Any Two Hour Period)
2. Lack Of Control Over Eating During The Binge Episode (I.E. The Feeling That One Cannot Stop Eating).
B. Binge Eating Episodes Are Associated With Three Or More Of The Following:
1. Eating Until Feeling Uncomfortably Full 
2. Eating Large Amounts Of Food When Not Physically Hungry
3. Eating Much More Rapidly Than Normal
4. Eating Alone Because You Are Embarrassed By How Much You're Eating
5. Feeling Disgusted, Depressed, Or Guilty After Overeating
C. Marked Distress Regarding Binge Eating Is Present
D. Binge Eating Occurs, On Average, At Least 2 Days A Week For Six Months
E. The Binge Eating Is Not Associated With The Regular Use Of Inappropriate Compensatory Behavior (I.E. Purging, Excessive Exercise, Etc.) And Does Not Occur Exclusively During The Course Of Bulimia Nervosa Or Anorexia Nervosa.
*From The DSM-IV, Diagnostic And Statistical Manual Of Mental Disorders, Fourth Edition, Washington D.C.: American Psychiatric Association, 1994.
Some Warning Signs:


 Rapid Weight Gain Or Obesity
- Constant Weight Fluctuations
- Frequently Eats An Abnormal Amount Of Food In A Short Period Of Time (Usually Less Than Two Hours)
- Does Not Use Methods To Purge Food
- Eats Rapidly (I.E. Frequently Chewing Without Swallowing)
- Feeling A Lack Of Control Over One's Eating (I.E. Unable To Stop)
- Eating Alone, "Secretive Eating Habits", Hiding Food, Etc.
- Eating Late At Night
- Eating When Not Hungry
- Disgust And Shame With Self After Overeating.
- Hoarding Food (Especially High Calorie/Junk Food)
- Coping With Emotional And Psychological States Such As Stress, Unhappiness Or Disappointment By Eating.
- Eating Large Amounts Of Food Without Being Hungry
- Consuming Food To The Point Of Being Uncomfortable Or Even In Pain
- Attribute Ones Successes And Failures To Weight
- Avoiding Social Situations Especially Those Involving Food.
- Depressed Mood
- Anxious Mood
Some Medical Consequences:


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Obesity
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Diabetes
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High Blood Pressure
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High Cholesterol
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Kidney Disease And/Or Failure
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Gallbladder Disease
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Arthritis
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Bone Deterioration
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Stroke
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Upper Respiratory Problems
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Skin Disorders
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Menstrual Irregularities 
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Ovarian Abnormalities
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Complications Of Pregnancy
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Depression, Anxiety And Other Mood Disorders
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Suicidal Thoughts
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Substance Abuse

Treatment Options:
   Studies Have Found That People With Binge Eating Disorder May Find It Harder Than Other People To Continue In Weight Loss Treatment. In Addition, They May Be More Likely To Regain Weight Quickly.  These Are Some Of The Reasons That People With Binge Eating Disorder May Require Treatment That Focuses On Their Binge Eating Before They Try To Lose Weight. Further, Even Those Who Are Not Overweight Are Frequently Distressed By Their Binge Eating And May Benefit From Treatment.
There Are Several Methods Currently Used To Treat Binge Eating Disorder. 
A. Cognitive-Behavioral Therapy: Method In Which The Client Is Taught Techniques To Monitor And Change Their Eating Habits, As Well As To Change The Way They Respond To Difficult And Stressful Situations. 
B. Interpersonal Psychotherapy: Method In Which The Client Is Taught To Examine Their Relationships With Friends And Family And To Make Changes In Problem Areas. 
C. Medications: Antidepressants May Be Helpful For Some Individuals. 
D. Self-Help Groups: These Groups May Be A Good Additional Source Of Support For Many.
Research Is Still Trying To Attempting To Determine Which Method Or Combination Of Methods Is The Most Effective In Controlling Binge Eating Disorder. 
Often Those Who Have Binge Eating Disorder Suffer With The Disorder For Years, Feel Ashamed, Depressed May Feel Very Alone. It Is Important To Recognize That You Are Not Alone, There Are Millions Like You And There Are Successful Treatment Options Available For You.  
To Determine The Type Of Treatment That Is Best Suited For Your Situation Treatment Options Should Be Discussed With A Licensed Mental Health Practitioner Who Can Assess Your Needs.

Diabulimia - What Is It?
   Diabulimia Is An Eating Disorder In Which People With Type 1 Diabetes Deliberately Give Themselves Less Insulin Than They Need For The Purpose Of Weight Loss.  When Insulin Is Omitted, Calories Are Purged Through The Loss Of Glucose In The Urine. Individuals With Diabulimia Manipulate Insulin As An Inappropriate Behavior To Prevent Weight Gain. This Is One Of The Criteria Of Bulimia Nervosa.1 Clinicians Have Not Defined The Frequency And Duration Of Insulin Omission And Many Do Not Recognize This Dual Condition As A Disorder. Some Propose The Following Definition: An Insulin Reduction At Least Twice A Week Or Of Over One Quarter Of The Prescribed Insulin For The Purpose Of Weight Loss For More Than Three Months.2,3   
The Term "Diabulimia" Started To Surface Among Public And Health Communities Through News, Magazines, And Health Journals In The Summer Of 2007. 4,5
Although Diabulimia Is Not Yet A Recognized Medical Term, Cases Of Type 1 Diabetes Combined With Eating Disorders Have Been Published Since The 1970s And Early 1980s. 6,7,8,9  In The Past Few Years, The Prevalence Has Ranged From 11 Percent To 39 Percent 10,11,12 Among Type 1 Diabetes, Depending On The Sample Size, The Age Group, And The Geographic Area. 13,14   Studies Were Conducted Through Self-Report Questionnaires. Because Some People Do Not Return Surveys And Some People Don't Tell The Full Stories During Their Interviews, Researchers Believe That The Actual Prevalence Of Type 1 Combined With An Eating Disorder Could Be Much Higher. 15
Who Has Diabulimia And What Are The Complications?
Inadequate Blood Glucose Control Might Result In Slow Growth And Development In Some Teenagers. 16   In One Long-Term Study, Teenagers With Type 1 Diabetes Who Misused Insulin To Prevent Weight Gain Had Serious Medical Consequences In Adulthood. Some Suffered From Eye Problems Ranging From Blurred Version To Requiring Laser Surgery To Blindness; Kidney Failure Which For Some Required Dialysis; Or Foot Ulcers Necessitating Amputation.17,18,19 According To One Study, The Painful Sensation From Nerve Damage Caused By Uncontrolled Blood Glucose Coincided With The Peak Of Weight Loss. Remission Of Pain Occurred As Weight Was Regained. 20   The Published Evidence Of Complications From Type 1 Diabetes With Disordered Eating Behavior Is Staggering. The Death Rate Of Type 1 Diabetes Was Three Times Those Who Had Eating Disorders Compared To Those Who Did Not. 21
Recently I Received A Phone Call From A Woman, Lucy, Who Was In Tears. "I Am Forty And Have Been Battling An Eating Disorder And Diabetes For Twenty-Five Years. I Skip Shots And Have Numerous Diabetes Complications. I Now Use A Wheelchair Because Of A Foot Ulcer And Neuropathy. Please Help Some Younger People Who Have Not Yet Destroyed Their Bodies Like Me. I Have No Hope Now." Another Woman Wrote, "I Have Done So Much Damage To My Body That I Feel More Like 75 Years Old Instead Of 35 Years Old. And I Have Completely Ruined My Chance Of Having Children."
Unfortunately, Few Teenagers Are Willing To Face The Long-Term Consequences Of Their Actions. Patricia, A Sixteen-Year-Old, Said To Me "Many People Tried To Scare Me With Talk Of Kidney Dialysis. Don't Worry," She Said, "I Would Have Killed Myself By The Time I Needed Dialysis."  
One Out Of Five Adolescents With Type 1 Diabetes Suffers From Depression, According To Studies. 14 This Further Worsens The Prognosis And Outcome Of This Serious And Deadly Condition.
Diabulimia Can Affect Anyone Who Wants To Lose Weight.  Joyce Was 13 When She Was Diagnosed With Type 1. According To Her, She Was Obese Through Her Life Until She Lost Forty Pounds For A Couple Months Prior To Diagnosis Of Diabetes. Within Few Weeks Of Insulin Management, She Regained The Water She Was Missing And Recovered Some Of The Lost Tissue Mass. She Gained 25 Pounds. It Didn't Take Long For Her To Figure Out That She Could Refuse Insulin When She Wished To Feel Good About Being Slim.
What To Watch For
Some Of The Common Warning Signs For Families And Friends To Watch For:
Consistent High Hemoglobin A1c (Glycosylated Hemoglobin) Or EAG (Estimated Average Glucose). 
Glycosylated Hemoglobin, Or A1c, Tests Provide An Index To The Average Blood Glucose Level Over A Period Of Approximately Three Months.2 Estimated Average Glucose Uses The Same Units (Mg/Dl) That Patients See Routinely.22  

Frequent Emergency Room Visits For Diabetic Ketoacidosis (DKA) May Be An Indicator Of The Presence Of An Eating Disturbance.17  That Said, Some Patients With Diabulimia Skip Rapid-Acting Insulin And Continue To Take Basal Insulin, And They May Not Experience DKA. Average Glucose Of 250 To 400 Mg/Dl Is Common. Patricia, The Teenager Who Couldn't Face Long Term-Consequences, Had An A1c Of Around 14. Joyce, The Teen Who Disliked Gaining Back All The Weight She Lost Pre-Diagnosis, Had An A1c That Never Fell Below 11.
Body Image Concerns
Individuals Who Suffer From Diabulimia May Be Underweight, Overweight, Or Within A Good Weight Range. They Show A Significant Increase In Drive For Thinness And Body Dissatisfaction 23. Joyce Continued To Struggle With Being 25 Pounds Overweight. She Weighed Herself Twice A Day; If There Was Any Ounce Of Weight Gain On The Scale, She Skipped Insulin And Meals. Patricia Was In A Good Weight Range, Yet Regarded Herself As Fat. She Wished To Lose At Least 15 Pounds.
Irregular Eating Patterns
The Eating Behavior Of Diabulimia Is Very Similar To The Eating Pattern Of Bulimia Nervosa.
Individuals May Restrict Intake, Skip Meals, And Eliminate Sweets And Fats With The Intention Of Losing Weight. This Behavior Is Followed By An Intense Over-Eating And Sense Of Guilt. The Individuals Then Proceed To Limit Their Eating Or Avoid Taking Insulin. The Vicious Cycle Repeats. The Intention For People With Diabulimia Is To Lose Weight, And Some May Demonstrate Weight Loss In A Period Of Time. However, The Erratic Eating Behavior Slows The Metabolism, And Lasting Weight Loss Seldom Occurs. 
Discomfort Eating Around Other People
Because Of Their Irregular Eating Behavior, Individuals With Diabulimia Prefer Not To Eat Around Other People, Especially When They Have The Urge To Overeat. Even If They Sit With Their Family At The Dining Table, They Will Choose Foods With Fewer Calories And Eat Small Portions. Patricia Refused To Eat Breakfast With Her Family Or Lunch With Classmates, Yet As Soon As She Came Home From School She Ate A Big Bag Of Chips And A Half Dozen Cookies In Private.
Hoarding Food Without Insulin, Nutrients Cannot Get To The Cells.  When The Cells Need Nutrients, The Individual Feels Hungry. To Satisfy Hunger, They Crave Food. But Patients With Diabulimia May Feel Guilty, Defeated, Or Ashamed When They Lose Control Over Their Hunger. Therefore, They May Hoard Foods And Eat Alone During Weak Moments.
Joyce's Parents Could Not Understand Why They Kept Finding Candy Bar Wrappers In Her Room When She Claimed That She Was On A Diet To Lose Weight.
Irregular Or Nonexistent Menses
High A1c Levels Have Been Reported To Cause Irregular Menses, Cessation Of Periods, And Delayed Puberty Due To Interference With The Function Of The Brain.16   Joyce Had Not Yet Started Her Menstruation Cycles At The Age Of 15, And Patricia Had Irregular Menses.
Unwillingness To Follow Through With Appointments 
Fourteen-Year-Old Mary Cried Out For Help With Three DKA Episodes. On Her Third Visit To The Emergency Room, She Told The Doctors That She Had Not Been Taking Insulin At Home; She Needed Help And Wished To Be Admitted To The Hospital. She Was, And After Discharge, She Was Referred To An Endocrinologist And A Psychotherapist For Follow-Up Treatment. Her Pediatrician Also Referred Her To Me For Nutritional Counseling.  
Her Parents Could Not Accept That Eating Disorders Might Have Played A Role In Mary's Diabetes. They Requested That The Endocrinologist Prescribe The "Right Dose" Of Insulin And Teach Her The "Correct Information."  After The Initial Nutritional Evaluation, Her Parents Cancelled The Appointment With Me. "The Dietitian Didn't Really Fix Her Eating," Her Parents Said To Her Pediatrician.  Mary's Parents Didn't Follow Through With Her Therapist Either. They Believed Mary's Problem Was Strictly Medical And Not Psychological.
I Can Only Imagine How Helpless And Hopeless Mary Must Have Felt. She Finally Got A Health Team's Attention, But Then Her Parents Could Not Support Her Treatment.

In Another Case, A Mother Recognized How Much Her 22-Year-Old Daughter, Susan, Was Struggling.  She Saw Susan Curl Like A Ball In The Corner Of Her College Dorm Room When She Visited Her.  Susan Was Tired And Nauseous Most Of The Time From Hyperglycemia. When Her Mother Checked, There Seemed To Be The Same Amount Of Insulin In The Fridge As There Was A Week Ago.  
Susan's Mom Arranged Multiple Appointments For Her Daughter's Diabetes Care, But Susan Managed To Make One Excuse After Another And Cancelled The Appointments.
Due To The Unwillingness Of The Individuals To Get Well And The Lack Of Awareness And Information For The Families, Follow-Up Treatment For Diabulimia Is A Great Challenge.

Doubtful Blood Glucose Monitoring
If The Numbers Shown In Blood Glucose Meters Seem Too Good To Be True, They Are.
Patricia Informed Me That A Specific Proportion Of Water And Milk Substituted For Blood On The Test Strip Produced An Ideal Reading Of Blood Glucose Below 200mg/DL. That Was How She Convinced The Health Providers And Her Mother That She Checked Her Blood Glucose And That The Readings Were Fine. If Her Mother's Suspicions Were Raised By Those Almost Perfect Numbers, Patricia Then Mixed Juice With Water To Increase The Number Of The Reading. 
In Both The Diabetes Clinic At Children's Hospital At Stanford And My Nutrition Counseling Private Practice Offices, I Observed The Feigned Forgetfulness Of Those Who Practiced Diabulimia. They Claimed They Forgot To Bring Their Meters; They Forgot To Enter Carbohydrates Consumed Onto Their Insulin Pump; Or They Forgot The Trend Of Their Blood Glucose. Either They Didn't Want Me To Know The Truth, Or They Didn't Think I Could Handle The Truth. Yet The Truth Was That They Were Taking Less Than Their Prescribed Insulin And Managing Their Diabetes Poorly.
There Have Been Few Studies Conducted To Determine Treatments For Diabulimia.
The Following Are What I Have Compiled From A Few Articles, From Talking To Health Professionals, And (Chiefly) Through My Own Experiences.  
Proposed Treatment Plans For Diabulimia
Inpatient Treatment
Some Individuals Require Hospitalization To Achieve Metabolic Control. Those With Symptoms Of Complications May Also Need Inpatient Treatment. 
Multi-Disciplinary Team Approach  
If Hospitalization Is Not Yet Necessary, Individuals With Diabulimia Should Be Followed By A Team Of Experts. For Successful Treatment Of The Multi-Faceted Symptoms And Behavior Of Diabulimia, A Multi-Disciplinary Team Approach Is Crucial. This Team Should Include:  
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An Endocrinologist Who Is Sensitive To The Psychosocial Component Of Individuals
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A Psychotherapist Experienced With Both Chronic Illness And Eating Disorders
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A Registered Dietitian Who Is Passionate About Eating Disorders And, More Importantly, Skillful In Mastering The Management Of Blood Glucose Patterns And Insulin Regimens 
In My Practice, I Follow Clients With Diabulimia Every Other Week For Nutritional Education. I Also Request That They Visit Their Endocrinologists Or Nurse Practitioners Monthly And Their Therapists At Least Once A Week.
Develop Healthy Eating Habits
Helping Individuals To Develop Healthy Eating Behavior Is The Foundation Of Medical Nutrition Therapy For Diabulimia. For Those Who Are Overweight, I Work With Them On Proper Portions; High Nutrients, And Low Caloric Food Choices; A Good Breakfast; Healthy Snacks; A Realistic Meal Schedule; And Simple Recipes For Homemade Meals. They Make Steady Weight Loss Progress By Improving Their Lifestyle. 
Shift Focus Away From Weight 
For Those Who Are Obsessed About Body Weight, Refraining From Weighing Themselves Is The Best Approach. At The Lucille Packard Children's Hospital @ Stanford (LPCH) Diabetes Clinic, Patients Have The Choice Of Not Knowing Their Weight. In My Offices I Have Clients Look Away From The Scale When I Weigh Them. 
Promote Appropriate Exercise
With The Exception Of Patients Diagnosed With Anorexia Nervosa, Who Are Underweight, Who Have Unstable Vital Signs, Or Who Exhibit Compulsive Exercise Behavior, Appropriate Physical Activities Can Be Usefully Integrated Into The Diabulimia Treatment Plan. 
Find Motivators: Everyone Has Something Important To Them
Success In Helping Individuals Make Progress Depends On Learning What Motivates Them. There Is Always Something Important To Someone; It's Up To Clinicians And Families To Find It. You Might Motivate Them By Explaining They Could:

a.       Decrease Tiredness, Headache, Or Nausea And Thus Be Able To Better Concentrate At School Or In The Workplace
b.       Decrease Thirst, Frequent Drinking, Or Bathroom Trips, And Thus Be Able To Socialize
c.       Maintain Muscle Mass And Energy To Keep Up With Sports Performance
d.       Have Less Intermittent Blurred Vision
e.       Reduce The Symptoms Of Painful Neuropathy
One Might Think That Preventing Limb Amputation, Blindness, Renal Dialysis, Or Death Would Be Good Motivators. However, Most Teenagers And Young Adults Don't Seem To Think That Could Happen To Them; It's Just Too Far Away. Immediate Gratification And Consequences Seem To Work Much Better.
Educate Persistently
When I Started Working With The Eating Disorders Program At Lucille Packard Children's Hospital Over 20 Years Ago, I Was Not Sure If Any Of The Information I Provided Really Helped. Most Of My Patients Claimed That They Read More Nutrition Books Than I Did, And They Selectively Believed Information Acquired From Friends, The Internet, Or Magazines. Soon I Learned That Resilience Is The Key To Educating This Population. It's Like Putting Nickels In A Slot Machine; In Order To Get The Jackpot, One Can't Give Up.
And Yes, I Have Been Depositing Rolls And Rolls Of Nickels To Help My Diabulimia Patients. I Pick A Subject At Each Visit, Such As Blood Sugar Monitoring, Metabolic Blood Glucose Control, Healthy Lifestyle, Or Short-Term And Long-Term Complications Of Hyperglycemia. I Simply Provide Education Without Judgment, Without A Sales Pitch, And Without Scary Tactics.
Set Small Goals
It's Overwhelming For Those Who Have Diabulimia When Healthcare Providers Or Caretakers Expect Them To Accept The Full Amount Of Insulin Prescribed. The Less Insulin They Took, The Higher Their A1c Would Be. Thus, They Would Be Prescribed More Insulin At The Next Visit To The Doctor. Therefore, The Gap Between What Was Prescribed And What Was Taken Actually Widened.
Source: Http://Www.Edreferral.Com

Anorexia And Hypnotherapy

There Are A Number Of Different Methods Of Therapy That A Professional Doctor May Use To Treat Anorexia. Due To The Fact That Anorexia Is An Illness That Doesn’t Necessarily Have A Set Treatment Or Cure, Many Different Types Of Treatment Are Generally Administered To See Which One Is Effective. Hypnotherapy Is A New Treatment That Has Come To Treat A Number Of Different Medical Conditions, One Of Them Being Anorexia. Hypnotherapy Will Use A Process Known As Hypnosis In Order To Change The Mentality Of Patients About Anorexia. Anorexia Can Be Very Dangerous If It Is Not Treated Soon Enough. Hypnosis Will Not Have A Lasting Negative Effect So It Should Be Tried If You Have Been Unsuccessful At Finding A Cure As Of Yet. This Article Will Provide You With Some Basic Information To Begin Using Hypnosis As A Form Of Treatment For Your Anorexia.
First You Will Need To Find A Professional Licensed Physician That Provides Hypnotherapy Often Known As A Hypnotherapist. Hypnosis Might Also Be Provided From A Psychotherapist Who Is A Medical Professional Whose Main Focus May Be Eating Disorder Treatments. Just Be Sure That You Are Aware Of What Is Expected From The Average Person Through Hypnotherapy. When The Average Person Undergoes Hypnosis, Your Medical Physician Should Give You Tips Through Encouraging You With Positive Words To Help You Become Better Acquainted With Eating And Food. Being Better Acquainted With Eating Through Hypnosis Will Help You To Be Less Opposed To The Consumption Of It. Your Body Will Start Accepting The Food Better Into The Body Through This Form Of Hypnotherapy. This Way You Will Be On Your Path Towards Living A Healthier Lifestyle Far Away From Anorexia.
Be Sure To Focus During Your Hypnotherapy Sessions Because Each One Can Be A Potential Drastic Change Of Your Mentality And Health. Try Your Best Not To Think Of Any Outside Distractions When You Are Entering Your State Of Hypnosis. Your Hypnotherapist Will Be Your Guide To Help You Relax By Using A Few Different Methods. Once You Are Feeling As If The Hypnosis Has Put You In A Trance That Means It Is Working. Be Prepared To Enter A Few Hypnotherapy Sessions In Order To See Any Results. If You Believe That You Would Rather Perform Hypnosis On Yourself At Home You Can Learn To Do So From Your Medical Physician As Well. You Should Try Working With Your Medical Physician And Continue With Several Hypnotherapy Sessions To See How Effective It Can Be. Once You Feel That You Are Comfortable Enough To Enter A State Of Hypnosis On Your Own Without Any Help You Can Try To Learn It Slowly. You Must Remember That Anorexia Is A Continuous Battle That Many People Continue To Accompany Them Throughout Their Whole Life. Even With These Hypnotherapy Sessions Where Your Mind Becomes Better With Dealing With Anorexia Through Hypnosis, You Must Be Patient And Persistent With The Battle. That Will Be The Only Way For You To Fully Recover And Beat The Battle Against Anorexia Through Hypnotherapy.

Source: Www.Hypnotherapist.Org
On The Teen Scene:
Eating Disorders Require Medical Attention
By Dixie Farley
For Reasons That Are Unclear, Some People--Mainly Young Women--Develop Potentially Life-Threatening Eating Disorders Called Bulimia Nervosa And Anorexia Nervosa. People With Bulimia, Known As Bulimics, Indulge In Bingeing (Episodes Of Eating Large Amounts Of Food) And Purging (Getting Rid Of The Food By Vomiting Or Using Laxatives). People With Anorexia, Whom Doctors Sometimes Call Anorectics, Severely Limit Their Food Intake. About Half Of Them Also Have Bulimia Symptoms.
The National Center For Health Statistics Estimates That About 9,000 People Admitted To Hospitals Were Diagnosed With Bulimia In 1994, The Latest Year For Which Statistics Are Available, And About 8,000 Were Diagnosed With Anorexia. Studies Indicate That By Their First Year Of College, 4.5 To 18 Percent Of Women And 0.4 Percent Of Men Have A History Of Bulimia And That As Many As 1 In 100 Females Between The Ages Of 12 And 18 Have Anorexia.
Males Account For Only 5 To 10 Percent Of Bulimia And Anorexia Cases. While People Of All Races Develop The Disorders, The Vast Majority Of Those Diagnosed Are White.
Most People Find It Difficult To Stop Their Bulimic Or Anorectic Behavior Without Professional Help. If Untreated, The Disorders May Become Chronic And Lead To Severe Health Problems, Even Death. Antidepressants Are Sometimes Prescribed For People With These Eating Disorders, And, In November 1996, FDA Added The Treatment Of Bulimia To The Indications For The Antidepressant Prozac (Fluoxetine).
About 1,000 Women Die Of Anorexia Each Year, According To The American Anorexia/Bulimia Association. More Specific Statistics From The National Center For Health Statistics Show That "Anorexia" Or "Anorexia Nervosa" Was The Underlying Cause Of Death Noted On 101 Death Certificates In 1994, And Was Mentioned As One Of Multiple Causes Of Death On Another 2,657 Death Certificates. In The Same Year, Bulimia Was The Underlying Cause Of Death On Two Death Certificates And Mentioned As One Of Several Causes On 64 Others.
As To The Causes Of Bulimia And Anorexia, There Are Many Theories. One Is That Some Young Women Feel Abnormally Pressured To Be As Thin As The "Ideal" Portrayed By Magazines, Movies And Television. Another Is That Defects In Key Chemical Messengers In The Brain May Contribute To The Disorders' Development Or Persistence.
The Bulimia Secret
Once People Begin Bingeing And Purging, Usually In Conjunction With A Diet, The Cycle Easily Gets Out Of Control. While Cases Tend To Develop During The Teens Or Early 20s, Many Bulimics Successfully Hide Their Symptoms, Thereby Delaying Help Until They Reach Their 30s Or 40s. Several Years Ago, Actress Jane Fonda Revealed She Had Been A Secret Bulimic From Age 12 Until Her Recovery At 35. She Told Of Bingeing And Purging Up To 20 Times A Day.
Many People With Bulimia Maintain A Nearly Normal Weight. Though They Appear Healthy And Successful--"Perfectionists" At Whatever They Do--In Reality, They Have Low Self-Esteem And Are Often Depressed. They May Exhibit Other Compulsive Behaviors. For Example, One Physician Reports That A Third Of His Bulimia Patients Regularly Engage In Shoplifting And That A Quarter Of The Patients Have Suffered From Alcohol Abuse Or Addiction At Some Point In Their Lives.
While Normal Food Intake For Women And Teenagers Is 2,000 To 3,000 Calories In A Day, Bulimic Binges Average About 3,400 Calories In 1 1/4 Hours, According To One Study. Some Bulimics Consume Up To 20,000 Calories In Binges Lasting As Long As Eight Hours. Some Spend $50 Or More A Day On Food And May Resort To Stealing Food Or Money To Support Their Obsession.
To Lose The Weight Gained During A Binge, Bulimics Begin Purging By Vomiting (By Self-Induced Gagging Or With An Emetic, A Substance That Causes Vomiting) Or By Using Laxatives (50 To 100 Tablets At A Time), Diuretics (Drugs That Increase Urination), Or Enemas. Between Binges, They May Fast Or Exercise Excessively.
Extreme Purging Rapidly Upsets The Body's Balance Of Sodium, Potassium, And Other Chemicals. This Can Cause Fatigue, Seizures, Irregular Heartbeat, And Thinner Bones. Repeated Vomiting Can Damage The Stomach And Esophagus (The Tube That Carries Food To The Stomach), Make The Gums Recede, And Erode Tooth Enamel. (Some Patients Need All Their Teeth Pulled Prematurely). Other Effects Include Various Skin Rashes, Broken Blood Vessels In The Face, And Irregular Menstrual Cycles.
Complexities Of Anorexia
While Anorexia Most Commonly Begins In The Teens, It Can Start At Any Age And Has Been Reported From Age 5 To 60. Incidence Among 8- To 11-Year-Olds Is Said To Be Increasing.
Anorexia May Be A Single, Limited Episode With Large Weight Loss Within A Few Months Followed By Recovery. Or It May Develop Gradually And Persist For Years. The Illness May Go Back And Forth Between Getting Better And Getting Worse. Or It May Steadily Get More Severe.
Anorectics May Exercise Excessively. Their Preoccupation With Food Usually Prompts Habits Such As Moving Food About On The Plate And Cutting It Into Tiny Pieces To Prolong Eating, And Not Eating With The Family.
Obsessed With Weight Loss And Fear Of Becoming Fat, Anorectics See Normal Folds Of Flesh As "Fat" That Must Be Eliminated. When The Normal Fat Padding Is Lost, Sitting Or Lying Down Brings Discomfort Not Rest, Making Sleep Difficult. As The Disorder Continues, Victims May Become Isolated And Withdraw From Friends And Family.
The Body Responds To Starvation By Slowing Or Stopping Certain Bodily Processes. Blood Pressure Falls, Breathing Rate Slows, Menstruation Ceases (Or, In Girls In Their Early Teens, Never Begins), And Activity Of The Thyroid Gland (Which Regulates Growth) Diminishes. Skin Becomes Dry, And Hair And Nails Become Brittle. Lightheadedness, Cold Intolerance, Constipation, And Joint Swelling Are Other Symptoms. Reduced Fat Causes The Body Temperature To Fall. Soft Hair Called Lanugo Forms On The Skin For Warmth. Body Chemicals May Get So Imbalanced That Heart Failure Occurs.
Anorectics Who Additionally Binge And Purge Impair Their Health Even Further. The Late Recording Artist Karen Carpenter, An Anorectic Who Used Syrup Of Ipecac To Induce Vomiting, Died After Buildup Of The Drug Irreversibly Damaged Her Heart.
Getting Help
Early Treatment Is Vital. As Either Disorder Becomes More Entrenched, Its Damage Becomes Less Reversible.
Usually, The Family Is Asked To Help In The Treatment, Which May Include Psychotherapy, Nutrition Counseling, Behavior Modification, And Self-Help Groups. Therapy Often Lasts A Year Or More--On An Outpatient Basis Unless Life-Threatening Physical Symptoms Or Severe Psychological Problems Require Hospitalization. If There Is Deterioration Or No Response To Therapy, The Patient (Or Parent Or Other Advocate) May Want To Talk To The Health Professional About The Plan Of Treatment.
There Are No Drugs Approved Specifically For Bulimia Or Anorexia, But Several, Including Some Antidepressants, Are Being Investigated For This Use.
If You Think A Friend Or Family Member Has Bulimia Or Anorexia, Point Out In A Caring, Nonjudgmental Way The Behavior You Have Observed And Encourage The Person To Get Medical Help. If You Think You Have Bulimia Or Anorexia, Remember That You Are Not Alone And That This Is A Health Problem That Requires Professional Help. As A First Step, Talk To Your Parents, Family Doctor, Religious Counselor, Or School Counselor Or Nurse.
Dixie Farley Is A Staff Writer For FDA Consumer.

DISORDERS' DEFINITIONS
According To The American Psychiatric Association, A Person Diagnosed As Bulimic Or Anorectic Must Have All Of That Disorder's Specific Symptoms:
Bulimia Nervosa
·                    Recurrent Episodes Of Binge Eating (Minimum Average Of Two Binge-Eating Episodes A Week For At Least Three Months)
·                    A Feeling Of Lack Of Control Over Eating During The Binges
·                    Regular Use Of One Or More Of The Following To Prevent Weight Gain: Self-Induced Vomiting, Use Of Laxatives Or Diuretics, Strict Dieting Or Fasting, Or Vigorous Exercise
·                    Persistent Over-Concern With Body Shape And Weight.
Anorexia Nervosa
·                    Refusal To Maintain Weight That's Over The Lowest Weight Considered Normal For Age And Height
·                    Intense Fear Of Gaining Weight Or Becoming Fat, Even Though Underweight
·                    Distorted Body Image
·                    In Women, Three Consecutive Missed Menstrual Periods Without Pregnancy.
Source:www.Fda.Gov
Eating Disorders In Men
From Jerry Kennard, Former About.Com Guide
Eating Disorders Have Mostly Been Investigated Within The Female Population. To A Large Extent This Is Because Of The Apparent Prevalence Of Eating Disorders In Women. On Closer Inspection However Gender Distributions Of Eating Disorders Show About 10 Per Cent Of People With Anorexia Are Men.

Doctors Fail To Recognize Male Eating Disorders

To Date The Evidence Suggests That The Gender Bias Of Clinicians Mean 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.

Eating Disorders And Occupation

There Are A Few Occupations In Which The Demand For Low Body Weights Can Lead To Anorexia Or Bulimia; Among Them Are Horse Racing, Modelling, Dancing, Distance Running And Driving.

Cultural, Social Issues And Eating Disorder

In Part, The Hidden Problem Of Eating Disorders In Men Is Cultural. Women Tend To Discuss Emotions And Psychological Problems More Than Men. Anorexia And Bulimia Are Perceived As A Woman's Problems. Discussion Of Weight Issues, Weight Control, Linking Thinness With Beauty Are Common Features In Women's Magazines And So Are Eating Disorders. Young Women Can Therefore Adopt The Same Behavior Without It Being Seen As Too Socially Unacceptable.

Little Recognition Male Eating Disorders

The Lack Of Visibility Of Anorexia Or Bulimia In The Male World Means A Number Of Things. Men Do Not Discuss Eating Disorders. Men Tend Not To Share The Information With Other Men Because The Subject Is A Female Issue. Men's Beauty Has To Do With Body Mass, Muscle Bulge And Definition, Not Weight Loss. This Male World, Socially Defined As Powerful And Masculine Results In Men Not Seeking Help Because Of Their Reluctance To Admit To The Problem.

Research Into Male Eating Disorders

A Large US Study Of Adolescents Reported In 1995 Does Show That Significant Numbers Of Young Males Experiencing Problem Weight Control Behavior.

2%-3% Of Males Diet All The Time Or More Than Ten Times A Year

5%-14% Of Males Deliberately Vomit After Eating

12%-21% Had A History Of Binge Eating

A Study Published In The April 2001 American Journal Of Psychiatry Found Many Psychological Similarities Between Men And Women With Eating Disorders, With Both Groups Experiencing Similar Symptoms.

Getting Help For Male Eating Problems

If You Are Experiencing Problems With Weight Control You Are Not Alone. Get Help By Contacting Your Family Doctor, A Psychologist, Mental Health Center Or A Doctor Specializing In Eating Disorders.
Article Sources Include:Woodside Et Al, D. Blake. "Comparisons Of Men With Full Or Partial Eating Disorders, Men Without Eating Disorders, And Women With Eating Disorders In The Community." American Journal Of Psychiatry (2001): 570.



Eating disorders - adam.about.com 






Highlights

Eating Disorders Overview
  • Eating disorders typically occur in young women.
  • Bulimia nervosa involves a pattern of bingeing and purging. Many people with bulimia nervosa also suffer from depression.
  • Anorexia nervosa involves a pattern of self-starvation. Patients often have an accompanying anxiety disorder (such as obsessive compulsive disorder) or depression. Patients who have anorexia and depression have a high risk for suicide.
Complications of Bulimia Nervosa
Many medical problems are directly associated with bulimic behavior, including:
  • Tooth erosion, cavities, and gum problems
  • Water retention, swelling, and abdominal bloating
  • Acute stomach distress
  • Low potassium levels
  • Irregular menstrual periods
  • Swallowing problems and esophagus damage
Complications of Anorexia Nervosa
Anorexia nervosa can increase the risk for serious health problems such as:
  • Hormonal changes, including reproductive, thyroid, stress, and growth hormones
  • Heart problems such as abnormal heart rhythm
  • Electrolyte imbalance
  • Fertility problems
  • Bone density loss
  • Anemia
  • Neurological problems
Treatment of Bulimia Nervosa
  • Bulimia nervosa is treated with a combination of psychotherapy and medication.
  • Cognitive behavioral therapy, which is given along with nutritional counseling, is the preferred psychotherapeutic approach.
  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), are the first choice for drug therapy.
Treatment of Anorexia Nervosa
  • Unlike bulimia nervosa, anorexia nervosa does not respond as well to drug treatment, although SSRIs are sometimes used as an adjunct to psychotherapy.
  • Nutritional rehabilitation therapy, which may include the entire family, is an important part of the treatment process.
  • Patients who are severely underweight and who have other physical risks may need to be hospitalized while weight is restored.

Introduction

Eating disorders are psychological problems marked by an obsession with food and weight. There are four general categories of eating disorders:
  • Bulimia nervosa
  • Anorexia nervosa
  • Binge eating
  • Eating disorders not otherwise specified

Bulimia Nervosa

Bulimia nervosa is more common than anorexia, and it usually begins early in adolescence. It is characterized by cycles of bingeing and purging, and typically takes the following pattern:
  • Bulimia is often triggered when young women attempt restrictive diets, fail, and react by binge eating. (Binge eating involves consuming larger than normal amounts of food within a 2-hour period.)
  • In response to the binges, patients compensate, usually by purging, vomiting, using enemas, or taking laxatives, diet pills, or drugs to reduce fluids.
  • Patients then revert to severe dieting, excessive exercise, or both. (Some patients with bulimia follow bingeing only with fasting and exercise. They are then considered to have non-purging bulimia.)
  • The cycle then swings back to bingeing and then to purging again.
  • To be diagnosed with bulimia, however, a patient must binge and purge at least twice a week for 3 months.
  • In some cases, the condition progresses to anorexia. Most people with bulimia, however, have a normal to high-normal body weight, although it may fluctuate by more than 10 pounds because of the binge-purge cycle.

Anorexia Nervosa

The term "anorexia" literally means absence of appetite. Anorexia can be associated with medical conditions or medications that cause a loss of appetite. Anorexia nervosa, however, involves a psychological aversion to food that leads to a state of starvation and emaciation. In anorexia nervosa:
  • At least 15% to as much as 60% of normal body weight is lost.
  • The patient with anorexia nervosa has an intense fear of gaining weight, even when severely underweight.
  • Individuals with anorexia nervosa have a distorted image of their own weight or shape and deny the serious health consequences of their low weight.
  • Women with anorexia nervosa miss at least three consecutive menstrual periods. (Women can also be anorexic without this occurrence.)
Patients with this condition are often characterized as anorexia restrictors or anorexic bulimic patients. Each type is equally prevalent.
  • Anorexia restrictors reduce their weight by severe dieting.
  • Anorexic bulimic patients maintain emaciation by purging. Although both types are serious, the bulimic type, which imposes additional stress on an undernourished body, is the more damaging.

Binge Eating (Binge Eating Disorder)

Bingeing without purging is characterized as compulsive overeating (binge eating) with the absence of bulimic behaviors, such as vomiting or laxative abuse (used to eliminate calories). Binge eating usually leads to becoming overweight.
To be diagnosed as a binge eater, a patient typically:
  • Consumes 5,000 - 15,000 calories in one sitting
  • Eats three meals a day plus frequent snacks
  • Overeats continually throughout the day, rather than simply consuming large amounts of food during binges
Treatment for binge eating is usually similar to treatment for bulimia. Since binge eating is often associated with obesity, it may also require weight and dietary management. [For more information, see In-Depth Report #53: Weight control and diet.]

Eating Disorders Not Otherwise Specified

A fourth category called eating disorders not otherwise specified (EDNOS) is used to describe eating disorders not specifically defined as anorexia or bulimia. This category includes:
  • Infrequent binge-purge episodes (occurring less than twice a week or having such behavior for less than months)
  • Repeated chewing and spitting without swallowing large amounts of food
  • Normal weight and anorexic behavior
Such patients tend to be older at diagnosis. Although less serious than other eating disorders, these patients still face similar health problems, including a higher risk for fractures and other conditions.

Causes

There is no single cause for eating disorders. Although concerns about weight and body shape play a role in all eating disorders, the actual cause of these disorders appear to result from many factors, including those that are genetic and neurobiologic, cultural and social, and behavioral and psychologic.
Although much has been written about the role of families and parenting as causes of eating disorders, there is no evidence supporting this claim.

Genetic Factors

Anorexia is eight times more common in people who have relatives with the disorder. Studies of twins show they have a tendency to share specific eating disorders (anorexia nervosa, bulimia nervosa, and obesity). Researchers have identified specific chromosomes that may be associated with bulimia and anorexia.

Biologic Factors

The bodys hypothalamic-pituitary-adrenal axis (HPA) may be important in eating disorders. This complex system originates in the following regions in the brain:
  • Hypothalamus. The hypothalamus is a small structure that plays a role in controlling our behavior, such as eating, sexual behavior and sleeping, and regulates body temperature, hunger and thirst, and secretion of hormones.
  • Pituitary gland. The pituitary gland is involved in controlling thyroid functions, the adrenal glands, growth, and sexual maturation.
  • Amygdala. This small almond-shaped structure lies deep in the brain and is associated with regulation and control of major emotional activities, including anxiety, depression, aggression, and affection.
Hypothalamus

Click the icon to see an image of the hypothalamus.
The HPA system releases certain neurotransmitters (chemical messengers) that regulate stress, mood, and appetite. Abnormalities in the activities of three of them, serotonin, norepinephrine, and dopamine, may play a particularly important role in eating disorders. Serotonin is involved with well-being, anxiety, and appetite (among other traits), and norepinephrine is a stress hormone. Dopamine is involved in reward-seeking behavior. Imbalances with serotonin and dopamine may explain in part why people with anorexia do not experience a sense of pleasure from food and other typical comforts.

Cultural Pressures

The media plays a role in promoting unrealistic expectations for body image and a distorted cultural drive for thinness. At the same time, cheap and high-caloric foods are aggressively marketed. The response of the media is contradictory and creates confusing messages.

Risk Factors

In the United States, about 7 million females and 1 million males suffer from eating disorders.

Age

Eating disorders occur most often in adolescents and young adults. However, they are becoming increasingly prevalent among young children. Eating disorders are more difficult to identify in young children because they less commonly suspected.

Gender

Eating disorders occur predominantly among girls and women. About 90 - 95% of patients with anorexia nervosa, and about 80% of patients with bulimia nervosa, are female.

Race and Ethnicity

Most studies of individuals with eating disorders have focused on Caucasian middle-class females. However, eating disorders can affect people of all races and socioeconomic levels.

Personality Disorders

People with eating disorders tend to share similar personality and behavioral traits, including low self-esteem, dependency, and problems with self-direction. Specific psychiatric personality disorders may put people at higher risk for eating disorders.
Avoidant Personalities. Some studies indicate that many patients with anorexia nervosa have avoidant personalities. This personality disorder is characterized by:
  • Being a perfectionist
  • Being emotionally and sexually inhibited
  • Having less of a fantasy life than people with bulimia or those without an eating disorder
  • Being perceived as always being "good," not being rebellious
  • Being terrified of being ridiculed or criticized or of feeling humiliated
People with anorexia are extremely sensitive to failure, and any criticism, no matter how slight, reinforces their own belief that they are "no good".
Obsessive-Compulsive Personality. Obsessive-compulsive personality defines certain character traits (being a perfectionist, morally rigid, or preoccupied with rules and order). This personality disorder has been strongly associated with a higher risk for anorexia. These traits should not be confused with the anxiety disorder called obsessive-compulsivedisorder (OCD), although they may increase the risk for this disorder.
Borderline Personalities. Borderline Personality Disorder (BPD) is associated with self-destructive and impulsive behaviors. People with BPD tend to have other co-existing mental health problems, including eating disorders.
Narcissistic Personalities. People with narcissitic personalities tend to:
  • Have an inability to soothe oneself
  • Have an inability to empathize with others
  • Have a need for admiration
  • Be hypersensitive to criticism or defeat

Accompanying Mental Health Disorders

Many patients with eating disorders experience depression and anxiety disorders. It is not clear if these disorders, particularly obsessive-compulsive disorder (OCD), cause the eating disorders, increase susceptibility to them, or share common biologic causes.
Obsessive-Compulsive Disorder (OCD). Obsessive-compulsive disorder is an anxiety disorder that may occur in up to two thirds of patients with anorexia and up to a third of patients with bulimia. Some doctors believe that eating disorders are variants of OCD. Obsessions are recurrent or persistent mental images, thoughts, or ideas, which may result in compulsive behaviors (repetitive, rigid, and self-prescribed routines) that are intended to prevent the manifestation of the obsession. Women with anorexia and OCD may become obsessed with exercise, dieting, and food. They often develop compulsive rituals (weighing every bit of food, cutting it into tiny pieces, or putting it into tiny containers.
Obsessive-compulsive disorder
Obsessive-compulsive disorder is an anxiety disorder characterized by an inability to resist or stop continuous, abnormal thoughts or fears combined with ritualistic, repetitive, and involuntary defense behavior.
Other Anxiety Disorders. Other anxiety disorders associated with both bulimia and anorexia include:
  • Phobias. Phobias often precede the onset of the eating disorder. Social phobias, in which a person is fearful about being humiliated in public, are common in both types of eating disorders.
  • Panic Disorder. Panic disorder often follows the onset of an eating disorder. It is characterized by periodic attacks of anxiety or terror (panic attacks).
  • Post-Traumatic Stress Disorder. Some patients with serious eating disorders report a past traumatic event (such as sexual, physical, or emotional abuse), and exhibit symptoms of post-traumatic stress disorder (PTSD) -- an anxiety disorder that occurs in response to life-threatening circumstances.
Depression. Depression is common in anorexia and bulimia. Major depression is unlikely to be a cause of eating disorders, however, because treating and relieving depression rarely cures an eating disorder. In addition, depression often improves after anorexic patients begin to gain weight.

Being Overweight

Extreme eating disorder behaviors, including use of diet pills, laxatives, diuretics, and vomiting, are reported more often in overweight than normal weight teenagers.

Body Image Disorders

Body Dysmorphic Disorder. Body dysmorphic disorder (BDD) involves a distorted view of one's body that is caused by social, psychologic, or possibly biologic factors. It is often associated with anorexia or bulimia, but it can also occur without any eating disorder. People with this disorder commonly suffer from emotional disorders, including obsessive-compulsive disorder and depression. As part of obsessive thinking, some people with BDD may obsess about a perceived deformity in one area of their body, and may repeatedly seek cosmetic surgery to "correct" it. People with BDD are also at higher risk for suicidal thinking and attempts.
Muscle Dysmorphia. Muscle dysmorphia is a form of body dysmorphic disorder in which the obsession involves musculature and muscle mass. It tends to occur in men who perceive themselves as being underdeveloped or "puny," which results in excessive body building, preoccupation with diet, and social problems. Such individuals are prone to eating disorders and other unhealthy behaviors, including the use of anabolic steroids.

Excessive Physical Activity

Highly competitive athletes are often perfectionists, a trait common among people with eating disorders.
Female Athletes. Excessive exercise is associated with many cases of anorexia (and, to a lesser degree, bulimia). In young female athletes, exercise and low body weight postpone puberty, allowing them to retain a muscular boyish shape without the normal accumulation of fatty tissues in breasts and hips that may blunt their competitive edge. Many coaches and teachers compound the problem by overstressing calorie counting and loss of body fat.
In response, people who are vulnerable to such criticism may feel compelled to strictly diet and lose weight. The term "female athlete triad" is a common and serious disorder that affects young female athletes and dancers. It includes:
  • Eating disorders, including anorexia
  • Amenorrhea (absent or irregular menstruation)
  • Osteoporosis (bone loss, which is related to low weight)
Male Athletes. Male wrestlers and lightweight rowers are also at risk for excessive dieting. Many high school wrestlers use a method called weight-cutting for rapid weight loss. This process involves food restriction and fluid depletion by using steam rooms, saunas, laxatives, and diuretics. Although male athletes are more apt to resume normal eating patterns once competition ends, studies show that the body fat levels of many wrestlers are still well below their peers during off-season and are often as low as 3% during wrestling season.

Diabetes or Other Chronic Diseases

Eating disorders may be more common in teenagers with chronic illness, such as diabetes or asthma. They are particularly serious problems for people with either type 1 or type 2 diabetes
  • Binge eating (without purging) is most common in type 2 diabetes and, in fact, the obesity it causes may even trigger this diabetes in some people.
  • Both bulimia and anorexia are common among young people with type 1 diabetes. The combination of diabetes and an eating disorder can have serious health consequences. Some women with diabetes often omit or underuse insulin in order to control weight. If such patients develop anorexia, their extremely low weight may appear to control the diabetes for a while. Eventually, however, if they fail to take insulin and continue to lose weight, these patients develop life-threatening complications.
Type I diabetes

Click the icon to see an image of type 1 diabetes.

Early Puberty

There appears to be a greater risk for eating disorders and other emotional problems for girls who undergo early menarche and puberty, when the pressures experienced by all adolescents are intensified by experiencing these early physical changes, including normal increased body fat.

Complications of Bulimia

Effects of Bulimic Behavior on the Body

Many medical problems are directly associated with bulimic behavior, including:
  • Tooth erosion, cavities, and gum problems
  • Water retention, swelling, and abdominal bloating
  • Acute stomach distress
  • Fluid loss with low potassium levels (due to excessive vomiting or laxative use; can lead to extreme weakness, near paralysis, or lethal heart rhythms)
  • Irregular menstrual periods
  • Swallowing problems and esophagus damage
Forced vomiting can cause:
Esophagus
The esophagus connects the mouth with the stomach. The epiglottis folds over the trachea when a swallow occurs, to prevent the swallowed substance from being inhaled into the lungs. When a person is unable to swallow because of illness or coma, a tube may be inserted either through the mouth or nose, past the epiglottis, through the esophagus and into the stomach. Nutrients pass directly through the tube into the stomach.
  • Rupture of the esophagus
  • Weakened rectal walls (a rare but serious condition that requires surgery)
Rectum

Click the icon to see an image of the rectum.

Self-Destructive Behavior

A number of self-destructive behaviors occur with bulimia:
  • Smoking. Many teenage girls with eating disorders smoke because it is thought to help prevent weight gain.
  • Impulsive Behaviors. Women with bulimia may be at higher-than-average risk for dangerous impulsive behaviors, such as sexual promiscuity, self-cutting, and kleptomania.
  • Alcohol and Substance Abuse. Many patients with bulimia abuse alcohol, drugs, or both. Women with bulimia also frequently abuse over-the-counter medications, such as laxatives, appetite suppressants, diuretics, and drugs that induce vomiting (ipecac).

Complications of Anorexia

Anorexia nervosa is a very serious illness that has a wide range of effects on the body and mind. It is frequently associated with a number of other medical problems, ranging from frequent infections and general poor health to life-threatening conditions.

Psychological Effects and Substance Abuse

Adolescents with eating behaviors associated with anorexia are at high risk for anxiety and depression in young adulthood. Patients with anorexia are at risk for suicidal behavior or attempts. Alcohol and drug abuse are also common in patients with anorexia nervosa.

Hormonal Changes

One of the most serious effects of anorexia nervosa is hormonal changes, which can have severe health consequences.
  • Reproductive hormones, including estrogen and dehydroepiandrosterone (DHEA), are lower. Estrogen is important for healthy hearts and bones. DHEA, a weak male hormone, may also be important for bone health and for other functions.
  • Thyroid hormones are lower.
  • Stress hormones are higher.
  • Growth hormones are lower. Children and adolescents with anorexia may experience retarded growth.
The result of many of these hormonal abnormalities in women is long-term, irregular or absent menstruation (amenorrhea). This can occur early on in anorexia, even before severe weight loss. Over time this causes infertility, bone loss, and other problems.

Heart Disease

Heart disease is the most common medical cause of death in people with severe anorexia nervosa. The effects of anorexia on the heart are:
  • Dangerous heart rhythms, including slow rhythms known as bradycardia, may develop. Such abnormalities can show up even in teenagers with anorexia.
Bradycardia
Bradycardia is a slowness of the heartbeat, usually at a rate under 60 beats per minute (normal resting rate is 60 - 100 beats per minute).
  • Blood flow is reduced.
  • Blood pressure may drop.
  • The heart muscles starve, losing size.
A primary danger to the heart is from imbalances of minerals, such as potassium, calcium, magnesium, and phosphate, which are normally dissolved in the body's fluid. The dehydration and starvation that occurs with anorexia can reduce fluid and mineral levels and produce a condition known as electrolyte imbalance. Certain electrolytes (especially calcium and potassium) are critical for maintaining the electric currents necessary for a normal heartbeat. An imbalance in these electrolytes can be very serious and even life threatening unless fluids and minerals are replaced. Heart problems are a particular risk when anorexia is compounded by bulimia and the use of ipecac, a drug that causes vomiting.

Effect on Fertility and Pregnancy

After treatment and an increase in weight, estrogen levels are usually restored and periods resume. In severe anorexia, however, even after treatment, normal menstruation never returns in some patients.
  • If a woman with anorexia becomes pregnant before regaining normal weight, she faces a higher risk for miscarriage, cesarean section, and for having an infant with low birth weight or birth defects. She may also be at higher risk for postpartum depression.
  • Women with anorexia who seek fertility treatments have lower chances for success.

Effect on Bones and Growth

Almost 90% of women with anorexia experience osteopenia (loss of bone calcium), and 40% have osteoporosis (more advanced loss of bone density). Up to two-thirds of children and adolescent girls with anorexia fail to develop strong bones during their critical growing period. Boys with anorexia also suffer from stunted growth. The less the patient weighs, the more severe the bone loss. Women with anorexia who also binge-purge face an even higher risk for bone loss.
Bone loss in women is mainly due to low estrogen levels that occur with anorexia. Other biologic factors in anorexia also may contribute to bone loss, including high levels of stress hormones (which impair bone growth) and low levels of calcium, certain growth factors, and DHEA (a weak male hormone). Weight gain, unfortunately, does not completely restore bone. Only achieving regular menstruation as soon as possible can protect against permanent bone loss. The longer the eating disorder persists the more likely the bone loss will be permanent.
Testosterone levels decline in boys as they lose weight, which also can affect their bone density. In young boys with anorexia, weight restoration produces some catch-up growth, but it may not produce full growth.

Neurological Problems

People with severe anorexia may suffer nerve damage that affects the brain and other parts of the body. The following nerve-related conditions have been reported:
  • Seizures
  • Disordered thinking
  • Numbness or odd nerve sensations in the hands or feet (peripheral neuropathy)
Brain scans indicate that parts of the brain undergo structural changes and abnormal activity during anorexic states. Some of these changes return to normal after weight gain, but some damage may be permanent.

Blood Problems

Anemia is a common result of anorexia and starvation. A particularly serious blood problem is caused by severely low levels of vitamin B12. If anorexia becomes extreme, the bone marrow dramatically reduces its production of blood cells, a life-threatening condition called pancytopenia.

Gastrointestinal Problems

Bloating and constipation are both very common problems in people with anorexia.

Multiorgan Failure

In very late stages of anorexia, the organs simply fail. The main warning sign is high blood levels of liver enzymes, which require immediate administration of calories.

Complications in Adolescents with Type 1 Diabetes

Eating disorders are particularly serious for young people with type 1 diabetes.
Low blood sugar, for example, is a danger for anyone with anorexia, but it is a particularly dangerous risk for those with diabetes. If patients do not take their insulin, high blood sugar, which is also very dangerous, can occur. Unfortunately, patients with eating disorders may skip or reduce their daily insulin in order to decrease their intake of calories. Extremely high blood sugar levels can cause diabetic ketoacidosis, a condition in which acidic chemicals (ketones) accumulate in the body. This condition can lead to coma and death.

Symptoms

Symptoms Specific to Bulimia Nervosa

Symptoms or behavioral signs of bulimia may include:
  • Regularly going to the bathroom right after meals
  • Suddenly eating large amounts of food or buying large quantities that disappear right away
  • Compulsive exercising
  • Broken blood vessels in the eyes (from the strain of vomiting)
  • Pouch-like appearance to the corners of the mouth due to swollen salivary glands
  • Dry mouth
  • Tooth cavities, diseased gums, and irreversible enamel erosion from excessive gastric acid produced by vomiting
  • Rashes and pimples
  • Small cuts and calluses across the tops of finger joints due to self-induced vomiting
  • Evidence of discarded packaging for laxatives, diet pills, emetics (drugs that induce vomiting), or diuretics (medications that reduce fluids)

Symptoms Specific to Anorexia Nervosa

The primary symptom of anorexia is major weight loss from excessive and continuous dieting, which may either be restrictive dieting or binge-eating and purging.
Other symptoms of anorexia may include:
  • Infrequent or absent menstrual periods
  • Compulsive exercising coupled with excessive thinness
  • Refusal to eat in front of others
  • Ritualistic eating, including cutting food into small pieces
  • Hypersensitivity to cold -- some women wear several layers of clothing to both keep warm and hide their thinness
  • Yellowish skin, especially on the palms of the hands and soles of the feet -- from eating too many vitamin A-rich vegetables such as carrots
  • Dry skin covered with fine hair
  • Thin scalp hair
  • Cold or swollen feet and hands
  • Stomach problems, including bloating after eating
  • Confused or slowed thinking
  • Poor memory or judgment

Diagnosis

The first step toward a diagnosis is to admit the existence of an eating disorder. Often, the patient needs to be compelled by a parent or others to see a doctor because the patient may deny and resist the problem. Some patients may even self-diagnose their condition as an allergy to carbohydrates, because after being on a restricted diet, eating carbohydrates can produce gastrointestinal problems, dizziness, weakness, and palpitations. This may lead such people to restrict carbohydrates even more severely.
It is often extremely difficult for parents as well as the patient to admit that a problem is present.

Screening Tests

Various questionnaires are available for assessing patients. The Eating Disorders Examination (EDE), which is an interview of the patient by the doctor, and the self-reported Eating Disorders Examination-Questionnaire (EDE-Q) are both considered valid tests for assessing eating disorder diagnosis and determining specific features of the individuals condition (such as vomiting or laxative use).
Another test is called the SCOFF questionnaire, which can help identify patients who meet the full criteria for anorexia or bulimia nervosa. (It may not be as accurate in people who do not meet the full criteria.)

SCOFF Questionnaire

Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone's worth of weight (14 pounds) in a 3-month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?
Answering yes to two of these questions is a strong indicator of an eating disorder.

Measuring Body Mass Index

A doctor will evaluate a patients body mass index (BMI). The BMI)is the measurement of body fat. It is derived by multiplying a person's weight in pounds by 703 and then dividing it twice by the height in inches. (BMI calculators are available online.)
  • A healthy BMI for women over age 20 is 19 - 25.
  • Those over 25 are considered overweight; those over 30 are considered obese.
  • Those under 17.5 are considered to be at risk for health problems related to anorexia. (However, young teenagers can have lower BMIs without necessarily being anorexic.)
For example, a woman who is 5'5" and weighs 125 pounds has a healthy BMI of 21. A woman at the same height who weighs 90 pounds would have a dangerously low BMI of 15.

Diagnosing Bulimia Nervosa

A doctor generally makes a diagnosis of bulimia if there are at least two bulimic episodes per week for 3 months. Because people with bulimia tend to have complications with their teeth and gums, dentists can play a crucial role in identifying and diagnosing bulimia.

Diagnosing Anorexia Nervosa

Generally, an observation of physical symptoms and a personal history will confirm the diagnosis of anorexia. The standard criteria for diagnosing anorexia nervosa are:
  • The patient's refusal to maintain a body weight normal for age and height
  • Intense fear of becoming fat even though underweight
  • A distorted self-image that results in diminished self-confidence
  • Denial of the seriousness of emaciation and starvation
  • The loss of menstrual function for at least 3 months
The doctor then categorizes the anorexia further:
  • Restricting (severe dieting only)
  • Anorexia bulimia (binge-purge behavior)

Diagnosing Complications of Eating Disorders

Once a diagnosis is made, a doctor will check for any serious complications of starvation and also rule out other medical disorders that might be causing the anorexia. Tests should include:
  • A complete blood count
  • Tests for electrolyte imbalances
  • Test for protein levels
  • An electrocardiogram and a chest x-ray
  • Tests for liver, kidney, and thyroid problems
  • A bone density test

Treatment

Treatment goals for eating disorders include:
  • Restore normal weight for anorexia nervosa
  • Reduce, and hopefully stop, binge eating and purging for bulimia nervosa
  • Treat physical complications and any associated psychiatric disorders
  • Teach patients proper nutritional habits and how to develop healthy eating patterns and meal plans
  • Change patients dysfunctional thoughts about the eating disorder
  • Improve self-control, self-esteem, and behavior
  • Provide family counseling
  • Prevent relapse
A multidisciplinary team approach with consistent support and counseling is essential for long-term recovery. Depending on the severity and type of eating disorder, team members may include:
  • Doctors specializing in relevant medical complications
  • Dietitians and nutritional counselors
  • Cognitive-behavioral therapists, family therapists, or other psychotherapists
All should be experienced in treating eating disorders.

General Treatment Approaches

Eating disorders are nearly always treated with some form of psychiatric or psychologic treatment, often tied in with nutritional counseling. Depending on the disorder and the individual patient, certain psychologic approaches may work better than others.
Nutritional rehabilitation counseling is essential for recovery. It can help patients develop structured meal plans and healthy eating and weight management. In anorexia nervosa, family-based therapies that involve the parents assistance in feeding their adolescent child have proven to be very helpful.
Medications such as selective serotonin reuptake inhibitor (SSRI) antidepressants may be added to psychotherapy for bulimia, but there is limited evidence that these or other drugs have any significant effect on anorexia nervosa.
Although anorexia nervosa generally presents more treatment challenges than bulimia nervosa, long-term studies show recovery in many people treated for anorexia. Studies indicate that a majority of people with bulimia and up to half of patients with anorexia nervosa are free from eating disorders within 10 years of treatment.

Choosing a Treatment Site

The patients condition, social circumstances, and health insurance coverage determine the type of treatment facility -- inpatient hospitalization, residential hospitalization, partial hospitalization, or outpatient care. Patients and their families should discuss with their doctors the various options available and how structured and intense the treatment should be.
Moderately to severely ill anorexic patients may require hospitalization when:
  • Weight loss continues even with outpatient treatment
  • Weight is 30% below ideal body weight
  • Depression is severe or the patient is suicidal
  • There are symptoms of medical complications (disturbed heart rate, low potassium levels, altered mental status, low blood pressure, severe sensations of cold)
When severe metabolic or medical problems occur, patients with anorexia may need to be hospitalized either voluntarily or involuntarily. A variety of partial hospitalization or day care programs are also available.
For people with severe anorexia, many doctors recommend 10 - 12 weeks of hospitalization with full nutritional support in order for the patient to reach ideal body weight. It is particularly important for women with both diabetes and anorexia to achieve 100% of ideal weight before being released from an inpatient facility.

Treatment for Bulimia

Some doctors recommend a stepped approach for patients with bulimia, which follow specific stages depending on the severity and response to initial treatments:
  • Support groups may be helpful for patients who have mild conditions with no health consequences.
  • Cognitive-behavioral therapy (CBT) along with nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.
  • Drug therapy used for bulimia is typically a selective serotonin-reuptake inhibitor (SSRI) antidepressant. A combination of CBT and SSRIs may be effective if CBT alone is not helpful.
Patients with bulimia rarely need hospitalization except under the following circumstances:
  • Binge-purge cycles have led to anorexia
  • Drugs are needed for withdrawal from purging
  • Major depression is present

Psychotherapeutic Approaches and Medications for Bulimia

Psychologic Therapy. Cognitive-behavioral therapy (CBT) is the first-line of therapy for most patients with bulimia. Interpersonal therapy may be tried if CBT fails. In interpersonal therapy (also known as "talk therapy"), therapists help patients explore how social and family relationships may affect their eating disorder.
Antidepressants. The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs) such as:
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
Studies are mixed, however, on whether SSRIs offer an additional advantage in reducing binge-eating compared to CBT. Fluoxetine has been approved for bulimia and is considered the drug of choice, although some studies suggest that other SSRIs work just as well. Other types of antidepressants, such as tricyclics, MAO inhibitors, and buprorion (Wellbutrin), carry more risks of side effects than SSRIs and do not appear to be effective for treatment of bulimia.
Antidepressants may increase the risks for suicidal thoughts and actions during the first few months of treatment. In particular, adolescents and young adults should be carefully monitored during this time period for any changes in behavior. [For more information on antidepressants, see In-Depth Report #08: Depression.]

Other Drug Therapy for Bulimia Nervosa

Topiramate. The antiepileptic drug topiramate (Topamax) has been shown in studies to reduce bingeing and purging episodes in patients with bulimia. However, due to this drugs risk for serious side effects, topiramate should be used only if other medication has failed. In addition, because people tend to lose weight while taking topiramate, it should not be used by patients who have low or even normal body weight.

Treatment for Anorexia

Nutrition rehabilitation and psychotherapy are the cornerstones of anorexia nervosa treatment. Patients may also require treatment of medical problems related to the condition, such as bone loss, and imbalances in important electrolytes.

Restoring Normal Weight and Nutritional Intervention

Nutritional intervention is essential. Weight gain is associated with fewer symptoms of anorexia and with improvements in both physical and mental function. Restoring good nutrition can help reduce bone loss, and raising the level of energy available to the body by balancing food intake and exercise can normalize hormonal function. Restoring weight is also essential before the patient can fully benefit from additional psychotherapeutic treatments.
Goals for Weight Gain and Good Nutrition. A weight-gain goal of 2 - 3 pounds a week for hospitalized patients, and 0.5 - 1 pound a week for outpatients, is strongly encouraged. Patients typically begin with a calorie count as low as 1,000 - 1,600 calories a day, which is then gradually increased to 2,000 - 3,500 calories a day. Patients may initially experience intensified anxiety and depressive symptoms, as well as fluid retention, in response to weight gain. These symptoms decrease as the weight is maintained.
Tubal Feedings. Feeding tubes that pass through the nose to the stomach are not commonly used, since they may discourage a return to normal eating habits and because many patients interpret their use as punishing forced feeding. However, for patients who are at significant risk or for those who refuse to eat, tube feeding through the nose or through a tube inserted through the abdomen into the stomach can help with weight gain and improve the nutritional status of the patient.
Intravenous Feedings. Intravenous feedings may be needed in life-threatening situations. This involves inserting a needle into the vein and infusing fluids containing nutrients directly into the bloodstream. Intravenous feedings must be administered carefully. When given at home, no more than the prescribed amount should be used. Overzealous administration of glucose solutions can cause phosphate levels to drop severely and trigger a condition called hypophosphatemia. Emergency symptoms include irritability, muscle weakness, bleeding from the mouth, disturbed heart rhythms, seizures, and coma.
The Maudsley Approach. For adolescent and other younger patients in the early stages of anorexia nervosa, the Maudsley approach to refeeding may be effective. The Maudsley approach is a type of family therapy that enlists the family as a central player in the patients nutritional recovery. Parents take charge of planning and supervising all of the patients meals and snacks. As recovery progresses, the patient gradually takes on more personal responsibility for determining when and how much to eat. Weekly family meetings and family-based counseling are also part of this therapeutic approach.

The Role of Exercise in Recovery

The role of exercise in recovery is complex, since, for those with anorexia, excessive exercise is often a component of the original disorder. However, very controlled exercise regimens may be used as both a reward for developing good eating habits and as a way to reduce the stomach and intestinal distress that accompanies recovery. Exercise should not be performed if severe medical problems still exist and if the patient has not gained significant weight. The goal of exercise should be on improving physical fitness and health, not on burning off calories.

Psychologic Approaches and Medications for Patients with Anorexia Nervosa

Psychotherapy. Family therapy is an important component of anorexia treatment, especially for children and adolescents. Adults usually begin with motivational psychotherapy that provides an empathetic setting and rewards positive efforts towards weight gain. After weight is restored, cognitive behavioral therapy techniques may be helpful.
Antidepressants. Studies have not reported benefits for treating anorexia nervosa with selective serotonin reuptake inhibitors (SSRIs), the antidepressants that are often useful for patients with bulimia. A few studies suggest that these drugs could be useful for people with anorexia nervosa who also have obsessive-compulsive disorder (OCD).
Nutritional Supplements. Calcium and vitamin D supplements are often recommended. Some studies have reported that zinc supplements may help patients gain weight.

Psychotherapy

Eating disorders are nearly always treated with some form of psychotherapy. Depending on the problem, different psychological approaches may work better than others.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) works on the principle that a pattern of false thinking and belief about one's body can be recognized objectively and altered, thereby changing the response and eliminating the unhealthy reaction to food. One approach for bulimia is the following:
  • Over a period of 4 - 6 months the patient builds up to eating 3 meals a day, including foods that the patient has previously avoided.
  • During this period, the patient monitors and records the daily dietary intake along with any habitual unhealthy reactions and negative thoughts toward eating while they are occurring.
  • The patient also records any relapses (binges or purging). Such lapses are reported objectively and without self-criticism and judgment.
  • The patient discusses the responses with a cognitive therapist at regular sessions. Eventually the patient is able to discover the false attitudes about body image and the unattainable perfectionism that underlies the opposition to food and health.
  • Once these habits are recognized, food choices are broadened, and the patient begins to challenge any entrenched and automatic ideas and responses. The patient then replaces them with a set of realistic beliefs along with actions based on reasonable self-expectations.

Interpersonal Therapy

Interpersonal therapy deals with depression or anxiety that might underlie the eating disorders along with social factors that influence eating behavior. This therapy does not deal with weight, food, or body image at all.
The goals are to:
  • Express feelings
  • Discover how to tolerate uncertainty and change
  • Develop a strong sense of individuality and independence
  • Address any relevant sexual issues or traumatic or abusive event in the past that might be a contributor of the eating disorder
Studies generally report that interpersonal therapy is not as effective as cognitive therapy for bulimia and binge eating, but may be useful for some patients with anorexia. The skill of the therapist plays a strong role in its success.

Motivational Enhancement Therapy

Motivational enhancement therapy is another form of behavioral therapy that uses an empathetic approach to help patients understand and change their behaviors concerning food. It may be offered in an individual or group setting.

Family Therapy

Because a patients eating disorder affects the entire family, family therapy can be an important component of recovery. It can help all family members better understand the complex nature of eating disorders, improve their communication skills with one another, and teach strategies for coping with stress and negative feelings. Family-based psychotherapies are also integral parts of nutritional rehabilitation counseling programs, such as the Maudsley approach.

Resources

References

American Psychiatric Association. Treatment of patients with eating disorders, third edition. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54.
Attia E, Walsh BT. Behavioral management for anorexia nervosa. N Engl J Med. 2009 Jan 29;360(5):500-6.
Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007 May;40(4):293-309.
Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007 May;40(4):310-20.
Gowers SG. Management of eating disorders in children and adolescents. Arch Dis Child. 2008 Apr;93(4):331-4. Epub 2007 Oct 9.
Hall MN, Friedman RJ 2nd, Leach L. Treatment of bulimia nervosa. Am Fam Physician. 2008 Jun 1;77(11):1588, 1592.
Hunt TJ, Thienhaus O, Ellwood A. The mirror lies: body dysmorphic disorder. Am Fam Physician. 2008 Jul 15;78(2):217-22.
Ipser JC, Sander C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005332.
Kaye W. Neurobiology of anorexia and bulimia nervosa. Physiol Behav. 2008 Apr 22;94(1):121-35. Epub 2007 Nov 29.
Keel PK, Haedt A. Evidence-based psychosocial treatments for eating problems and eating disorders. J Clin Child Adolesc Psychol. 2008 Jan;37(1):39-61.
le Grange D, Lock J, Loeb K, Nicholls D. Academy for eating disorders position paper: The role of the family in eating disorders. Int J Eat Disord. 2009 Sep 2;43(1):1-5. [Epub ahead of print]
Schmidt U, Lee S, Beecham J, et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. Am J Psychiatry. 2007 Apr;164(4):591-8.
Williams PM, Goodie J, Motsinger CD. Treating eating disorders in primary care. Am Fam Physician. 2008 Jan 15;77(2):187-95.

Review Date: 1/11/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


































































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Shortly about my book...

This book is written in a very light way for reading like a fiction based on a real life story of the Ukrainian girl from a little town who has been caught by cruel disease- anorexia. Reading this book you will find out how everything began and what circumstances has led to such a serious consequence. You will be plunged into the breathtaking world of different real events and stunning cogitations what will catch you and make you to be lost in meditations… you will find out not only the mechanism of anorexia leverage, you will learn life infinite wisdom what is useful for any person of any age. Moreover, you will receive the priceless advices how to fight anorexia either if you suffer from it or if you are a close person of such a girl. This book is useful for every person who is under the power of any fears and addictions and who wants to change his life for better, who wants to become the owner of his life, who wants to be happy! You will learn how to reach harmony in your heart and how to be strong enough for to resist any difficulties and problems on your life way reaching all your goals!