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Prevelance
of Eating Disorders
Anorexia
nervosa - Approximately 0.5% to 1.0% of late adolescent or adult
women meet criteria for the diagnosis of Anorexia nervosa.
Bulimia nervosa
- Approximately 1.0% to 2.0% of late adolescent and adult women
meet criteria for the diagnosis of Bulimia nervosa.
Sub-syndromal
symptoms - At any given time 10% or more of college aged women
report symptoms of eating disorders. Although these symptoms may
not satisfy full diagnostic criteria, they do cause distress. Interventions
with these individuals may be helpful and may prevent the development
of more serious disorders.
Consequence
Of Eating Disorders
Psychosocial
Eating disorders can have a profound, negative impact on an individual's
quality of life. Self-image, relationships, and professional performance
often suffer. The extent to which these problems are an inherent
part of the disorders or are secondary is unclear. The range of
the negative effects does, however, highlight the critical importance
of treatment.
Eating disorders
are also associated with high rates of other co-existing psychiatric
disorders, particularly mood disorders, anxiety disorders, and personality
disorders. Bulimia nervosa may be particularly associated with substance
abuse problems. Anorexia nervosa is often associated with obsessive-compulsive
symptoms.
Medical
Semi starvation in Anorexia Nervosa can affect most organ systems.
Physical signs and symptoms include constipation, cold intolerance,
abnormally low heart rate, abdominal distress, dryness of skin,
hypotension, fine body hair (lanugo), and lack of menstruation in
females. Anorexia Nervosa causes anemia, kidney dysfunction, cardiovascular
problems, changes in brain structure, and osteoporosis (inadequate
bone calcium).
Self-induced
vomiting can lead to swelling of salivary glands, electrolyte and
mineral disturbances, and dental enamel erosion. Use of ipecac to
induce vomiting can lead to extreme muscle weakness, including heart
muscle weakness. Laxative abuse can lead to long lasting disruptions
of normal bowel functioning (rarer complications include tearing
the esophagus, and developing life-threatening irregularities of
the heart rhythm. Rarely, even more serious bowel and cardiac problems
occur.
Course And
Outcome Of Eating Disorders
The course and outcome of Anorexia Nervosa are variable, and include
recovery after a circumscribed episode, a fluctuating pattern, a
chronic, debilitating course and death. Less is known about the
long term outcome of Bulimia Nervosa, but among clinic cases, intermittent
and chronic courses are common.
Etiology
The precise causes of eating disorders are unknown but it is virtually
certain that a variety of factors contribute to their development.
Sociocultural
Factors
Undue emphasis on low body weight and slimness in the presence of
plenty, and the easy availability of high fat, high calorie, highly
palatable foods have been implicated as contributing causes of eating
disorders. Persistent and pervasive media messages encouraging dieting
almost certainly lead to high rates of chronic dieting in at-risk
groups of adolescents. Chronic dieting has been strongly implicated
in the development of disordered eating.
Psychological
Factors
Self esteem is fragile in adolescence. It is now widely recognized
that the group most at risk for eating disorders, namely adolescent
girls, generally experience a marked decrease in self-esteem in
mid-adolescence. Low self esteem seems to represent a significant
risk factor for the development of eating pathology. Psychological
tendencies to be perfectionistic and to set rigid standards for
oneself may represent other risk factors. Characteristic personality
tendencies to avoid harm (in anorexia nervosa) or to have a very
emotional nature (in bulimia nervosa) have been identified as risk
factors.
Family Factors
Family factors such as obesity in the family, parental preoccupation
with eating and weight, unrealistic expectations for achievement,
and family disharmony also have been identified as factors that
may promote the development of disordered eating.
Biological
Factors
Genetic tendencies contribute to eating disorders. If one of two
identical (monozygotic) twins suffers from anorexia nervosa or bulimia
nervosa, the second twin is at much higher risk than chance to also
have the same condition. And, if one identical twin has an eating
disorder, the second identical twin is also at much higher risk
than she would be if they were non-identical (dizygotic or fraternal)
twins. Inherited factors may include tendencies toward obesity and
genetic factors contributing to temperment and personality like
those mentioned above. Other factors that influence the individual's
constitution, such as maternal alcohol or cigarette use during pregnancy,
low birth weight, severe early traumas, and other harmful factors,
may also contribute to vulnerability. Neurotransmitter deficits
(e.g., reduced serotonin activity) that persist with recovery also
have been identified in eating disorder patients.
Treatment
Many patients with uncomplicated bulimia nervosa and binge eating
disorders respond well to cognitive behavior therapy and other treatments.
Patients with anorexia nervosa require a treatment team consisting
of a primary care physician, such as a pediatrician or adolescent
medicine specialist, and other health and mental health professionals
knowledgeable about eating disorders including psychotherapists,
physicians, nutritionists, and nurses. The treatment of individuals
with complex combinations of eating disorders and other psychiatric
disorders is complex. Good treatment often requires a spectrum of
treatment options, ranging from basic psychoeducational interventions
designed to teach basic nutritional and symptom management techniques
to long term residential placements.
Most individuals
with eating disorders are treated on an outpatient basis after a
comprehensive evaluation. Individuals with medical complications
due to severe weight loss or due to the effects of binge eating
and purging may require hospitalization. Others, for whom outpatient
therapy has not been effective, may benefit from day-hospital treatment,
hospitalization, or residential placement. Treatment is usually
conducted in the least restrictive setting that can provide adequate
safety for the individual. Many patients with eating disorders also
have depression, anxiety disorders and other psychiatric problems
requiring treatment along with the eating disorder.
Initial Assessment
The initial assessment of individuals with eating disorders involves
a thorough review of the patient's history, current symptoms, physical
status, weight control measures, and other psychiatric issues or
disorders such as depression, anxiety, substance abuse, or personality
issues. Consultation with other specialists on the treatment team
and/or a registered dietician may also be recommended. The initial
assessment is the first step in establishing a diagnosis and treatment
plan.
Outpatient
Outpatient treatment for an eating disorder often involves a coordinated
effort between the patient, a psychotherapist, a physician, and
a nutritionist. Yet, many patients are treated by their pediatrician
or physician with or without a mental health clinician's involvement.
Similarly, many patients are seen and helped by generalist clinicians
without specialist involvement. Not all individuals, then, will
require a multidisciplinary approach but the qualified clinician
should have access to all of these resources.
Psychotherapy:
There are several different types of outpatient psychotherapies
with demonstrated effectiveness with patients with eating disorders.
These include cognitive-behavioral therapy, interpersonal psychotherapy,
family therapy, and behavioral therapy. Other therapies which some
clinicians and patients have found to be useful include psychodynamic
therapies and expressive therapies such as psychodrama, art and
movement therapies.
Psychopharmacology:
Psychiatric medications play a role in the treatment of some patients
with eating disorders. Most of the research to date has involved
antidepressant medications such as fluoxetine (Prozac), although
some clinicians and patients have found that other types of medications
may also be effective.
Nutritional
Counseling:
Regular contact with a registered dietician can be an effective
source of support and information for patients who are regaining
weight or who are trying to normalize their eating behavior.
Medical Follow-up:
Patients with eating disorders are subject to a variety of physical
problems and concerns. Adequate medical monitoring is a cornerstone
of effective outpatient treatment.
Day Hospital
Care
Patients for whom outpatient treatment is inadequate may benefit
from the increased structure provided by a day-hospital treatment
program. These programs provide structured eating situations and
active treatment interventions while allowing the individual to
live at home and, in some cases, to continue to work or to attend
school.
Inpatient
Care
Inpatient treatment provides a structured and contained environment
in which the patient with an eating disorder has access to clinical
support 24-hours a day. Many programs are now affiliated with a
day-hospital program so that patients can "step-up" and "step-down"
to the appropriate level of care depending on their clinical needs.
Residential
Care
Residential programs provide a longer term treatment option for
patients who require prolonged treatment. |
Prevalence
Of Eating Disorders