How Do Doctors Diagnose Eating Disorders
Teenagers with anorexia, bulimia, and binge eating disorder often try to hide the problem, so formal diagnosis can be delayed or difficult. Even when caring friends or family members ask about the weight loss or other symptoms, most teenagers with eating disorders are ashamed or embarrassed, especially by the purging that accompanies bulimia. Because of distorted body image, those with anorexia may not be able to recognize the seriousness of their extreme weight loss. Unbearable fear of being fat may cause people with anorexia to resist attempts to help them gain weight. A concerned health professional might ask questions about eating, body image, and exercise. Blood or other laboratory tests can help determine if a persons nutrition is adequate and if general body chemistry is balanced. A careful interview and health history may reveal concerns about body image or distorted opinions about body appearance.
A doctor can generally determine if adults are obese by measuring their body weight and height. Obesity in children can be similarly determined but these measurements should be considered more carefully because the child is still growing. Over the last decade, there has been a significant rise in obesity in children in the . This is likely in part a result of people eating more frequently in fast food restaurants, watching a lot of television, working or playing games on computers, and engaging in other activities that promote over-eating and a sedentary lifestyle.
Avoidant/restrictive Food Intake Disorder
Previously called selective eating disorder, avoidant/restrictive food intake disorder is an eating disorder that involves a restricted food intake in the absence of the body image disturbance commonly seen in anorexia nervosa. It is manifested by persistent failure to meet appropriate nutritional and/or energy needs.
What Is Bulimia Nervosa
Bulimia nervosa is a condition where people have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over their eating. This binge eating is followed by behaviors that compensate for the overeating to prevent weight gain, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.
Symptoms and health consequences of bulimia nervosa include:
- Chronically inflamed and sore throat
- Swollen salivary glands in the neck and jaw area
- Worn tooth enamel and increasingly sensitive and decaying teeth from exposure to stomach acid when vomiting
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration from purging
- Electrolyte imbalance , which can lead to stroke or heart attack
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What Causes An Eating Disorder
Eating disorders are believed to result from a combination of biological vulnerability, environmental, and social factors. A useful way of thinking about what causes an eating disorder is to distinguish predisposing, precipitating and perpetuating factors that contribute to its onset and maintenance.
Dr Kathleen Kara Fitzpatrick
While many children do express food preferences and many will have strong aversions to certain foods, ARFID is distinguished by the global and pervasive nature of food refusal.
The condition can have serious consequences. Individuals with ARFID do not eat enough to meet their energy and nutritional needs. However, unlike individuals with anorexia nervosa, people with ARFID do not worry about their weight or shape or becoming fat and do not restrict their diet for this reason.
What Are The Symptoms Of Eating Disorders
You cant always tell by someones appearance that they have an eating disorder. You can have an eating disorder at any body weight or size. Eating disorders often impact the way people think about food or relate to it, which is not reflected in their weight or size.
Specific symptoms of eating disorders vary by type. It may be difficult to spot an eating disorder as it often mimics dieting. Or, a person struggling with an eating disorder may be reluctant to share their eating concerns. If you or a loved one has an eating disorder, you may notice these general changes:
- Mood swings.
- Thinning hair or hair loss.
- Frequent bathroom breaks after eating.
- Unexplained weight changes or drastic weight loss.
- Unusual sweating or hot flashes.
Other changes could include:
- Solo dining or not wanting to eat with other people.
- Withdrawing from friends or social activities.
- Hiding food or throwing it away.
- Fixation on food, calories, exercise or weight loss.
- Food rituals .
Why Is It Challenging To Create Films About Eating Disorders
A comprehensive understanding of eating disorders and mainstream education about the disease are only starting to emerge. As the illness grows in the public eye, Hollywood is trying to catch up and accurately show this somewhat enigmatic disease. However, as of now, depictions of eating disorders in film fall short . Why is it so difficult to make a good movie about this topic?
Lastly, the constraints on the length of films also contribute to the difficulty of portraying eating disorders realistically. There is not enough time to show the slow onset of the disorder and the slow recovery . Overall, how to show eating disorders in film is a complicated issue, but it is one that we need to tackle if we want to debunk harmful myths and promote conversations about eating disorders.
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The Beginning Of An Eating Disorder
People described how their problems often developed gradually over a few years. Sometimes the development was slow with on/off periods and then something would trigger a rapid deterioration. Often people didnt realise things were getting out of hand and the eating disorder developed before I knew it. David said his bulimia nervosa developed over a period of a couple years it wasnt something that I really necessarily noticed it just started to creep on.
When youve been doing that for such a long time, it just becomes habit and routine and you lose sight of why you did it in the first place. Steph
An eating disorder could also develop quickly, over a course of a few months. Young people we talked with often recalled specific times holidays, school trips, arguments at school, home or with friends that had happened just before things flipped over. Once the eating disorder had kicked in in full, people described how things quickly spiralled out of control. Soon they realised they had become engrossed in an obsessive routine of behaviours that took on a life of its own and which could include:
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Once you start doing a lot of things it became easier and easier to fall into habits. Chloe
Different eating disorders could have different early signs and forms. Something that started as restricting food intake could turn into bingeing and purging, and the other way around. Patterns of eating usually went hand in hand with exercise. People with anorexia nervosa often said how it had started off as just a health kick eating more healthily, or starting a diet to lose a bit of weight. They saw friends or family members dieting and it seemed to be what everybody did. Initially people cut out or ate less of particular foods , then they cut out foods or food groups completely and started to skip meals. The view of what was enough/a lot of food could become distorted.
I think I just got to a point where I kind of flipped over and then it was literally an apple is too much. Sara
Some said they went for days without eating, or never ate at school, saving up their lunch money.
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Eating Disorders: Disordered Eating Past And Present
Anorexia nervosa and bulimia nervosa have become familiar household words. As recently as the 1980s, it was difficult to find anybody who knew the true meaning of these terms, much less to know someone truly suffering from one of these syndromes. Today disordered eating is alarmingly common, and having an eating disorder is almost seen as a trendy problem. Starving and purging have become the acceptable weight loss methods for 80 percent of our eighth-grade girls. Binge eating disorder, a newly named syndrome, goes beyond overeating to an out-of-control illness ruining the person’s life. Eating disorders are becoming so common that the question seems to be not “Why do so many people develop eating disorders?” but, rather, “How is it that anyone, particularly if female, does not?”
The first hint that eating disorders might become a serious problem was introduced in 1973 in a book by Hilde Bruch called Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within. It was the first major work on eating disorders but was geared to professionals and was not readily available to the public. Then, in 1978, Hilde Bruch gave us her pioneer work, The Golden Cage, which continues to provide a compelling, passionate, and empathetic understanding of the nature of eating disorders, particularly anorexia nervosa, and of those who develop them. Finally, the public, for better or worse, began to be educated.
DIAGNOSTIC CRITERIA FOR EATING DISORDERS
First Mention Of Binge Eating
BED was first noted back in 1959 by psychiatrist Albert Stunkard. In his paper titled Eating Patterns and Obesity, Stunkard describes an eating pattern marked by consuming large amounts of food at irregular intervals. He observed that some of these episodes were linked to night eating.
The term binge eating eventually caught on. It was used to describe eating episodes that were not connected with sleep or the overnight hours.
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When Did The Term Bipolar Disorder First Appear In The Dsm
Herein, When did the term bipolar disorder first appear in the DSM?
The term bipolar disorder first appeared in the third, 1980 revision of the DSM . It has gradually replaced the older term manic-depressive illness, which, although more accurate and descriptive, did nothing to discourage people with bipolar disorder from being stigmatized as maniacs. Neel Burton…
When was bipolar depression added to the DSM-3?
In the DSM-III-R , further improvement was made to the diagnosis of bipolar depression as research about mood disorders and disorders of childhood and adolescence were added.
When did manic depression become bipolar disorder?
In 1980, with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders , the term manic depression was officially changed in the classification system to bipolar disorder. 1 Why Bipolar Disorder Instead of Manic Depression?
What is the DSM 5 definition of bipolar disorder?
Bipolar Disorder in the DSM-5. Instead, a manic, hypomanic or depressive episode can be specified as “With Mixed Features,” a specifier with its own definition in the manual. The Bipolar II diagnosis in the DSM-IV excluded a history of mixed episodes. This exclusion has been removed, an important change.
What was the first known diagnosis of bipolar disorder?
What Medical Complications Are Caused By Eating Disorders
Eating disorders are serious problems and can cause a variety of medical complications. In anorexia, rapid weight loss can lead to blood chemical imbalances, failure to , slow pulse, low , and heart problems. In some cases, damage to vital organs is so serious that it can result in death. The frequent vomiting associated with bulimia can cause throat tears or sores, damaged tooth enamel, broken blood vessels in the eyes, and puffy cheeks from swollen . With both anorexia and bulimia, bowel and intestinal problems can occur and serious vitamin and mineral deficiencies can cause serious and long-lasting problems. Binge eating often results in obesity, which in turn can lead to other health problems. People who are obese are at greater risk of developing , *, *, , and other health problems.
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How Does An Eating Disorder Begin
Eating disorders dont happen overnight they can develop over the course of a few months or a few years. Like with any mental health condition, eating disorders, begin differently for each person. For some, it may be losing a few pounds and enjoying the way their body looks with less weight, for others it may be finding comfort in food, and still, for others, it may begin due to depression, stressful triggers, or trauma.
Those with anorexia have significant weight loss from restricting calories, often not realizing how underweight they may be and perceiving themselves as fat, despite a dangerously low body weight. Anorexia has the highest mortality rate of any mental health condition and claims the lives of an estimated 10-20% individuals due to complications. Associated with a distorted sense of body image, anorexia is closely linked to depression.
Bulimia is characterized by cycles of binge eating followed by purging the body of unwanted calories. The sequence can be triggered by stress, anxiety, depression, and a lack of control. Individuals who have bulimia might feel regret after a binge, but find comfort and well-being following a purge. Purging can bring a sense of control and ease in the stress and anxiety someone may be feeling. Often consuming between 3,400 calories in as little as an hour or as many as 20,000 calories in eight hours, those with bulimia may repeat the cycle several times in a week.
From Sporadic Observations To Nosography
The evolution of the empirical method and positivism led to new approaches in the field of medicine, psychiatry, and in particular also in the way eating disorders were conceptualized. For example, the first complete pathological nosography was proposed by Erasmus Darwin in 1794. Later, Darwin categorized a voluntary fasting practice that would eventually lead to death, caused in young women by the obsessive idea of being too fat.27 The French physician Luis Victor Marcé author of Traité de la Folie des Femmes Enceintes, des Nouvelles Accouchées et de Nourices, published in 1858, and of Traité Pratique des maladies Mentales published in 1862 wrote a paper in 1860 that could be recognized as one of the first attempts to describe, from a proper psychiatric point of view, the nosography of what is currently defined as AN.28 In this work, he reported two clinical cases, outlining the delusional beliefs which led to food-refusal. In the second half of the 19th century, food-refusal was progressively described from a clinical point of view.
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Are Certain Personality Traits More Common In Individuals With Eating Disorders
Individuals who develop eating disorders, especially those with the restricting subtype of anorexia nervosa are often perfectionistic, eager to please others, sensitive to criticism, and self-doubting. They may have difficulty adapting to change and be routine bound. A smaller group of patients with eating disorders have a more extroverted temperament and are novelty-seeking and impulsive with difficulty maintaining stable relationships. There is no one personality associated with eating disorders, however.
What Forms Of Treatment Are Effective For Anorexia Nervosa
Treatment of anorexia nervosa involves nutritional rehabilitation to normalize weight and eating behavior. Psychotherapy is aimed at correcting irrational preoccupations with weight and shape, managing challenging emotions and anxieties and preventing relapse. Interventions include monitoring weight gain, prescribing an adequate diet, and admitting patients who fail to gain weight to a specialty inpatient or partial hospitalization program. Specialty programs combining close behavioral monitoring and meal support with psychological therapies are generally very effective in achieving weight gain in patients unable to gain weight in outpatient settings. The fear of fatness and body dissatisfaction characteristic of the disorder tend to extinguish gradually over several months once target weight and normal eating patterns are maintained, and 50-75% of patients eventually recover. No medications have been shown to significantly facilitate weight gain in patients with this disorder. In the case of patients under 18 years of age, family therapy aimed at helping parents support normal eating in their child has been found to be more effective than individual therapy alone.
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New Insights On Eating Disorders
Scientists are uncovering the faulty neurobiology behind anorexia and bulimia, debunking the myth that such eating disorders are solely driven by culture and environment.
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Monitor on Psychology47
Public misunderstanding of mental health disorders is nothing new. But for eating disorders in particular, misinformation abounds.
“You still read more about anorexia in the celebrity section of publications than in health sections,” says Nancy Zucker, PhD, a professor of psychology and neuroscience at Duke University. “The emphasis is on it being a culturally guided phenomenon.”
Even medical definitions of eating disorders have often focused on external factors, including cultural pressures, parents’ attitudes toward weight and diet, and stressful or traumatic events that might trigger disordered eating habits.
While the environment certainly plays a part in shaping the behaviors, evidence is mounting that eating disorders begin in the brain.
“Lots of people diet or want to lose weight, but relatively few of them end up with anorexia nervosa or bulimia nervosa,” says Walter Kaye, MD, director of the Eating Disorders Treatment and Research Program at the University of California, San Diego School of Medicine.
In fact, fewer than 1 percent of women develop anorexia, the more severe of those two diseases. “Culture plays some role but maybe less so than we thought in the past,” Kaye says.
How Do I Know If I Need Inpatient Treatment
If you think you have an eating disorder, if your symptoms have persisted or worsened despite attempts at outpatient treatment, or if you feel constantly preoccupied by thoughts of food and weight, then a good place to start is with a comprehensive evaluation in our Consultation Clinic. To safely provide the best possible care during the COVID pandemic, we have expanded our outpatient telemedicine services to include remote clinical consultation and outpatient visits with our eating disorders doctors by videolink across multiple states. Video visits allow patients to connect face-to-face in real time without leaving their home by using their smartphone, tablet or computer. Virtual connections are secure and HIPAA compliant.
You will be seen by a psychiatrist who will perform a thorough review of your history and symptoms, medical tests and past treatment. We recommend you forward any past treatment records ahead of your appointment for the doctor to review. Whenever possible we ask that you attend the consultation with a close family member or significant other, since we believe family support and involvement is very important when you are struggling with an eating disorder. The doctor will also be interested in any medical or psychiatric problems you may have besides the eating disorder.
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