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An overview of the eating problems among young female students

  • Nobakht and Dezhkam[ 63 ] reported a prevalence of 0;
  • Psychopathological and clinical features of outpatients with an eating disorder not otherwise specified;
  • They may also appear to eat normally in front of peers or family while secretly restricting food intake, bingeing, purging, or over exercising;
  • Slimming exercises practiced No significant change in body weight because of above measures.

Find articles by Pratap Sharan A. Shyam Sundar Find articles by A. This article has been cited by other articles in PMC. Abstract Eating disorders, especially anorexia nervosa and bulimia nervosa have been classically described in young females in Western population. Recent research shows that they are also seen in developing countries including India. The classification of eating disorders has been expanded to include recently described conditions like binge eating disorder. Eating disorders have a multifactorial etiology.

Genetic factor appear to play a major role. Recent advances in neurobiology have improved our understanding of these conditions an overview of the eating problems among young female students may possibly help us develop more effective treatments in future. Premorbid personality appears to play an important role, with differential predisposition for individual disorders. The role of cultural factors in the etiology of these conditions is debated.

Culture may have a pathoplastic effect leading to non-conforming presentations like the non fat-phobic an overview of the eating problems among young female students of anorexia nervosa, which are commonly reported in developing countries. With rapid cultural transformation, the classical forms of these conditions are being described throughout the world. Diagnostic criteria have been modified to accommodate for these myriad presentations.

Nutritional rehabilitation and psychotherapy remains the mainstay of treatment, while pharmacotherapy may be helpful in specific situations. Although recent research has shown that the prevalence in males was previously underestimated, these disorders do have a clear female preponderance.

The overvaluation of slimness, which is commonly seen in Western females, is considered to be an important contributory factor in the pathogenesis of eating disorders. In this chapter, some of the recent research findings in eating disorder are discussed, with emphasis on Indian studies.

As the amount of research in this area in our country is relatively sparse, it is augmented with data from other developing countries. The contribution of research from developing countries in understanding the concept of these disorders and the lacunae in current research are discussed.

The term anorexia nervosa was introduced by William Gull in 1874 to describe four cases of adolescent girls with deliberate weight loss. Some authors[ 5 ] have hypothesized that bulimia nervosa was nonexistent before recent times, and changes in the cultural and economic conditions, such as the rising prosperity and surplus of food, has led to the onset of disorder.

Others[ 9 ] have presented historical cases with probable bulimia nervosa to suggest that the disorder may have existed but may not have been identified in earlier times. However, Keel and Klump,[ 10 ] who reviewed the historical cases systematically, suggest that these were closer to binge eating disorder BED ; and that bulimia nervosa is probably a culture-bound syndrome of recent origin. In the developing countries, anorexia nervosa was rarely reported till the 1970s and 1980s.

Bulimia nervosa is subtyped into purging and nonpurging type. Studies have shown that the majority of the patients with eating disorders fit into the redundant category of eating disorder not otherwise specified EDNOS.

ICD 10 partly circumvents this problem by including subsyndromal forms of the disorders as atypical anorexia nervosa and atypical bulimia nervosa.

Recent research is geared towards finding clinically useful and nosologically valid entities within the EDNOS group; e. Purging disorder is seen in individuals of normal weight who self-induce vomiting or purge by laxatives in the absence of binge eating.

Night eating syndrome is characterized by eating large quantities of food in the night time associated with sleeplessness and morning anorexia.

Innovations in the nosology of eating disorders are expected from the future classificatory systems. Indeed, there is scant evidence that obesity, in general, is caused by mental dysfunction. It is considered useful because it is clear and objective. But studies have reported that there are many patients who meet all clinical criteria for anorexia nervosa except for that of amenorrhea. Most of the differences between patients with and without amenorrhea seem to reflect the nutritional status of the patient, rather than any core pathology.

So, various authors have advocated for the removal of amenorrhea as an essential criteria for the diagnosis of anorexia nervosa. Less than one-half of the patients were found to report fat phobia at any time during their illness. Instead, weight loss was primarily attributed to stomach bloating, loss of appetite, fear of food, or simply eating less.

Furthermore, endorsement of a fat phobia can emerge during treatment. However, due to its frequent presentation in various countries, they suggest its inclusion as a common presentation of EDNOS to enhance its clinical detection.

Most of the criteria share the following essential features: The essential psychopathology seems tightly linked to overvalued beliefs, primarily the overvaluation of thinness. The drive for thinness as a psychopathological motif has been emphasized more by Americans, beginning with Hilde Bruch, whereas the morbid fear of fatness, the phobic avoidance of normal weight, has been emphasized more by the British[ 1 ] The medical consequences of starvation: For example endocrine dysfunction manifested as amenorrhea in women and loss of sexual potency in men, hypothermia, bradycardia, orthostasis and severely reduced body fat stores, etc Anorexia nervosa is often, but not always, associated with disturbances of body image, the perception that one is distressingly large despite obvious medical starvation.

The distortion of body image is disturbing when present, but not pathognomonic, invariable, or required an overview of the eating problems among young female students diagnosis. Bulimia nervosa The ICD 10[ 14 ] enlists the following criteria for bulimia nervosa: Self-induced vomiting Self-induced purging Alternating periods of starvation Use of drugs such as appetite suppressants, thyroid preparations, or diuretics; when bulimia occurs in diabetic patients, they may choose to neglect their insulin treatment.

There is self-perception of being too fat, with an intrusive dread of fatness usually leading to underweight. Patients with bulimia nervosa have a powerful and intractable urge to overeat and have a feeling of lack of control over the episodes of binge eating.

There are controversies as regard to the criteria for what constitutes a binge. Some focus on the quantity of food taken, some on the subjective state of the person and others on the rapid rate of eating. These disorders can be differentiated by the presence of large amount of weight loss seen in patients of anorexia nervosa. Related features include eating until uncomfortably full, eating when not physically hungry, eating alone and feelings of depression or guilt.

Although it is not limited to obese individuals, it is most common in this group and those who seek help do so for treatment of overweight rather than for binge eating.

It has a more equal gender ratio than bulimia nervosa. Anxiety disorders often have their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa.

In the setting of an eating disorder, vulnerable personality traits may be amplified into what appear to be primary personality disorders but are actually secondary personality disturbances. In patients with anorexia nervosa, every major organ system can be involved, and the risk of mortality is substantial.

Particular areas of concern include dermatologic changes some of which evidently need acute intervention; e. In a meta-analysis conducted in 1995 of 42 published studies,[ 44 ] the crude mortality rate was 5. Hence they underestimate the incidence in the community. Eating disorders are among the most gender-divergent disorders in psychiatry, but the divergence is substantially narrower than previously believed.

Eating disorders in women

Previous estimates of the ratio of men to women for eating disorders were typically 1 in 20—1 in 10. Recent community-based epidemiological studies, however, found ratios of approximately 3 to 1 for both anorexia nervosa and bulimia nervosa. Nobakht and Dezhkam[ 63 ] reported a prevalence of 0. Surveys among high school students found a prevalence of 0. The authors hypothesize that bulimia is more culturally dependent than anorexia nervosa. Although this theory was soon disproved, a variety of subsequent theories have been advanced focusing on putative biological underpinnings - for example, the hypothesis that some predisposing hypothalamic abnormality exists, evidenced by amenorrhea.

However, recent evidence suggests that the endocrine abnormalities occur as a consequence of starvation. Recent evidence has shown a strong genetic contribution to the etiology of eating disorders. Twin studies demonstrate a 3 times higher concordance in monozygotic twins compared to dizygotic twins. Large studies have shown consistent but not specific linkage between polymorphic variants of 5-HT 2A receptor gene and the BDNF gene and anorexia nervosa restricting subtype.

Contemporary theories have pointed to putative serotonin mechanisms, based on observations that individuals with anorexia nervosa have abnormal cerebrospinal fluid serotonin levels when ill, that may not completely reverse on partial weight gain. Neuroimaging studies suggest that white matter and gray matter volume losses occur in eating disorders, but these remit with recovery.

Studies have implicated cingulate, frontal, temporal, and parietal regions in anorexia nervosa. Functional studies suggest that challenges such as food and body image distortions may activate some of these regions. These disturbances persist after recovery from anorexia nervosa, raising the possibility that these traits may be a part of the vulnerability to develop an eating disorder. However, they were replaced by formulations emphasizing maturational and existential fears; with restricting type anorexia nervosa being hypothesized as providing an escape from onrushing negative visions of the emerging sexuality and other biological and social challenges of adolescence.

Presence in childhood of traits such as perfectionism, rigidity, and being rule-bound each increase the risk of subsequently developing anorexia nervosa by a factor of nearly seven. Trauma during childhood or adolescence contributes to the likelihood of later psychiatric disorders, in general, not specifically an eating disorder. Investigators are beginning to identify endophenotypes have like poor set shifting and weak central coherence the help of family studies.

Many of the cases from non-Western countries have been found to lack weight concerns. The view that eating disorders are etiologically related to the internalization of the social pressure resulting from the standards of female beauty of the modern industrial society or Western culture holds a dominant position in the current discourse around etiology of eating disorders. Lee[ 78 ] suggests that admiration of thinness is not inherent to non-Western cultures.

Subjects from India, Oman and the Philippines demonstrated eating attitudes that were similar to or worse than subjects from Western countries and Japan, but their desire for thinness was not as strong.

The study showed that although non-Western cultures have disordered eating behavior, it may be motivated by reasons other than body dissatisfaction. However globalization and exposure to Western media may increase the rate of eating disorders in non-Western countries. Recent studies from Fiji suggest that the introduction of popular television programs highlighting slimness and stigmatizing obesity launched widespread dieting behavior and led to the emergence of new cases of eating disorders in populations that were previously unconcerned with these issues.

It was hypothesized that difficulties in integration into the Western an overview of the eating problems among young female students led to the disordered eating behavior. However, even this evidence points to an overview of the eating problems among young female students importance of cultural factors in the pathogenesis of eating disorders, even as it clarifies that more than one cultural factor may play a role.

Some cases of eating disorder are hypothesized to be a caused and maintained by family pathology. The management of eating disorders begins with forming of a therapeutic alliance, followed by a comprehensive psychiatric and medical evaluation including body mass index. The need for laboratory analyses should be determined on an individual basis. Bone density examinations should be obtained for patients who have been amenorrheic for 6 months or more.

Treatment planning requires matching the intensity of treatment to the severity of illness. The methods of treatment include medical, nutritional, educational, psychotherapeutic, behavioral, and pharmacological components. Caloric intake should be carefully tailored to avoid refeeding syndrome. Available evidence shows that fluoxetine may be beneficial in relapse prevention of anorexia nervosa after weight restoration.