Eating Disorders In Social Work
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CHOP Presentation on Eating Disorders
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Based on diagnostic interview data from the National Comorbidity Survey Replication NCS-R , median age of onset was 21 years-old for binge eating disorder and 18 years-old for both bulimia nervosa and anorexia nervosa. Based on diagnostic interview data from the NCS-R, the data below indicate the past year prevalence of each type of eating disorder among U. Statistics NIMH statistics pages include statistics on the prevalence, treatment, and costs of mental illness for the population of the United States. Help for Mental Illnesses If you or someone you know has a mental illness, there are ways to get help. Clinical Trials If you or a friend or family member are thinking about taking part in clinical research, this page contains basic information about clinical trials.
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Share Page. Eating Disorders. Definitions Binge Eating Disorder Binge eating disorder is characterized by recurrent binge eating episodes during which a person feels a loss of control and marked distress over his or her eating. Unlike bulimia nervosa, binge eating episodes are not followed by purging, excessive exercise or fasting. As a result, people with binge eating disorder often are overweight or obese. Bulimia Nervosa Bulimia nervosa is characterized by binge eating eating large amounts of food in a short time, along with the sense of a loss of control followed by a type of behavior that compensates for the binge, such as purging e.
Unlike anorexia nervosa, people with bulimia can fall within the normal range for their weight. But like people with anorexia, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Anorexia Nervosa Anorexia nervosa is characterized by a significant and persistent reduction in food intake leading to extremely low body weight in the context of age, sex, and physical health; a relentless pursuit of thinness; a distortion of body image and intense fear of gaining weight; and extremely disturbed eating behavior.
Many people with anorexia see themselves as overweight, even when they are starved or severely malnourished. Age of Onset Based on diagnostic interview data from the National Comorbidity Survey Replication NCS-R , median age of onset was 21 years-old for binge eating disorder and 18 years-old for both bulimia nervosa and anorexia nervosa. The overall prevalence of binge eating disorder was 1.
Prevalence of binge eating disorder was twice as high among females 1. Based on Sheehan Disability Scale associated with past year behavior, The lifetime prevalence of binge eating disorder was 2. Figure 1. Adults Demographic Percent Overall 1. The purpose of the research was to identify the incidence of, and relationship between all substance use and eating pathology. This identified interesting patterns that distinguished males and females. There was a very strong link between mood altering drugs such as cocaine, hallucinogens, crack and heroin and eating disorders in females, but not in males. This and other studies show that bulimia is over represented in alcoholics in both sexes Various studies have looked at the sequential relationship between eating disorders and addictive behaviour to see if one leads to the other or predicts the other.
The evidence suggests that, in males as well as females, the strongest relationship between the two disorders is that eating disorders — especially bulimia, may lead to later substance abuse. However, in some males and females , alcohol dependency will increase the risk of an eating disorder setting in. Many studies do not differentiate between type of eating disorder, gender and type of compulsive or dependent behaviour. Thus we cannot interpret the data fully but we cannot ignore it either. It is possible that men who with eating problems might turn to alcohol to block the distress of their bulimic behaviour, or may use alcohol to try to deaden their appetite.
Recent studies that focused on the course of eating disorders in males and the incidence of co-morbid psychiatric diagnoses, demonstrate remarkable similarities between males and females with eating disorders. Additionally, for women, the diagnosis insists on loss of periods for at least 3 consecutive cycles. This objective criterion — amenorrhea, is lacking in males with anorexia. This makes it harder to recognize anorexia in males.
However most studies report that males and females with anorexia behave and think in very much the same way. Excessive exercising was found to be more frequent and laxative abuse less frequent in the male group than in the female group, which is in agreement with other studies. Studies on age of onset in males disagree, with some saying that men get anorexia later than women. Female anorexia has peak onset in adolescent years, with the vast majority developing the disorder between the ages of 13 and A review article by Sterling and Segal, however, cites a mean age of onset of Puberty occurs, on average 1 to 2 years later in males than in females. This is of interest because puberty in girls heralds the period of highest risk for anorexia.
However puberty may have very different meanings for girls and boys in terms of its relationship to body image. Subcutaneous fat deposition in the breasts, buttocks, hips and other areas that contribute to the mature female contour is a dramatic feature of the pubertal process in females. Males do not experience body fat gain in puberty, in fact the reverse, males tend to lose fat and gain muscle in adolescence.
Studies have noted major differences between males and females in their response to early maturation. Girls who begin puberty early, experience a loss of self-esteem and a higher incidence of self abuse. Conversely, males who mature early gain self worth, social status and emotional strength. The physical outcomes of starvation in men include stunting of growth and decrease in plasma gonadotrophins, which in turn lead to loss of sexual drive.
Men get osteoporosis too. When males with anorexia regain their weight, the increase in plasma leuteinising factor boosts hormone and testosterone levels, kindling physical and emotional puberty. Weight gain in growing females changes the physiology in similar ways and at similar thresholds of pre-illness weight. Some psychotherapists believe that anorexia in men is atypical — a flight from their feminine side which has not been adequately integrated into the psyche during the course of their development — and which is represented by their body fat. The male body, parodied into an ultra lean frame, could be the last refuge for men who are trying to hang on to certain masculine distinctions in a world where female working and sexual roles can undermine male confidence.
Men with anorexia, as already described, have similar problems with self regard and emotional resilience as do women. Bulimia nervosa is a disorder of binge eating and inappropriate compensatory methods to prevent weight gain. The behaviour in bulimia may take the form of vomiting, laxative, diuretic abuse or excessive exercise. Bulimics tend to be unduly influenced by their body weight and shape and have strange ideas of how much it is appropriate to eat. The mean age of onset for bulimia is between 18 and 26 for males, compared to age in females. However, larger studies are needed to confirm that men tend to get bulimia at an older age than women.
Males with bulimia have a high prevalence of depression, anxiety disorder substance abuse and personality disorder; particularly cluster B personality disorders — i. This is exactly the same as in females. Binge Eating Disorder exists when there are recurrent episodes of binge eating without compensatory behaviours, except for dieting. Binge eating is defined as eating within a discrete period of time e. People who binge feel out of control around food some of the time both before and during an eating event. Over-evaluation of shape and weight are part of the disorder.
In the absence of good quality research we estimate that binge eating among males could be as common as it is among women in the community at large. People who binge but do not purge usually struggle with their weight, and there are certainly as many overweight males as there are females. Males seem to be less bothered about binge eating. This may explain why they are less inclined to purge and less inclined to address it by, for example, heading off to slimming clubs or going to the GP to demand a diet pill.
They are also less scared of the effects of a high calorie meal. However, the obsessive behaviours and abuse of chemicals, hormones and steroids in pursuance of this goal may cripple both physical and emotional health. The disorder goes largely unrecognised and untreated. Muscle Dysmorphia is, like anorexia, a perceptual disturbance of the body which is, in this case, considered too thin, too puny and too flabby.
The consequence of this perceptual disturbance is the adoption of harmful weight and shape control practices. These usually involve a change of diet which is also harmful, such as purging if the man eats fat. Thus the condition may morph from a body dysmorphic disorder into an eating disorder. Men with Muscle Dysmorphia are similar to men with anorexia. They are likely to compare themselves constantly and critically to men with more muscle in the same way as the male anorexic compares himself to males who are leaner. They are perfectionist, obsessive, anxious and usually have low self esteem. The sufferer is likely to seek supplements which boost muscle size and seek illegal anabolic steroids or other hormones which will help them to lose fat and bulk up muscle.
They may cut out major food groups such as fat and overdose on protein. Dietary chaos and nutritional deficiencies often lead to reactive binge eating and it is not unusual for sufferers to purge so that they will not gain fat. The similarities between male anorexia and the Adonis complex is that they may be opposing expressions of the same condition. In both, there is denial of a problem and a relentless pursuit of perfection. Even if men admit to either of these problems, there is a double taboo.
Reluctance to talk about personal difficulties and a self esteem penalty for even having feelings about the appearance of the body. Current theory suggests that males respond to the same treatment for eating disorders as females. Therapy for eating disorder must be holistic, embracing physical, psychological and interpersonal interventions. There are no good quality studies which would help us to identify extra aspects of treatment which would be helpful to men. They may, for example, prefer a male therapist while women prefer females by and large who they feel are more sympathetic to their concerns.
Men also benefit from social support, although one major problem is that eating disorder settings and services usually have a very high ratio of female patients. Many men are reluctant to join groups which are largely composed of women who may be talking about Kate Moss rather than a male athlete. Even so, a group can be good in helping a man to confront the self esteem issues that may have led him into his problem. So it is helpful to persuade a male sufferer to give it a go. Antidepressants are of variable value in treating bulimia, however, there are no published studies on whether they are particularly useful for males.
This is compounded by a tendency for eating disorders in males to go unrecognised or undiagnosed, due to reluctance among males to seek treatment for these stereotypically female conditions. This may now be changing due to increased public information and awareness. More work needs to be done to identify treatment approaches which are especially helpful to males, as well as prevention strategies which will help males as well as females maintain a balanced relationship with food.
If you have answered YES to two or more of these questions you may have an eating disorder. Self-Help is one useful treatment approach and sufferers as well as therapists will benefit from learning more about eating disorders in men. Statistics It is very hard to know how many men suffer from an eating disorder at any one time. Eating Disorders In General A great deal of attention has been devoted to the subject of eating disorders and the number of publications on anorexia nervosa and binge eating disorder has grown exponentially during the last half century. Men And Boys Get Eating Disorders Too Culturally, men are celebrated for what they can achieve and conquer, while women are valued for their appearance.
Men do worry about their appearance but: They favour a fit healthy ideal with a v-shaped back rather than a skinny frame. For men there is a social penalty for being underweight. They do not want to look slimmer than other males as women strive to be thinner than other women. They tend not to view themselves as fat unless they are fatter than most males around them while women of all weights tend to feel fat as default.
They are concerned with their stomach, hair and genital size while women are sensitive about their hips and thighs. When the average male looks in a mirror they largely perceive an image which is fairly accurate in shape and size, while women see an image which is larger than they really are. Media images which are iconic for males are strong and muscled, or lean and sporty while for women they are pathologically thin with surgically enhanced breasts.
With regard to ideal shape, men in studies reliably select the ideal shape that is bigger more powerful than they are. So it would seem that although males and females share a culture in which there are strong pressures to attain an appearance which is aesthetically pleasurable and appropriate, there are still some differences in gendered receptivity to these pressures. However, males can and do get eating disorders too. The presence of an eating disorder in a man can often be traced to a specific trigger: Being bullied or criticised for being overweight Comments from an athletic coach Being in a sport which requires extreme weight control Illness and loss at home A relationship breakdown Not coping with pressures, such as exams A career change Unbearable pressure at work.
Possible Risk Factors. Anorexia Nervosa Recent studies that focused on the course of eating disorders in males and the incidence of co-morbid psychiatric diagnoses, demonstrate remarkable similarities between males and females with eating disorders. Age Of Onset Studies on age of onset in males disagree, with some saying that men get anorexia later than women. Physiology Of Males With Anorexia The physical outcomes of starvation in men include stunting of growth and decrease in plasma gonadotrophins, which in turn lead to loss of sexual drive.
Psychological Explanations Some psychotherapists believe that anorexia in men is atypical — a flight from their feminine side which has not been adequately integrated into the psyche during the course of their development — and which is represented by their body fat. Bulimia Nervosa In Males Bulimia nervosa is a disorder of binge eating and inappropriate compensatory methods to prevent weight gain. Age Of Onset The mean age of onset for bulimia is between 18 and 26 for males, compared to age in females. Females Males with bulimia have a high prevalence of depression, anxiety disorder substance abuse and personality disorder; particularly cluster B personality disorders — i. Binge Eating Disorder In Males Binge Eating Disorder exists when there are recurrent episodes of binge eating without compensatory behaviours, except for dieting.
Personality Men with Muscle Dysmorphia are similar to men with anorexia. Treating Eating Disorders In Males Current theory suggests that males respond to the same treatment for eating disorders as females. Are you a male with an Eating-disorder? Does eating play great significance in your life?