Eating disorders, one of the most difficult mental illnesses to diagnose andcure, are divided into three categories: anorexia nervosa, bulimia nervosa, and binge eating. Frequently, sufferers flatly deny they have aproblem, and treatment by doctors and psychiatrists produces little success.There appears to be a connection between both anorexia and bulimia, and (depression). Thus, antidepressants are often used in treating eating disorders.
In February 1998, researchers identified a pair of hormones which influence eating habits in rats. These hormones--orexin A and orexin B, bind to two receptors in one part of the hypothalamus (the region of the brainbelieved to regulate appetite). Whether these hormones produce a similar activity in humans is not yet known; however, researchers hope that the development of drugs imitating these hormones may help treat eating disorders by stimulating or depressing appetite.
The psychological driving force behind anorexia has been defined as "the relentless pursuit of thinness." Described in a paper for the first time in 1694by Richard Morton, anorexia nervosa, translated as "nervous loss of appetite," was given its name by Sir William Gull in the 1870s.
The fact is, however, that patients don't usually lose their appetite until the disease is well developed. In fact, the condition often starts with an extreme interest in food, as the patient bakes and cooks for the entire family.Gradually, patients then start counting calories, and then eat less and lessas they embark on a grueling exercise regimen in their quest for thinness. Eventually, sufferers can develop serious medical complications including heartconditions and electrolyte imbalances. Patients with anorexia have such an overwhelming need to be thin that they can virtually starve themselves to death.
A doctor will suspect anorexia in the presence of the following symptoms:
- refusing to hold body weight above 85% of normal based on age and height
- an intense fear of gaining weight
- the inability to see one'sshape or body weight as it truly is
- absence of at least three consecutive menstrual cycles in girls who have entered puberty
Some anorectics display unusual behavior such as collecting recipes, cookingfor others but not eating themselves, hiding food, cutting food into small pieces, obsessively counting calories, avoiding eating in public, and secretlyexercising (perhaps for an entire night) so family members can't stop them.
While sharing a phobia of gaining weight, people with bulimia(Greek for "ox-like hunger") go about keeping weight off by first consuming huge amounts of food (binge eating) and then forcing themselves to vomit (purge) the food as a way of staying thin. While people with bulimia are just as afraid ofgetting fat, most maintain a normal weight for their height.
While bulimia appeared in publications during the 18th century, it was not classified as an illness until 1979; it was not until 1987 that English psychiatrist Gerald Russell named the condition bulimia nervosa. A doctor will suspect bulimia if a patient exhibits "binge" eating at least twice a week for three months or longer accompanied by frequent "purging," such as induction of vomiting; misuse of laxatives, diuretics or enemas; fasting; and excessive exercise.
While anorexia and bulimia are separate entities, they have considerable overlap:
- both occur primarily in adolescents and young women (between 13and 30)
- are long-running and difficult to treat
- interfere with social development
- are often accompanied by depression or obsessivebehaviors
- are found more often found in places where thin is the cultural ideal
- occur in middle-to-upper class families
- are linked to major depression, obsessive-compulsive disorder, or anxiety.
Several factors may play a role in the development of both bulimia and anorexia:
- overly protective or strict parents
- family history of eating disorders
- social pressure to be thin
- family disturbances
- fear of sexuality
The specific causes of bulimia and anorexia aren't known, but evidence linksbrain chemicals serotonin and norepinephrine to the binge/purge cycle. Thesechemicals have also been identified in depression and other psychological illnesses and are linked closely with emotion, mood and appetite. Since severalstudies have found most bulimic and anorexic patients were depressed, it's not surprising that antidepressant drugs that affect these chemicals in the brain also may help ease bulimia and anorexia.
Still, both disorders are very hard to treat, and relapses are common. The most effective treatment for bulimia and anorexia appear to be a combination ofdrug therapy and counseling. Prozac -- a drug that boosts the level of serotonin in the brain -- is the only antidepressant to be approved specifically for the treatment of bulimia. While it has not been formally approved for thetreatment of anorexia, it's widely prescribed by doctors as an "off label" therapy. Studies have shown that Prozac can help ease eating binges in up to 63% of people with bulimia. By addressing the underlying biological problem, and with intensive supportive counseling and nutritional advice, the cycle of anorexia and bulimia can be broken.
In severe cases, hospitalization may be required to help deal with harmful practices such as vomiting, or diuretic and laxative abuse. A combined programof medication, nutritional counseling and intensive psychological and behavioral therapy may help. Support groups and group counseling may provide neededempathy to recovering patients.
Binge eating shares many symptoms with bulimia, except the patient does not purge after eating. Up to two percent of the population has a serious problem with binge eating, and approximately 30 percent of people in medically-supervised weight control programs are diagnosed as binge eaters.
A doctor will suspect binge eating if a patient has recurring episodes of overeating and feelings of loss of control when eating until uncomfortably full.Problems with obesity and a history of dramatic weight fluctuations are common; associated medical problems may include high cholesterol, diabetes, heartdisease, gallbladder disease, and depression.
Treatment with psychotherapy and drugs that affect serotonin levels (such asProzac)s can be helpful.