Eating Disorders

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Does disordered eating qualify as an eating disorder?

Undoubtedly, eating disorders are characterized by disturbances in eating behavior however there are other striking features that characterize an eating disorder.

At the core of an eating disorder is an intense fear of gaining body weight and appearing fat which is coupled with the excessive pursuit of thinness. Individuals often have distorted perceptions of their own body shapes and sizes, they relentlessly make efforts to become thin and focus disproportionately on their appearances.

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    What is Anorexia Nervosa?

    Anorexia nervosa is an eating disorder characterized by a deliberate effort to reduce body weight and morbid fear of gaining weight or becoming fat. The bodyweight of the individuals falls drastically and is significantly below the level expected from the person’s age and height. Even though most individuals with anorexia nervosa appear painfully thin, they frequently deny having any problems. They are always overwhelmed by a potent fear of losing control over eating and have distorted body image. The individual, therefore, restricts food intake drastically or indulges in purging behavior like self-induced vomiting or the misuse of laxatives and diuretics.

    What is Bulimia Nervosa?

    Bulimia Nervosa includes episodes of binge eating involving the consumption of large amounts of food during which the individual demonstrates a complete lack of control over eating and an inability to stop. This form of binge eating subsequently gives rise to colossal guilt and disgust. This is coupled with drastic efforts to compensate and the individual indulges in compensatory strategies to undo the effects of binge eating like self-induced vomiting, self-starvation, excessive exercise, or abuse of purgatives. There is constant preoccupation and dissatisfaction with one’s own body weight. However, as compared to patients with anorexia, demonstrate slightly better body weight measures. People with both disorders demonstrate the common fear of becoming fat.

    How important is it for people suffering from eating disorders to seek treatment?

    Individuals having eating disorders often experience depressive symptoms, anxiety, obsessional thoughts and rituals, insomnia, irritability, suicidal ideation and disturbed interpersonal relationships. Eating disorders involve severe derangements in eating behaviors subsequently leading to deviance in the functioning of the body. Often women who demonstrate such illness have menstrual abnormalities and disturbed reproductive and sexual functioning. Severe deprivation of food in anorexia is related to deviance in major biological systems of the body and most of the parameters of body functioning get disturbed. Refusal to consume appropriate nutrition coupled with denial of the seriousness of the illness makes it difficult for individuals with anorexia to understand the need for treatment. Bulimia nervosa similarly puts a person at risk of several complications related to vomiting, purgative abuse, and bingeing. Both the disorders warrant treatment.

    Common Symptoms in Eating Disorders

    • Behaviours
    • Psychopathology
    • Physical Symptoms

    Behaviours

    Restrictive behaviour

    • Cutting back on amount of food eaten
    • Strict rules about eating (eg, time of day, specific macronutrient content)
    • Prolonged fasting (greater than 8 waking hours)
    • Ritualised behaviour associated with the purchase, preparation, and consumption of food.
    • Little variety in foods (eg, extreme vegan diets, avoidance of fat, etc)
    • Avoidance of social eating
    • Secret eating
    • Social competitiveness around eating

    Binge eating

    • Eating an amount of food in a discrete time that is considered excessive in view of the situational context (objective)
    • Eating an amount of food that is not excessive in view of the context but is considered large by the individual because of associated feelings of loss of control over eating (subjective)

    Associated features of binge eating

    • Eating more rapidly than normal
    • Eating until uncomfortably full
    • Eating large amounts when not hungry
    • Eating alone because of embarrassment
    • Feeling disgusted, depressed, or very guilty because of eating

    Purgative behaviour

    • Self-induced vomiting; spitting
    • Misuse of laxatives, diuretics, diet pills, etc

    Excessive exercise

    • Intense, highly driven exercising of a compulsive nature
    • The drive to exercise is associated with impaired social or physical function, or both

    Drinking

    • Limited drinking (<0·5 L per day)
    • Excess drinking (>1·5 L per day)

    Body checking

    • Repeated weighing
    • Pinching or measuring the size of body parts (eg, circumference of wrist)
    • Repeatedly checking the protrusion of specific bones
    • Checking that specific clothes fit
    • Mirror gazing
    • Comparison with others’ bodies

    Body avoidance

    • Avoidance of behaviours above (eg, refusal to weigh, avoidance of mirrors, wearing bulky clothes)

    Psychopathology

    Body image disturbance

    • Weight and shape concerns (eg, preoccupation with weight, shape, or both)
    • Overvaluation of shape and weight in determination of self-worth
    • Minimisation or denial of symptom severity
    • Disturbance in the way body is experienced
    • Intense fear of weight gain, even though underweight

    Physical Symptoms

    • Weight loss or failure of growth with associated features of starvation – eg, amenorrhoea.
    • Absence of at least three consecutive menstrual cycles (women)
    • Reduced libido
    • Reduction in waking erections (men)
    • Reduced beard growth in men
    • Sensitivity to cold
    • Weakness, fatigue, etc

    Is there a way to treat eating disorders?

    Eating disorders involve a comprehensive management plan beginning with the choice of treatment setting based on the severity of the physical complication arising due to chronic derangements in eating patterns, this is followed by management of risk both psychological and physical, weight restoration, pharmacological and psychotherapeutic interventions.

    Best Treatment of Eating Disorders in Delhi & Noida

    rTMS in
    Eating Disorders

    • The man should be the sexual leader
    • Masturbation is wrong
    • A woman should not initiate sex
    • Men should not express their emotions
    • A woman should always have sex when her partner makes sexual
    • approaches
    • All physical contact must lead to sex
    • Good sex leads to a wild orgasm
    • A man feels like having sex at any time
    • Sex equals intercourse

    Medications in
    Eating Disorders

    • Sex happens automatically
    • A `respectable’ woman should not enjoy sex too much and should
    • certainly never masturbate
    • All other couples have sex several times a week; have orgasm every time
    • they have sex & orgasm simultaneously
    • There must be something wrong with the relationship if sex is not good
    • Cultural beliefs about formation of Semen and genital secretions

    Psychotherapy in
    Eating Disorders

    • Role of ‘Physical strength’ or ‘Muscle power’ in sexual performance
    • Size of the penis
    • Circumcision and sexual performance
    • Bending of Penis
    • Vasectomy/tubectomy decreases sexual potency
    • Drugs enhance sexual potency in normal persons
    • Porn increases sexual drive

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