MHM101.pdf

11/16/23, 11:16 AM Realizeit for Student Overview of Eating Disorders Although many believe that eating disorders are relatively new, documentation from the Middle Ages indicates willful dieting leading to selfstarvation in female saints who fasted to achieve purity. In the late 1800s, doctors in...

11/16/23, 11:16 AM Realizeit for Student Overview of Eating Disorders Although many believe that eating disorders are relatively new, documentation from the Middle Ages indicates willful dieting leading to selfstarvation in female saints who fasted to achieve purity. In the late 1800s, doctors in England and France described young women who used self-starvation to avoid obesity. It was not until the 1960s, however, that anorexia nervosa was established as a mental disorder. Bulimia nervosa was first described as a distinct syndrome in 1979. Eating disorders can be viewed on a continuum, with clients with anorexia eating too little or starving themselves, clients with bulimia eating chaotically, and clients with obesity eating too much. There is much overlap among the eating disorders; 30% to 35% of normal-weight people with bulimia have a history of anorexia nervosa and low body weight, and about 50% of people with anorexia nervosa exhibit the compensatory behaviors seen in bulimic behavior, such as purging and excessive exercise. The distinguishing features of anorexia include an earlier age at onset and below-normal body weight; the person fails to recognize the eating behavior as a problem. Clients with bulimia have a later age at onset and near-normal body weight. They are usually ashamed and embarrassed by the eating behavior (Call, Attia, & Walsh, 2017). More than 90% of cases of anorexia nervosa and bulimia occur in women. Although fewer men than women suffer from eating disorders, the number of men with anorexia or bulimia may be much higher than previously believed, many of whom are athletes. Men, however, are less likely to seek treatment. The prevalence of both eating disorders is estimated to be 2% to 4% of the general population in the United States. In addition, a majority of the general population is dissatisfied with body image and preoccupied with weight and dieting at some point in their lives (Call et al., 2017). Categories of Eating Disorders Anorexia nervosa is a life-threatening eating disorder characterized by the client’s restriction of nutritional intake necessary to maintain a minimally normal bodyweight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. Clients with anorexia have a body weight that is less than the minimum expected weight considering age, height, and overall physical health. In addition, clients have a preoccupation with food and food-related activities and can have a variety of physical manifestations (Box 20.1 ). BOX 20.1 Physical Problems of Anorexia Nervosa Amenorrhea Constipation Overly sensitive to cold, lanugo hair on body Loss of body fat Muscle atrophy Hair loss Dry skin Dental caries Pedal edema Bradycardia, arrhythmias Orthostasis Enlarged parotid glands and hypothermia Electrolyte imbalance (i.e., hyponatremia, hypokalemia) Clients with anorexia nervosa can be classified into two subgroups depending on how they control their weight. Clients with the restricting subtype lose weight primarily through dieting, fasting, or excessive exercising. Those with the binge eating and purging subtype engage regularly in binge eating followed by purging. Binge eating means consuming a large amount of food (far greater than most people eat at one time) in a discrete period of usually 2 hours or less. Purging involves compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics. Some clients with anorexia do not binge but still engage in purging behaviors after ingesting small amounts of food. Clients with anorexia become totally absorbed in their quest for weight loss and thinness. The term “anorexia” is actually a misnomer; these clients do not lose their appetites. They still experience hunger but ignore it and also ignore the signs of physical weakness and fatigue; they often believe that if they eat anything, they will not be able to stop eating and will become fat. Clients with anorexia are often preoccupied with food-related activities, such as grocery shopping, collecting recipes or cookbooks, counting calories, creating fat-free meals, and cooking family meals. They may also engage in unusual or ritualistic food behaviors such as refusing to eat around others, cutting food into minute pieces, or not allowing the food they eat to touch their lips. These behaviors increase their sense of control. Excessive exercise is common; it may occupy several hours a day. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 1/2 11/16/23, 11:16 AM Realizeit for Student Bulimia nervosa, often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. The amount of food consumed during a binge episode is much larger than a person would normally eat. The client often engages in binge eating secretly. Between binges, the client may eat low-calorie foods or fast. Binging or purging episodes are often precipitated by strong emotions and followed by guilt, remorse, shame, or self-contempt. The weight of clients with bulimia is usually in the normal range, though some clients are overweight or underweight. Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these clients. Dentists are often the first health care professionals to identify clients with bulimia. Related Disorders Binge eating disorder is characterized by recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychological distress. Binge eating disorder frequently affects people over age 35, and it occurs more often in men than does any other eating disorder. Individuals are more likely to be overweight or obese, overweight as children, and teased about their weight at an early age (Call et al., 2017). Night eating syndrome is characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. It is associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss (Tu, Meg Tseng, Chang, 2018). Most people with night eating syndrome are obese. Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants has shown limited yet positive effects (McCuen-Wurst, Ruggieri, & Allison, 2018). Eating or feeding disorders in childhood include pica, which is persistent ingestion of nonfood substances, and rumination, or repeated regurgitation of food that is then rechewed, reswallowed, or spit out. Both of these disorders are more common in persons with intellectual disability. Orthorexia nervosa, sometimes called orthorexia, is an obsession with proper or healthful eating. It is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, but some believe it is on the rise and may constitute a separate diagnosis. Others believe it is a type of anorexia or a form of obsessive–compulsive disorder. Behaviors include compulsive checking of ingredients; cutting out an increasing number of food groups; inability to eat only “healthy” or “pure” foods; unusual interest in what others eat; hours spent thinking about food, what will be served at an event; and obsessive involvement in food blogs (Costa, Hardi-Khalil, & Gibbs, 2017). Comorbid psychiatric disorders are common in clients with anorexia nervosa and bulimia nervosa. Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive–compulsive disorder are most common. Both anorexia and bulimia are characterized by perfectionism, obsessive–compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder. In addition, clients with bulimia may also exhibit high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorder. Eating disorders are often linked to a history of sexual abuse, especially if the abuse occurred before puberty. Such a history may be a factor contributing to problems with intimacy, body satisfaction, sexual attractiveness, and low interest in sexual activity (Mitchison et al., 2018). Clients with eating disorders and a history of sexual abuse also have higher levels of depression and anxiety, lower self-esteem, more interpersonal problems, and more severe obsessive–compulsive symptoms. Childhood neglect, both physical and emotional, is also associated with eating disorders (Pignatelli, Wampers, Loriedo, Biondi, & Vanderlinden, 2017). Whether sexual abuse has a cause-and-effect relationship with the development of eating disorders, however, remains unclear. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXP1mimyVQOPOHLAvYAjZdL7GFyh%2bBfe9WR6sPHV… 2/2