disorder. Other disorders have not been studied enough
to draw any conclusions. Interestingly, serotonin also
helps regulate mood, and low serotonin levels are thought
to play a role in causing depression.
Personality type can also put people at risk for
developing an eating disorder. Low self-worth is com-
mon among all people with eating disorders. Binge
eaters and people with bulimia tend to have problems
with impulse control and anger management. A ten-
dency toward obsessive-compulsive behavior and
black-or-white, all-or-nothing thinking also put peo-
ple at higher risk.
Social and environmental factors also affect the
development and maintenance of eating disorders and
may trigger relapses during recovery. Relationship
conflict, a disordered, unstructured home life, job or
school stress, transition events such as moving or
starting a new job all seems to act as triggers for
some people to begin disordered eating behaviors.
Dieting (nutritional and social stress) is the most com-
mon trigger of all. The United States in the early
twenty-first century is a culture obsessed with thin-
ness. The media constantly send the message through
words and images that being not just thin, but ultra-
thin, is fashionable and desirable. Magazines aimed
mostly at women devote thousands of words every
month to diet and exercise advice that creates a sense
of dissatisfaction, unrealistic goals, and a distorted
body image.Diagnosis
Diagnosis involves four components: a health his-
tory, a physical examination, laboratory tests, and a
mental status evaluation. Health histories tend to be
unreliable, because many people with eating disorders
lie about their eating behavior, purging habits, and
medication abuse. Based on the health history and
physical examination, the physician will order appro-
priate laboratory tests. Mental status can be evaluated
using several different scales. The goal is to get an
accurate assessment of the individuals’s physical con-
dition and her thinking in relationship to self-worth,
body image, and food.Treatment
Treatment depends on the degree to which the
individual’s health is impaired. People with anorexia
or bulimia may need to be hospitalized or attend
structured day programs for an extended period.
Some people are helped with antidepressant medica-
tion, but the mainstay of treatment is psychotherapy.
An appropriate therapy is selected based on the type ofeating disorder and the individual’s psychological pro-
file. Some of the common therapies used in treating
eating disorders include:
Cognitive behavior therapy (CBT) is designed to
confront and then change the individual’s thoughts
and feelings about his or her body and behaviors
toward food, but it does not address why those
thoughts or feelings exist. Strategies to maintain
self-control may be explored. This therapy is rela-
tively short-term. CBT is often the therapy of choice
for people with eating disorders.
Psychodynamic therapy, also called psychoanalytic
therapy, attempts to help the individual gain insight
into the cause of the emotions that trigger their dys-
functional behavior. This therapy tends to be more
long term than CBT.
Interpersonal therapy is short-term therapy that
helps the individual identify specific issues and prob-
lems in relationships. The individual may be asked to
look back at his or her family history to try to recog-
nize problem areas or stresses and work toward
resolving them.
Dialectical behavior therapy consists of structured
private and group sessions in which the therapist
and patient(s) work at reducing behaviors that inter-
fere with quality of life, finding alternate solutions to
current problem situations, and learning to regulate
emotions.
Family and couples therapy is helpful in dealing with
conflict or disorder that may be a factor in perpetu-
ating the eating disorder. Family therapy is especially
useful in helping parents who are anorectics avoid
passing on their attitudes and behaviors on to their
children.Nutrition/Dietetic concerns
Eating disorders result in abnormal nutrition that
can have life-threatening consequences. A nutritionist
or dietitian who can provide nutritional counseling
and healthy meal planning is an essential part of the
treatment team for any eating disorder. However,
nutritional counseling alone will not resolve an eating
disorder.Prognosis
Recovery from eating disorders can be along, dif-
ficult process interrupted by relapses. About half of all
anorectics recover. Up to 20% die of complications of
the disorder. The recovery rate for people with bulimia
is slightly higher. Binge eaters experience many relap-
ses and may have trouble controlling their weight even
if they stop bingeing. Not enough is known about theEating disorders