"The 4 P's" of Eating Disorders
Eating disorders are medical/psychiatric conditions that requires treatment from health care professionals trained in this specialty. One way to understand an eating disorder and other conditions that effect behavior, thoughts and mental state is to understand the “The 4 P’s."
1) PREDISPOSING FACTORS
Eating disorders and many other mental health conditions are thought to have underlying genetic factorsinherited at birth much in the same way that eye and hair color are determined by genetics.Specific regions on human chromosomes have been identified as potential “markers” that may predispose one to developing an eating disorder. Several studies have also estimated that heritability may contribute 28-84% of the susceptibility for the onset of an eating disorder. The bottom line is that genetics may make one person more prone to developing an eating disorder than another person with different genetics. that are
2) PRECIPITATING FACTORS
Just because a person inherits the genetic properties that may make them prone to a certain illness, does not mean they will get that illness. It is believed that may people may be genetically prone to conditions such as heart disease. Still, if they eat healthy, exercise, avoid tobacco and toxic substances and generally take care of themselves, they may never develop the illness. Likewise with eating disorders, there are certain types of stressors and triggering events that can “set-off” disordered eating patterns in an individual such as a history of trauma, drive for perfectionism, fear of failure, and dysfunctional family systems to name a few, can be factors that precipitate the onset of an eating disorder.
3) PERPETUATING FACTORS
Perpetuating factors are conditions and situations that can support and maintain disordered eating behaviors and patterns. Perpetuating factors may include environmental stressorsmay be of a biological nature such as changes that occur in the brain and central nervous system such as changes in neurotransmitters or even with the brain anatomy itself. Just as biology can effect environment, the environment can alter biology. such as difficult interpersonal relationships or they
4) PRESCRIPTION
The prescription for an eating disorder is the treatment plan. With many eating disorder patientsthe prescription includes physician based treatment working in conjunction with other health care providers including qualified licensed therapists, nutritional consultations, group work, and family therapy at times. A medical physician experienced in eating disorders often monitors vital signs, blood and urine chemistries, cardiac and gastrointestinal functioning and, at times, prescribes medications when indicated for co-existing medical or psychiatric conditions. Part of the prescription also involves helping the patient with emotional states associated with the significant distress found with eating disorders and psychotherapist often utilize cognitive behavioral therapy in treatment.Perhaps the most important part of the prescription is making sure that all involved in the treatment are very well trained and experienced with working with eating disorders. And while many people who suffer from an eating disorder share some common feelings, obsessive thoughts and troubling behaviors, each individual has their own combination of the “4 P’s” which makes their condition unique to them.
Facts about Eating Disorders & Body Dysmorphic Disorder
(Source: The Biology of Eating Disorders (DeSarbo) )
* Anorexia nervosa is present in about 1-2.2% of the general population.
* Bulimia nervosa is present in about 1-2% of the general population with 5-10% having some symptoms.
* Binge eating disorder is present in about 1-5% of the general population.
* Body dysmorphic disorder (BDD) is found in about 7-12% of the general population.
* About 7-12% of patients undergoing plastic surgery suffer from BDD, and in follow-up studies had greater BDD issues after surgery.
* The typical person who has an eating disorder is often intelligent, perfectionistic, and usually from a family of middle to high socioeconomic status.
* Eating disorders have the highest mortality rate of any psychiatric disorder (10-15%).
* In deaths related to eating disorders, about 50% are from medical complications and the other 50% are from suicide.
* Females account for about 90% of the cases of eating disorders.
* Nearly 70-80% of individuals with eating disorders also have another related psychiatric condition (i.e. depression, anxiety, OCD, post-traumatic stress disorder, ect.)
* Nearly 30% of individuals with an eating disorder may have coexisting alcohol or illicit substance use issues.
What is an Eating Disorder? Criteria for Diagnosis
Eating disorders can present in a variety of forms and symptoms. While many eating disorders fit specific criteria for a medical diagnosis, many forms of disordered eating patterns can present which do not meet specific medical criteria yet cause significant distress and disturbances to one's life.
ANOREXIA NERVOSA
Anorexia nervosa (AN) is a disorder in which individuals exhibit significant weight loss and extreme restrictions in their food intake.
Specific criteria for the diagnosis of anorexia nervosa currently includes:
• Weight loss and refusal to maintain what is considered a normal body weight for that
person’s age and height (minimally 85% of expected normal weight).
• Intense fear of gaining weight despite being belowexpected weight.
• Distorted view or denial of their actual body weight and/or shape.
• Loss of menstrual cycle. (May be eliminated in the 2013 edition of the DSM-V)
Anorexia nervosa is currentlyspecified into two types:
1. Restricting Type:
Categorized assevere restriction of food intake with the absence of binge-eating or purging.
2. Binge/Purge Type:
Categorized as engaging in binge eating or purging behavior while exhibiting behaviors classified asanorexia. Purging is characterized as a way to eliminate food from your body either through
self-induced vomiting, excessive exercise, or through laxatives, diuretics, or enemas.
In addition to the diagnostic criteria, the following are considered warning signs, or possible precursors, of anorexia nervosa:
• Restricting certain types of food and the amount of food intake.
• Preoccupation with weight, body shape, and the calorie and fat content of food.
• Dramatic weight loss.
• Excessive exercise.
• Distress over body weight and shape.
• Withdrawal from previously enjoyed activities, and from family and friends.
Bulimia Nervosa
Bulimia nervosa (BN) is a disorder in which individuals eat excessive amounts of food in a short period of time and then feels the need to eliminate this food (or calories) from their body through some type of purging behavior. It is estimated that 1.1 to 4.2% of the female population suffers from BN.
Criteria for diagnosis of bulimia nervosa currently includes:
• Recurring episodes of binge eating, characterized as an uncontrollable consumption of food in a short
period of time.
• Episodes of purging behavior following binging episode in which the individual tries to prevent weight
gain through self-induced vomiting, laxatives, diuretics, enemas, fasting, or excessive exercise.
• Self-evaluation is influenced by weight and body shape.
Bulimia nervosa is currently specified into two types:
1. Purging Type:
Characterized by self-induced vomiting or through the use of laxatives, diuretics, or enemas.
2. Nonpurging Type:
Characterized by fasting or excessive exercise is the compensatory behavior that is
used to prevent weight gain.
Other Disordered Eating Patterns:
Binge Eating Disorder (BED)
Consuming large quantities of food in a short amount of time and feeling a lack of control in the process.
Compulsive Overeating
Eating excessive amounts of food frequently throughout the day or at specific times of the day.
Night Eating Syndrome
Waking up during sleep and compulsively eating usually not remembering the event the next day.
PICA
Pica isthe persistent eating of nonnutritive substancesat an age wherethe behavior may
be consideredinappropriate. Individuals with pica have been reported to mouth and/or
ingest a wide variety of nonfood substances, including, but not limited to, clay, dirt, sand,
stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice,
foam rubber, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.
