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New trends for eating disorders


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New trends for eating disorders

  1. 1. New Eating Disorders Anorexia and bulimia arent the only dangerous eating behaviorsFor decades, the eating disorder lexicon had two main entries: anorexia and bulimia. But modernresearch reveals that these fall woefully short of encompassing the many facets of disordered eating. Inthe early 90s, the American Psychiatric Association introduced a new diagnostic category: eatingdisorders not otherwise specified (EDNOS). A catch-all label that includes dozens of subdiagnoses,EDNOS applies to patients who dont meet the exact criteria for anorexia or bulimia but still have verytroubled relationships with food or distorted body images. Today, EDNOS diagnoses significantlyoutnumber anorexia and bulimia cases. "The atypical has become the typical," says Ovidio Bermudez,M.D. These define just a few atypical eating disorders.OrthorexiaA fixation with healthy or righteous eatingOrthorexics often eat only organic foods, eliminate entire food groups, or refuse to eat anything thatisnt "pure" in quality, says clinical psychologist Sari Shepphird, Ph.D. Unlike anorexics, they dontnecessarily think theyre fat or strive to be thin; some are motivated by a fear of bad health, a fixationwith complete control, or the desire to improve their own self-esteem. Ironically, severe orthorexia canlead to malnourishment.PregorexiaExtreme dieting and exercising while pregnant to avoid gaining the 25 to 35 pounds of weight doctorsusually recommend"Theres more social pressure on women to look thin during and after pregnancy," says Shepphird. "Butpregorexia comes with very serious health problems." Starving moms-to-be are at risk for depression,anemia, and hypertension, while their malnourished babies are often miscarried or born with birthdefects.Binge EatingCompulsive overeating, often to deal with negative emotions or stressBinge eaters consume large amounts of food very quickly—until theyre uncomfortably full. Mostsufferers eat in secret to hide their habits. Many feel powerless to stop eating and are disgusted withthemselves afterward; but unlike with bulimia, they dont attempt to reverse a binge by vomiting orfasting. While not all patients are overweight, obesity—and its related health problems—are obviously arisk."As early as age 30, many women hit a point at which they feel there are certain things they should haveaccomplished," says Kronberg. "They evaluate their lives, and if they see a void, they look for somethingthat will make them feel good." In essence, a perceived lack of success can morph into a feeling offailure and become an eating disorder catalyst. But emerging research shows that yet another factorcould turn an innocent desire for self-improvement into an unstoppable compulsion.
  2. 2. Anorexia AthleticaAn addiction to exerciseSufferers work out well beyond the requirements for good health, often to the point that their gym timeinterferes with their job or relationships. "Instead of throwing up, so-called compulsive exercisers purgecalories by working out religiously," says Shepphird. "Often, if they dont keep up with their rigorousroutine, they feel tremendous anxiety or guilt." Theyre also at risk for potentially fatal cardiac problemsand depression.DrunkorexiaRestricting food intake in order to reserve those calories for alcohol and binge drinkingA University of Missouri study found that almost 30 percent of female college students exhibitdrunkorexic behavior, "saving" their calories for booze in order to avoid gaining weight or to get drunkfaster. Bad idea: These women are upping their chances for alcohol poisoning, uninhibited sexualbehavior, and long-term consequences like heart and liver diseases.Reference:
  3. 3. Young Binge Eaters Prone to Illicit Drug Use: Study Overeating occurred first in large review of 17,000 boys and girls December 10, 2012By Alan MozesHealthDay ReporterMONDAY, Dec. 10 (HealthDay News) -- Tweens, teens and young adults who routinelyovereat appear to be more likely to experiment with marijuana or other drugs, new researchsuggests.The observation stems from a decade-long research effort, during which nearly 17,000 boysand girls were tracked to assess eating and drug-use patterns.The bottom-line: Drug use increased among all overeaters, regardless of whether thatbehavior took the form of relatively controlled overeating or binge-eating behavior, whichinvolves a loss of eating control."Previous research has demonstrated a link between overeating and binge eating and otherhealth concerns, so most of the results were as we expected," said Kendrin Sonneville, aregistered dietician in the division of adolescent/young adult medicine at Childrens HospitalBoston.She did suggest, however, that some findings, including that "teens who binge eat were nomore likely to start binge drinking frequently than those who did not binge eat," weresomewhat surprising.Whats more, Sonneville noted, although "it may seem that overeating and binge eatingwould only be a concern for individuals who are obese, this study shows that thesebehaviors are problematic for all kids. No matter what they weighed, teens who reportedbinge eating where more likely to start using drugs and to become depressed than thosewho did not binge eat."The study, which appears online Dec. 10 in the journal Archives of Pediatrics &Adolescent Medicine, received funding from the U.S. National Institutes of Health.All participants were between the ages of 9 and 16 when first enrolled in the study. Between1996 and 2005, they completed questionnaires regarding their eating and drug-use habitsevery one or two years.At one point or another, the questionnaires asked about the use of marijuana, hashish,cocaine, crack, heroin, ecstasy, PCP, GHB, LSD, psychedelic mushrooms, ketamine, crystalmeth and amphetamines, as well as nonprescription use of tranquilizers, painkillers,sleeping pills and stimulants.The authors found that binge eating was more common among girls, reaching just over 3percent among girls and 1 percent among boys. In turn, binge eating was linked to a higherrisk for becoming overweight or obese, as well as for developing depressive symptoms.However, simply overeating -- with self-control -- was not linked to either.Both overeating and binge-eating behaviors were associated with a greater risk for drug-useinitiation, but not binge-drinking behavior.
  4. 4. "Based on the findings of this study alone, we cant explain why adolescents who overeat orbinge arent at higher risk for binge drinking," Sonneville said. "It is important to note thatfrequent binge drinking was common in our study, [as] 60 percent of the teens startedbinge drinking during the course of the study.""The fact that we didnt see an association between binge eating and the onset of frequentbinge drinking may have something to do with the fact that this behavior is so normativeamong teens," she added.Registered dietician Lona Sandon, assistant professor of clinical nutrition at the University ofTexas Southwestern Medical Center at Dallas, said the findings are in line with what shewould expect."Most people might not make that connection between binge eating and drug use, butpeople often use food to address emotional states the same way they might use drugs," shesaid. "They may be engaging in binge eating for a way to somehow improve their moodor ... cover up negative emotions. That may be the same reason they also then turn tomarijuana or some other drug.""We see this in cases when patients come in for bariatric surgery," Sandon added. "In manyof those cases the drug of choice, so to speak, was food. If you dont change their mindsetregarding food and out-of-control eating, they are going to keep having the same issuesafter surgery.""Often what happens is they turn to alcohol in place of food, because after bariatric surgeryits much easier to down alcohol than it is food," she added.Although the study showed an association between binge eating and increased risk of druguse, it did not prove a cause-and-effect relationship.More informationVisit the Nemours Foundation for more on binge eating and children.Copyright © 2012 HealthDay. All rights reserved.Reference:
  5. 5. Posttraumatic Stress Disorder and Eating Disorders Unlocking past trauma that may underlie an eating disorderReprinted from Eating Disorders ReviewNovember/December 2012 Volume 23, Number 6©2012 Gürze BooksAlthough posttraumatic stress disorder (PTSD) often brings to mind combat-related injury, PTSD canaffect anyone with a history of physical, emotional, or sexual abuse, or being exposed to a variety oftraumatic experiences. PTSD may also lead to eating disorders.Disordered eating behaviors may represent an individual’s methods for coping with the uncomfortableemotions and experiences correlated with all types of trauma. After trauma, she may begin restrictingfood intake as a way of feeling in control and by doing so may gain a false sense of security. Or, she maybinge-eat as a way to seek comfort through food and to “stuff down” negative feelings.Dr. Tim Brewerton, Clinical Professor of Psychiatry and Behavioral Sciences at the Medical University ofSouth Carolina, Charleston, an expert in PTSD and eating disorders, has noted that disordered eatingbehaviors, especially purging, may be used as an avoidance mechanism by individual to numb painfulfeelings and to block or forget painful memories. About 10% of women will develop PTSD at some timein their lifetime (Arch Gen Psychiatry 1995; 52:1048).In related findings, recent research at the San Francisco VA Medical Center has shown that rates ofeating disorders are significantly higher among returning female veterans with comorbid mental healthproblems compared with those without mental health diagnoses (Women’s Health Issues 2012;22:e403).A Major Study Lays Important GroundworkFifteen years ago, researchers in the National Women’s Study evaluated a representative sample ofmore than 3000 women who were interviewed at length about their traumatic experiences. More thanhalf of those meeting diagnostic criteria for bulimia nervosa (BN) reported having been raped, molested,or physically assaulted; fewer than a third of those without eating disorders had experienced suchtraumas (Int J Eat Disord 1997; 21:2130218). Dr. Brewerton, one of the authors of that study, pointedout that in 84% of cases the first rape preceded the first binge-eating episode, establishing assault as apotentially contributing if not causative factor for the development of BN. Similar results were found formolestation and physical assault. He reported that 37% of women with BN also had full-blown historiesof PTSD, and many more had partial PTSD syndromes.Psychologist Matthew T. Tull, PhD, associate professor and director of anxiety disorders research at theUniversity of Mississippi Medical Center, Jackson, conducts research on anxiety disorders centeringaround PTSD and substance abuse. He and his colleagues have reported that those with PTSD are threetimes more likely to develop bulimic behavior than those who do not have PTSD. And, according to Dr.Jacqueline M. Hirth and her colleagues at the University of Texas Medical Branch, Galveston, nearly a
  6. 6. third of U.S. women have experienced traumatic experiences related to intimate partner violence duringtheir lifetimes and two-thirds of these women will develop at least some symptoms of PTSD. Othershave shown that patients with PTSD after childhood sexual abuse and a co-occurring eating disorder candevelop body image disorders. The results of one study show for the first time that the behavioralcomponent of body image is impaired in female patients with PTSD in addition to the cognitive-affectivecomponent. This is not solely due to a comorbid eating disorder (Psychopathology 2012; Sept. 7 [Epubahead of print]. Few studies have examined the mediating effect of depressive symptoms and PTSD; in arecent study researchers in France found that PTSD symptoms fully mediated the effects of early adultsexual assault on disordered eating, and depressive symptoms were a partial mediator of thisrelationship (J Trauma Stress 2012; 25:50; doi 10.1002/1002/jts.21664.)Shame is another component. As Dr. Brewerton has pointed out, trauma-related shame is a majorfeature of trauma-related conditions, and the reaction of mothers to their daughters’ disclosure ofabuse is a powerful predictor of subsequent PTSD and other post-traumatic problems. When the abusedperson’s story is believed and he or she receives an empathetic, supportive, accepting andnonjudgmental response, the patient can better deal with the traumatic events, and a more favorableoutcome results. In contrast, when the victim is challenged about the trauma, and not believed ordoubted, this can aggravate shame, self-loathing (including loathing directed at the body), and can leadto a much poorer outcome.PTSD among AN patientsWhen a large study, the NIH-sponsored Genetics of Anorexia Nervosa Collaborative Study, evaluated753 women with AN, 13.7% (103) met DSM-IV criteria for PTSD (Psychosom Med 2011; 73: 291). Inpairwise comparisons across AN subtypes, the odds of having a PTSD diagnosis were significantly lowerin individuals with restricting AN (RAN) than individuals with purging AN without binge eating (PAN)(OR=0.49, 95% CI=0.30, 0.80). The majority of participants with PTSD reported that the first traumaticevent occurred before the onset of AN (64.1%, n=66). The most common traumatic events reported bythose with a PTSD diagnosis were sexually related traumas during childhood (40.8%) and duringadulthood (35.0%).Most participants with PTSD reported the first traumatic event before the onset of AN, and the mostcommon traumatic events reported were sexual-related trauma during childhood (40.8%) and duringadulthood (35.0%). However, the participants had experienced a wide range of traumatic events. Theauthors made an important point, the importance of assessing a history of trauma and possible PTSDamong patients with AN.Dr. Brewerton and others have also noted that certain elements have an impact on the success oftreatment, including adequate nutritional rehabilitation, with normalization of weight and eating beforeany exposure work begins. - MKSReference:
  7. 7. Eating Disorders And Womens Obsession With Thin Bodies Could Be Addressed By Increasing The Amount Of Plus-Size ModelsBritish womens obsession for thin bodies could potentially be changed if advertising showed more plus size models, suggests apreliminary study just published.The Durham University researchers, who studied over 100 women, provide evidence to back calls for models in adverts to bemore representative of the actual population. This move could ultimately help girls and women to develop a healthier attitudeto eating, the researchers say.In the preliminary study, women who habitually strongly preferred thin body shapes were significantly less keen on thin bodiesafter they had been shown pictures of plus size catalogue models. Conversely, showing slim models increased womenspreference for thin bodies.The effects could be found whether the women were shown catalogue models or ordinary women of either size.The findings provide research data for policy-makers and support for on-going calls from Government and health charities tonormalise female models in the media.The research is published in the leading international academic journal, PLOS ONE, and was led by Durham University withcolleagues from Newcastle University and the VU University Amsterdam.Follow up research will look in more detail at the change in preferences and will include both women and men.Lead author Dr Lynda Boothroyd, from Durham Universitys Department of Psychology, said: "This really gives us some food forthought about the power of exposure to super-slim bodies. There is evidence that being constantly surrounded through themedia by celebrities and models who are very thin contributes to girls and women having an unhealthy attitude to their bodies."Although we dont yet know whether brief exposure to pictures of larger women will change womens attitudes in the longterm, our findings certainly indicate that showing more normal models could potentially reduce womens obsession forthinness."Susan Ringwood, Chief Executive from the leading UK eating disorders charity, Beat, commented: "This study points towards animportant aspect of our modern lives. We see an average of 2,000 images a day in advertising alone, and most of these includebodies that are more slender than average. Increasing the diversity of body shapes and sizes portrayed in the media couldrebalance our views about our own bodies in an emotionally healthy way."Dr Boothroyd added: "Thinner bodies are definitely in vogue and within western media, thinness is overwhelmingly idolised andbeing overweight is often stigmatised. Although the media doesnt directly cause eating disorders, research suggests it is a verypowerful factor in creating body dissatisfaction."Furthermore, it seems that even so-called cautionary images against anorexia might still increase our liking for thinner bodies,such as those featuring the late French model Isabelle Caro, who gained worldwide publicity for posing nude for an anti-anorexia campaign while suffering from the illness. These campaigns may not have the desired effect which is a soberingthought."The images used in the study were of thin and plus size models from high street catalogues and beauty contests, and ofordinary women photographed in plain grey leotards. The thin models shown were a standard size for catalogue models and
  8. 8. the women in leotards had a Body Mass Index (BMI) of between 11 and 14. The plus size models were a minimum of clothessize 16 and the women in leotards had a BMI of between 36 and 42¹.The study also looked at the influence of positive and negative associations with weight. When women were shown theaspirational images of larger models, paired with the plain images of underweight women, their preferences also shifted awayfrom thinness. This supports the idea that, in the West, our associations between thinness and good health and high status mayplay a part in strong preferences for thin bodies.This is in contrast to some developing countries where being overweight is generally perceived as an indicator of health, wealthand femininity, and many people tend to prefer women who carry more fat.Rachel CoweyRachel Cowey is 25 years old and from South Shields. She is the co-creator of Team Recovery Ninja, an online resource aimed atsupporting people through recovery from eating disorders, and is also a volunteer for Beat. Rachel developed anorexia whenshe was 16 years old and now considers herself 90 per cent recovered.Rachel said: "There were lots of factors which led to me developing my eating disorder such as school pressures andexpectations, bullying, family issues, not feeling good enough and the need to be perfect."Just like there were many factors which led to the eating disorder, there have also been a number of elements which havehelped me recover. I am determined and stubborn in nature and I have used those character traits in my focus to recover. Ihave also put myself out in the real world; at university, working for charities, travelling and ultimately accepted myself for whoI am."I was discharged from hospital treatment three years ago although I consider myself to be 90 per cent recovered. Recovery isan ongoing process."In order for me to have got to where I am now, I have had to take very small steps and overcome huge challenges. The mediasportrayal of women has not helped in that."There is an immense pressure to be seen to have it all and be perfect at everything. Within the media, being thin andattractive is linked to being successful."The doctors told me it was impossible to survive at the weight I was, yet the media constantly showed skinny celebrities whowere apparently absolutely fine. That was hugely unhelpful for my mindset and recovery."I think this research is incredibly important as anything that can help us understand eating disorders is valuable. It also helps tohighlight the medias impact on people, and that what they print can sometimes have devastating consequences."As well as the medias constant focus on weight loss and looking thin and perfect, the often sensationalist portrayal of eatingdisorders also makes it more difficult to speak out. The publication of peoples lowest weights and their pictures when ill causesdamage, hurt and stigma. It gives the perception that eating disorders are only about weight and appearance which is not thecase."Reference: