Eating Disorders Diagnosis

  • Diagnosis

    People with eating disorders such as anorexia nervosa, binge eating, or bulimia nervosa have an intense and extreme preoccupation with food and weight. Eating disorders affect people of all backgrounds. Eating disorders often begin in the teenage years; however, they may begin as early as age 8. Eight million people in the U.S. have been diagnosed with an eating disorder, ninety percent of whom are women. Of college freshmen, 4.5% to 18% of women and 0.4% of men have a history of bulimia. As many as 1 in 100 females between the ages of 12 and 18 have anorexia. Binge eating disorder is present in about 2% of the general population, mostly in women.

    People with anorexia avoid eating because they fear gaining weight, while those with bulimia eat large amounts of food, or binge, and then purge by vomiting or using laxatives. Anorexia and bulimia are both illnesses in which individuals are obsessed with their weight and food intake. This obsession leads to severe weight loss in people with anorexia, and a binge/purge cycle for people with bulimia. Both anorexics and bulimics may over-exercise and use laxatives or diet pills to “control” their weight.

    An illness that is similar to bulimia nervosa is binge-eating disorder. Like bulimia, it is characterized by bouts of uncontrollable eating. However, the disorder differs from bulimia because those who suffer from it do not purge their bodies of excess food or use other extreme methods of weight control. People with binge-eating disorder are more likely to be male, and they are frequently overweight.

    Some eating disorders do not meet the criteria for any specific eating disorder. For example, some people have all the behaviors of bulimia, however, they may engage in the binge and purge cycle less than twice a week or for less than three months. Others may try to compensate for having consumed food, but may do so after only eating small amounts of food rather than the large amounts typically consumed during a binge.

    In most cases, eating disorders can be treated with help from a mental health professional and a nutritionist. A multidisciplinary approach is important, and includes a physician consultation and hospitalization for weight restoration, where necessary.

    Psychological, environmental, and genetic factors predispose people to eating disorders Table 01. While there is no one cause for eating disorders, a broad range of factors can produce anorexia, bulimia, and binge eating. Psychological factors include chemical imbalances that are linked to personality and emotional disorders. Of all patients with eating disorders, 40% to 96% experience depression and anxiety disorders. Other factors include cultural and familial pressures, and situations that promote a dissatisfaction with the way one looks. Genetic factors have also been associated with eating disorders. In fact, relatives of patients with anorexia or bulimia are ten to twenty times more likely than others to have eating disorders.

    Table 1.   Factors Involved In Eating Disorders

    Dysfunctional families/relationships
    Personality traits (e.g., fear of losing control, inflexible thinking, perfectionism, low self-esteem, feelings of helplessness)
    Cultural pressures to be slender
    Stressful situations (e.g., rape, abuse, trauma)
    Participation in sports in which low weight is emphasized
    Repeated critical comments regarding body image
    Other psychiatric disorders; e.g., depression
    Personal and family history of obesity (relevant to bulimia)

    The most common symptoms of eating disorders are denial that there is a problem, and preoccupation with food and weight Table 02 Table 03. Anorexics continue to think they look fat, even though they are bone-thin. They obsess about their weight, and constantly worry about their next encounter with food. People with bulimia have less severe weight loss than anorexics, and are less likely to suffer physical consequences. For bulimics, binge eating is not a response to intense hunger; rather, it results from depression, stress, or other feelings related to body weight, shape, or food.

    Table 2.  Symptoms of Eating Disorders

    Anorexia Bulemia
    Refusal to achieve or maintain a normal body weight Binge eating at least two times a week for three months
    Denial that there is a problem Feeling out of control during a binge
    Intense fear of gaining weight or becoming fat, even when already thin Fasting, vomiting, exercising excessively, or using laxatives and other medications to prevent weight gain at least two times a week for three months
    Feelings of self-worth that are dictated by body shape and weight Feelings of self-worth that are dictated by body shape and weight
    Amenorrhea, or absence of at least three menstrual cycles in a row ?

    Table 3.  Physical Signs of Bulimia and Anorexia

    Anorexia Bulemia
    Absence of menstrual periods Swelling of hands and feet
    Soft, downy body hair Abdominal bloating
    Weight loss of at least 25% of original weight (in children, failure to achieve age-appropriate weight) Fatigue/weakness
    Electrolyte and hormonal disturbances Puffy cheeks
    Sensitivity to cold Tooth sensitivity/dental erosion
    Bone pain/fractures Depression
    Impaired growth/short staturea Irregular menses and infertility
    Loss of scalp hair Calluses on hands
    Dry, scaly skin Enlargement of the salivary glands
    Hypotension ?
    Arrythmias ?
    Liver failure ?

    a In adolescents for whom the extreme weight loss occurs before the onset of the puberty

    Denial and preoccupation with food and body weight can lead to strange eating habits. People with anorexia may cut their food into smaller pieces, refuse to eat in front of others, or fix elaborate feasts for others without eating the meal themselves. Binge eaters and people with bulimia view the process of bingeing and purging as a way of regaining control in their lives.

    If anyone in your family has had an eating disorder, you may be predisposed to the condition also. Female relatives are most often affected. If a girl has a sibling with an eating disorder, she is 10 to 20 times more likely to develop the illness herself.

    Social or cultural approval of thinness can lead naturally thin or naturally heavier people alike towards having an eating disorder.

    If you are involved in competitive athletics in which low body weight is promoted, you may be more likely to develop an eating disorder. Eating disorders, along with menstrual dysfunction and osteoporosis, are an increasing problem among young female athletes and dancers. Some coaches and teachers encourage calorie counting and loss of body fat so that the female athletes retain their boyish shape and competitive edge.

    If you are involved in or have been linked to dysfunctional relationships or situations that induce stress and encourage a poor self/body image, you may be predisposed to developing an eating disorder. Environmental factors either cause negative feelings, resulting in a poor body image, or put undue pressure on both men and women to be the thin “ideal.” Traumatic situations and dysfunctional relationships can lead to altered eating habits, predisposing individuals to eating disorders. As a result of these two factors, men or women may exhibit personality traits such as fear of losing control, inflexible thinking, perfectionism, low self-esteem, feelings of helplessness, and an intense dissatisfaction with the way they look.

    If you are employed in a profession in which thinness is a professional requirement, you may be at risk for developing an eating disorder. Society’s obsession with being thin as reflected in advertising and the media puts pressure on those in the public eye (e.g., actors, models, athletes, dancers) to remain thin.

    If you have abnormal eating behaviors and are preoccupied with food and your body weight, you may have an eating disorder. Anorexics lose weight by reducing their total food intake to 1,000 calories per day or less, when the average food intake for a healthy person is 2,000 to 3,000 calories. Anorexics usually limit their diet to vegetables like lettuce and carrots, or popcorn. Bulimics and binge eaters consume massive quantities of food, usually 3,400 calories in 1¼ hours and up to 20,000 calories in 8 hours, after which bulimics purge themselves. Often, bulimics and anorexics use laxatives, enemas, diet pills, and water pills to control their weight.

    If you view yourself as heavy, even though you are very thin and continue to limit your food intake, you may have anorexia Figure 01. People with eating disorders, namely anorexia, have a distorted body image, and are obsessed with being thin. Anorexics do not want to eat because they are afraid of gaining weight. In fact, a person with anorexia may be unusually preoccupied with counting calories and fat grams in the food they eat. Anorexics refuse to maintain their body weight within 15% of their normal weight. As people with anorexia lose normal fat padding, sitting or lying down may be uncomfortable, and may make sleep difficult. Because anorexics hide and deny their problem, it may be harder to detect, and the actual diagnosis may not be made until other medical complications arise. When anorexics finally come to the attention of a healthcare provider, they often do not provide accurate information about their problem. Therefore, the provider may seek information from family members to better assess the degree of weight loss and extent of the illness.

    Click to enlarge: Body mass indicator

    Figure 01. Body mass indicator

    If you tend to eat massive amounts of food as a means of calming yourself in a stressful situation, you may have bulimia or be a binge eater. Unlike anorexics, bulimics are usually close to normal weight, which makes them harder to diagnose. Unless the patient is honest about his or her behavior, bulimia is usually not discovered until a related medical condition crops up. However, a provider may become suspicious if he or she notices that the patient’s esophagus is always inflamed, the glands near the cheeks are swollen, and the teeth appear to be damaged. Bulimics may hide or store food for binges. After a binge, some bulimics fast or over-exercise to control their weight. Overeating, or binge eating, is common in psychological disorders such as depression. Binge eating often produces a feeling of relief or euphoria, but the self-loathing caused by the overeating quickly replaces the short-lived elation. If your doctor is aware that you may be depressed, he or she may ask if that is the cause of your overeating.

    Avoid situations and people who cause you to have a poor body image and low self-esteem. Once people start engaging in abnormal eating behaviors as a result of a stressful or dysfunctional situation, the behaviors can perpetuate themselves. In response to the stress of living with an abusive person, for example, people with low self-esteem may attempt to cope by adopting abnormal eating patterns.

    If you have any psychological, genetic, or environmental factors that may predispose you to an eating disorder, seek professional help immediately. It is crucial that you go to a licensed psychologist or other appropriate mental health expert to get an accurate diagnosis.

  • Prevention and Screening

    Avoid situations and people who cause you to have a poor body image and low self-esteem. Once people start engaging in abnormal eating behaviors as a result of a stressful or dysfunctional situation, the behaviors can perpetuate themselves. In response to the stress of living with an abusive person, for example, people with low self-esteem may attempt to cope by adopting abnormal eating patterns.

    If you have any psychological, genetic, or environmental factors that may predispose you to an eating disorder, seek professional help immediately. It is crucial that you go to a licensed psychologist or other appropriate mental health expert to get an accurate diagnosis.

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