module B55 relief and nutrition in disasters, crises and for populations at risk: hunger – a global challenge eating disorders and biological psychiatry short introduction into psychiatric symptomatology major depression (psychotic type) bipolar psychosis, manic phase dysthymia (depressive symptoms) anxiety disorder obsessive-compulsive personality disorder schizophrenia with •loss of contact with reality •hallucinations •delusions •flattened affect •cognitive deficits •and social dysfunction anorexia nervosa: loss of contact with reality? hallucinations? delusions? flattened affect? cognitive deficits? and social dysfunction? Mortality and recovery rates Without treatment, up to twenty percent (20%) of people with serious eating disorders die. With treatment, that number falls to two to three percent (2-3%). In 2005, Dr. Wright of the Eating Disorders Program at Presbyterian Hospital in Dallas, Texas indicated that the mortality rate for untreated anorexia nervosa may be even higher, up to 25 percent. source: With treatment, about sixty percent (60%) of people with eating disorders recover. They maintain healthy weight. They eat a varied diet of normal foods and do not choose exclusively low-cal and non-fat items. They participate in friendships and romantic relationships. They create families and careers. Many say they feel they are stronger and more competent in life than they would have been if they had not developed confidence in themseles by conquering the disorder. In spite of treatment, about twenty percent (20%) of people with eating disorders make only partial recoveries. They remain too much focused on food and weight. They participate only superficially in friendships and romantic relationships. They may hold jobs but seldom have meaningful careers. Much of each paycheck goes to diet books, laxatives, jazzercise classes, and binge food. The remaining twenty percent (20%) do not improve, even with treatment. They are seen repeatedly in emergency rooms, eating disorders programs, and mental health clinics. Their routinely desperate lives revolve around food and weight concerns, spiraling down into depression, anxiety loneliness, and feelings of helplessness and hopelessness. Eating disorders in Western and non-Western countries In a study reported in Medscape's General Medicine 6(3) 2004, prevalence rates in Western countries for anorexia nervosa ranged from 0.1% to 5.7% in female subjects. Prevalence rates for bulimia nervosa ranged from 0% to 2.1% in males and from 0.3% to 7.3% in female subjects. Prevalence rates in non-Western countries for bulimia nervosa ranged from 0.46% to 3.2% in female subjects. Studies of eating attitudes indicate abnormal eating attitudes in non- Western countries have been gradually increasing, presumably because of the influence, at least in part, of Western media: movies, TV shows, and magazines. Researchers conclude that the prevalence of eating disorders in non-Western countries is lower than that of Western countries, but it appears to be increasing. The better-known eating disorders Anorexia nervosa: the relentless pursuit of thinness Person• refuses to maintain normal body weight for age and height. Weighs• 85% or less than what is developmentally expected for age and height. Young• girls do not begin to menstruate at the appropriate age. Puberty is delayed in• both sexes. In• women, menstrual periods stop. In men, levels of sex hormones fall. Sex drive disappears or• is much diminished. Person• denies the dangers of low weight. Is• terrified of becoming fat. I• s terrified of gaining weight even though s/he is alarmingly underweight. Reports• feeling fat even when emaciated. In• addition, anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories. Person may have low tolerance for change and new situations; may fear growing up and assuming adult responsibilities and an adult lifestyle. May be overly engaged with or dependent on parents or family. Dieting may represent avoidance of, or attempts to cope with, the demands of a new life stage such as adolescence or adulthood. Bulimia nervosa: the diet-binge-purge disorder Person• diets, becomes hungry, and then binge eats in response to powerful cravings• and feelings of deprivation. Feels• out of control while eating. Fears• gaining weight and frantically tries to "undo" the binge. Vomits, abuses laxatives, • exercises, or fasts to get rid of the calories. Swears• to "be good," to never binge eat again, but then continues to restrict food intake which starts yet another repeat of the deprivation-hunger-binge-purge cycle. Believes• self-worth requires being thin. (It does not.) May• shoplift, be promiscuous, and abuse alcohol, drugs and credit cards. May engage in risk-taking behavior and have other problems with impulse control. Person acts with little thought of consequences. Weight• may be normal or near normal unless anorexia is also present. Like• anorexia, bulimia can kill. Even though bulimics put up a brave front, they are often depressed, lonely, ashamed, and empty inside. Friends may describe them as competent, glamorous, adventurous and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeling unworthy, they have great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger. Binge eating disorder The• person binge eats large amounts of food frequently and repeatedly. Feels• out of control and unable to stop eating during binges. May• eat rapidly and secretly, or may snack and nibble all day long. Feels• guilty and ashamed of binge eating. Has• a history of diet failures Tends• to be depressed and obese. People• who have binge eating disorder do not regularly vomit, overexercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger. Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse. Information reported in the March 2003 New England Journal of Medicine suggests that for some people, but not all, a genetic flaw in combination with lifestyle factors can predispose to binge eating and subsequent obesity. ED-NOS: Eating disorders not otherwise specified An• official diagnosis. The phrase describes atypical eating disorders. Includes• situations in which a person meets all but a few of the criteria for a particular diagnosis. What• the person is doing with regard to food and weight is neither normal nor healthy. Less-well-known eating disorders and related problems Purging disorder Not• yet a formal diagnosis, but seems to be separate from bulimia nervosa. At present, falls into the category of "Eating disorder not otherwise specified: EDNOS." The• person purges (vomits, abuses laxatives, diuretics, emetics, etc.) but does not binge eat. Person• maintains normal or near normal weight. Researchers• suspect that purging disorder may be more common than anorexia nervosa and bulimia combined. There• is a scholarly discussion of purging disorder in the International Journal of Eating Disorders 2005; 38:191- 100. A public librarian or a research librarian in your school or local hospital can tell you how to obtain a copy. Anorexia athletica (compulsive exercising) Not• a formal diagnosis. The behaviors are usually a part of anorexia nervosa, bulimia, or obsessive-compulsive disorder. The• person repeatedly exercises beyond the requirements for good health. May• be a fanatic about weight and diet. Steals• time to exercise from work, school, and relationships. Strives• to achieve and master ever more difficult challenges. Forgets that physical activity can be fun. Defines• self-worth in terms of performance Is• rarely or never satisfied with athletic achievements. Small satisfactions are fleeting. Does not savor victory but pushes on to the next challenge immediately. Justifies• excessive behavior by defining self as a dedicated or elite athlete. Compulsive• exercising is not an official diagnosis as are anorexia, bulimia, and binge eating disorder. We include it here because many people who are preoccupied with food and body size exercise compulsively in attempts to control weight. The real issues are not weight and performance excellence but rather control and self-respect. For more information, go to Athletes With Eating Disorders and Males and Females and Obligatory Exercise Body dysmorphic disorder People• with BDD are excessively concerned about appearance, in particular perceived flaws of face, hair, and skin. They are convinced these flaws exist in spite of reassurances from friends and family members who usually can see nothing to justify such intense worry and anxiety. The• person with an eating disorder says, "I am so fat." The person with BDD says, "I am so ugly." BDD• often includes social phobias. Sufferers are shy and withdrawn in new situations and with unfamiliar people. BDD• affects about two percent of the people in the United States. It strikes males and females equally. Seventy percent of cases appear before age eighteen. BDD• sufferers are at elevated risk for despair and suicide. In some cases