Anorexia nervosa is characterized by persistent restriction on food intake, an intense fear of gaining weight or of becoming fat, and a distortion of body weight or shape. An individual with anorexia nervosa will maintain a body weight that is below a minimally normal level for age, sex, and physical health.
Some people with anorexia lose weight by dieting, fasting, or exercising excessively; this is called the restricting type of anorexia. Others lose weight by self-induced vomiting or misusing laxatives, diuretics, or enemas. People who use these methods are considered to have the binge-eating/purging type of anorexia. More characteristics of anorexia nervosa include:
- Significant weight loss
- Continual dieting
- Intense fear of gaining weight or becoming fat, even if underweight
- Undue influence of body weight or shape on self-evaluation
- Preoccupation with calories or nutrition
- Preference to eat alone
- Compulsive exercise
- Bingeing and purging
- Brittle hair or nails
- Infrequent or absent menstrual periods (in females who have reached puberty)
- Growth of fine hair over body
- Mild anemia, and muscle weakness and loss
- Severe constipation
- Low blood pressure, slowed breathing and pulse
- Drop in internal body temperature, causing a person to feel cold all the time
Some people with anorexia nervosa feel they are overweight in all areas of their body, while others may recognize that they are thin but are concerned that certain body parts are "too fat," such as their abdomen or buttocks. They may use many different techniques to evaluate their body size or weight, such as frequent weighing and obsessive measuring of body parts. Additionally, the self-esteem of individuals with anorexia is closely tied to their perceptions of their body shape and weight. Weight gain is often viewed as a major failure, while weight loss is an impressive achievement.
Many people with anorexia have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development. The semi-starvation state of anorexia can also result in serious and potentially life-threatening conditions. The 12-month prevalence of anorexia among young females is estimated to be 0.4 percent.
Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (binge-eating), and feeling a lack of control over the eating. This is followed by some type of behavior that compensates for the binge, such as purging (vomiting, excessive use of laxatives or diuretics), fasting, and/or excessive exercise. Unlike individuals with anorexia nervosa, people with bulimia maintain body weight at or above a minimally normal level. Additional symptoms include:
- Recurrent episodes of binge eating
- Purging by strict dieting, fasting, vigorous exercise, or vomiting
- Abuse of laxatives or diuretics to lose weight
- Frequent use of bathroom after meals
- Reddened fingers
- Swollen cheeks
- Self-evaluation that is unduly influenced by body shape and weight
- Depression or mood swings
- Irregular menstrual periods
- Dental problems, like tooth decay
- Heartburn or bloating
- Intestinal distress and irritation from laxative abuse
- Kidney problems from diuretic abuse
- Severe dehydration from purging of fluids
People with bulimia tend to feel embarrassed or ashamed of their eating behaviors and try to hide their symptoms by binge eating in secrecy. The most common triggers for binge eating are negative affect (e.g. sadness, fear, guilt), interpersonal stressors (e.g. arguments), inadequate food intake, negative feelings about body weight or shape, and boredom. The 12-month prevalence of bulimia among young females is estimated to be 1.5 percent.
Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over his or her eating. An episode of binge-eating is defined as eating an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese. Community surveys have estimated that 1.6 percent of females and 0.8 percent of males experience binge-eating disorder in a twelve-month period.
Characteristics of binge-eating disorder include:
- Binge-eating occurring, on average, at least once a week for six months
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not hungry
- Eating alone because of embarrassment caused by how much is eaten
- Feeling disgusted with oneself, depressed, or guilty after binge eating
- Marked distress about the binge-eating behavior
- Binge-eating not associated with regular use of compensatory behaviors (purging, fasting, excessive exercise)
Avoidant/Restrictive Food Intake Disorder
Avoidant/restrictive food intake disorder (ARFID) is characterized by the avoidance or restriction of food intake. This diagnoses replaces the DSM-IV diagnosis of feeding disorder of infancy or early childhood, and broadened the diagnostic criteria to include adults. Individuals with ARFID have a lack of interest in eating or food, or avoid food based on a past negative experience with the food or the sensory characteristics of the food (e.g., appearance, smell, taste, texture, presentation). This form of "picky eating" typically develops in infancy or early childhood and may continue into adulthood. It may also be present in individuals with heightened sensory sensitivities associated with autism.
Characteristics of ARFID include:
- Significant weight loss
- Failure to achieve expected weight gain in children
- Significant nutritional deficiency
- Inability to participate in normal social activities, such as eating with others
Rumination disorder is characterized by repeated regurgitation of food after eating. Individuals with this disorder bring up previously swallowed food into the mouth without displaying any signs of nausea, involuntary retching, or disgust. This food is typically then re-chewed and spit out or swallowed again. The regurgitating behavior is sometimes described as habitual or outside of the control of the individual.
Characteristics of rumination disorder include:
- Repeated regurgitation of food over a period of at least one month
- The repeated regurgitation is not a result of an associated gastrointestinal or other medical condition
- Weight loss and failure to make expected weight gains in children
- Attempts to hide the regurgitation behavior by placing a hand over the mouth or coughing
- Avoidance of eating before social situations, such as work or school
Rumination disorder can develop in infancy, childhood, adolescence, or adulthood. Infants with the disorder tend to strain and arch their back with their head held back, making sucking movements with their tongue. Malnutrition may occur despite ingestion of large amounts of food, particularly when regurgitated food is spit out. In infants as well as in older people with intellectual disability, the regurgitation and rumination behavior seems to have a self-soothing or self-stimulating function, much like other repetitive motor behaviors (i.e. rocking, head banging).
Pica is characterized by the eating of one or more nonnutritive, nonfood substances on a persistent basis. Some of the substances commonly eaten among people with pica include paper, soap, hair, gum, ice, paint, pebbles, soil, and chalk. People with pica do not typically have an aversion to food in general.
In order for Pica to be diagnosed, the behavior of eating nonnutritive, nonfood substances must be present for at least one month. Children below the age of two are typically not diagnosed with pica to exclude the developmentally appropriate mouthing of objects by infants that may result in ingestion. People may experience medical complications from pica, such as bowel problems and intestinal obstruction. People may also experience infections if they have eaten feces or dirt. The prevalence of pica is unknown, but it is more prevalent among people with intellectual disability. Some pregnant women also develop pica when specific cravings such as chalk or ice occur.
Males with Eating Disorders
About seven million women across the country suffer from eating disorders including anorexia nervosa and bulimia and, as a result most research involving these disorders have only been conducted on females. However, as many as a million men may also suffer from these same disorders. Women are not the only people prone to disliking what they see when they look into the mirror. Now a days more men are worried about their body shape. Clinical reports tell us that one in ten men suffer from eating disorders. More attention needs to be paid to mens eating habits.
What eating disorders do men and boys get?
Just like girls and women, males get anorexia nervosa and bulimia nervous. Many males describe themselves as compulsive eaters, and they have binge eating disorder.
Anorexia nervosa means a nervous loss of appetite. Symptoms are a refusal to maintain body weight or an intense fear of gaining weight or becoming fat. An inability to perceive one’s body weight or shape correctly, (Scientific American, http://wwwsciam.com.exploration/1998/033298eating/anorexia.html).
An increasingly amount of men are seeking treatment. Just as women with this disorder are often involved in ballet and modeling, males suffer often from wrestling, running or practice similar sports that place a great deal of emphasis on dieting.
Bulimia nervosa means to binge eat and the get it out of your system by means of purging. Symptoms are recurrent episodes of binge eating and purging to prevent weight gain. (Scientific American).
Men are also seeking treatment for Bulimia. Women in ballet and modeling are also prone to this disorder. Most men in wrestling are affected with this disease instead of anorexia because they find it easier to hide. They can eat all they want in public but then the go get rid of it in privacy.
How many males have these disorders?
Perhaps as many as one in six cases of anorexia nervosa occur in males, (ANRED http://www.anred.com). Binge eating disorder seems to occur almost equally in males and females, although males are not as likely to feel guilty or anxious after a binge as women do. It is difficult to known exactly how many males have bulimia. Some researchers believe about 15% of all cases of this disorder occurs in men. Clinics and counselors see many more females than males, but that may be because males are reluctant to confess what has become known as a “teenage girl’s problem.” My health professionals do not expect to see eating disorders in men and may therefore misdiagnose them.
Are the risk factors any different for males than they are for females?
Risk factors for males include the following: They were overweight as children. They have been dieting. Dieting is one of the most powerful eating disorder triggers for both males and females, (ANRED). They participate in a sport that demands thinness. Runners and jockeys are at a higher risk than football players and weight lifters. Wrestlers who try to shed pounds quickly before a match so they can compete in a lower weight category seem to be at high risk. Body builders are at risk if they deplete body fat fluid reserves to achieve high definition. They have job or profession that demands thinness like models and actors. So males are members of the gay community where men are judged on physical appearance. Male patients are usually more active, have more sexual anxiety, have fewer bulimic episodes, with less vomiting or laxative abuse, and have a more preoccupation with food and weight.
Differences in disorders between males and females.
Males often begin and eating disorder at older ages then females do, and they more often have history of obesity or are overweight. Men are also made up to be strong and powerful, to build their bodies and make them large so they can compete successfully, and defend and protect, their skinny female companion. When women are asked what they would do with one wish, they almost always want to lose weight. Men asked the same question want money, power, sex, and a successful lifestyle. They usually think their bodies are fine the way they are. If they do have body concerns, they often want to bulk up and become larger and more muscular, not tiny like women do. Males usually equate thinness with weakness and that in something they desperately try to avoid.
Treatment of eating disorders in males.
Because eating disorders have been described as female problems, males are often exceedingly reluctant to admit they are in trouble and need help. Most treatment programs and support groups have been designed for females and are populated exclusively by females. Males report feeling uncomfortable and out of place in discussions of lost menstrual periods, women’s socio-cultural issues, female-oriented advertising, and similar topics. Like females, males usually need professional help to recover. Research shows that males who complete treatment given by professionals have better outcomes. Being male has no adverse affect on recovery once the person commits to an effective, well run program, (ANRED).
In terms of psychotherapy that is specifically geared to males, a report by Levine and colleagues on a professionally led support group for males with eating disorders concluded that extra effort is required by support-group leaders to reach out to this less prevalent, more secretive and resistant subgroup. These investigators also concluded that this subpopulation of males with eating disorders is likely to require additional social support, and that a support grout can have many positive effects for the men who give it a chance.( Braun http://www.medscape.com).
Why eating disorders?
Men appear to diet for different reasons than women: the presence of the actual illness obesity; weight loss related to greater sports attainment or the fear of gaining weight because of a sports injury; and weight loss in order to avoid weight related medical illnesses found in other family members. (Men with Eating Disorders, http://www.goaskalice.columbia.edu.html ). Other reasons men with eating disorders diet: a desire to improve athletic performance, a history of being teased, criticized, or picked on for being overweight. Wanting to change a specific body part to remove flab is another reason. Guys who also have eating disorders have them because they want to be more attractive to a potential partner and to look less like one’s father and to look like models in magazines.
One of the nation’s leading researchers on eating disorders is Arnold E. Anderson, M.D. a professor of psychiatry in the University of Iowa College of Medicine. He has edited a book of studies, Males with Eating Disorders (Brunner/Mazel 1990), and is writing another for families faced with the problem. His most recent project involves tracing and comparing the development of attitudes about body shape and weight among fifth and sixth grade males and females in the Unites States and India. “Males with eating disorders have been relatively ignored, neglected, dismissed because of statistical infrequency or legislated out of existence by theoretical dogma,” said Anderson. Anderson said that although the disorders look the same for men and women, the paths for getting there are quite different. “The twin spotlights of empirical scientific studies and broad clinical experience can be brought to focus on either the similarities or the dissimilarities between males and females with eating disorders,” said Anderson. “When individuals are very ill, suffering from emaciation or abnormal electrolytes and other medical complications, they appear very similar and require similar treatment.” Binge eating disorder may go unrecognized in males because an overeating male is less likely to provoke attention than an overeating female. “And men are hesitant to seek medical attention for a disorder they fear will be seen as a girl’s disorder or a gay guy’s disease,” Anderson said.
Eating disorders remain predominantly female illnesses. However, these disorders are common that even if only 10% of sufferers were male, hundreds of thousands of young men would be affected, making it an important health problem for males. Researchers believe that eating disorders may be under diagnosed in males. During the 1980s and 1990s there has been an apparent increase in recognition and interest by researchers in eating disorders among males, which has resulted in a number of articles, at least two Internet sites and one book about eating disorders in males. Although there appear to be more similarities than differences between males and females with eating disorders, much can be learned from the differences between the two groups. Gender differences that have emerged in some studies of patients with eating disorders include a higher incidence of homosexuality among males with eating disorders. Extreme pressure to be thin may alone be strong enough to precipitate development of eating disorders. Such added attention to weight and body fat and pressure to diet might be environmental pressures experienced by obese males.(Braun http://www.medscape.com). Further study of eating disorders may determine the treatment and prevention strategies that are most appropriate for males.
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