Psychological elements of eating disorders

Eating disorders are complex and very common illnesses that affect adolescents all around the world. Some statistical data are showing that they rank as the third most common chronic illness in adolescent females, with an incidence of up to 5% (2,3), a rate that has increased dramatically over the past three decades.
What important should be point out about these disorder? Well, everyone should know that the two major subgroups of the disorders are recognized:

·         a restrictive form, in which food intake is significanly limited (also known as anorexia nervosa)

·         a bulimic form, in which eating episodes are followed by attempts to minimize the effects of overeating via vomiting, catharsis, exercise or fasting (also known as bulimia nervosa)

Although patients usually aren't aware of this- the fact is that anorexia nervosa and bulimia nervosa are associated with serious biological, psychological and sociological morbidity, and significant mortality. Logically, it isn't hard to assume that eating disorders are more common in cultures focused on weight loss and body image. Good thing is that - there has been an increased awareness about these types of illnesses because people realized that it is a rather serious proble!  Eating disorders affect a person’s physical and emotional health. They are very dangerous illnesses and can be fatal if they are not treated. Treatment is possible!

There are three types of eating disorders:

3.       ED-NOS (Eating Disorders Not Otherwise Specified)

Every person shoould know that there are many different theories regarding the causes of eating disorders. Most of the experts believe that, most likely, eating disorders are caused by a combination of psychological, family, genetic, environmental and social factors.
Family history of mood disorders

Several researhces done in the past have confirmed a fact that an individual may have a family history of mood disorders such as depression. This is because, eating disorders are often associated with feelings of helplessness, sadness, anxiety, and the need to be perfect. This can cause a person to use dieting or weight loss to provide a sense of control or stability. Although it could be hard to believe- the fact is alsot that teens who participate in competitive sports  such as ballet, running, gymnastics, or skating, are more likely to develop an eating disorder.  

Several statistical researches done recently have came to the number of estimated 0.5 to 3.7 percent of females which suffer from anorexia nervosa in their lifetime. Symptoms of anorexia nervosa include:

·         Almost absolute resistance to maintaining body weight at a minimally normal weight for age and height

·         Intense fear of gaining weight or becoming fat

·         Disturbance in the way in which one's body weight or shape is experienced

·         Infrequent or absent menstrual periods

What's the most common characteristic of these people? It is the fact that these people see themselves as overweight even though they are dangerously thin. How come? Well, the fact is that the process of eating becomes an obsession. Most of these people develop some kinds of unusual eating habits, such as avoiding some kinds of food and meals or eating these in small quantities. Not only that- most of the researches have came to the fact that people with anorexia may repeatedly check their body weight, practicing even  other techniques to control their weight: intense and compulsive exercise, vomiting and abuse of laxatives, enemas, and diuretics.
The outcome
What is the outcomeof all this? Well, the course and outcome of anorexia nervosa vary across individuals: some fully recover; some have a fluctuating pattern of weight gain; others experience a chronically course of illness over many years.
Mortality rates
It is extremely important to point out that the mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.

Statistical data are sayiong that about 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime. Some of the most common symptoms of bulimia nervosa include:

·         The most common symptom is eating an excessive amount of food within a short  period of time because of  ” lack of control “ over eating during the episode

·         Inappropriate behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise

·         Eating and inappropriate compensatory behaviors both  

·         Self-evaluation is unduly influenced by body shape and weight

Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height.  

Everyone should know that EDNOS is short term for Eating Disorder Not Otherwise Specified. It represents an illness in which someone has some, but not all, of the symptoms of anorexia or bulimia. Hoe come?  Well, some female may only binge eat or they may have periods of restrictive eating followed by periods of overeating or binge eating. This female may be at a very low weight, but not have anorexia because she still get their menstrual period.  

Diagnostic criteria for eating disorders such as described in DSM-IV (4) may not be entirely applicable to adolescents. Some of the symptoms which could hardly be applyed to addolescents are:

·         The wide variability in the rate, timing and magnitude of both height and weight gain during normal puberty;

·         the absence of menstrual periods in early puberty along

·         unpredictability of menses soon after menarche

·         the lack of psychological awareness regarding abstract concepts (such as self-concept, motivation to lose weight or affective states) owing to normative cognitive development

In addition, clinical features such as pubertal delay, growth retardation or impairment of bone mineral acquisition could be seen as the part of the subclinical level of eating disorders.

In clinical practice, the diagnosis of an eating disorder should be considered in an adolescent patient who:

·         engages in potentially unhealthy weight control practices

·         demonstrates obsessive thinking about food, weight, shape or exercise

·         fails to attain or maintain a healthy weight, height, body composition or stage of sexual maturation

Although most people don't thing about this- the fact is that almost all the organs in the human's body is affected during these diseases!  Good thing about all this is the fact that the majority of physical complications in adolescents with an eating disorder appear to improve with nutritional rehabilitation and recovery from the eating disorder. However, when the line is crossed- some may be potentially irreversible.  Medical complications in adolescents that are potentially irreversible include:

·         growth retardation if the disorder occurs before closure of the epiphyses  

·         pubertal delay or arrest

·         impaired acquisition of peak bone mass during the second decade of life  

·         increasing the risk of osteoporosis in adulthood

People shoudl be aware of the fact that sometimes, none of the previous criteria must be present in order to set the diagnosis! It is simple-  all adolescents who restrict food intake, vomit, purge or binge in any combination, with or without severe weight loss, require treatment even if they do not meet strict criteria for an eating disorder. The treatment should be serious and long enough until the adolescent has demonstrated a return to both medical and psychological health.

Most of the experts claim that all eating disorders that develop during adolescence interfere with adjustment to pubertal development. As such- they also interfere with several important  developmental tasks necessary to become a healthy functioning adult.  Problem is also that social isolation and family conflicts arise always at the bad time because this is the time when families should provide a milieu to support development. All this leads to the impaired issues related to self-concept, reduced self-esteem, autonomy, separation from the family, the capacity for intimacy, affective disorders; sometimes even substance abuse should and suicide! That's why- it should be pointed out that all patients should be evaluated for psychiatric illness, including disorders of anxiety, depression, dissociation and behaviour.  The fact is that early mental health intervention for adolescents with eating disorders could be extremely helpful and sometimes even the only cure! Family therapy should be considered as an important part of treatment.