The Silent Suffering
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What are eating disorders?
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EATING DISORDERS-
ANOREXIA NERVOSA
BULIMIA NERVOSA
BINGE EATING DISORDER
ED-NOS
THE LESSER-KNOWN EATING DISORDERS; RELATED DISORDERS-
DIABULIMIA
PICA
BODY DYSMORPHIC DISORDER
ORTHOREXIA NERVOSA
ANOREXIA ATHLETICA
NOTE: THIS PART OF THE WEBSITE WILL CONTAIN MORE DETAILED INFORMATION OF THE LESSER-KNOWN EATING DISORDERS BECAUSE MOST OF THE OTHER SECTIONS ARE FOCUSED ON ANOREXIA, BULIMIA, BED, AND ED-NOS.
Anorexia Nervosa is a life threatening eating disorder characterized by a distorted body image, weight loss and lack of eating. The food & weight struggle is actually a symptom of a much deeper problem. At it's root, anorexia [or any other eating disorder] is not about food. Diagnostic criteria for eating disorders are used as a guideline for medical professionals and do not indicate severity. There has been much controversy over this, and many are pushing for the diagnostic criteria to be updated.
Diagnostic Criteria for Anorexia Nervosa, according to the DSM-IV -
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarchal females, amenorrhea i.e., the absence of at least three consecutive cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen administration.)
Specify type:
-Restricting Type: During the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
-Binge-Eating/Purging Type: During the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
Bulimia Nervosa is an eating disorder characterized by a binge/purge cycle.
Diagnostic Criteria for Bulimia Nervosa according to the DSM-IV -
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
(1). Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
(2). A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting or excessive exercise
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
D. Self-evaluation is unduly influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of anorexia nervosa
Purging type: During the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Nonpurging type: During the current episode of bulimia nervosa, the person has used inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Binge Eating Disorder [BED]
Diagnostic criteria for BED according to the DSM-IV -
(1). Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
(2). The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. Binge-eating episodes are associated with three (or more) of the following:
(1). eating much more rapidly than normal
(2). eating until feeling uncomfortably full
(3). eating large amounts of food when not feeling physically hungry
(4). eating alone because of being embarrassed by how much one is eating
(5). feeling disgusted with oneself, depressed, or very guilty after overeating
C. Marked distress regarding binge eating is present
D. The binge eating occurs, on average, at least 2 days a week for 6 months Note: The method of determining frequency differs from that used for bulimia nervosa; future research should address whether the preferred method of setting a frequency threshold is counting the number of days on which binges occur or counting the number of episodes of binge eating
E. The binge eating is not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise, etc.) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa
Eating Disorder - Not Otherwise Specified [ED-NOS]
Diagnostic Criteria for ED-NOS according to the DSM-IV -
The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder. Examples include:
1 For females, all the criteria for Anorexia Nervosa are met except that the individual has regular menses.
2 All the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individuals current weight is in the normal range.
3 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 a duration of less than 3 months.
4 The regular use of inappropriate compensatory behaviour by an individual of normal body weight after eating small amounts of food (e.g. self-induced vomiting after the consumption of two biscuits.
5 Repeatedly chewing and spitting out, but not swallowing, large amounts of food. 6 Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviours characteristic of Bulimia Nervosa.
Diabulimia
Taken from Kelie Gardner's Website:
Diabulimia refers to an eating disorder in which Type 1 diabetes sufferers omit their insulin injections for the purpose of weight loss.
Failure to administer insulin places the body in a starvation state, resulting in breakdown of muscle and fat into ketone bodies and subsequently ketoacids. This typically results in significant weight loss but also places the patient at risk of a life-threatening condition known as diabetic ketoacidosis. Prolonged failure to administer insulin results in long-term complications such as diabetic neuropathy.
Following a diagnosis of Type 1 diabetes, a patient is put on insulin injections, a more controlled diet, and several blood sugar checks a day. This may result in weight gain, which some (particularly teen girls) may find embarrassing. This may lead them to neglect their insulin treatment for the purposes of returning to their former weight.
Often, people with Type 1 diabetes who omit insulin injections will have already been diagnosed with an eating disorder such as anorexia nervosa, bulimia nervosa and/or compulsive eating. In cases where a person with Type 1 diabetes has another eating disorder, there is a tendency to discuss the other eating disorders more openly than they do about diabulimia as many people with diabetes are not happy that they have lost control of their diabetes. These individuals are often not aware that diabulimia is more common than what they think and is also very difficult to overcome. Unlike anorexia and bulimia, diabulimia only sometimes requires the afflicted individual to stop caring for a medical condition. Unlike vomiting or starving, there is sometimes no action or willpower involved. Diabulimia may be more appealing to individuals who want to lose weight and do not want to feel hungry, or to not engage in vomiting in order to purge. Often there is an obsessive compulsive urge to engage in this activity for the purpose of emotional disassociation or a need to satisfy feelings of 'control'.
This condition can be triggered or exacerbated by the need for constant vigilance in regard to food, weight and glycemic control. In adolescents the need for parental control over the young Diabetic's life, and the increased weight gain that insulin treatment can cause, may play roles in the increased risk for onset of Anorexia and/or Bulimia. The frustration of managing blood sugars and their subsequent effects on weight and self perception (altered by dealing with a chronic illness) can also be damaging to self esteem and body image.
A person with diabulimia, especially if not caught and treated early, is likely to suffer the extent of diabetes earlier than a person with diabetes who is maintaining their diabetes in a healthy manner. The extent of diabetes includes renal failure, blindness and diabetic neuropathy. With diabulimia there is an increased chance of fatality. Diabetic ketoacidosis (DKA) is very common in persons with Type 1 diabetes that have diabulimia. This is due to the reduction in the amount of insulin and an increase in blood sugars levels. DKA is a very serious condition that occurs without enough insulin and without treatment causes death.
Most commonly Diabulimia appears to start in adolescence and is more likely to occur in women than men. Diabulimia can be identified in a patient if there are unexplainable spikes in their Hemaglobin A1c, weight loss, lack of marks from finger sticks, lack of prescription refills for diabetes medications, and records that do not match the HbA1c.
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I am delighted to share with you the following website which will give you much more detailed information on Diabulimia. She is really awesome and most of my information on Diabulimia came from her site. In addition to general informationon Diabulimia, the site also includes Kelie's personal story and interviews she has participated in.
http://www.keliegardner.com/
Pica
Pica is characterized by the consumption of non-food items that contain no nutrition (e.g. clay, soil, chalk, paper. May also include food ingredients like flower, raw rice, ice cubes). It may sometimes be linked to mineral deficiencies or social/psychological issues. In order for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for magpie, a bird which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women and small children, especially among children who are developmentally disabled, where it is the most common eating disorder.
Causes
A common assumption is that people eat these substances to make up for deficiencies in their diets, a thought supported by the finding that some pregnant women stopped struggling with pica when they were given iron supplements. However, other factors can be at work as well. Some individuals who diet may try to fill their stomachs with no-calorie substances to satisfy cravings.
Dangers
•Eating something toxic (e.g., lead poisoning)
•Infections
•Presence of parasites
•Blockage of the intestines or other gastrointestinal problems
Treatment
Treatment may involve several kinds of professionals, depending on the reasons for the disorder and the symptoms. A doctor will be necessary for physical problems caused by pica. If there are socioeconomic issues involved, a social worker may be able to provide guidance that alleviates underlying problems. Finally, if psychological issues are present, a therapist or psychiatrist is helpful.
http://eatingdisorders.about.com/od/othereatingdisorders/a/pica.htm
Compiled from - http://en.wikipedia.org/wiki/Pica_(disorder)
Orthorexia Nervosa
In order to adequately explain Orthorexia, I have retrieved this article from the NEDA. At the bottom of the page you will see a link to the original document -
"Those who are obsessed with healthy eating may be suffering from orthorexia nervosa, a term which means literally fixation on righteous eating. Orthorexia starts out as an innocent attempt to eat more healthfully, but the orthorexic becomes fixated on food quality and purity. They become more and more consumed with what and how much to eat, and how to deal with slip-ups. An iron-clad will is needed to maintain this rigid eating style. Every day is a day to
eat right, be good, rise above others in dietary prowess, and self-punish if temptation wins (usually stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of their diet and they often feel superior to others,
especially in regards to food intake.
Eventually food choices become so restrictive, with both variety and calories, that health suffers an ironic twist for a person so completely dedicated to healthy eating. Eventually, the obsession with healthy eating can crowd out other
activities and interests, impair relationships, and become physically dangerous.
Is Orthorexia An Eating Disorder?
Orthorexia is a term coined by Steven Bratman, MD, to describe his own experience with food and eating. It is not an officially recognized disorder, but is similar to other eating disorders. Those with anorexia nervosa or bulimia nervosa
obsess about calories and weight while orthorexics obsess about healthy eating (not about being thin and losing weight).
Why Does Someone Get Orthorexia?
Orthorexia appears to be motivated by health, but there are underlying motivations, which can include safety from poor health, compulsion for complete control, escape from fears, wanting to be thin, improving self-esteem, searching for spirituality through food, and using food to create an identity.
Do I Have Orthorexia?
Consider the following questions. The more yes responses, the more likely you are dealing with orthorexia.
• Do you wish that occasionally you could just eat and not worry about food quality?
• Do you ever wish you could spend less time on food and more time on living and loving?
• Does it sound beyond your ability to eat a meal prepared with love by someone else one single meal and not try to control what is served?
• Are you constantly looking for the ways foods are unhealthy for you?
• Do love, joy, play and creativity take a backseat to having the perfect diet?
• Do you feel guilt or self-loathing when you stray from your diet?
• Do you feel in control when you eat the correct diet?
• Have you positioned yourself on a nutritional pedestal and wonder how others can possibly eat the food they eat?
So Whats The Big Deal?
The diet of the orthorexic can actually be unhealthy, with the nutritional problems dependent on the specific diet the person has imposed upon him or herself. Social problems are more obvious. An orthorexic may be socially isolated, often because they plan their life around food. They may have little room in life for anything other than thinking about and planning food intake. Orthorexics lose the ability to eat intuitively to know when they are hungry, how much they need, and when they are full. The orthorexic never learns how to eat naturally and is destined to keep falling off the wagon and thus feeling shameful, similar to any other diet mentality.
When Orthorexia Becomes All Consuming
Dr. Bratman, who went through orthorexia, states I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on
normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed. I found
it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life's meaning had been transferred inexorably to food, and I could not reclaim it. (Source: www.orthorexia.com)
Are You Telling Me Its Unhealthy to Follow A Healthy Diet?
Following a healthy diet does not mean you are orthorexic, and nothing is wrong with eating healthfully. Unless, however, 1) it is taking up an inordinate amount of time and attention in your life; 2) deviating from that diet is met
with guilt and self-loathing; and/or 3) it is used to avoid life issues.
What Is The Treatment for Orthorexia?
Society pushes healthy eating and thinness, so it is easy for many to not realize how problematic this behavior can become. Even more difficult is that the person doing the healthy eating can hide behind the thought that they are
simply eating well (and that others do not). Further complicating treatment is the fact that motivation behind orthorexia is multi-faceted. First, the orthorexic must admit there is a problem, then identify what caused the
obsession. They must also become more flexible and less dogmatic with their eating. There will be deeper emotional issues, and working through them will make the transition to normal eating easier.
While orthorexia is not a condition your doctor will diagnose, recovery can require professional help. A practitioner skilled at treating those with eating disorders is the best choice. This handout can be used to help the professional
understand more about orthorexia.
Recovery
The recovered orthorexic will still eat healthfully, but there will be a different understanding of what healthy eating is. They will realize that food will not make them a better person and that basing their self-esteem on the quality of their diet is irrational. Their identity will shift from the person who eats health food to a broader definition of who they are a person who loves, who works, who is fun. They will find that while food is important, it is one small aspect of life and, often, there are things that are more important!"
**PLEASE VISIT THE VIDEOS PAGE TO WATCH AN INTERVIEW WITH SOMEONE WHO STRUGGLED WITH ORTHOREXIA!**
LINKS
Official Website for Orthorexia
Above article in its original context
Anorexia Athletica
Anorexia Athletica is also known as compulsive exercise. Typically individuals with this disorder exercise out of obligation or guilt, not because they find enjoyment in it. Anorexia athletica is not a formal diagnosis in itself and it is usually diagnosed as a subclinical disorder under anorexia nervosa or bulimia nervosa.
A person with anorexia athletica consistently exercises far beyond the requirements for good health. This may amount to hours and and hours every single day. In addition to compulsive exercise, the person may also be extremely focused on diet and weight. The individual with anorexia athletica participates in enough physical activity to hinder a normal healthy life and it usually interferes with work, school, and social interaction.
Self-worth is often determined in terms of performance by a person with anorexia athletica, and they may never feel fully satisfied with the amount of activity or their accomplishments.