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   are a group of conditions characterized by abnormal eating
habits that may involve either insufficient or excessive food intake to the detriment of an
individual's physical and emotional health. Eating disorders typically occur in young
women.
There are   
  of eating disorders:

Bulimia nervosa

Anorexia nervosa

Binge eating

Eating disorders not otherwise specified

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Bulimia nervosa is more common than anorexia, and it usually begins early in
adolescence. It is characterized by cycles of bingeing and purging, and typically takes
the following pattern:

Bulimia is often triggered when young women attempt restrictive diets, fail, and
react by binge eating. (Binge eating involves consuming larger than normal
amounts of food within a 2-hour period.)

In response to the binges, patients compensate, usually by purging, vomiting,
using enemas, or taking laxatives, diet pills, or drugs to reduce fluids.

Patients then revert to severe dieting, excessive exercise, or both. (Some
patients with bulimia follow bingeing only with fasting and exercise. They are then
considered to have non-purging bulimia.)

The cycle then swings back to bingeing and then to purging again.

To be diagnosed with bulimia, however, a patient must binge and purge at least
twice a week for 3 months.

In some cases, the condition progresses to anorexia. Most people with bulimia,
however, have a normal to high-normal body weight, although it may fluctuate by
more than 10 pounds because of the binge-purge cycle.

Forced vomiting can cause:

Rupture of the esophagus

Weakened rectal walls (a rare but serious condition that requires surgery)



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A number of self-destructive behaviors occur with bulimia:

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 Many teenage girls with eating disorders smoke because it is thought
to help prevent weight gain.

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. Women with bulimia may be at higher-than-average risk for
dangerous impulsive behaviors, such as sexual promiscuity, self-cutting, and
kleptomania.

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 
 Many patients with bulimia abuse alcohol, drugs,
or both. Women with bulimia also frequently abuse over-the-counter medications,
such as laxatives, appetite suppressants, diuretics, and drugs that induce
vomiting (ipecac).



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u  
 !" Cognitive-behavioral therapy (CBT) is the first-line of
therapy for most patients with bulimia. Interpersonal therapy may be tried if CBT
fails. In interpersonal therapy (also known as "talk therapy"), therapists help
patients explore how social and family relationships may affect their eating
disorder.


! 
" The most common antidepressants prescribed for bulimia are
selective serotonin reuptake inhibitors (SSRIs) such as:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Topiramate The antiepileptic drug topiramate (Topamax) has been shown
in studies to reduce bingeing and purging episodes in patients with
bulimia.

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Many medical problems are directly associated with bulimic behavior, including:

Tooth erosion, cavities, and gum problems

Water retention, swelling, and abdominal bloating

Acute stomach distress

Fluid loss with low potassium levels (due to excessive vomiting or laxative use;
can lead to extreme weakness, near paralysis, or lethal heart rhythms)

Irregular menstrual periods

Swallowing problems and esophagus damage

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The term "anorexia" literally means absence of appetite. Anorexia can be associated
with medical conditions or medications that cause a loss of appetite. Anorexia nervosa,
however, involves a psychological aversion to food that leads to a state of starvation
and emaciation. Symptoms of anorexia may include:

Infrequent or absent menstrual periods

Compulsive exercising coupled with excessive thinness

Refusal to eat in front of others

Ritualistic eating, including cutting food into small pieces

Hypersensitivity to cold -- some women wear several layers of clothing to both
keep warm and hide their thinness

Yellowish skin, especially on the palms of the hands and soles of the feet -- from
eating too many vitamin A-rich vegetables such as carrots

Dry skin covered with fine hair

Thin scalp hair

Cold or swollen feet and hands

Stomach problems, including bloating after eating

Confused or slowed thinking

Poor memory or judgment

Women with anorexia nervosa miss at least three consecutive menstrual periods.
(Women can also be anorexic without this occurrence.)

Patients with this condition are often characterized as anorexia restrictors or anorexic
bulimic patients. Each type is equally prevalent.

Anorexia restrictors reduce their weight by severe dieting.

Anorexic bulimic patients maintain emaciation by purging. Although both types
are serious, the bulimic type, which imposes additional stress on an
undernourished body, is the more damaging.

Some studies indicate that many patients with anorexia nervosa have avoidant
personalities. This personality disorder is characterized by:

Being a perfectionist

Being emotionally and sexually inhibited

Having less of a fantasy life than people with bulimia or those without an eating
disorder

Being perceived as always being "good," not being rebellious

Being terrified of being ridiculed or criticized or of feeling humiliated

People with anorexia are extremely sensitive to failure, and any criticism, no matter how
slight, reinforces their own belief that they are "no good".

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" Obsessive-compulsive 

  defines certain
character traits (being a perfectionist, morally rigid, or preoccupied with rules and order).
This personality disorder has been strongly associated with a higher risk for anorexia.
These traits should not be confused with the anxiety disorder called obsessive-
compulsive 

 (OCD), although they may increase the risk for this disorder.

x u 
" Borderline Personality Disorder (BPD) is associated with
self-destructive and impulsive behaviors. People with BPD tend to have other co-
existing mental health problems, including eating disorders.
 
u 
r People with narcissitic personalities tend to:

Have an inability to soothe oneself

Have an inability to empathize with others

Have a need for admiration

Be hypersensitive to criticism or defeat



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u 
 !" Family therapy is an important component of anorexia
treatment, especially for children and adolescents. Adults usually begin with
motivational psychotherapy that provides an empathetic setting and rewards
positive efforts towards weight gain. After weight is restored, cognitive behavioral
therapy techniques may be helpful.


! 
" Studies have not reported benefits for treating anorexia
nervosa with selective serotonin reuptake inhibitors (SSRIs), the antidepressants
that are often useful for patients with bulimia. A few studies suggest that these
drugs could be useful for people with anorexia nervosa who also have obsessive-
compulsive disorder (OCD).



  !!&
" Calcium and vitamin D supplements are often
recommended. Some studies have reported that zinc supplements may help
patients gain weight.

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Anorexia nervosa can increase the risk for serious health problems such as:

Hormonal changes

ü Reproductive hormones, including estrogen and dehydroepiandrosterone

(DHEA), are lower. Estrogen is important for healthy hearts and bones.
DHEA, a weak male hormone, may also be important for bone health and for
other functions.
ü Thyroid hormones are lower.
ü Stress hormones are higher.
ü Growth hormones are lower. Children and adolescents with anorexia may
experience retarded growth.

Heart problems

ü abnormal heart rhythm

ü Blood flow is reduced.
ü Blood pressure may drop.
ü The heart muscles starve, losing size.

Electrolyte imbalance

Fertility problems

ü If a woman with anorexia becomes pregnant before regaining normal weight,

she faces a higher risk for miscarriage, cesarean section, and for having an
infant with low birth weight or birth defects. She may also be at higher risk for
postpartum depression.
ü Women with anorexia who seek fertility treatments have lower chances for
success.

Bone density loss

ü Almost 90% of women with anorexia experience osteopenia (loss of bone

calcium), and 40% have osteoporosis (more advanced loss of bone
density).

Anemia

ü caused by severely low levels of vitamin B12

Neurological problems

ü Seizures
ü Disordered thinking
ü Numbness or odd nerve sensations in the hands or feet (peripheral
neuropathy)

Other anxiety disorders associated with both bulimia and anorexia include:

u $ " Phobias often precede the onset of the eating disorder. Social phobias,
in which a person is fearful about being humiliated in public, are common in both
types of eating disorders.

u " Panic disorder often follows the onset of an eating disorder. It is
characterized by periodic attacks of anxiety or terror ( 
).

u

 &
 
 " Some patients with serious eating disorders
report a past traumatic event (such as sexual, physical, or emotional abuse), and
exhibit symptoms of post-traumatic stress disorder (PTSD) -- an anxiety disorder
that occurs in response to life-threatening circumstances.

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 Bingeing without purging is characterized as compulsive overeating (binge
eating) with the absence of bulimic behaviors, such as vomiting or laxative abuse (used
to eliminate calories). People with binge eating disorder are embarrassed and ashamed
of their eating habits, so they often try to hide their symptoms and eat in secret. Many
binge eaters are overweight or obese, but some are of normal weight.

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Inability to stop eating or control what you¶re eating

Rapidly eating large amounts of food

Eating even when you¶re full

Hiding or stockpiling food to eat later in secret

Eating normally around others, but gorging when you¶re alone

Eating continuously throughout the day, with no planned mealtimes

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Feeling tension that is only relieved by eating

Embarrassment over how much you¶re eating

Feeling numb while bingeing²like you¶re not really there or you¶re on auto-pilot.

Never feeling satisfied, no matter how much you eat

Feeling guilty, disgusted, or depressed after overeating

Desperation to control weight and eating habits

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- Type 2 diabetes - Gallbladder disease

- Sleep apnea - High cholesterol

- High blood pressure - Heart disease

- Certain types of cancer - Osteoarthritis

- Joint and muscle pain - Gastrointestinal problems



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The goal of treatment for binge eating disorder is

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 $   !" If obesity is endangering your health, weight loss may be
another goal. However, dieting can contribute to binge eating, so any weight loss efforts
should be carefully monitored by your treatment team.


! 
 ! are particularly helpful in the treatment of binge eating
disorder and compulsive overeating:

 
%$ % 
 ! ± Cognitive-behavioral therapy focuses on the
dysfunctional thoughts and behaviors involved in binge eating. One of the main
goals is for you to become more self-aware of how you use food to deal with
emotions. Your therapist may ask you to keep a food diary or a journal of your
thoughts about eating, weight, and food. The therapist will also help you
recognize your binge eating triggers and learn how to avoid or combat them.
Cognitive-behavioral therapy for binge eating disorder also involves education
about nutrition, healthy weight loss, and relaxation techniques.

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!  ! 
 ! - Interpersonal psychotherapy for binge eating
disorder focuses on the relationship problems and interpersonal issues that
contribute to compulsive eating. Your therapist will also help you improve your
communication skills and develop healthier relationships with family members
and friends. As you learn how to relate better to others and get the emotional
support you need, the compulsion to binge becomes more infrequent and easier
to resist.

 
 $ %
 ! ± Dialectical behavior therapy combines cognitive-
behavioral techniques with mindfulness meditation. The emphasis of therapy is
on teaching binge eaters how to accept themselves, tolerate stress better, and
regulate their emotions. Your therapist will also address unhealthy attitudes you
may have about eating, shape, and weight. Dialectical behavior therapy typically
includes both individual treatment sessions and weekly group therapy sessions.

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The medications that show promise for binge eating disorder include:


! 
 ± Research shows that antidepressants decrease binge eating
in people with bulimia. Antidepressants may also help people with binge eating
disorder, but studies also show that relapse rates are high when the drug is
discontinued.

!!

!! 
 ± Studies on the appetite-suppressing drug sibutramine,
known by the brand name Meridia, indicate that it reduces the number of binge
eating episodes and promotes weight loss.


! & * ± The seizure drug topiramate, or Topamax, may decrease binge
eating and increase weight loss. However, Topamax can cause serious side
effects, including fatigue, dizziness, and burning or tingling sensations.


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Binge eating symptoms are also present in bulimia nervosa. The formal
diagnosis criteria are similar in that subjects must binge at least twice per week for a
minimum period of three months for bulimia nervosa and a minimum of 6 months for
BED.[5] Unlike in bulimia, those with BED do not purge, fast or engage in strenuous
exercise after binge eating. Additionally, bulimics are typically of normal weight, are
underweight but have been overweight before, or are slightly overweight. Those with
binge eating disorder are more likely to be overweight or obese.
 Binge eating disorder is similar to, but distinct from, compulsive overeating.
Those with BED do not have a compulsion to overeat and do not spend a great deal of
time fantasizing about food. On the contrary, some people with binge eating disorder
have very negative feelings about food. As with other eating disorders, binge eating is
an "expressive disorder"²a disorder that is an expression of deeper psychological
problems. Some researchers believe BED is a milder form or subset of bulimia nervosa,
while others argue that it is its own distinct disorder. Currently, the DSM-IV categorizes
it under Eating disorder not otherwise specified (EDNOS), an indication that more
research is needed.


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A fourth category called eating disorders not otherwise specified (EDNOS) is used to
describe eating disorders not specifically defined as anorexia or bulimia. This category
includes:

Infrequent binge-purge episodes (occurring less than twice a week or having
such behavior for less than months)

Repeated chewing and spitting without swallowing large amounts of food

Normal weight and anorexic behavior

Such patients tend to be older at diagnosis. Although less serious than other eating
disorders, these patients still face similar health problems, including a higher risk for
fractures and other conditions.

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 is an obsession with a perceived defect in the sufferer's body or appearance.
The most common area of dissatisfaction is the face, typically the size and shape
of noses, eyes, ears and mouths, eyebrows, chins, and jaws. A sufferer may
agonize over wrinkles and blemishes (real or perceived) and will regularly check
their appearance in the mirror.
 is not limited to a person's face; a sufferer can obsess about any part of their
body, including the legs, hips, arms, belly and genitals. When the sufferer's
obsession is with their weight or being "fat", it is possible they have anorexia or
bulimia.

 According to ½   , a person with Body Dysmorphic Disorder exhibits

the following symptoms:

Ô Preoccupation with an imagined defect in appearance. If a slight physical

anomaly is present, the person's concern is markedly excessive.
Ô The preoccupation causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Ô The preoccupation is not better accounted for by another mental disorder (for
example, dissatisfaction with body shape and size in anorexia nervosa)

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 is a condition where the sufferer will crave and eat non-food items. The types of
items consumed can vary, but common ones include:

Ô Dirt and clay

Ô Paint chips, plaster and chalk
Ô Cornstarch, laundry starch, baking soda
Ô Coffee grounds
Ô Cigarette ashes, burnt match heads
Ô Rust

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 is similar to bulimia in that the sufferer purges (through self-induced vomiting,
laxative or diuretic abuse, or other compensatory behaviors) after eating.
 women with purging disorder and bulimics shared emotional and psychological
characteristics, including body image problems, anxiety and depression.
 dangers of purging disorder are similar to those of bulimia, including tooth
decay, dehydration, and electrolyte imbalances.

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"Muscle dysmorphia", "reverse anorexia" and "bigorexia" are all terms meaning
essentially the same thing: somebody who believes they are underweight and
puny when the opposite is true.
 tends to affect males more than females because men are under more pressure
to be toned and muscular.

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According to the u  ë
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 Prader-Willi Syndrome is a

disorder of chromosome 15 and affects approximately 1 in 12,000 to 1 in 15,000
people.
 is a complete genetic disorder that usually causes low muscle tone, short
stature, incomplete sexual development, cognitive disabilities, problem
behaviors, and a chronic feeling of hunger that can lead to excessive eating and
life threatening obesity.


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is a pathological obsession with eating proper food. The exact type of food may
vary, but the individual has a fixation on only eating food they consider to be
healthy or beneficial - to them, it is "pure" food.


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is a fairly new term that is still being investigated. Somebody with N.S.-S.E.D.
eats in their sleep, often waking up with candy wrappers around them but having
no memory of what happened. The eating may or may not be in the form of a
binge.
  Sleeping pills are not a recommended treatment for N.S.-S.E.D., since they are
likely to cause even more confusion and this might lead to injury during episodes
of N.S.-S.E.D. Stress management courses, assertiveness training and
counseling can call help reduce the frequency of N.S.-S.E.D. episodes.


There 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
appear to result from many factors, including those that are genetic and neurobiologic,
cultural and social, and behavioral and psychologic.

Although much has been written about the role of families and parenting as causes
of eating disorders, there is no evidence supporting this claim.

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Anorexia is eight times more common in people who have relatives with the
disorder. Studies of twins show they have a tendency to share specific eating disorders
(anorexia nervosa, bulimia nervosa, and obesity). Researchers have identified specific
chromosomes that may be associated with bulimia and anorexia.

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The bodys hypothalamic-pituitary-adrenal axis (HPA) may be important in eating

disorders. This complex system originates in the following regions in the brain:


  
. The hypothalamus is a small structure that plays a role in
controlling our behavior, such as eating, sexual behavior and sleeping, and
regulates body temperature, hunger and thirst, and secretion of hormones.

u  . The pituitary gland is involved in controlling thyroid functions, the
adrenal glands, growth, and sexual maturation.

  . This small almond-shaped structure lies deep in the brain and is
associated with regulation and control of major emotional activities, including
anxiety, depression, aggression, and affection.

The HPA system releases certain neurotransmitters (chemical messengers) that

regulate stress, mood, and appetite. Abnormalities in the activities of three of them,
serotonin, norepinephrine, and dopamine, may play a particularly important role in
eating disorders. Serotonin is involved with well-being, anxiety, and appetite (among
other traits), and norepinephrine is a stress hormone. Dopamine is involved in reward-
seeking behavior. Imbalances with serotonin and dopamine may explain in part why
people with anorexia do not experience a sense of pleasure from food and other typical
comforts.


u
 The media plays a role in promoting unrealistic expectations for body image and
a distorted cultural drive for thinness. At the same time, cheap and high-caloric foods
are aggressively marketed. The response of the media is contradictory and creates
confusing messages.

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Eating disorders occur most often in adolescents and young adults. However, they
are becoming increasingly prevalent among young children. Eating disorders are more
difficult to identify in young children because they less commonly suspected.

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Eating disorders occur predominantly among girls and women. About 90 - 95% of
patients with anorexia nervosa, and about 80% of patients with bulimia nervosa, are
female.

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Most studies of individuals with eating disorders have focused on Caucasian middle-
class females. However, eating disorders can affect people of all races and
socioeconomic levels.

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- both considered valid tests for assessing eating disorder

diagnosis and determining specific features of the individuals
condition (such as vomiting or laxative use).
-

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- can help identify patients who meet the full criteria for anorexia
or bulimia nervosa.
ü Do you make yourself 0 because you feel uncomfortably full?
ü Do you worry you have lost 
 over how much you eat?
ü Have you recently lost more than  stone's worth of weight (14 pounds) in
a 3-month period?
ü Do you believe yourself to be 
when others say you are too thin?
ü Would you say that  dominates your life?
 - Answering yes to two of these questions is a strong indicator of
an eating disorder.

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ü http://adam.about.com/reports/Eating-disorders.htm

ü http://en.wikipedia.org/wiki/Binge_eating_disorder

ü http://www.helpguide.org/mental/binge_eating_disorder.htm

ü http://www.pale-reflections.com/ednos.asp