Eating Disorders
Eating disorders, one of the most difficult mental illnesses to diagnose and cure, are divided into three categories: anorexia nervosa, bulimia nervosa, and binge eating. Frequently, sufferers flatly deny they have a problem, and treatment by doctors and psychiatrists produces little success. There appears to be a connection between anorexia and bulimia, and affective disorders (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 the lateral hypothalamus, the region of the brain believed to regulate appetite. Whether these hormones produce a similar activity in humans is yet unknown; however, researchers appear optimistic that the development of drugs imitating these hormones may aid in the treatment of eating disorders by stimulating or depressing appetite.
The psychological driving force behind anorexia and bulimia has been defined as "the relentless pursuit of thinness." Described in a paper for the first time in 1694 by Richard Morton, anorexia nervosa, translated as "nervous loss of appetite," was given its name by Sir William Gull 1870s. The fact is, patients do not usually lose their appetite until the disease is well developed. The anoretic has such an overwhelming need to be thin they virtually starve themselves to death. Diagnosis consists of refusal to hold body weight above 85% of normal based on age and height; an intense fear of gaining weight; the inability to see one's shape or body weight as it truly is; and, in females past the age of puberty, the absence of at least three consecutive menstrual cycles. Unusual behavior displayed by some anoretics include collection of recipes, cooking for others while not eating themselves, hiding food, cutting food into small pieces, obsessively counting calories, avoiding eating in public, and secretly exercising--perhaps for an entire night--so family members can't stop them. A common connection between anoretics is overly-protective or strict parents; excessive dieting may give them a sense of control over their own lives. Anorexia commonly begins between 13 and 30 years, is more prevalent in countries where "thin is beautiful," in middle-to-upper classes, and in single females. An increasing number of young males are presenting with the disorder, however. Anorexia is particularly difficult to treat, and sufferers develop serious medical complications. Between five and 18 percent die from starvation, cardiac arrest, or suicide.
Bulimia—Greek for "ox-like hunger"— appeared in publications during the 18th century but was not classified as an illness until 1979. In 1987, English psychiatrist Gerald Russell gave it the name Bulimia nervosa. Diagnostic criteria include "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. Evidence links two brain biochemicals-- serotonin and norepinephrine--to the binge/purge cycle, chemicals that have also been identified in depression and other psychological illnesses.
While anorexia and bulimia are separate entities, they have considerable overlap: both occur primarily in adolescents and young adults, are long-running and difficult to treat, interfere with social development, are commonly accompanied by depression and obsessive behaviors, and show a family or personal history of major depression, obsessive-compulsive disorder, or anxiety. Mood elevators and/or antidepressants can be helpful in treatment.
Binge eating is similar to bulimia except purging does not occur. 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. Diagnosis includes 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 characteristic, and associated medical problems include high cholesterol, diabetes, heart disease, gallbladder disease, and depression. Treatment through psychotherapy and antidepressants affecting serotonin levels can be helpful.
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