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Eating disorders - Anorexia nervosa - Bulimia nervosa - Binge eating disorder
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Eating disorders - Anorexia nervosa - Bulimia nervosa - Binge eating disorder


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Doctors aren't sure of the exact causes of eating disorders. It appears that a variety of factors are involved, including genetics, family behavior and culture. In some instances, the biological systems in the brain that govern mood and appetite develop abnormalities.

Part of the explanation may also be the messages that the media in modern, economically developed nations send to young people, particularly females. These messages are that excessive thinness is attractive. To be as thin as some teen idols and models requires some people to achieve and maintain a weight that's not healthy. Although it's possible for some idols and models to be both thin and healthy, the trouble arises when some young people aren't able to sustain those body shapes without an unhealthy — for them — amount of weight suppression.

For some young people, the media message of thinness contributes to a distorted body image. A bright, high-achieving 14-year-old who is rational in every other way may come to believe that 90 pounds is the ideal weight for her 5-foot-4-inch frame, when 110 pounds is actually the average weight for a girl that age. Gradually, she may begin skipping meals, denying herself the fuel her body needs to develop normally. She may get thinner and thinner, but still believe she is fat. Eventually, she may become so undernourished that she needs to be admitted to the hospital for anorexia.

Risk factors

These factors may increase the risk of an eating disorder:

  • Gender. Teenage girls and young women are more likely than teenage boys and young men to develop eating disorders, though eating disorders do occur in teenage boys and young men.

  • Age. Although eating disorders can occur in midlife, they are much more common during the teens and 20s.

  • Family influences. People who feel less secure in their families, whose parents and siblings may be overly critical, are at higher risk of eating disorders.

  • Heredity. Eating disorders may be more common in people who have close family members with eating disorders.

  • Emotional disorders. People with depression, anxiety disorders and obsessive-compulsive disorder are more likely to have an eating disorder. People with anorexia tend to have perfectionist traits. Some with bulimia have problems with impulse control.

  • Excessive exercise. People who participate in highly competitive athletic activities are at greater risk of developing an eating disorder. At particular risk of anorexia are females in sports such as gymnastics, figure skating and track.

When to seek medical advice

If you have severe weight loss or if you find yourself alternating between binge eating and strict dieting, talk to your doctor to see if you have an eating disorder. Because denial often is a part of eating disorders, seeking medical advice may come only at the insistence of a family member or friend. If you notice the signs and symptoms of eating disorders in a family member or friend, urge that person to talk to a doctor.

Screening and diagnosis

Your doctor likely will perform a physical examination and ask you a number of questions about your eating habits and medical history. The questions your doctor asks may include your history of dieting and binge eating, whether you self-induce vomiting or use laxatives, your exercise routine, how you perceive your body image, and how you think others perceive your body image. Doctors diagnose eating disorders based on symptoms and eating habits.

Besides recording your weight, a physical exam will help determine if you're suffering from any of the side effects of an eating disorder. These complications may include problems with your gums or teeth, bloating, unusual heart rhythms, loss of bone density, anemia and changes in your menstrual cycle. Your doctor may order these tests:

  • Complete blood count (CBC). This test can signal the presence of a wide variety of health problems, including anemia. One substance measured by this blood test is hemoglobin. Hemoglobin is the red, iron-rich substance that binds to oxygen to carry it throughout your bloodstream.

  • Electrocardiogram. This procedure measures the pattern of electrical impulses generated in your heart. The test can help identify heart damage and irregular heart rhythms. The procedure involves attaching electrodes to your skin on your chest. The electrodes detect electrical impulses, and the impulses are recorded on a graph.

  • Chest X-ray. An image of your heart generated by an X-ray may reveal whether anorexia has damaged your heart muscles by reducing the size of your heart.

  • Other imaging tests. Tests such as a computerized tomography (CT) scan may reveal damage to your brain or digestive tract.

  •  Bone density test. Your doctor uses a device called a sonometer to pass painless sound waves through your bones to measure bone density.

  • Tests of the function of various organs. Your doctor may order more extensive blood tests to detect your blood levels of hormones, enzymes, proteins, electrolytes, vitamins and other substances to gauge the performance of various organs, such as your liver, kidney, thyroid, pituitary gland and ovaries.

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