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Chapter I: Classification

Currently recognized in medical manuals:

Anorexia nervosa $A&(, characterized by refusal to maintain a healthy body weight, an obsessive

fear of gaining weight, and an unrealistic perception of current body weight. owever, some patients can suffer from anorexia nervosa unconsciously. *hese patients are classified under 

/atypical eating disorders/. Anorexia can cause menstruation to stop, and often leads to bone

loss, loss of s#in integrity, etc. "t greatly stresses the heart, increasing the ris# of heart attac#s andrelated heart problems. *he ris# of death is greatly increased in individuals with this disease. *he

most underlining factor researchers are starting to ta#e notice of is that it may not just be a

vanity, social, or media issue, but it could also be related to biological and or geneticcomponents.

)ulimia nervosa $)&(, characterized by recurrent binge eating followed by compensatory

 behaviors such as purging $self!induced vomiting, excessive use of laxatives0diuretics, or excessive exercise(. 1asting and over!exercising may also be used as a method of purging

following a binge.

Eating disorders not otherwise specified $E%&'S( is an eating disorder that does not meet the

%S2!"3 criteria for anorexia or bulimia. Examples can be a female who suffers from anorexia

 but still has her period or someone who may be at a /healthy weight/ but who has anorexicthought patterns and behaviors4 it can mean the sufferer equally participates in some anorexic as

well as bulimic behaviors $sometimes referred to as purge!type anorexia( or to any combination

of eating disorder behaviors that do not directly put them in a separate category.

)inge eating disorder $)E%( or 5compulsive overeating5, characterized by binge eating, withoutcompensatory behavior. *his type of eating disorder is even more common than bulimia or 

anorexia. *his disorder does not have a category of people in which it can develop. "n fact, thisdisorder can develop in a range of ages and is unbiased to classes.

+ica, characterized by a compulsive craving for eating, chewing or lic#ing non!food items or foods containing no nutrition. *hese can include such things as chal#, paper, plaster, paint chips,

 ba#ing soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes. *hese individuals cannot

distinguish a difference between food and non!food items.

Not currently recognized in standard medical manuals:

ompulsive overeating $'E( characteristic of binge eating disorder, in which people tend to eatmore than necessary resulting in more stress. *his is mainly caused by 5binge eating disorder5.

+urging disorder, characterized by recurrent purging to control weight or shape in the absence of  binge eating episodes.

6umination, characterized by involving the repeated painless regurgitation of food following ameal which is then either re!chewed and re!swallowed, or discarded.

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%iabulimia, characterized by the deliberate manipulation of insulin levels by diabetics in an

effort to control their weight.

1ood maintenance, characterized by a set of aberrant eating behaviors of children in foster care.

 &ight eating syndrome, characterized by morning anorexia, evening polyphagia $abnormally

increased appetite for consumption of food $frequently associated with insomnia, and injury tothehypothalamus(.

'rthorexia nervosa, a term used by Steven )ratman to characterize an obsession with a /pure/

diet, in which people develop an obsession with avoiding unhealthy foods to the point where it

interferes with a person5s life.

%run#orexia, commonly characterized by purposely restricting food inta#e in order to reserve

food calories for alcoholic calories, exercising excessively in order to burn calories consumed

from drin#ing, and over!drin#ing alcohols in order to purge previously consumed food.

+regorexia, characterized by extreme dieting and over!exercising in order to control pregnancy

weight gain. 7nder!nutrition during pregnancy is associated with low birth weight, coronaryheart disease, type 8 diabetes, stro#e, hypertension, cardiovascular disease ris#, and depression.

Chapter II: Causes

*here is no single cause for eating disorders. Although concerns about weight and body shape

 play a role in all eating disorders, the actual cause of these disorders appears to involve many

factors, including those that are genetic and neurobiological, cultural and social, and behavioraland psychological.

Genetic Factors

6esearch suggests that genetic factors may increase the li#elihood of an

individual developing an eating disorder. "ndividuals with a first!degree relative

who has a history of an eating disorder are more li#ely than individuals withoutsuch a relative, to themselves develop an eating disorder. "n addition,

researchers have identified specific genes that influence hormones such as

leptin and ghrelin. Experts believe that as well as regulating feeding, thesehormones may influence the personality traits and behaviors that are associated

with anorexia and bulimia.

Influences at Home or at School

Existing research into the role of family in triggering an eating disorder is largely cross!sectional,

retrospective and unsubstantiated. owever, it has been suggested that parents9 behaviors mayinfluence their child9s eating habits. 1or example, mothers who diet or worry excessively about

their weight may trigger their child to develop an abnormal attitude towards food, as may a

father or sibling who teases an individual about their weight or shape.

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Similarly, comments made by classmates in the school environment can influence a

child9s attitude to eating habits and a parent or teacher9s high expectations of a

child9s performance at school may also help lay the foundations for an eatingdisorder.

Personality and Character

+eople with eating disorders tend to share similar personality and behavioral traits

such as low self!esteem, perfectionism, approval see#ing, dependency, and problemswith self!direction. "n addition, specific personality disorders can increase the ris# 

for developing eating disorders, these include:

Avoidant Personality isorder

+eople with this condition are typically perfectionist, emotionally and sexually inhibited,

nonrebellious and terrified of being criticized or humiliated.

!"sessive#Compulsive Personality isorder

"ndividuals with this disorder may be perfectionist, morally rigid, or overly concerned with rules

and order.

$orderline Personality isorder

*his disorder is associated with self!destructive and impulsive behaviors.

Narcissistic Personality isorder

1eatures of this disorder include an inability to comfort oneself or to empathize with others aswell as a need for admiration and oversensitivity to criticism or defeat.

Psychological Factors

+sychological conditions such as post!traumatic stress disorder, panic disorder, phobias and

depression have all been associated with abnormal eating habits, as have life stressors such as job

loss, divorce, or coping with bullying or a learning difficulty such as dyslexia. Stressful or upsetting situations such as tight deadlines at wor#, school or university or experiencing the

death of a loved one are all examples of factors that may contribute to the development of an

eating disorder.

$ody Image isorders

)ody image disorders such as body dysmorphic disorder, where an individual has adistorted view of their body, or muscle dysmorphia which describes an obsession

with muscle mass, are often associated with anorexia or bulimia.

Cultural Pressures

*he impact of the media in ;estern culture can fuel a desire for or obsession withthe idea of becoming thin. "n the media, thinness or slimness is often equated with

success and popularity, which may cultivate and encourage the idea of being thin,

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especially among young girls. owever, the media also fiercely mar#ets cheap and calorific

foods, which can cause confusion and stress. +ressure to become thin may also be perceived by

individuals who ta#e part in competitive or athletic activities such as modelling, ballet or running. As a result, people can develop unrealistic expectations for their body image and place

an overemphasis on the importance of being thin.

$iologic Factors

A bodily system called the hypothalamic!pituitary!adrenal axis $+A( may play an importantrole in eating disorders.

*he +A releases regulators of appetite, stress and mood such as serotonin, norepinephrine, and

dopamine. Abnormalities of these chemical messengers are considered to play an important rolein eating disorders. Serotonin is important in the control of anxiety and appetite while

norepinephrine is a stress regulator and dopamine plays a role in reward!see#ing behavior. An

imbalance of serotonin and dopamine may help to explain why people with anorexia do notderive a sense of pleasure from food and other common comforts.

Chapter III: Symptoms#complications

Anore%ia Nervosa

"n anorexia nervosa9s cycle of self!starvation, the body is denied the essential nutrients it needsto function normally. *he body is forced to slow down all of its processes to conserve energy,

resulting in serious acute and long!term medical consequences including: abnormally slow heart

rate and low blood pressure4 damage to the structure and function of the heart4 increased ris# ofheart failure and death4 reduction of bone density $osteopenia and osteoporosis( which results in

dry, brittle bones4 muscle loss and wea#ness4 severe dehydration, which can result in #idneyfailure4 edema $swelling(4 fainting, fatigue, lethargy and overall wea#ness4 dry s#in and hair, brittle hair and nails, hair loss4 anemia $can lead to fatigue, shortness of breath, increased

infections, and heart palpitations(4 severe constipation4 prepubertal patients may have arrested

sexual maturity and growth failure4 drop in internal body temperature, with subsequent growth of 

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decalcification of teeth, enamel loss, staining, severe tooth decay and gum disease as a result of

repeated exposure to stomach acid4 edema $swelling(4 chronic irregular bowel movements,

constipation and other gastrointestinal problems4 peptic ulcers and pancreatitis4 swollen, enlargedsalivary glands in the nec# and jaw area4 acid reflux disorder4 infertility, increased rates of

miscarriage and other fetal complications.

$inge &ating isorder

)inge eating disorder $)E%( is much more prevalent than either anorexia or bulimia. )E% oftenresults in many of the same health ris#s associated with clinical obesity yet people with )E% can

 be of normal weight. Some of the potential health consequences of )E% include: high blood

 pressure4 high cholesterol levels4 heart disease as a result of elevated triglyceride levels4 type ""

diabetes mellitus4 obstructive sleep apnea4 edema $swelling( #idney disease4 gall bladder disease4arthritis $degenerative( ! caused by hormonal imbalances and vitamin deficiencies as well as

increased stress on the joints4 infertility4 various forms of cancer4 increased rates of irritable

 bowel syndrome $")S(, fibromyalgia and insomnia have also been reported.

&ating isorder Not !ther'ise Specified (&N!S)

"t9s a common misconception that the E%&'S diagnosis is not as serious or does not warrant the

same level of concern as the other eating disorder diagnoses discussed above. "n reality, all of

the same medical problems can be experienced by those with E%&'S who are acting on variouseating disorder symptoms. "n fact, recent research has actually shown that the associated

mortality rate for E%&'S exceeds the rates for both anorexia and bulimia.

&ating isorders * Suicide

Suicide accounts for a significant number of eating disorder deaths. *hose struggling with eating

disorders are more li#ely than individuals without eating disorders to thin# about suicide and

attempt suicide. *he suicide rate for women with eating disorders is >- times greater than thosewithout.

Chapter I+: ,ests and diagnosis

Eating disorders are diagnosed based on signs, symptoms and eating habits. ;hen doctors

suspect someone has an eating disorder, they typically run many tests or perform exams. *hesecan help pinpoint a diagnosis and also chec# for related complications. ?ou may see both a

medical doctor and a mental health provider for a diagnosis.

Physical evaluations

*hese exams and tests generally include: physical exam that may include measuring height,

weight and body mass index4 chec#ing vital signs, such as heart rate, blood pressure and

temperature4 chec#ing the s#in for dryness or other problems4 listening to the heart and lungs4and examining your abdomen4 laboratory tests that may include a complete blood count, as well

as more!specialized blood tests to chec# electrolytes and protein, as well as liver, #idney and

thyroid function. A urinalysis also may be done and other studies such as @!rays that may be

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ta#en to chec# for pneumonia or heart problems. Electrocardiograms may be done to loo# for

heart irregularities.

Psychological evaluations

"n addition to a physical exam, people with eating disorders will have a thorough psychological

evaluation. *heir doctor or mental health provider may as# them a number of questions abouttheir eating habits, beliefs and behavior. *he questions may focus on their history of dieting,

 bingeing, purging and exercise. *hey will explore how you perceive your body image and how

you thin# others perceive your body image. *hey may also fill out psychological self!assessments and questionnaires.

iagnostic criteria

*o be diagnosed with an eating disorder, you must meet criteria spelled out in the %iagnostic and

Statistical 2anual of 2ental %isorders $%S2( published by the American +sychiatric

Association. Each eating disorder has its own set of diagnostic criteria. ?our mental health provider will review your signs and symptoms to see if you meet the necessary diagnostic

criteria for a particular eating disorder. Some people may not meet all of the criteria but still have

an eating disorder and need professional help to overcome or manage it.

*he diagnosis for Anorexia &ervosa are: restriction of energy inta#e relative to requirement,

leading to a significantly low body weight in the context of age, sex, developmental trajectory,

and physical health4 intense fear of gaining weight or of becoming fat or persistent behavior thatinterferes with weight gain, even though at a significantly low weight4 disturbance in the way in

which one5s body weight or shape is experienced, undue influence of body weight or shape on

self!evaluation, or persistent lac# of recognition of the seriousness of the current low bodyweight.

*he diagnosis for )ulimia &ervosa are: recurrent episodes of binge eating4 recurrent

inappropriate compensatory behaviors $such as self!induced vomiting, misuse of laxatives,

fasting, or excessive exercise( in order to prevent weight gain4 the binge eating and inappropriate

compensatory behaviors both occur, on average, at least x0wee# for months4 self!evaluation isunduly influenced by body shape and weight4 the disturbance does not occur exclusively during

episodes of anorexia nervosa

*he diagnosis for )inge Eating %isorder are: recurrent episodes of binge eating4 mar#ed distressregarding binge eating4 the binge eating occurs, on average, at least x0wee# for months4 binge

eating is not associated with the regular use of inappropriate compensatory behavior and does not

occur exclusively during the course of bulimia nervosa or anorexia nervosa)inge eating episodes are associated with three or more of the following: eating much more

rapidly than normal4 eating large amounts of food when not feeling physically hungry4 eating

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until feeling uncomfortably full4 eating alone because you are embarrassed by how much you5re

eating4 feeling disgusted with oneself, depressed, or very guilty after overeating.

%iagnostic examples of Eating %isorder &ot 'therwise Specified

*he %iagnostic B Statistical 2anual $%S2!"3( currently lists six clinical examples of E%&'S.

"t9s important to note that this list in not exhaustive, and there are other situations and variations

of symptoms that would also warrant an E%&'S diagnosis: all criteria for anorexia nervosa aremet except the individuals has regular menstrual cycles4 all criteria for anorexia nervosa are met

except that, despite significant weight loss, the individual9s current weight falls within the

normal range4 all criteria for bulimia nervosa are met except that binge eating or purging

 behaviors occur less than twice per wee# or for fewer than three months4 an individual purgesafter eating small amounts of food while retaining a normal body weight4 repeatedly chewing

and spitting out large amounts of food without swallowing4 all criteria are met for binge eating

disorder.

Chapter +: ,reatments and drugs

Eating disorder treatment depends on your specific type of eating disorder. )ut in general, ittypically includes psychotherapy, nutrition education and medication. "f your life is at ris#, you

may need immediate hospitalization.

Psychotherapy

"ndividual psychotherapy can help you learn how to exchange unhealthy habits for healthy ones.

?ou learn how to monitor your eating and your moods, develop problem!solving s#ills, andexplore healthy ways to cope with stressful situations. +sychotherapy can also help improve your relationships and your mood. A type of psychotherapy called cognitive behavioral therapy is

commonly used in eating disorder treatment, especially for bulimia nervosa and binge!eating

disorder. Croup therapy also may be helpful for some people.

1amily!based therapy is the only effective treatment for children and adolescents with eatingdisorders. *his type of therapy begins with the assumption that the person with the eating

disorder is no longer capable of ma#ing sound decisions regarding his or her health and needs

help from the family. An important part of family!based therapy is that your family is involved inma#ing sure that your child or other family member is following healthy!eating patterns and is

restoring weight. *his type of therapy can help encourage support from concerned familymembers.

-eight restoration and nutrition education

"f you5re underweight due to an eating disorder, the first goal of treatment will be to start getting

you bac# to a healthy weight. &o matter what your weight, dietitians and other health care providers can give you information about a healthy diet and help design an eating plan that can

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help you achieve a healthy weight and instill normal!eating habits. "f you have binge!eating

disorder, you may benefit from medically supervised weight!loss programs.

Hospitalization

"f you have serious health problems or if you have anorexia and refuse to eat or gain weight,

your doctor may recommend hospitalization. ospitalization may be on a medical or psychiatricward. Some clinics specialize in treating people with eating disorders. Some may offer day

 programs, rather than full hospitalization. Specialized eating disorder programs may offer more

intensive treatment over longer periods of time.

.edications

2edication can5t cure an eating disorder. owever, medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. 2edications such as

antidepressants and anti!anxiety medications may also help with symptoms of depression or

anxiety, which are frequently associated with eating disorders.

Chapter +I: /ifestyle and home remedies

;hen you have an eating disorder, ta#ing care of your health needs often isn5t one of your

 priorities. )ut proper self!care can help you feel better during and after treatment and help

maintain your overall health.

*ry to ma#e these steps a part of your daily routine: stic# to your treatment plan4 don5t s#iptherapy sessions and try not to stray from meal plans4 tal# to your doctor about appropriate

vitamin and mineral supplements to ma#e sure you5re getting all the essential nutrients4 don5tisolate yourself from caring family members and friends who want to see you get healthy andhave your best interests at heart4 tal# to your health care providers about what #ind of exercise, if 

any, is appropriate for you4 read self!help boo#s that offer sound, practical advice, consider

discussing the boo#s with your health care providers4 resist urges to weigh yourself or chec#yourself in the mirror frequently, otherwise, you may simply fuel your drive to maintain

unhealthy habits.

Chapter +II: Coping and support

"n addition to getting professional treatment for your eating disorder, you can also follow these

coping s#ills: boost your self!esteem4 get involved in activities that interest you and that are personally rewarding4 these may include learning a new s#ill, developing a hobby or

 participating in a social group in your church or community4 be realistic4 don5t accept what some

of the media portray about what5s a normal weight and what5s an ideal body image4 resist the

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urge to diet or s#ip meals4 dieting actually triggers unhealthy eating and ma#es it difficult to cope

with stress4 remind yourself what a healthy weight is for your body, especially at times when you

see images that may trigger your desire to binge and purge4 don5t visit websites that advocate orglorify eating disorders4 these sites can encourage you to maintain dangerous habits and can

trigger relapses4 identify troublesome situations that are li#ely to trigger thoughts or behavior

that may contribute to your eating disorder so that you can develop a plan to deal with them4 loo# for positive role models, even if they5re not easy to find4 remind yourself that the ultrathin

models or actresses showcased in popular magazines often don5t represent healthy bodies4

ac#nowledge that you may not be the best judge of whether your eating habits and weight arehealthy4 consider journaling about your feelings and behaviors. Dournaling can ma#e you more

aware of your feelings and actions, and how they5re connected.

Conclusion

Eating disorders must be ta#en seriously. A person may fall into the trap of an eating disorderwithout any intention of doing so. 'nce established, anorexia nervosa or bulimia nervosa can

seriously affect a person5s life. Sometimes the outcome is a truly chronic illness or even, rarely,death.

"t9s unfortunate, but in today9s society, people have forgotten that it9s what9s inside a person that

counts, not what9s on the outside. ;e need to start loving and accepting each other for who weare, not what we loo# li#e. "f we learn to love and accept ourselves, we will also begin to love

our bodies, no matter what size we are. ;e also need to teach our children to be proud of who

they are. ;e need to remind them that people come in all shapes and sizes, and we need to teachthem to accept everyone for who they are. +arents need to also teach their children the value of

healthy eating and not send the message that being thin is important.

" would also li#e to stress the fact that diets don9t wor#. Eating three healthy meals a day, a fewsnac#s and doing moderate exercise, will allow your body to go to it9s natural set point. "t9simportant to remember that no food will ma#e you fat, as long as it9s eaten in moderation. Stop

 buying those fashion magazines and diet products, and stop believing all the lies being told to

you by the fashion and diet industries. "nstead, focus on learning to love and accept yourself. &onumber on a scale and fitting into a smaller dress size will not ma#e you happy. appiness can

only come from within.

$i"liographyhttp:00www.ibuzzle.com

http:00www.med.umich.edu0yourchild0topics0eatdisteen.htm

http:00umm.edu0health0medical0reports0articles0eating!disorders

http:00www.sciencedaily.com

http:00eatingdisorder.org

http:00en.wi#ipedia.org0wi#i0Eatingdisorder 

http:00www.mayoclinic.org

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