Results. Ninety new cases of eatingdisorders accord- ing to Diagnostic and Statistical Manual of Mental Dis- orders, Fourth Edition criteria were identified during the follow-up. In the multivariate logistic analysis, a higher risk of incident eating disorder was found for several exposures assessed at the beginning of follow-up, such as younger age, usually eating alone (odds ratio [OR]: 2.9; 95% confidence interval: 1.9 – 4.6), and frequently reading girls’ magazines or listening to radio programs (OR: 2.1; 1.2–3.8 for those most frequently using both media). No independent association was found for television view- ing or socioeconomic status. A marital status of parents different from “being married” was associated with a significantly higher risk in the multivariate analysis (OR: 2.0; 1.1–3.5).
Those with low self-esteem are perhaps more vulnerable to negative comments, pressures to lose weight, or adopt unhealthy eating patterns from family, friends and the media. An association exists between low self-esteem and unhealthy eating behaviour (i.e., meal skipping, using food as a coping mechanism; Button, Sonuga-Barke, & Thompson, 1996). Moreover, in a cross-sectional ethnically diverse study of males and females, those with low self-esteem were at significantly greater risk of developing the more severe signs of eatingdisorders (Martyn-Nemeth, Penckofer, Gulanick, Velsor- Friedrich, & Bryant, 2009). Other supporting research has found that self-esteem is a predictor of bulimic symptoms (Ata et al., 2007; Bardone, Vohs, Abramson, Heatherton & Joiner, 2000; Dykens & Gerrard, 1986), and anorexic behaviours (Grant & Fodor, 1986), suggesting, self-esteem acts as an important predictor of the development of eating pathology (Button et al., 1996; French et al., 2001). Women with eatingdisorders may derive their self-esteem disproportionately from their appearance and perhaps, future research should look at creating educational tools or interventions that aid in building self-esteem which, in turn, may prevent unhealthy eating behaviours.
Sociocultural transition and gender roles as related to industrialization, urbanization and eating disturbances Among the manifold changes set in motion by the pro- cesses of industrialization and urbanization, there also exists ample evidence of a profound and dramatic shift in gender roles that occurs within societies undergoing transition. This shift marks one of the most significant contextual factors in the rise of EDs across diverse Asian societies, uniting concurrent forces of economic pres- sures, a developing consumer culture including global- ized fashion and beauty industries, as well as media influence and acculturation. This pattern, which has been observed consistently across Asia, has a particularly transformative effect on the landscape of women’s lives. Specifically, Witcomb, Arcelus and Chen  suggest that the demands of an increasingly competitive envir- onment in which women are expected to develop a new set of skills, may unavoidably expose them to greater criticism from peers, colleagues, and society, perhaps in turn prompting women to engage in more self- evaluation. Thus, physical appearance becomes one of several domains in which women ‘measure’ themselves against an aspirational ideal . In Asia, the ‘gendered’ nature of societal transformation and globalization is es- pecially striking due to the fact that economic develop- ment was initially driven by the growth in the manufacturing (specifically garment) industry, and later, the service industries, which resulted in a spike in de- mand for women’s labor in particular .
This study provides insight into the educational resources needed to inform the lay audience regarding eating disor- ders as well as some factors to consider in the education or prevention of eatingdisorders among those affected. There is a clear difference between perceived causes of eatingdisorders from those who have experienced them and those who have not. Those who had not struggled with an eating disorder were more likely to believe that media and cultural ideals influenced eatingdisorders. For those who had lived with an eating disorder, this was one of the least likely perceived causes. Social problems, in contrast, were fre- quently listed by participants with eatingdisorders and less frequently listed by participants without. Genetics and trau- matic events were listed most infrequently by both groups, and there were also relatively low levels of endorsement for traumatic life events, sports and health, and family prob- lems among both groups. Both groups listed body image as a fairly frequent cause, and although both groups highly en- dorsed psychological and emotional problems as causes, there was a clear negative stigma surrounding psychological and emotional problems when listed by non-disordered participants. Improved educational programs should seek to give those who are uninformed a greater understanding of how psychological, social, and relational factors influ- ence those with eatingdisorders. Increased opportunities for those who have lived with eatingdisorders to share their stories and perspectives are also needed. With the opportunity to provide first-hand knowledge, these indi- viduals can be an excellent asset for researchers, profes- sionals, and lay people.
Body image concerns and preoccupation with body weight and shape increase as girls become older and more aware of the idealized societal preference for a thin body shape. The images of women in the media and popu- lar culture place pressure on vulnerable young girls and women to live up to these expectations, regardless of their natural body shape.[8,9] In British Columbia, it was found that by age 18, 80% of girls at all weights reported that they would like to weigh less.[15,16] A school-based population study involving 1,739 adolescent women aged 12 to 18 years in Toronto, Hamilton and Ottawa found that current dieting to lose weight was reported by 23% of participants, binge-eating by 15%, self-induced vomiting by 8.2% and the use of diet pills by 2.4%. Body shape dissatisfaction and preoccupation with weight are not limited to adolescents but also occur in children. A recent Canadian school-based study concluded that 34% of prepubescent girls, 36% of early pubescent girls and 76% of post-pubescent girls were dissatisfied with their body shape. In a survey of eating and smoking behaviours among boys and girls in grades 4 to 8 in south-
Eatingdisorders are nowadays a grave and, unfortunately, growing social problem. Their etiology is multifactorial with complex psychological, biological, familial and socio-cultural mechanisms playing a role. Socio-cultural fac- tors are becoming more and more relevant, including the impact of mass media which provides socially accepted standards of attractiveness. They set the socially valued norms of appearance and show the impact of complying or failing to comply to these norms. Eatingdisorders lead to numerous anomalies in the oral cavity. They affect both the teeth and soft tissues. Although dry mouth, oral mucosa injuries, diseases of periodontium, dental decay are observed in patients, still the most common findings are non-carious lesions. Dental treatment is multipronged, mainly conservative and prosthetic. However, a crucial element of problem management is the prevention of fur- ther formation of erosive lesions. For such treatment to be effective, simultaneous implementation of psychological therapy is needed. Therefore, it is necessary to provide comprehensive health care to patients suffering from eatingdisorders (Dent. Med. Probl. 2016, 53, 4, 524–528).
The limited knowledge of nutrition and healthy food are the factor that leads to cause eating disorder(Anne, 2009) while binge eating is common among overweight and obese people mostly looking for weight loss treatment and there is some indication that it is associated with poor treatment fulfillment(Any, 2009).Eatingdisorders are multifaceted conditions caused by a combination of biological, socio-cultural, psychological, family and precipitating factors disappointment with body image and unhealthy eating behaviors are important issues for mainly in female, exposure of media has also been concerned with enhancing risk for the development of an eating disorder no one want poor body image and cultural pressure to be a thin (Zain, 2011). Strike dieting or food restriction have been verified to surge the risk of binge eating and prolong binge eating causes binge eating disorder. Physiologically craving is all about the wish for food triggered by anything from the thought, smell and sights of it a powerful desire for one particular type of food. Taste, satisfaction or pleasure of food is determined by the opioid system Ingestion of sweet and fatty foods and fluids increases opioid receptor binding within this region of the natural reward system and by the system gamma- aminobutric acid/benzodiazepine neurotransmitters (Mathes, 2009). On the other hand, the desire for food is determined by the mesencephalic dopaminergic system. People can eat being full so there may be other motives to eat beyond hunger. This suggests a second system involved in food motivation, namely motivational or reward system (Nilofer, 2006 ; Ignacio, 2012). However the function of sweet in regulation of appetite is not fully cleared though some studies show a stimulating effect and most studies show no effect of sweet taste on appetite and food intake (Sorensen, 2003). Whereas eatingdisorders can also cause several system diseases like liver dysfunction, osteoporosis, and diabetic complications to acrocyanosis. Particularly, anorectic patients have been reported to die at a premature age possibly from one of the above stated medical complications (Mitchell, 2006) the previous research had also shown that eatingdisorders run in families. Behavioral symptoms or incidence of binge eating is found in our population which could lead to cause eating disorder. For the
In summary, it can be argued that an ideal male body shape has become, to some degree, as popularised in the media as has the “ideal” female body shape. The sociocultural pressures on males may be experienced as particularly unsettling, espe- cially in terms of changing social roles and expectations, which may predispose males to the development of an eating disor- der. The result of this is that the body seems to become the medium for self assertion and expression – whether this is through bulimia nervosa, anorexia nervosa or so-called reverse anorexia (the fear of being too small or weak, also termed the adonis complex). Just as reverse anorexia may be under diagnosed, such is also true for bulimia nervosa and anorexia nervosa among males, especially when one considers the bias in diagnostic criteria. In addition to sociocultural pressures, particular family dynamics may predispose the development of an eating disorder.
Stephen W. Touyz, PhD, is Professor of Psychology and Honorary Professor of Psychological Medicine at the University of Sydney and Co-Director of the Peter Beumont Centre for EatingDisorders at Wesley Private Hospital. He has written or edited five books and over 180 research articles and book chapters on eatingdisorders and related topics. He is a Fellow of the Academy of EatingDisorders and the Australian Psychological Society and is Past President of the EatingDisorders Research Society. He was the inaugural treasurer of the Australian and New Zealand Academy of EatingDisorders and is an executive member of the Eating Disorder Foundation. He is a member of the Editorial Board of the European EatingDisorders Review.
may consult nutrition specialists aiming to lose weight or asking for specific diets, including exclusion diets for reported food intolerance or digestive discomfort. Signs of malnutrition without an organic etiology in adolescents or young adults should be regarded as suggestive of an underlying ED. ED diagnosis is often neglected or is made at a stage of severe malnutrition or metabolic disorders, including hypokalemia and/or osteoporosis. Recently, “early intervention” programs for EDs have been proposed in primary care aiming at enhanced prevention of EDs. These programs are based on early-stage detection 120 and
First of all there are physical effects when the body is constantly being deprived of nutrition. A person at a very low weight may experience dizziness or blackouts, become anaemic (lack of iron in the blood), lose their ability to menstruate (women), have lowered testosterone (men), experience hair loss and changes in the texture of their skin, nails and hair. They may find that a fine layer of body hair has grown on their back, face and arms as their body tries to stay warm. Their metabolic rate may slow down substantially in order to conserve energy, the body may also slow down heart rate, blood pressure and body temperature. People who are at a very low weight often feel very cold, not only on the outside of their bodies but on the inside as well. They tend not to be able to sleep very well or feel that they are not refreshed after a night’s sleep. Although a person experiencing the starvation syndrome may experience intense hunger, they also feel very full and/or bloated after eating very little.
An innovative family-based model that targets the needs of children and young people with eatingdisorders, and builds on community-based and early responses to eatingdisorders, has been established at The Royal Children’s Hospital with new investment of $3 million over three years. An additional $4.9 million over four years was allocated in 2012–13 to further develop intensive community-based treatment models for young people and adults through the Wellness and Recovery Centre which includes the Monash Butterfly Day Program (Monash Health), and the Body Image and EatingDisorders Treatment and Recovery Service (Austin Health in partnership with St Vincent’s). Melbourne Health is also funded to provide a specialist eating disorder service. Annual investment of more than $4 million funds specialist eating disorder beds attached to each of these services, and forms part of the continuum of highly intensive and specialist responses for people with eatingdisorders in Victoria. Medical and specialist mental health inpatient services within tertiary facilities are also part of the continuum of more intensive treatment responses.
ABSTRACT. Pediatricians are called on to become in- volved in the identification and management of eatingdisorders in several settings and at several critical points in the illness. In the primary care pediatrician’s practice, early detection, initial evaluation, and ongoing manage- ment can play a significant role in preventing the illness from progressing to a more severe or chronic state. In the subspecialty setting, management of medical complica- tions, provision of nutritional rehabilitation, and coordi- nation with the psychosocial and psychiatric aspects of care are often handled by pediatricians, especially those who have experience or expertise in the care of adoles- cents with eatingdisorders. In hospital and day program settings, pediatricians are involved in program develop- ment, determining appropriate admission and discharge criteria, and provision and coordination of care. Lastly, primary care pediatricians need to be involved at local, state, and national levels in preventive efforts and in providing advocacy for patients and families. The roles of pediatricians in the management of eatingdisorders in the pediatric practice, subspecialty, hospital, day pro- gram, and community settings are reviewed in this state- ment.
In the event of malnutrition, the diet plan involves regular small meals and supportive snacks, easy to eat and digest to make sure the menu is not too tiring or stressful. After about a week, under such a regime, the body will begin to recover, as the body temperature will normalize and the body will have energy. The next stage involves the construction of new, healthy tissues. Initially, a malnourished person will have lower-than-expected energy needs of 1500-2000kcal per day.(In order to maintain an approximate weight gain of 500 g/week.) Within a few weeks, the intake should be increased to about 3000kcal or more to fully recover and return to full physical health. As people work to achieve their target weights, realistic goals are set at 0.5-1 kg/week. Nutritionists help with meal choices and provide a structured eating plan that ensures nutritional adequacy and inclusion of all major food groups. It is believed that the amount of solid food should not exceed the amount that the particular person would normally eat. Possible food allergies and religious and cultural practices are also taken into account when building a nutritional plan. Daily intake usually starts at 30-40 kcal/kg per day. During the weight gain phase, it may need to be gradually increased to 70-100 kcal/kg per day for some people i.e. men because they need a much higher number of calories to gain weight. It should be borne in mind that delayed function of the digestive tract reduces the person's ability to tolerate 1000 calories/day. In such circumstances, it is often more effective to start with 200-300 calories over the usual caloric intake (for example, a person that consumes 400 calories a day may need to start at 600-700 calories a day). In addition to increasing calorie intake, vitamin and mineral supplements should be introduced to the diet. Serum potassium levels should be monitored regularly in people who are systemically vomiting. Hypocalcemia should be treated with oral or intravenous potassium intake and rehydration.
Numerous theories have evolved to describe the function of eatingdisorders within a family. Minuchin described the role of eatingdisorders structurally, as an attempt to promote boundaries between parent and child in a family dynamic defined by enmeshment and poor conflict resolution strategies (Minuchin, Rosman, & Baket, 1978). In addition to a shortage of data on family therapy for adults with eating disorder, limited data exist on therapeutic approaches for couples affected by eatingdisorders. Bulik et al. (2011) developed a model called Uniting Couples in the treatment of Anorexia Nervosa, or UCAN, which applies a cognitive behavioural couple’s therapy (CBCT) model. The primary aim of the treatment is to unite the couple as a team, working towards a shared goal of recovery (Bulik et al.). Though this model is specifically adapted to working with couples, the need for systemic interventions for adults with eatingdisorders is evidenced. The current study further confirms the complex and multi layered dynamics that are inexorable when an eating disorder infiltrates a family unit. Further research and pilot studies are needed to explore the efficacy of such treatment interventions.
emptiness or a true state of anxiety (16-20). Eating behavior is disturbed and presents itself as a ritual: the adolescent is alone, swallows large quantities of food, without making any distinction, chaotically, in great haste and without getting any pleasure from it. The duration of the episode goes from a few minutes to the hour; subsequently a feeling of profound discomfort, disgust, humiliation, intense devaluation of oneself arises. Then follows self- induced vomiting, abuse of laxatives and diuretics (subtype with elimination pipelines) or long periods of fasting and excessive exercise (subtype without elimination) in an attempt to counteract the effects of food. In fact, there is a persistent concern and constant control over nutrition that, on the occasion of the bulimic crisis, is completely lost, leaving space for this uncontrolled drive. The bulimic teenager is almost always normal weight or even underweight, but you live too fat with a constant fear of gaining weight. Therefore there is an alteration of the body image which is a central psychopathological aspect in bulimia nervosa. In fact bulimics are frequently observed with attention focused on the body, dissatisfaction with one's own forms, the fear of gaining weight, the tendency to significantly overestimate one's body dimensions and a discrepancy between ideal measures and perceived measures of one's body. In the distortion of perception the affective component plays a prominent role. The alteration of the body image in eatingdisorders does not consist in seeing or thinking, but in feeling fat. The importance of the emotional element is confirmed by the results of studies in which the perceptive overestimation appeared to be strongly correlated with low self- esteem, ego fragility, high levels of anxiety and depression. Finally, from the initial stages, there is also an evident change in character, generally undervalued as it is considered typical of age. Apparently normal, mild, sociable, available, diligent girls become closed, grumpy, lonely and sad, they don't make new friends, they neglect the previous ones, they don't have emotional ties typical of the age, in school they live isolated even if they are hyperactive, in the family they are irritable , especially with their mother, and they do not tolerate comments on their appearance, they spend a lot of time in front of the mirror worrying excessively about their appearance and becoming
Abstract: Eatingdisorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality. “Sudden death” has been defined as the abrupt and unexpected occurrence of fatality for which no satisfactory explanation of the cause can be ascertained. In many cases of sudden death, autopsies do not clarify the main cause. Cardiovascular complications are usually involved in these deaths. The purpose of this review was to report an update of the existing literature data on the main findings with respect to sudden death in eatingdisorders by means of a search conducted in PubMed. The most relevant conclusion of this review seems to be that the main causes of sudden death in eatingdisorders are those related to cardiovascular complications. The predictive value of the increased QT interval dispersion as a marker of sudden acute ventricular arrhythmia and death has been demonstrated. Eating disorder patients with severe cardiovascular symptoms should be hospitalized. In general, with respect to sudden death in eatingdisorders, some findings (eg, long-term eatingdisorders, chronic hypokalemia, chronically low plasma albumin, and QT intervals .600 milliseconds) must be taken into account, and it must be highlighted that during refeeding, the adverse effects of hypophosphatemia include cardiac failure. Monitoring vital signs and performing electrocardiograms and serial measurements of plasma potassium are relevant during the treatment of eating disorder patients.
Taking these conclusions into consideration, participants’ original negative reasons for beginning to practice may be a discouraging finding. However, negative reasons for starting to practise yoga may not be unhelpful in the long- term. For example, they may be helpful if they lead to a practice that may change the practitioner’s relationship with their body, bring a number of other positive changes, and eventually change the reason for the practice to a more helpful one. In relation to the mechanisms through which these changes may occur, participants’ reflections suggested that their view of themselves has shifted as a result of yoga. They reported that their relationship with their body, food and with eating, as well as with their yoga practice, has changed over time. For example, their view of food seemed to change from being all bad to it being nourishing and a fuel, although at times still challenging. Hence yoga practice seems to have been helpful even for those who began practising for unhelpful ED-related reasons. Yet, monitoring of future practitioners’ motivation for the practice would still be advisable to prevent the practice from escalating to detrimental levels.
Understanding the relationship between EDs and cre- ativity is important both for helping to understand EDs and because it may have implications for treatment. Tchanturia, Lloyd and Lang  have developed Cogni- tive Remediation Therapy (CRT) for AN as a therapy that tries to encourage more flexible thinking and thus addresses a maintenance factor that may make other AN therapies less effective. They point out that although CRT was developed for use with people with brain injuries it has been used with a range of disorders. Tchanturia, et al. described CRT as a brief individual intervention which en- courages patients to discover how they think and to ex- periment with different ways of thinking and behaving between sessions. They summarize evidence that CRT can be effective in leading AN patients to think more flexibly, and such changes to thinking could be helpful in increas- ing the effectiveness of other interventions trying to change patient behaviour. However unlike CRT, the set- switching studies that underpin the argument that an ED is associated with less flexibility present participants with defined options rather than ask participants to find new options. In the alternative uses task participants do not demonstrate flexibility by switching between defined cat- egories, they instead do so by switching to new categories they themselves define. Therefore if an ED is associated with lower flexibility in the AUT then this strengthens the theoretical underpinnings of CRT.
Fetissov and colleagues in 2002 were able to identify antibodies against α -melanocyte-stimulating hormone (α-MSH) and adrenocorticotropic hormone (ACTH) in patients with AN and BN. In this study, they hypothesized that because people with eatingdisorders have trouble with the regulation of food intake and the hypothalamic system is involved in energy intake and expenditure, then it may be the target by autoAbs in AN/BN patients, as shown in other neurological disorders. After testing the sera of 57 patients with eatingdisorders, they found that a significant subpopulation of AN/BN patients have autoAbs that bind to α-MSH or ACTH hormone. Another major finding pointed to the involvement of stress (12). α - MSH is a peptide found in the anterior pituitary gland that is involved in appetite control and the stress response (13), and ACTH is a hormone extracted from the pituitary gland involved in stimulating the adrenal glands to release glucocorticoids, which in turn affect metabolism (14). Nevertheless, if these hormones are being attacked by autoAbs, with what biological pathway could this interfere? First of all, these autoAbs could interrupt signaling with food intake regulatory neurons such as neuropeptide Y, which was already recognized in AN/BN patients (15, 16). Second, they could interfere with receptors, like MC4, which is involved in the regulation of body weight (16). Lastly, these autoAbs may block the overall function of α - MSH/ACTH thereby affecting a person’s appetite and metabolism. Therefore, all these explanations suggest that if autoAbs react with neuropeptides responsible for the central control of appetite and this further characterizes the pathogenesis of eatingdisorders. Yet, some researchers still view AN/BN as a mental disorder, so can these autoAbs have an affect on psychological traits?