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Dr. Zabrin Inan, MD
Child, Adolescent and Adult Psychiatry
Chicago

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Eating Disorders

Eating disorders are considered developmental and psychiatric disorders because they have a complex array of causative factors that include emotional, familial, cultural and biological elements.  

An eating disorder often brings a sense of control, achievement and power to a person as he or she seeks to control their environment by controlling food intake.

Eating disorders are very easy to understand when you look at each disorder individually, its possible progression and the factors that can trigger or exacerbate it. It is very important to understand that eating disorders can progress to serious mental and physical health problems. For that reason, early diagnosis and treatment are critical to recovery.

The three most common eating disorders are:

Related problems often include:

  • Difficulty communicating anger, sadness or fear
  • Difficulty dealing with conflict
  • Depression
  • A need to please others, excessive concern about gaining approval from friends, parents or others in authority
  • Perfectionism, always striving to be the best
  • Low self-esteem, tending to withdraw from others for fear of being seen as less than perfect
  • Problems with identity´┐Żnot certain of who he or she is, or where he or she is going in life.
  • A history of sexual or physical abuse

1.  Binge Eating Disorder

It is the sense of loss of control and not the amount of food eaten that defines binge eating. Binge Eating Disorder (BED) can be triggered by excessive dieting, depression, anxiety, or even tension that is relieved by binge eating.

Everyone living with BED suffers a combination of symptoms similar to those of Bulimia. The sufferer periodically goes on binges, consuming an unusually large quantity of food in a short period of time (less than two hours), uncontrollably eating until he or she is uncomfortably full.

Unlike with Bulimia, there is no purging after a binge episode. Eating binges are used as a way to hide from emotions, to fill a void felt inside, and to cope with daily stresses and problems.

The following typical symptoms of  BED in no way represents what a sufferer feels or experiences in living with the illness:

  • Mood swings
  • Depression
  • Fatigue
  • Insomnia; poor sleeping habits.

Binging can be used to keep others away, and, as with Bulimia, binging can be used as self-punishment, or as a way to make the sufferer feel bad about himself or herself.

A person with BED is at risk for a heart attack, high blood pressure and cholesterol, kidney disease and/or failure, arthritis and bone deterioration, and stroke.

Symptoms of Binge Eating Disorder

Recurrent episodes of binge eating. An episode of binge eating is characterized by the following:

  • Eating, within any two-hour period, an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
  • A sense of lack of control over eating during the episode (a feeling that one cannot stop eating or control what or how much one is eating)
  • Marked distress regarding binge eating
  • Engaging in binge eating, on average, at least two days a week for six months      

The binge eating episodes are associated with at least three of the following:  

  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of embarrassment about how much one is eating
  • Feeling disgusted with oneself, depressed or very guilty after overeating.

Binge eating is not associated with the regular use of inappropriate compensatory behaviors (purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

2.  Bulimia

  • Bulimia is the loss of control over purging of food, not the amount of food eaten.
    While females are more likely to develop Bulimia Nervosa than males, people of any age, sex or race can develop the disorder.
  • While not everyone with bulimia makes themselves vomit, all regularly use inappropriate behavior in response to overeating. Bulimia consists of finding ways to rid your body of that food (purging).

Purging usually includes self-induced:

  • Vomiting
  • Misuse of laxatives, diuretics, enemas or other medications
  • Fasting to compensate for an eating binge
  • Exercising excessively to compensate for an eating binge.

This binge-purge cycle causes serious mental and physical health problems. Early diagnosis and treatment of Bulimia is very important for recovery and for reducing the chances of serious health issues, heart or stomach problems as a result of repeated vomiting or malnutrition.

Treatment for Bulimia is usually effective and includes psychiatric counseling, medication and regular physical health monitoring.

Symptoms of Bulimia Nervosa

  • Recurring episodes of eating an unusually large amount of food within a short period of time (two hours) and a sense of lack of control over how much is eaten
  • Recurring inappropriate responses to overeating, such as self-induced vomiting, excessive exercise, or misuse of laxatives, diuretics, enemas or other medications
  • Binge-purge episodes occurring at least twice a week for three months or longer.

Some related disorders commonly occur along with Bulimia Nervosa, which may make treatment more difficult:

Most people who have Bulimia can be successfully treated without being admitted to a hospital or eating disorder treatment center; however, sometimes admission is necessary.

Damage to the digestive tract is a serious complication of Bulimia.  You  must call your doctor immediately if you: 

  • Are not able to pass urine
  • Notice that your heart skips beats or beats more slowly than normal
  • Have severe abdominal pain; vomit up blood; or have black, sticky (tarry) stools.

In general, people who actively participate in their treatment and do not have any other conditions (such as depression) recover more quickly than those who are reluctant to participate in treatment and also have other conditions.

3.  Anorexia

Anorexia is very difficult to treat because the person may resist medical treatment as unnecessary, or intensely fear gaining weight. People with Anorexia who also have other conditions such as Bulimia Nervosa or depression need ongoing intensive treatment.

  • Anorexia is considered a lifelong illness. People who have Anorexia usually must continue combined physical and mental health treatment for a period that can range from several months to years.
  • About 40% of individuals with Anorexia will recover. Another 30% will improve. The remaining 30% will have problems with Anorexia throughout their lives. People with Anorexia who are of normal weight, who are young, and who start treatment early in their illness usually do well.

Hospitalization or admission to an eating disorder treatment facility is sometimes needed to manage Anorexia. In this setting, a team of health professionals will treat the patient until he or she is well enough for outpatient care.

Symptoms of Anorexia Nervosa

  • Weighs 85% or less of what is expected for age and height, or fails to make expected weight gains during a period of growth;
  • Has an intense fear of gaining weight or becoming fat, even though underweight;
  • Has a distorted body image (seeing the body as fat when it really is too thin); evaluates self-worth by body shape and weight;
  • Denies the seriousness of being underweight or the recent drop in weight;
  • Has stopped having menstrual cycles (missed at least three consecutive periods). Or, if the female child is at a pre-puberty age, does not get her menstrual cycle when expected;
  • May become obsessed with exercising too much or too frequently, possibly injuring joints such as the knee;
  • May induce vomiting or abuse laxatives or diuretics to lose weight.

There are no specific tests to diagnose Anorexia. The person is usually first seen by a health professional for other complaints related to Anorexia, which may include:

  • Fatigue and lack of energy
  • Abdominal pain, constipation
  • Absence of menstrual periods
  • Frequent vomiting (although the person does not admit it is self-induced)
  • Symptoms of depression
  • Joint pain (from excessive exercise).

Long-term or severe Anorexia can cause serious medical complications:

  • Osteoporosis, resulting from a lack of calcium in the diet as well as too much cortisol and too little estrogen in the body. The teenage years are critical bone-forming years
  • Joint injuries from too much exercise
  • Fractures, which are common in female athletes who have an eating disorder, osteoporosis, and irregular menstrual cycles (known as the female athlete triad)
  • Anemia
  • Kidney function problems, often due to chronic dehydration or abuse of laxatives
  • Heart problems such as irregular heartbeat and low blood pressure (hypotension)
  • Cavities or tooth decay.

If left untreated, many of these conditions can lead to death.  Up to 15% of those with Anorexia Nervosa who also have major depression will eventually die from complications of malnutrition or suicide.

 


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