Types of Eating Disorders
Individuals are diagnosed as anorexic (according to the DSM-IV-TR) if they refuse to maintain the appropriate body weight (according to age and height), and have an intense fear of gaining any more weight - even though they are already underweight (Keel & Klump, 2003). Concisely, if patient "X" is significantly underweight, yet does not want to do anything to correct this then patient "X" is anorexic.
Bulimia nervosa, as defined by the DSM-IV-TR, is just as terrifying as anorexia nervosa. The criteria is as follows: Recurrent episodes of binge-eating--consuming an amount of food which is much larger than most would eat during a similar period of time--at least once a week for three months. A lack of control over binge eating. Recurrent and inappropriate behavior aimed at compensating for the weight gain, self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. The subject�s self-evaluation is based on and influenced mainly by body shape and weight. (Keel & Klump, 2003) In short, a diagnosis of bulimia nervosa is if subject "X" eats more then he or she should, and then inappropriately extinguishes the weight because the subject is not the weight he or she fantasizes to be.
These two disorders, anorexia nervosa and bulimia nervosa, are alarming. Do they have particular risk factors? Can culture, socioculture or genetics cause them? What is their prevalence? These are questions which this paper addresses.
Causes of Eating Disorders
To determine if an eating disorder is culture bound data must be collected and sorted from various cultures along a timeline of many years. Are Eating Disorders Culture-Bound Syndromes? Implications for Conceptualizing Their Etiology, by Pamela Keel and Kelly Klump did just that. They attained statistics from an assortment of cultures and along a timeline of sixty years. The experiment was done for anorexia nervosa and duplicated for bulimia nervosa. The results were surprising. Anorexia nervosa does not seem to be a culture-bound syndrome. Bulimia nervosa on the other hand does seem to be culture-bound. There has been a significant increase in bulimia nervosa during the later half of the twentieth century. One striking fact is that every non-western nation that had evidence of bulimia nervosa also had evidence of western influence. The authors do not take this to be a coincidence (Keel & Klump, 2003).
Cashel, Cunningham, Cokley, and Muhammad, in Sociocultural Attitudes and Symptoms of Bulimia: Evaluating the SATAQ with Diverse College Groups, tested the affect of sociocultural attitudes on eating disorders. The method was to question an array of students from a Midwestern University in the United States. The participants consisted of both men and women. The procedure consisted of having the subjects fill out a structured questionnaire, the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ). After the questionnaire was finished a correlation between Caucasian women, all men, African American women, Hispanic American women, Caucasian sororities and Caucasian non-sororities to body dissatisfaction, drive for thinness, and bulimia was calculated.. SATAQ Internalization was significantly correlated with EDI-2 (a self-report measure developed to assess a variety of symptoms reflective of eating disorders), Body Dissatisfaction and Drive for Thinness. SATAQ Awareness scores were extensively correlated with the Body Dissatisfaction and Drive for Thinness scales for the Caucasian American and Hispanic American female groups. The SATAQ Awareness scores for African American women and men were not considerably related to scores from the EDI-2. The extent of the correlations with eating disorders was the strongest for Caucasian and Hispanic American women (Cashel, Cunningham, Cokley, & Muhammad, 2003). To get to the point, this study proves that there is an affect of sociocultural attitudes on eating disorders.
A third possible cause for eating disorders is substance abuse by the parents. Von Ranson, McGue, and Lacono (2003) tested 674 females and their parents. Daughters underwent assessment of eating disorders while their parents underwent assessment of substance abuse. The results of this study show no correlation between parents with past substance abuse problems and their daughters� eating disorders.
Another possible cause for eating disorders is heredity. If a mother has an eating disorder does it mean her child will as well? Von Ranson et al. (2003) tested this possibility. The findings were chilling. The results show a high correlation between mothers that have eating disorders and daughters that have eating disorders. This strengthens the theory that eating disorders can be passed down from generation to generation.
Genetic relationships could be a cause of eating disorders. The most accurate way to study this hypothesis is by examining monozygotic and dizygotic twins. Monozygotic twins have identical genes, while dizygotic twins do not. The higher the correlation between monozygotic twins points to greater genetic causes and less environmental causes. A study by Klump, K., McGue, M. & Lacono, W titled: Genetic Relationships between Personality and Eating Attitudes and Behaviors was undertaken. The study showed an extremely high correlation between genetic influence and eating disorders for the monozygotic twins and a low correlation for the dizygotic twins. Data can be viewed in Chart G in Appendix I. This strengthens the idea that there is a significant genetic influence in eating disorders.
As presumed, there are many things that can cause an eating disorder. Sociocultural attitudes, heredity, and genetics are much stronger influences then substance abuse and culture causes. This is not enough. Factors such as parent-child bonds, economic status, and intelligence must be studied. Unfortunately they have not. In light of this, we seem to know very little about what actually causes eating disorders.
Prevalence of Eating Disorders
Table 1 shows the point prevalence (1 year) of adolescent males and females. Table A-2 shows the lifetime prevalence of the same adolescents (Andrews, Hops, Roberts, Seeley & Lewinsohn, 1993).
The data in tables A-1 & A-2 was collected by interviewing 10,200 adolescents (under the age of 18) and their parents that lived in a population of 200,000. They were interviewed two times by clinical psychologists or certified social workers. The second interview was about one year (13.3 month mean) after the first. The results of the experiment are divided into anorexia nervosa and bulimia nervosa and further broken down by gender.
Focusing on the point prevalence (Table A-1), neither the adolescent males nor females were diagnosed with anorexia. With regards to bulimia nervosa, a significant number of females in interview one were diagnosed (Andrews, Hops, Roberts, Seeley & Lewinsohn, 1993). During the second interview, just one year later, the amount of females with bulimia nervosa rose.
The results of the lifetime prevalence show that during the one-year gap between the interviews the number of adolescent females diagnosed with anorexia nervosa almost doubled. The adolescent males show no signs of anorexia nervosa. Bulimia nervosa, just as anorexia nervosa, nearly doubles for the female subjects. For males, a small portion were diagnosed with bulimia nervosa; and had a small rise in one year (Andrews, Hops, Roberts, Seeley & Lewinsohn, 1993).
Assessing these results shows the researcher that adolescents are at risk of developing an eating disorder. Females are obviously more at risk (Table A-1 & A-2), but males cannot be omitted. This also shows that adolescents were diagnosed with bulimia nervosa two times more then with anorexia nervosa.
Table B-1 shows the lifetime prevalence of adults with anorexia nervosa (Zhang, & Snowden, 1999). The full chart can be viewed in Appendix I Chart J. The results come from a study of 18,151 American adults (18 years and older). They are broken down into four groups of white, black, Hispanic, and Asian. The results show that white Americans are more vulnerable to be diagnosed with anorexia nervosa then minority groups.
Table C-1 shows the lifetime prevalence of adults with bulimia nervosa divided by sexual orientation. (Siever, 1994) 250 adults participated in the study. The full chart can be viewed in Appendix I Chart K. The results of these findings show that homosexuals, both male and female are at a higher risk of being diagnosed with bulimia nervosa.
In contrast of these prevalence findings you can conclude that anyone is at risk for becoming diagnosed with an eating disorder. In all cases women are at more risk then men. However, men should not be overlooked as victims, as they usually are. The "Eating Disorder Information Board" says that one out of six people with an eating disorder is a man (http://www.eatingdisorderinfo.org/men_eating_disorders.htm). Therefore, eating disorders should be taken very seriously by men, women, and parents of adolescents.Conclusion Do you know someone that has ever had an eating disorder? You answer is more then likely yes. This paper has proved that no sets of people are immune, and that there is a wide variety of ways to contract this disease. There are many causes of eating disorders � genetics, and sociocultural factors are the most relevant. Anyone is at risk for being diagnosed with an eating disorder, however adult women face the highest risk. In contrast, be aware. Learn if you are at high risk for catching this disease. Study the symptoms. If you are experiencing any of them, seek professional help. "Knowing is not enough; we must apply. Willing is not enough we must do" (Johann Wolfgang von Goethe).
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Anorexia nervosa is characterized by persistent restriction on food intake, an intense fear of gaining weight or of becoming fat, and a distortion of body weight or shape. An individual with anorexia nervosa will maintain a body weight that is below a minimally normal level for age, sex, and physical health.
Some people with anorexia lose weight by dieting, fasting, or exercising excessively; this is called the restricting type of anorexia. Others lose weight by self-induced vomiting or misusing laxatives, diuretics, or enemas. People who use these methods are considered to have the binge-eating/purging type of anorexia. More characteristics of anorexia nervosa include:
- Significant weight loss
- Continual dieting
- Intense fear of gaining weight or becoming fat, even if underweight
- Undue influence of body weight or shape on self-evaluation
- Preoccupation with calories or nutrition
- Preference to eat alone
- Compulsive exercise
- Bingeing and purging
- Brittle hair or nails
- Infrequent or absent menstrual periods (in females who have reached puberty)
- Growth of fine hair over body
- Mild anemia, and muscle weakness and loss
- Severe constipation
- Low blood pressure, slowed breathing and pulse
- Drop in internal body temperature, causing a person to feel cold all the time
Some people with anorexia nervosa feel they are overweight in all areas of their body, while others may recognize that they are thin but are concerned that certain body parts are "too fat," such as their abdomen or buttocks. They may use many different techniques to evaluate their body size or weight, such as frequent weighing and obsessive measuring of body parts. Additionally, the self-esteem of individuals with anorexia is closely tied to their perceptions of their body shape and weight. Weight gain is often viewed as a major failure, while weight loss is an impressive achievement.
Many people with anorexia have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development. The semi-starvation state of anorexia can also result in serious and potentially life-threatening conditions. The 12-month prevalence of anorexia among young females is estimated to be 0.4 percent.
Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (binge-eating), and feeling a lack of control over the eating. This is followed by some type of behavior that compensates for the binge, such as purging (vomiting, excessive use of laxatives or diuretics), fasting, and/or excessive exercise. Unlike individuals with anorexia nervosa, people with bulimia maintain body weight at or above a minimally normal level. Additional symptoms include:
- Recurrent episodes of binge eating
- Purging by strict dieting, fasting, vigorous exercise, or vomiting
- Abuse of laxatives or diuretics to lose weight
- Frequent use of bathroom after meals
- Reddened fingers
- Swollen cheeks
- Self-evaluation that is unduly influenced by body shape and weight
- Depression or mood swings
- Irregular menstrual periods
- Dental problems, like tooth decay
- Heartburn or bloating
- Intestinal distress and irritation from laxative abuse
- Kidney problems from diuretic abuse
- Severe dehydration from purging of fluids
People with bulimia tend to feel embarrassed or ashamed of their eating behaviors and try to hide their symptoms by binge eating in secrecy. The most common triggers for binge eating are negative affect (e.g. sadness, fear, guilt), interpersonal stressors (e.g. arguments), inadequate food intake, negative feelings about body weight or shape, and boredom. The 12-month prevalence of bulimia among young females is estimated to be 1.5 percent.
Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over his or her eating. An episode of binge-eating is defined as eating an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese. Community surveys have estimated that 1.6 percent of females and 0.8 percent of males experience binge-eating disorder in a twelve-month period.
Characteristics of binge-eating disorder include:
- Binge-eating occurring, on average, at least once a week for six months
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not hungry
- Eating alone because of embarrassment caused by how much is eaten
- Feeling disgusted with oneself, depressed, or guilty after binge eating
- Marked distress about the binge-eating behavior
- Binge-eating not associated with regular use of compensatory behaviors (purging, fasting, excessive exercise)
Avoidant/Restrictive Food Intake Disorder
Avoidant/restrictive food intake disorder (ARFID) is characterized by the avoidance or restriction of food intake. This diagnoses replaces the DSM-IV diagnosis of feeding disorder of infancy or early childhood, and broadened the diagnostic criteria to include adults. Individuals with ARFID have a lack of interest in eating or food, or avoid food based on a past negative experience with the food or the sensory characteristics of the food (e.g., appearance, smell, taste, texture, presentation). This form of "picky eating" typically develops in infancy or early childhood and may continue into adulthood. It may also be present in individuals with heightened sensory sensitivities associated with autism.
Characteristics of ARFID include:
- Significant weight loss
- Failure to achieve expected weight gain in children
- Significant nutritional deficiency
- Inability to participate in normal social activities, such as eating with others
Rumination disorder is characterized by repeated regurgitation of food after eating. Individuals with this disorder bring up previously swallowed food into the mouth without displaying any signs of nausea, involuntary retching, or disgust. This food is typically then re-chewed and spit out or swallowed again. The regurgitating behavior is sometimes described as habitual or outside of the control of the individual.
Characteristics of rumination disorder include:
- Repeated regurgitation of food over a period of at least one month
- The repeated regurgitation is not a result of an associated gastrointestinal or other medical condition
- Weight loss and failure to make expected weight gains in children
- Attempts to hide the regurgitation behavior by placing a hand over the mouth or coughing
- Avoidance of eating before social situations, such as work or school
Rumination disorder can develop in infancy, childhood, adolescence, or adulthood. Infants with the disorder tend to strain and arch their back with their head held back, making sucking movements with their tongue. Malnutrition may occur despite ingestion of large amounts of food, particularly when regurgitated food is spit out. In infants as well as in older people with intellectual disability, the regurgitation and rumination behavior seems to have a self-soothing or self-stimulating function, much like other repetitive motor behaviors (i.e. rocking, head banging).
Pica is characterized by the eating of one or more nonnutritive, nonfood substances on a persistent basis. Some of the substances commonly eaten among people with pica include paper, soap, hair, gum, ice, paint, pebbles, soil, and chalk. People with pica do not typically have an aversion to food in general.
In order for Pica to be diagnosed, the behavior of eating nonnutritive, nonfood substances must be present for at least one month. Children below the age of two are typically not diagnosed with pica to exclude the developmentally appropriate mouthing of objects by infants that may result in ingestion. People may experience medical complications from pica, such as bowel problems and intestinal obstruction. People may also experience infections if they have eaten feces or dirt. The prevalence of pica is unknown, but it is more prevalent among people with intellectual disability. Some pregnant women also develop pica when specific cravings such as chalk or ice occur.