Notes on Eating Disorders.
DSM-IV-TR recognizes three different forms of eating disorder: anorexia nervosa, bulimia nervosa, and eating disorder NOS. A fourth type of eating disorder, binge-eating disorder, is listed in the Appendix and is not yet part of the formal DSM. Both anorexia nervosa and bulimia nervosa are characterized by an intense fear of becoming fat and a drive for thinness. Patients with anorexia nervosa are seriously underweight. This is not true of patients with bulimia nervosa. Eating disorders are more common in women than they are in men. They can develop at any age, although they typically begin in adolescence. Anorexia nervosa has a lifetime prevalence of around 0.5%. Bulimia nervosa is more common, with a lifetime prevalence of 1–3%. Many more people suffer from less severe forms of disturbed eating patterns. Genetic factors play a role in eating disorders, although exactly how important genes are in the development of pathological eating patterns is still unclear. The neurotransmitter serotonin has been implicated in eating disorders. This neurotransmitter is also involved in mood disorders, which are highly comorbid with eating disorders. Sociocultural influences are important in the development of eating disorders. Our society places a heavy value on being thin. Western values about thinness may be spreading, helping explain why eating disorders are now found throughout the world. Finally, individual risk factors, such as internalizing the thin ideal, body dissatisfaction, dieting, negative affect, and perfectionism are implicated in the development of eating disorders. Anorexia nervosa is very difficult to treat. Treatment is long-term and many patients resist getting well. Current treatment approaches include re-feeding, family therapy and CBT. Medications are also used. The treatment of choice for bulimia nervosa is CBT. CBT is also helpful for binge-eating disorder. Obesity is defined as having a body mass index of thirty or above. Being obese is associated with many medical problems and increased risk of death from heart attack. Obesity is not viewed as an eating disorder or a psychiatric condition. A tendency to being thin or heavy may be inherited. However, unhealthy lifestyles are the most important cause of obesity. People are more likely to be obese if they are older, female, and from a low SES group. Being a member of an ethnic minority group is also a risk factor for obesity. Obesity is a chronic problem. Medications help patients to lose small amounts of weight; drastic weight loss usually requires bariatric surgery. Because obesity tends to be a life-long problem and because the treatment of obesity is so difficult, there is now a focus on trying to prevent people from becoming obese in the first place. Many recommendations will require major changes in social policy. What Kind of Disorder Is Anorexia?
Eating disorders in general, and anorexia in particular, are diagnostically complex owing to characteristics that overlap with other sections of the DSM. You might have already noted the similarity between obsessional thinking characteristic of OCD and the body preoccupation characteristic of anorexia and bulimia. As well, the anxiety that is caused by preventing a bulimic from purging or causing an anorexic to eat normally is similar to that evoked when phobics are exposed to their feared stimuli or compulsive OCD rituals are interrupted. Are anorexia and bulimia anxiety disorders? Alternatively, they can be viewed as mood disorders. The first clues to the possibility that some eating disorders were on the mood disorder “spectrum” were the observation that they sometimes respond to antidepressant medications. There is also some evidence that eating disorders run in families that have relatively high rates of depression. And the cognitive styles associated with some eating disorders are as distorted as those seen in depression. So the question is, should anorexia and/or bulimia be...
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