Eating disorders, particularly anorexia nervosa and bulimia nervosa have been centered of attention for clinicians and researchers. Eating disorders are one of the most significant problems in the care of adolescents and even children. These complex disorders are believed to arise from interaction of multiple risk factors. Eating disorders are defined by disturbance in the eating habits that may be either excessive or insufficient food intake. Bulimia nervosa, anorexia nervosa, and binge eating are the most common forms of eating disorder based on diagnostic and statistical manual of mental disorders (DSM-V). As defined in DSM-V, anorexia nervosa is a constant attempt to maintain body weight below minimally normal weight (85%) or body mass index <17.5 for age and height, with an intense fear of weight gain even though underweight, and inaccurate perception of own body size, shape, or weight. It may accompany with amenorrhea in girls and women after menarche. DSM-V also defines bulimia nervosa, as recurrent binge eating episodes followed by recurrent purging, excessive exercise, or prolonged fasting at least two times per week for three months. Excessive concern about weight or shape is also very common in bulimia nervosa. Another type of eating disorder is binge-eating disorder that is characterized by recurrent binge eating without purging, excessive exercise, or fasting. Atypical eating disorder is referred to clinically significant eating disorders associated with unexplained weight loss, rumination, unexplained food intolerances or an extremely picky eating habit that does not meet the criteria of anorexia nervosa, bulimia, or binge disorder. The average prevalence rates for anorexia nervosa and bulimia nervosa are 0.3% and 1% among adolescence and young people in western countries respectively. Prevalence rates of anorexia nervosa and bulimia nervosa increase during transition period from adolescence to adulthood. The estimated rate of anorexia nervosa and bulimia nervosa in males is between 5% and 15%. Men’s reluctance to be diagnosed with eating disorders or to participate in the study of eating disorders has been a big challenge; consequently, rate of eating disorders in males may be higher than it is reported.
Various psychiatric co-morbidities such as depression, anxiety disorder, obsessive-compulsive disorder, substance abuse, attention-deficit hyperactivity disorders, and personality disorders are prominent in patients with eating disorders. Wide range of medical complications such as anemia, endocrine system dysfunction, electrolytes disturbances, and cardiovascular diseases accompany eating disorders. Severity of medical complications depends on speed of weight loss, severity of underweight, duration of eating disorders, age of patients, and the intensity of purging.
The role of personality disorders in the development of eating disorders has been the center of attention for many researchers. Several studies have found that personality traits such as impulsivity, novelty seeking, stress reactivity, harm avoidance, perfectionism, and other personality traits are common in patients with eating disorders. Most of these studies assessed personality traits in their subjects during illness. Therefore, their personality traits could reflect adverse effects of starvation. A study shows the effect of starvation and recurrent binge and purging on development of anxiety, social withdrawal, and irritability in previously normal people only a few weeks after restricted food intake. Numerous studies used personality inventories such as Eating Disorder Inventory (EDI) to assess specific cognitive and behavioral dimensions of eating disorders such as drive for thinness, bulimia, body dissatisfaction ineffectiveness, perfectionism, interpersonal distrust, interceptive awareness, and maturity fear. Personality inventories are designed for the assessment of adult populations. Consequently, use of these inventories for assessment of personality traits in majority of subjects with eating disorders who are typically in early adolescent may not be appropriate. One important factor that could have possible effect on the accuracy of results in the study of personality traits in adolescences is the constantly changing patterns of perception about the environment and oneself due to ongoing developmental changes in personality. Medical and non-medical therapy in patients with chronic eating disorders could also affect post-morbid functions and personality traits of these patients. Interestingly some studies show the changes in behavior patterns such as harm avoidance, persistence, self-directedness, and self-transcendence after in-patient Cognitive Behavioral Therapy (CBT) for eating disorders. Future research should be aware of the effects of therapy on the result of study of personality traits in eating disorder cases.
It has been hypothesized that eating disorders have multiple and often shared etiologies including biological, psychological, developmental, and sociocultural. A tightly woven network of causes, symptoms, and outcomes of eating disorders makes the study of etiology of these disorders very challenging. Some suggested risk factors for eating disorders require to be defined as either integral parts of eating disorders syndrome such as body dissatisfaction, and perfectionism or outcome of prolonged disordered eating such as functional alterations in serotonin, and some mood disturbances. Researchers should structure their thought processes around this concept that some of currently well-known risk factors for eating disorders are concurrent symptoms of eating disorders. Hence paying special attention to the new and evolved concepts is highly recommended while studying the etiology of eating disorders.
AUTHORS: Shane Ramdeo, Michael Ubakanma , Bhuvashni Seetaram and Krystal Bridjmohan
DATE OF PUBLICATIONS: Not Published
STATUS: Completed
KEYWORDS: anorexia nervosa , bulimia nervosa , physical, mental, and social health, and well-being , eating disorders , socio-demographic, diet constituencies and academic performance