Eating disorders

The incidence of eating disorders has been rapidly rising for the past 50 years, being estimated that approximately 10% of the population at-risk (females of 15-29 years of age) suffer from these conditions (Polivy & Herman, 2002). Even though they affect women more, eating disorders also manifest in men, even if just for 10% of the totality of people diagnosed (Fairburn & Beglin, 1990). Anorexia nervosa, bulimia and EDNOS (eating disorders not otherwise specified) are serious conditions that can pose a threat to the life of the individual (starving to death or suicide). For instance, anorexia nervosa is one of the diseases with the highest death rates when compared to any other type of psychological disorders (The British Psychological Society and Gaskell report, 2004).

Possible causes:

According to Polivy & Herman (2002), a multitude of factors conspire for the apparition of these conditions:

• sociocultural factors (media, peer influence, society’s intolerance for fatness, social pressure to achieve a certain body type etc);
• family factors (a history of disease in the family, family emphasis on appearance, family conflict, parental deprivation or child abuse);
• personal factors (negative affect, low self-esteem, body image issues, cognitive factors such as obsessive thoughts, perfectionism, cognitive style or cognitive bias and well as biological factors – genetic and neuroendocrine factors).

Diagnosis:

In the case of anorexia nervosa, DSM-IV mentions the next symptoms: maintaining a body weight at a level of less than 85% of the normal weight for the corresponding age and height, an intense fear of gaining weight even though being underweight, disturbed experience of one’s body weight or shape and amenorrhea for a minimum of three consecutive menstrual cycles.

In the case of bulimia nervosa, the following symptoms allow for a diagnostic: recurrent episodes of both binge eating (i.e., within any 2 hour period, eating an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances coupled with the feeling of being unable to control one’s eating) and compensatory behaviors (such as purging, exercising, or fasting, using laxatives) to prevent the weight gain triggered by overeating. These behaviors must occur at least twice a week for a minimum of 3 months.

In the case of EDNOS, DSM-IV recommends to take into account symptoms that do not meet the criteria for any specific eating disorder: in the case of females, all the symptoms for anorexia excepting amenorrhea or abnormal weight (although the individual engages in significant weight loss activities); all the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for less than 3 months; use of compensatory behaviour in which an individual of a normal body type engages after eating small amounts of food (self-vomiting after eating a slice of bread and butter); chewing and spitting out large amounts of food without swallowing; binge eating episodes without engaging in compensatory behaviours that are specific to bulimia nervosa.

Treatment:

It is difficult to assess the right treatment for patients with eating disorders since the disease can have many aspects that differ from an individual to the other. According to Fairburn, Cooper, Doll, Norman and O’Connor (2000), a third of the patients continue to meet the diagnostic criteria 5 years and longer after the initial treatment.

However, research shows that a combined treatment, including cognitive behavioural, pharmacological and nutritional therapy could be effective if at least 4 month of treatment are permitted (Brambilla, Draisci, Peirone & Brunetta, 1995). Psychotherapy is doubtlessly a great aid, and the most recommended approaches are: dialectical behavioral therapy (Telech, 2001), cognitive behavioural therapy (Fariburn, Cooper & Shafran, 2003) as well as interpersonal therapy, group psychotherapy, self-help and guided self-help therapies (Garner & Garfinkel, 1997).

A correct and early diagnosis followed by the right treatment are absolutely vital for minimizing the risks that threaten the people predisposed to developing these conditions. In the same time, a familiar and socially positive climate, that can confirm and accept the individual for what he/she is will provide a psychologically balanced development and will, to a certain extent, help in preventing these conditions from occurring.

References:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.
Brambilla, F., Draisci, A., Peirone, A., & Brunetta, M. (1995). Combined : Combined Cognitive-Behavioral, Psychopharmacological and Nutritional Therapy in Eating Disorders. Neuropsychobiology, 32, 64-67. DOI: 10.1159/000119214.
Fairburn, C.G., & Beglin, S.J. (1990). Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry, 147, 401-408.
Fairburn, C. G., Cooper, Z., Doll, H. A., Norman, P., O’Connor, M. (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Arch. Gen. Psychiatry, 57, 659–65
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour research therapy, 41 (5), 509-528.
Garner, D. M, & Garfinkel, P. E. (1997). Handbook of treatment for eating disorders. New York: The Guilford Press.
Polivy, J. & Herman, C. P (2002). Causes of eating disorders. Annual Review Psychology, 53, 187-213.
Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical Therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69 (6), 1061-1065.
The British Psychological Society and Gaskell (2004): Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders, retrieved from http://www.nice.org.uk/