Eating disorder Classification and external resources
ICD-10	F50.
ICD-9	307.5
MeSH	D001068

An eating disorder is a compulsion to eat, or avoid eating, that negatively affects both one's physical and mental health. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The 2007 version of the ICD is available online at http//wwwwho The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Eating disorders are all encompassing. They affect every part of the person's life. According to the authors of Surviving an Eating Disorder, "feelings about work, school, relationships, day-to-day activities and one's experience of emotional well being are determined by what has or has not been eaten or by a number on a scale. "^[1] Anorexia nervosa and bulimia nervosa are the most common eating disorders generally recognized by medical classification schemes,^[2] with a significant diagnostic overlap between the two. Anorexia Nervosa is a psychiatric Diagnosis that describes an Eating disorder characterized by low Body weight and Body image distortion Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" ^[3] Together, they affect an estimated 5-7% of females in the United States during their lifetimes. ^[4] There is a third type of eating disorder currently being investigated and defined - Binge Eating Disorder. This is a chronic condition that occurs when an individual consumes huge amounts of food during a brief period of time and feels totally out of control and unable to stop their eating. It can lead to serious health conditions such as morbid obesity, diabetes, hypertension, and cardiovascular disease. ^[5] ANAD, or the National Association of Anorexia Nervosa and Associated Disorders is a non profit organization aimed at fighting these disorders. They work primarily in areas such as research, educating the public and running a hotline which is dedicated to referring those afflicted by disorders to support groups, therapists, or inpatient/outpatient clinics. ^[6]

Contents 1 Who Is At Risk? 2 Anorexia nervosa 3 Bulimia nervosa 4 Causes 4.1 Environmental 4.2 Biological 4.3 Developmental etiology 4.4 Trauma 5 Gender Differences 6 Diagnosis 7 References

Who Is At Risk?

Eating disorders,many people believe, occur mainly among young white females. This is not the case. While eating disorders do mainly affect women between the ages of 12 and 35, other groups are also at risk of developing eating disorders. Eating disorders affect all ethnic and racial groups and while the specific nature of the problem and the risk factors may vary, no population is exempt. ^[7] Younger and younger children seem to be at risk of developing eating disorders. While most children who develop eating disorders are between 11 and 13, studies have shown that 80% of 3rd through 6th graders are dissatisfied with their bodies or their weight and by age 9 somewhere between 30 and 40% of girls have already been on a diet. Between ages 10 and 16, the statistic jumps to 80%. Many eating disorder experts attribute this behavior to the effects of cultural expectations. Stress is also considered to be a factor in the development of eating disorders. According to Abigail Natenshon, a psychotherapist specializing in eating disorders, children as young as 5 show signs of stress related eating disorders. This includes compulsively exercising and running to burn off calories. Natanshon notes that as children reach puberty younger and younger, they are less equipped to understand the changes in their bodies. They understand the message of the media to be "thin" and try to fit in without comprehending the effects on their bodies. ^[8] While eating disorders affect younger and younger children, not only girls but also boys suffer from eating disorders. Boys who participate in sports where weight is an issue and often boys who experience issues regarding sexual identity are at risk of developing eating disorders. ^[9]

Anorexia nervosa

Main article: anorexia nervosa

Anorexia nervosa is deliberate and sustained weight loss driven by a fear of becoming overweight and a distorted body image. Anorexia Nervosa is a psychiatric Diagnosis that describes an Eating disorder characterized by low Body weight and Body image distortion Anorexia Nervosa is a psychiatric Diagnosis that describes an Eating disorder characterized by low Body weight and Body image distortion Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid Body image is a term which may refer to the Perceptions of a human's own Physical appearance, or the internal sense of having a body which is interpreted by the brain It is not to be confused with anorexia, which is its symptomatic general loss of appetite or disinterest in food. DSM-IV characterizes anorexia nervosa as:

• An abnormally low body weight (the suggested guideline ≤ 85% of normal for age and height, or BMI ≤ 17. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association 5).
• For postmenarcheal females, amenorrhea (the absence of three consecutive menstrual cycles). Menarche (American English məˈnɑrki British English mɛˈnɑːki is the first menstrual period, or first menstrual bleeding in the females of Human beings Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age
• An intense fear gaining weight or becoming fat and a preoccupation with body weight and shape. ^[10]

Most anorexics become so as adolescents, with 76% reporting onset of the disorder between the ages of 11 and 20. ^[11] The mortality rate for those diagnosed with anorexia nervosa is approximately 6%—the highest of any mental illness—with roughly half of those due to suicide. ^[12]There is a third type of eating disorder currently being investigated - Binge Eating Disorder. People who suffer from this disorder experience chronic episodes where they consume huge amounts of food in a very brief period. They experience feelings of being out of control. Unlike bulimia nervosa, they do not purge. Binge eating can lead to serious health risks such as morbid obesity, diabetes, hypertension, and an increased likelihood of cardiovascular disease. ^[13]

Anorexics are commonly perfectionists, driven to succeed; yet they set unattainable standards of performance for themselves. When they fail to meet these standards, they look for a part of their lives they can control; food and weight become that “control” for them. Low self-esteem and constant self-criticism cause anorexics to constantly fear losing control, and even consuming a small amount of food could be considered a loss of control.

Bulimia nervosa

Main article: bulimia nervosa

Bulimia nervosa is a cyclical and recurring pattern of binge eating (uncontrolled bursts of overeating) followed by guilt, self-recrimination and overcompensatory behaviour such as crash dieting, overexercising and purging to compensate for the excessive caloric intake. Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Overeating can refer either to eating too much at one time or to eating too much on average A crash diet is a diet which is extreme in its nutritional deprivations typically severely restricting Calorie intake

Bulimics often have "binge food," which is the food they typically consume during binges. Some describe their binge episodes as a physical high they feel, numbing out, going into auto-pilot, losing all control, immediate comfort, etc. The reasoning or triggers behind a binge may serve different purposes for different people. This binge episode leads the individual to feel guilt, shame, embarrassment, and complete failure. Bulimics try to regain control of themselves and the situation by purging the food–making up for their mistake. This leads to feeling famished and empty again, and therefore, another uncontrollable binge, followed by feeling powerless, and the vicious binge/purge cycle continues. Bulimics have extreme eating and exercising habits, instead of demonstrating moderation. This compulsive behavior is often echoed in similar destructive behavior such as sexual promiscuity, pathological lying, and shoplifting. Some bulimics not only struggle with the eating disorder, but these other harmful behaviors as well.

Causes

Environmental

The media may be a significant influence on eating disorders through its impact on values, norms, and image standards accepted by modern society. ^[14] Both society’s exposure to media and eating disorders have grown immensely over the past decade. Researchers and clinicians are concerned about the relationship between these two phenomena and finding ways to reduce the negative influence thin-ideal media has on women’s body perception and susceptibility to eating disorders. The dieting industry makes billions of dollars each year by consumers continually buying products in an effort to be the ideal weight. Hollywood displays an unrealistic standard of beauty that makes the public feel incredibly inadequate and dissatisfied and forces people to strive for an unattainable appearance. ^[15] This takes an enormous toll on one's self-esteem and can easily lead to dieting behaviors, disordered eating, body shame, and ultimately an eating disorder. In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth

Biological

Patients with severe obsessive compulsive disorder, depression or bulimia patients were all found to have abnormally low serotonin levels. Obsessive-compulsive disorder (OCD is a Chronic Anxiety disorder most commonly characterized by obsessive Distressing Intrusive thoughts Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons ^[16] Neurotransmitters such as serotonin, dopamine and norepinephrine are secreted by the intestines and central nervous system during digestion. See Chemical synapse for an introduction to concepts and terminology used in this article Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a ^[17]

Researchers have also found low cholecystokinin levels in bulimics. Cholecystokinin ( CCK; from Greek chole, "bile" cysto, "sac" kinin, "move" hence move the bile-sac Cholecystokinin is a hormone that causes one to feel full and decreases eating. Low levels of this hormone are likely to cause a lack of satiative feedback when eating, which can lead to overeating. Another explanation researchers found for overeating is abnormalities in the neuromodulator peptides, neuropeptide Y and peptide YY. Neuropeptide Y (NPY is a 36 Amino acid peptide Neurotransmitter found in the Brain and Autonomic nervous system. Peptide YY is a short (36 Amino acid) Protein released by cells in the Ileum and colon in response to feeding Both of these peptides increase eating and work with another peptide called leptin. Leptin (Greek leptos meaning thin is a 16 kDa Leptin is released by fat cells and is known to decrease eating. Research found the majority of people who overate produced normal amounts of leptin but they might have complications with the blood-brain barrier preventing an optimal amount to reach the brain. The blood-brain barrier (BBB is a metabolic or cellular structure in the Central nervous system (CNS that restricts the passage of various chemical substances and microscopic ^[17]

Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism. Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Situated along the perimeter of the Adrenal gland, the adrenal cortex mediates the stress response through the production of Mineralocorticoids and Glucocorticoids Blood sugar, used in a physiological context is a misnomer and misleading ^[17] High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus. ^[18] A study in London at Maudsley Hospital found that anorexics were found to have a large variation of serotonin receptors and a high level of serotonin. ^[19]

Many of these chemicals and hormones are associated with the hypothalamus in the brain. The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis ^[20] Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level. ^[17]

While scientists have determined that there are possible biochemical or biological causes leading to eating disorders because certain chemicals which control hunger, appetite or digestions are out of balance, experts such as Dr. Edward J. Cumella, executive director of the Remuda Treatment Programs, states that there are three components to eating disorders: 1. The genetic component; 2. The unique environmental factors, such as personal experiences; and 3) The shared environmental factors, such as culture. According to Dr. Cumella, "Some people are born with a predisposition to having an eating disorder and there are genetic markers that can push a person in the direction of anorexia or bulimia. . . but it does not guarantee that a person will automatically suffer from an eating disorder. The environment - a person's life experience - still has to pull the trigger. "^[21]

Developmental etiology

Research from a family systems perspective indicates that eating disorders stem from both the adolescent's difficulty in separating from over-controlling parents, and disturbed patterns of communication. Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of Psychotherapy that works with families When parents are critical and unaffectionate, their children are more prone to becoming self-destructive and self-critical, and have difficulty developing the skills to engage in self-care giving behaviors. Such developmental failures in early relationships with others, particularly maternal empathy, impairs the development of an internal sense of self and leads to an over-dependence on the environment. When coping strategies have not been developed in the family system, food and drugs serve as a substitute. ^[22]

Trauma

Eating disorders should also be understood in the context of experienced trauma, with many eating problems beginning as survival strategies rather than vanity or obsession with appearance. According to sociologist Becky Thompson, eating disorders stemming from women of varying socio-economic status, sexual orientation and race, and finds that eating disorders and a disconnected relationship with ones body is commonly a response to environmental stresses, including sexual, physical, and emotional abuse, racism, and poverty. This reality is further detrimental for women of color and other minority women, since they are forced to live in a culture that embraces a narrowly defined conception of beauty: "people furthest from the dominant ideal of beauty, specifically women of color, may suffer the psychological effects of low self-esteem, poor body image, and eating disorders. "^[23]

Gender Differences

"Frequent dieting and trying to look like persons in the media were independent predictors of binge eating in females of all ages. In males, negative comments about weight by fathers was predictive of starting to binge at least weekly. "^[24]

Diagnosis

Clinically, eating disorders are evaluated using instruments such as the Questionnaire of Eating and Weight Patterns (QEWP), which has specialized versions for adolescents and parents (QEWP-A, and QEWP-P). In addition to evaluating eating patterns, these tests also measure depression. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression ^[25]

References

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