Prime Med of Ozark specializes in treating patients suffering from eating disorders.

Overview

When you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder. There is a commonly held view that eating disorders are a lifestyle choice. Studies suggest that 1 in 20 people will be affected at some point in their lives. Ultimately without treatment, eating disorders can take over a person’s life and lead to serious, potentially fatal medical complications. Eating Disorders describe illnesses that are characterized by irregular eating habits and severe distress or concern about body weight or shape. Eating disturbances may include inadequate or excessive food intake which can ultimately damage an individual’s well-being. Males suffering from eating disorders and body image issues have an immense stigma to overcome and, as a result, have been significantly neglected in both diagnosis and treatment. Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men.

Types Of Eating Disorders And Their Symptoms

Anorexia Nervosa

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of only certain foods. Anorexia nervosa has the highest mortality rate of any mental disorder. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.

Symptoms include:

• Extremely restricted eating
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multiorgan failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility

Bulimia Nervosa

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.

Symptoms include:

• Eating unusually large amounts of food in a specific amount of time
• Eating even when you’re full or not hungry
• Eating fast during binge episodes
• Eating until you’re uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss

Causes

Eating disorders are very complex conditions, and scientists are still learning about the causes. Although eating disorders all have food and weight issues in common, most experts now believe that eating disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Unfortunately, this will eventually damage a person’s physical and emotional health, self-esteem and sense of control.

Factors that may be involved in developing an eating disorder include:

• Genetics: People with first degree relatives, siblings or parents, with an eating disorder appear to be more at risk of developing an eating disorder, too. This suggests a genetic link. Evidence that the brain chemical, serotonin, is involved also points a contributing genetic and biological factors.
• Environment: Cultural pressures that stress “thinness” as beautiful for women and muscular development and body size for men places undue pressure on people of achieve unrealistic standards. Popular culture and media images often tie being thin to popularity, success, beauty and happiness. This creates a strong desire to very thin.
• Peer Pressure: With young people, this can be a very powerful force. Pressure can appear in the form of teasing, bullying or ridicule because of size or weight.
• Physical or Sexual Abuse: A history of physical or sexual abuse can also contribute to some people developing an eating disorder.
• Emotional Health: Perfectionism, impulsive behavior and difficult relationships can all contribute to lowering a person’s self-esteem and make them vulnerable to developing eating disorders.

Examples of environmental factors that would contribute to the occurrence of eating disorders are:

Dysfunctional family dynamic

Professions and careers that promote being thin and weight loss, such as ballet and modeling

Aesthetically oriented sports, where an emphasis is placed on maintaining a lean body for enhanced performance. Examples include:

• Rowing
• Diving
• Ballet
• Gymnastics
• Wrestling
• Long distance running

Eating disorders affect all types of people. However there are certain risk factors that put some people at greater risk for developing an eating disorder.

• Age: Eating disorders are much more common during teens and early 20s.
• Gender: Statistically, teenage girls and young women are more likely to have eating disorders, but they are more likely to be noticed/treated for one. Teenage boys and men are less likely seek help, but studies show that 1 out of 10 people diagnosed with eating disorders are male.
• Family history: Having a parent or sibling with an eating disorder increases the risk.
• Dieting: Dieting taken too far can become an eating disorder.
• Changes: Times of change like going to college, starting a new job, or getting divorced may be a stressor towards developing an eating disorder.
• Vocations and activities: Eating disorders are especially common among gymnasts, runners, wrestlers and dancers.

Risk Factors

Muscle Dysmorphia

Men may develop this type of disorder marked by an extreme concern with becoming more muscular.

Comorbidity of Eaiting Disorder with Trauma and PTSD

Researchers have found trauma is more common in bulimic eating disorders compared to nonbulimic eating disorders, these findings linking eating disorders with trauma have been extended to children and adolescents with eating disorders; which results in multiple episodes, especially in boys. Trauma is associated with greater comorbidity (including and often mediated by PTSD) in eating disorder subjects; partial or sub-threshold PTSD may also be a risk factor for bulimia nervosa and bulimic symptoms; and the trauma and PTSD or its symptoms must be expressly and satisfactorily addressed in order to facilitate full recovery from the ED and all associated comorbidity.

Eating Disorders and Major Depressive Disorders

Central serotonin pathways modulate eating patterns, and may also participate in the regulation of behavioral impulsivity and mood. The impaired postingestive satiety in bulimia nervosa is associated with reduced hypothalamic serotonergic responsiveness. Serotonin dysregulation has been implicated in major depression, and may play a role in the increased prevalence of depressive episodes in patients with eating disorders. Early menarche (prior to 11.6 years) was associated with elevated depression and substance abuse.

Eating disorders can cause serious health problems related to inadequate nutrition, overeating, bingeing and other factors. The type of health problems caused by eating disorders depends on the type and severity of the eating disorder. In many cases, problems caused by an eating disorder require ongoing treatment and monitoring.

Health problems linked to eating disorders may include:

• Electrolyte imbalances, which can interfere with the functioning of your muscles, heart and nerves
• Heart problems and high blood pressure
• Digestive problems
• Nutrient deficiencies
• Dental cavities and erosion of the surface of your teeth from frequent vomiting (bulimia)
• Low bone density (osteoporosis) as a result of irregular or absent menstruation or long-term malnutrition (anorexia)
• Stunted growth caused by poor nutrition (anorexia)
• Mental health conditions such as depression, anxiety, obsessive-compulsive disorder or substance abuse
• Lack of menstruation and problems with infertility and pregnancy

Treatment

Psychotherapies

Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods. To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Medications

Medication can be a valuable tool in the treatment of eating disorders.

Anorexia

Medication is used less frequently to treat anorexia compared to other eating disorders. However, when medication is called for, antidepressants are typically prescribed to treat underlying mental health problems. Fluoxetine (Prozac) may help people with anorexia overcome their depression and maintain a healthy weight once they have gotten their weight and eating under control. Fluoxetine is in a class of drugs called selective serotonin uptake inhibitors (SSRIs). These drugs increase serotonin levels, a brain chemical connected to mood. If the patient does not do well on an SSRI, doctors may prescribe olanzapine (Zyprexa), an antipsychotic drug typically used to treat schizophrenia. This medication has been found to help some people with anorexia gain weight and change their obsessive thinking.

Bulemia

People with bulimia respond well to SSRI antidepressants, even if they aren’t depressed. Fluoxetine (Prozac) can help people stop binging and purging when used alone or with CBT. In fact, Fluoxetine is the only antidepressant approved by the U.S. Food and Drug Administration to treat bulimia. Other SSRI antidepressants may be helpful in treating bulimia and are often used, although scientific studies to support their use are limited. Another possible bulimia medication is topiramate (Topamax), an anti-seizure drug. Topiramate may help people with bulimia suppress their urge to binge and reduce their preoccupation with eating and weight. However, topiramate can have troublesome side effects compared to the SSRIs. Accumulating evidence suggests that antidepressants in combination with psychotherapy can be effective in the treatment of bulimia nervosa. Clinical experience supports the use of most selective serotonin reuptake inhibitors (i.e., fluoxetine, sertraline and citalopram) as well as some of the newer antidepressants (i.e., venlafaxine).

Binge Eating

About 2 percent of U.S. adults, or about 5 million people, have binge eating disorder, according to the Department of Health and Human Services. Standard treatment for binge eating and other eating disorders usually involves counseling and psychotherapy. Some doctors also prescribe antidepressants to try and curb eating disorders, though they are not approved for that use. Antidepressants can help treat binge eating disorder. SSRIs, such as Fluoxetine (Prozac) and Sertraline (Zoloft), may help reduce binge eating and can improve mood in patients who are also struggling with depression or anxiety. However, antidepressants in general will not help much with weight loss. Some have also tried anticonvulsants (Topiramate) for treating binge-eating disorder.

Vyvanse,

known chemically as lisdexamfetamine dimesylate, is part of a family of drugs that stimulate the central nervous system. Federal health regulators have approved an attention deficit disorder drug for a new use: A first-of-its kind treatment for binge-eating disorder. The Food and Drug Administration originally approved Vyvanse in 2007 as a once-a-day pill for attention deficit hyperactivity disorder. In February of 2015, the agency cleared the drug for adults who compulsively overeat. The drug is not approved for weight loss. Bupropion (Aplenzin, Forfivo, Wellbutrin), although it can cause seizures if taken by someone who binges then tries to rid the body of the food (purges).

Below is a listing of some of the most common medications prescribed in treating some victims of Eating Disorders (it is important to discuss medications, indications, side’s effects, etc. with your medical doctor and/or psychiatrist):

Zoloft (sertraline hydrochloride)

• Antidepressant (SSRI – selective serotonin reuptake inhibitor); SSRIs selectively affect neurotransmitter (the chemicals that send messages to and from the brain) mechanisms in the central nervous system
• Oral administration
• Used to treat mental depression, obsessive-compulsive disorder and panic disorders

Paxil (paroxetine hydrochloride)

• Antidepressant (SSRI – selective serotonin reuptake inhibitor); SSRIs selectively affect neurotransmitter (the chemicals that send messages to and from the brain) mechanisms in the central nervous system
• Oral administration
• Used to treat mental depression, obsessive-compulsive disorder and panic disorders

Prozac (fluoxetine hydrochloride)

• Antidepressant (SSRI – selective serotonin reuptake inhibitor); SSRIs selectively affect neurotransmitter (the chemicals that send messages to and from the brain) mechanisms in the central nervous system
• Oral administration
• Used to treat mental depression, obsessive-compulsive disorder and panic disorders

Effexor (venlafaxine hydrochloride)

• Antidepressant (unique class of antidepressants called serotonin and norepinephrine reuptake inhibitors; believed to work by increasing neurotransmitter effects in the brain)
• Oral administration
• Used to treat depression.

Wellbutrin (bupropion hydrochloride)

• Antidepressant (structurally unrelated to tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI) and monoamine oxidase inhibitors (MAOI)
• Used to treat major depressive disorders, by increasing the levels of certain nerve transmitters, such as norepinephrine, serotonin and dopamine; it is believed that it also acts as a brain stimulant
• The extended release formulation of this drug is also indicated to help in smoking cessation.

Luvox (fluvoxamine)

• Antidepressant
• Oral administration
• Used in the treatment of depression and for the symptomatic relief of depressive illness, significantly reduces the symptoms of obsessive-compulsive disorder

Despiramine/Norpramin (desipramine hydrochloride)

• Tricyclic antidepressant
• Oral administration
• Used in treatment of endogenous depressive illness, including the depressed phase of manic depressive illness, involutional melancholia and psychotic depression. It may also be indicated in the management of depression of a nonpsychotic degree such as in selected cases of depressive neurosis. Patients with transient mood disturbances or normal grief reaction are not expected to benefit from tricyclic antidepressants. It has also been used to treat cocaine withdrawal, panic disorder and Bulimia Nervosa

Imipramine/Tofranil (imipramine hydrochloride)

• Tricyclic antidepressant
• Oral administration
• Used for relief of depressive illness, panic disorder, chronic pain (from migraines, tension headaches, diabetes, cancer, arthritis), and Bulimia Nervosa

Remeron (mirtazapine)

• Tricyclic antidepressant
• Oral administration
• Used for the symptomatic relief of depressive illness

Xanax (alprazolam)

• Anxiety medication (a type of central nervous system (CNS) depressant or medicine that slows down the nervous system
• Oral administration
• Used to treat anxiety, anxiety associated with depression and panic disorders

Lithium (lithium carbonate)

• Antipsychotic/antimanic
• Oral administration
• Used in the treatment of acute manic episodes in patients with manic-depressive disorders. Maintenance therapy has been found useful in preventing or diminishing the frequency of subsequent relapses in patients with bipolar disorder. It has also been used to treat migraine headaches, bulimia, and alcoholism

Naltrexone / Revia (naltrexone hydrochloride)

• Oral administration
• Used for the treatment of Alcoholism, binge-related Eating Disorders. Naltrexone may also be useful in treating those who are “cutters” or who practice in self-multilation