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Eating Disorders

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Eating Disorders
Summary
  • Anorexia and bulimia are the two most commonly recognised Eating Disorders.
  • Eating Disorders occur in about 2% of the population.
  • There is no specific cause of Eating Disorders.
Description

Eating Disorders are a preoccupation with control over eating, bodyweight, body image and food. Anorexia and bulimia are the two most commonly recognised Eating Disorders.

Eating Disorders occur in about 2% of the population. They are more common in Western societies and among people whose occupations demand a particular body image e.g. models, athletes, dancers, gymnasts and body builders.1 Anorexia Nervosa is characterised by a morbid fear of obesity and deliberate excessive weight loss. 95% of people with anorexia are female, with the disease usually beginning in early adolescence.2 Patients restrict their food intake and may engage in regular, strenuous exercise in an effort to lose weight. 50% of people with anorexia will also engage in purging - deliberately vomiting or abusing laxatives or diuretics to lose weight. Even when the person becomes severely underweight, they continue to fear obesity and believe they are overweight.

Bulimia Nervosa is characterised by episodes of binge eating, where the patient feels compelled to eat huge quantities of food. This is followed by inappropriate attempts to avoid weight gain, such as deliberate vomiting, fasting, abuse of laxatives or diuretics or vigorous exercise. Unlike anorexia, most people with bulimia maintain normal body weight and some may suffer obesity.3


Cause

There is no specific cause of Eating Disorders. Rather, there are sets of influences that often affect people with these conditions. These influences include:

  • Feelings of powerlessness. Patients may develop an Eating Disorder out of a need to exert control over their lives.4
  • Parental attitudes. Insecurity in the parents, especially the mother, may be transferred to children.5
  • Childhood eating problems. Children who experience unpleasant meal times and struggles over food are more likely to develop an eating disorder6.
  • Genetics. An abnormality in the chromosomes may make some people more susceptible to Anorexia Nervosa.7
  • Past history of physical or sexual abuse.8 9
  • Social influences. Cultural emphasis on thinness as being the ideal body shape may contribute to Eating Disorders.10  


Prevention

The following tips can help improve attitudes towards food and may help prevent Eating Disorders.

  1. School-based education programmes may help inform children about correct diet, nutrition and the risks of Eating Disorders.11 Talk to the head of your child's school.
  2. Be aware of the signs and symptoms, and contact your Doctor if you or someone you know is experiencing them.
  3. Stress management is very important. It has been found that people who do not receive help during times of stress are more likely to develop an eating disorder.12
  4. Exercise for relaxation and enjoyment, not as a way to lose weight.13
  5. Promote healthy eating habits in your home. See the Healthy Eating Diet for further information.
  6. Try not to treat physical appearance with too much importance. Have realistic goals about your weight. Your Doctor can tell you the correct weight for your height.


Signs & Symptoms

Physical symptoms of Anorexia include weight loss, low heart rate, low blood pressure, hypothermia (low body temperature), increased body hair, swelling of the legs or ankles and in females, loss of menstruation (amenorrhoea) for at least three cycles.14 Anorexia greatly increases the risk of osteoporosis15. Death may occur as a result of starvation, dehydration, heart failure or suicide. In Bulimia, repeated vomiting can erode tooth enamel and lead to dental problems. The salivary glands may become swollen. In severe cases, the lining of the stomach or oesophagus (food pipe) can be torn. Electrolyte imbalances, especially low blood potassium (hypokalaemia) may become life-threatening.

Certain behaviours may occur in people with Eating Disorders. These include:

  • Hiding food, skipping meals or lying about food intake.
  • Obsessively counting calories.
  • Insisting on preparing meals for others. 
  • Leaving the table during or after meals to purge.
  • Wearing baggy clothing to disguise weight loss.
  • Excessive exercise.
  • Depression, social withdrawal and difficulty sleeping. 
  • Management

    Always consult your Doctor for diagnosis and advice. In no way is this information intended to replace the advice of a medical practitioner. Weight loss and reduced food intake may be caused by many illnesses other than Eating Disorders. A thorough medical examination is required to exclude other causes. Once the illness has been diagnosed, a team of health practitioners will be involved in treatment. Psychiatrists, psychologists, dieticians, nurses and dentists may all play a role. Treatment is likely to include nutritional management, medications, individual, group and family therapy and patient education classes.16 Prolonged hospitalisation may be necessary if the patient is severely malnourished or suicidal. Eating Disorders can be very difficult to treat.


    Lifestyle

    Vitamins/Minerals/Herbs

    Vitamins are not a substitute for a complete diet and should not be the only source of nutrients. However, supplementation may help prevent further illnesses when the dietary intake is inadequate.

    • Vitamin B1 (thiamine) deficiency is common in Anorexic patients. It can lead to a type of dementia called Wernicke-Korsakoff syndrome.17
    • Calcium and vitamin D may help prevent loss of bone strength and osteoporosis.18
    • Antioxidants such as vitamin E and vitamin C may help prevent damage to the cells and maintain healthy blood cholesterol levels.19 20
    • St. John's Wort (hypericum) may be beneficial in treating depression.21
    • Valerian, passionflower and chamomile may help promote relaxation and restful sleep.22
  • Pharmacist's Advice

    Ask your Pharmacist for advice.

    1. If you suspect that you or someone you are concerned about is suffering from an Eating Disorder, ask your Pharmacist to refer you to a Doctor or the local community health centre for more information and support.
    2. It is advisable to have a healthy diet and avoid excessive consumption of alcohol and/or recreational drugs.
    3. Relaxation, adequate rest and stress management may also be helpful.
  • Notes

    Organisations & Support Groups

    See the Australian National Association for Mental Health topic on the Healthpoint.


    Medical Terms

    Genes/Genetic: A gene is a unit that is responsible for the various characteristics that make a person individual. Genes (and sometimes genetic disorders) are passed on from a parent to their offspring through the cells.

    Binging: Compulsive eating of huge amounts of high calorie food.

    Purging: Using laxatives, diuretics or deliberate vomiting in an attempt to prevent weight gain from food.

    Laxatives: Medications that cause food to pass more quickly through the intestines.

    Diuretics: Medications that cause the kidneys to release more water and increase urination.


    References

    1. Levey R. Anorexia Nervosa. eMedicine Journal, 2001 Nov 28:2(11). At URL http://www.emedicine.com/med/topic144.htm.
    2. Beers M et al (eds). The Merck manual of diagnosis and therapy (17th ed). New Jersey: Merck Research laboratories; 1999.
    3. Beers M et al (eds). The Merck manual of diagnosis and therapy (17th ed). New Jersey: Merck Research laboratories; 1999.
    4. Fairburn CG et al. A cognitive behavioural theory of anorexia nervosa. Behav Res Ther. 1999 Jan;37(1):1-13.
    5. Ward A et al. Attachment in anorexia nervosa: a transgenerational perspective. Br J Med Psychol. 2001 Dec;74(Pt 4):497-505.
    6. Kotler LA et al. Longitudinal relationships between childhood, adolescent, and adult eating disorders. J Am Acad Child Adolesc Psychiatry. 2001 Dec;40(12):1434-40.
    7. Grice DE et al. Evidence for a Susceptibility Gene for Anorexia Nervosa on Chromosome 1. Am J Hum Genet. 2002 Jan 17.
    8. Waller G. Perceived control in eating disorders: relationship with reported sexual abuse. Int J Eat Disord. 1998 Mar;23(2):213-6.
    9. Romans SE et al. Child sexual abuse and later disordered eating: a New Zealand epidemiological study. Int J Eat Disord. 2001 May;29(4):380-92.
    10. Maddox RW et al. Eating disorders: current concepts. J Am Pharm Assoc (Wash). 1999 May-Jun;39(3):378-87.
    11. Huon GF et al. Reflections on prevention in dieting-induced disorders. Int J Eat Disord. 1998 May;23(4):455-8.
    12. Troop NA et al. Psychosocial factors in the onset of eating disorders: responses to life-events and difficulties. Br J Med Psychol. 1997 Dec;70 ( Pt 4):373-85.
    13. Asgarian L. Preventing Disordered Eating. Accessed January 21, 2002 at URL http://www.nutrifit.org/nutr_info/prevented.html.
    14. Beers M et al (eds). The Merck manual of diagnosis and therapy (17th ed). New Jersey: Merck Research laboratories; 1999.
    15. Zipfel S et al. Osteoporosis in eating disorders: a follow-up study of patients with anorexia and bulimia nervosa. J Clin Endocrinol Metab. 2001 Nov;86(11):5227-33.
    16. Mitchell JE et al. Combining pharmacotherapy and psychotherapy in the treatment of patients with eating disorders. Psychiatr Clin North Am. 2001 Jun;24(2):315-23.
    17. Winston AP et al. Prevalence of thiamin deficiency in anorexia nervosa. Int J Eat Disord. 2000 Dec;28(4):451-4.
    18. Grinspoon S et al. Mechanisms and treatment options for bone loss in anorexia nervosa. Psychopharmacol Bull. 1997;33(3):399-404.
    19. Rock CL et al. Vitamin status of eating disorder patients: relationship to clinical indices and effect of treatment. Int J Eat Disord. 1995 Nov;18(3):257-62.
    20. Scott-Moncrieff C. The Vitamin Alphabet. London: Collins & Brown; 1999.
    21. Kalb R et al. Efficacy and tolerability of hypericum extract WS 5572 versus placebo in mildly to moderately depressed patients. A randomized double-blind multicenter clinical trial. Pharmacopsychiatry. 2001 May;34(3):96-103.
    22. Gursche S. Encyclopedia of Natural Healing. Canada: Alive Books; 1997.
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