This paper examines five major eating disorders — anorexia nervosa, bulimia nervosa, binge-eating disorder, night eating syndrome, and eating disorder not otherwise specified (EDNOS) — drawing primarily on Sim et al. (2010). For each disorder, the paper outlines diagnostic criteria, prevalence, subtypes, physical signs, and clinical outcomes. A discussion section synthesizes research on psychological and social causes, including body dissatisfaction, identity development, family dynamics, cognitive distortions, and the relationship between eating disorders and conditions such as depression and obsessive-compulsive disorder. The paper concludes by arguing that full recovery must address physical, behavioral, and psychological dimensions simultaneously.
Eating disorders are psychological illnesses associated with a host of adverse medical conditions, negative psychological effects, and substantial reductions in quality of life. According to Leslie Sim et al. (2010), the main eating disorders are anorexia nervosa, bulimia nervosa, binge-eating disorder, night eating syndrome, and eating disorder not otherwise specified. This paper explores some of the causes research has attributed to these conditions.
Anorexia nervosa is described as abnormally low body weight — at least 15% below what would be expected — accompanied by a corresponding fear of weight gain and an undue emphasis on weight and shape in self-evaluation. The incidence of anorexia nervosa is approximately 0.5% to 1% and is highest among adolescent girls and young women.
Anorexia nervosa can be classified into two subtypes: the restricting subtype and the binge-eating/purging subtype. Patients with anorexia nervosa who rarely binge-eat or purge but maintain a fairly regular pattern of caloric restriction may be classified as having the restricting subtype. Those who regularly engage in binge eating and/or compensatory behavior to prevent weight gain may be diagnosed with the binge-eating/purging subtype. Many of those with the restricting subtype will eventually develop binge eating, with at least one-third of patients crossing over into bulimia nervosa. This crossover typically occurs within the first five years of the illness. Women with anorexia nervosa who develop bulimia nervosa are likely to relapse back into anorexia nervosa.
Unfortunately, outcomes for patients diagnosed with anorexia nervosa are poor. There is only a 35% to 85% recovery rate and a protracted recovery period ranging from 57 to 79 months. Furthermore, anorexia nervosa may evolve into a chronic condition and is one of the most medically serious psychiatric disorders. Individuals with this condition are affected not only by the physical consequences of severe weight loss, but also by psychological comorbid conditions that contribute to mortality. Suicides represent a large portion of deaths from anorexia nervosa. Depression, a consequence of poor caloric intake and low weight, is frequently observed with this condition. Anxiety symptoms are also common and often precede the development of the illness.
The negative effect of anorexia nervosa on patients' long-term physical health is well documented. This condition most commonly affects women during the period of peak bone mass development, and the effects on the skeletal system can be severe and debilitating (Sim et al., 2010).
Bulimia nervosa has a higher occurrence among women than anorexia nervosa. The disorder is typically found in women aged 16 to 22 years; however, older individuals may also be affected. Bulimia nervosa can also be classified into two subtypes. The purging type is characterized by episodes of binge eating followed by compensatory behavior, such as self-induced vomiting, laxative abuse, and diuretic abuse. The non-purging type is characterized by excessive exercise, fasting, and/or strict dieting. As with anorexia nervosa, patients with bulimia nervosa may place undue emphasis on their body shape and live in fear of gaining weight.
Binge eating and purging occurring in the context of low weight and amenorrhea indicate anorexia nervosa. Although crossover from anorexia nervosa to bulimia nervosa is common, crossover from bulimia nervosa to anorexia nervosa is relatively rare unless the patient was originally diagnosed with anorexia nervosa. Findings during an initial physical examination may not establish the presence of bulimia nervosa. Most patients will be of normal weight; however, calluses or abrasions on the dorsum of the hand caused by repeated contact with the incisors during self-induced vomiting may indicate the condition. Other physical signs include an unexpected frequency of dental caries and enamel erosion from repeated vomiting. Laboratory findings of hypokalemia, metabolic alkalosis, and/or hypochloremia in an otherwise healthy young woman should also prompt further inquiry (Sim et al., 2010).
"Criteria, prevalence, and physical complications"
"DSM catch-all category and clinical examples"
"Identity, cognition, family, and comorbid conditions"
Research by Bardone-Cone et al. (2010) suggests that not assessing psychological recovery may produce a pseudo-recovery state where individuals are "walking the walk but internally talking the same eating disordered talk." The authors define recovery using physical, behavioral, and psychological criteria. Their findings indicate that a positive self-concept is present among those who have recovered from an eating disorder on all three levels — physical, behavioral, and psychological — to the degree that they are indistinguishable from healthy individuals. Those with only physical and behavioral recovery may be considered partially recovered and tend to have self-concepts more similar to those with an active eating disorder.
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