Eating disorder

Eating disorders can be described as illnesses that are characterized by irregular eating habits and severe distress or concern about body weight or shape. Disturbance in eating can include inadequate or excessive food intake which can ultimately damage an individual’s physical or mental health.

Eating disorders include several diseases such as binge eating disorder, anorexia nervosa, bulimia nervosa, pica, rumination disorder, avoidant/restrictive food intake disorder, and a group of other specified feeding or eating disorders. These disorders do not include obesity.

Binge eating disorder

Binge eating disorder is characterized by the consumption of large amounts of food in a short time, accompanied by the feeling of lack of control, remorse and guilt. 

Anorexia nervosa

Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by a low weight, fear of gaining weight, a strong desire to be thin, and food restriction. 

Many people with anorexia see themselves as overweight even though they are in fact underweight (Pic. 1). Often they weigh themselves frequently, eat only small amounts, and only eat certain foods. Some will exercise excessively, force themselves to vomit, or use laxatives (substances that loosen stools and increase bowel movements) to produce weight loss. 

A person with anorexia nervosa may exhibit a number of signs and symptoms, the type and severity of which may vary and may be present but not readily apparent. 

Symtoms of eating disorders can be divided in two categories- physical and psychological. Firts of all people suffering from anorexia have low body mass index (BMI) for one’s age and height. The weight loss is continuous and very rapid. On the skin there may be lanugo, which is sof, fain hair growing over the face anf body. Anorectic people feel very often cold because the body temperature is lowered in an effort to conserve energy. Hypotension (low blood pressure) and bradycardia (slow heart rate) are common symptoms of anorexia nervosa. Abdomen became more enlarged. Very often patients are vomiting which is associated with bad breath. Skin and hair became thining and dry. Chronig fatigue, muscle aches and tension are very common. After prolonged weight loss women’s menses stop.

Psychological symptoms include fear of even the slightest weight gain, anorectic people are obsessed with counting calories and monitoring fat contents of food. Depression, anxiety and insomnia (a sleep disorder where people have trouble sleeping) may accompany this disease. A lot of people became avoiding friends and family and became more withdrawn and secretive. In severe cases there are habits of self harming or self- loathing. Anorectic people seen themself as overweight, even though they are not.

The cause is not known. 

Bulimia nervosa

Bulimia nervosa is a psychological eating disorder involving cyclical purging following eating (Pic. 2). Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives. Other efforts to lose weight may include the use of diuretics (any substance that promotes the increased production of urine), stimulants, water fasting, or excessive exercise. 

Patients who induce vomiting (Pic. 3), such as those with bulimia nervosa or binge eating-purging type are at risk for acid reflux (Pic. 4). Other possible manifestations are dry lips, burning tongue,parotid gland swelling, and temporomandibular disorders (a problem affecting the 'chewing' muscles and the joints between the lower jaw and the base of the skull).

Most people with bulimia are at a normal weight. Up to 95% of sufferers are women. The peak incidence is in young women. 

Pica

Pica is characterized by an appetite for substances that are largely non-nutritive, such as ice (pagophagia); hair (trichophagia); paper (papyrophagia); drywall or paint; metal (metallophagia); stones (lithophagia) or soil (geophagia); glass (hyalophagia); or feces (coprophagia); and chalk. 

According to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) criteria, for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate, not part of culturally sanctioned practice and sufficiently severe to warrant clinical attention. 

Pica is most commonly seen in pregnant women, small children, and those with developmental disabilities such as autism (a mental condition characterized by great difficulty in communicating and forming relationships with other people). 

Rumination syndrome

Rumination syndrome, or merycism, is an under-diagnosed chronic motility disorder characterized by effortless regurgitation (the expulsion of material from the pharynx, or esophagus, usually characterized by the presence of undigested food) of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. 

Symptoms of rumination syndrome include the acid-induced erosion of the esophagus and enamel (the hard mineralized surface of teeth), halitosis (bad breath), malnutrition (a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes health problems), severe weight loss and an unquenchable appetite. Individuals may begin regurgitating within a minute following ingestion, and the full cycle of ingestion and regurgitation can mimic the binging and purging of bulimia. 

There is no retching, nausea, heartburn, odour, or abdominal pain associated with the regurgitation, as there is with typical vomiting. 

The disorder has been historically documented as affecting only infants, young children, and people with cognitive disabilities. Today it is being diagnosed in increasing numbers of otherwise healthy adolescents and adults, though there is a lack of awareness of the condition by doctors, patients and the general public.

Food avoidant emotional disorder

Food avoidant emotional disorder was first described as a combination of inadequate food intake and emotional disturbance; these young people knew that they were underweight and wanted to be heavier, but found this difficult to achieve.
The only treatment of eating disorders is psychotherapy, which is demanding and take a long time.

Symptoms

Some physical symptoms of eating disorders are weakness, fatigue (a subjective feeling of tiredness which is distinct from weakness and has a gradual onset), sensitivity to cold, reduced beard growth in men, reduction in waking erections, reduced libido, weight loss and failure of growth. Unexplained hoarseness may be a symptom of an underlying eating disorder, as the result of acid reflux (a long-term condition where stomach contents come back up into the esophagus resulting in either symptoms or complications), or entry of acidic gastric material into the laryngoesophageal tract. 

Associated diseases

Anxiety disorders, depression, and substance abuse are common among people with eating disorders.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome is the most common endocrine disorder to affect women. PCOS is a set of symptoms due to elevated androgens (male hormones) in women. Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin.

Though often associated with obesity it can occur in normal weight individuals. PCOS has been associated with binge eating and bulimic behavior.

Some sufferers of anorexia nervosa exhibit episodes of bulimic tendencies through purging as a way to quickly remove food in their system. 

Complications

Growth retardation (failure to develop at a normal rate of height and weight for his or her age) may occur, as height gain may slow and can stop completely with severe weight loss or chronic malnutrition. 

Hepatic steatosis (the process describing the abnormal retention of lipids within a cell), or fatty infiltration of the liver, can also occur, and is an indicator of malnutrition in children.

Neurological disorders that may occur as complications include seizures and tremors. Wernicke encephalopathy (the presence of neurological symptoms caused by biochemical lesions of the central nervous system), which results from vitamin B1 deficiency, has been reported in patients who are extremely malnourished; symptoms include confusion, problems with the muscles responsible for eye movements and abnormalities in walking gait.

Anorexia nervosa increases the risk of sudden cardiac death, though the precise cause is unknown. 

Pica can lead to intoxication in children, which can result in an impairment in both physical and mental development. In addition, it can also lead to surgical emergencies due to an intestinal obstruction (happens when either your small or large intestine is partly or completely blocked) as well as more subtle symptoms such as nutritional deficiencies and parasitosis (infested with parasites).

Risk factors

Eating disorders occur more commonly among those involved in activities that value thinness such as high-level athletics, modelling, and dancing. Eating disorders also often begins following a major life-change or stress-inducing event.

Prevention

Prevention aims to promote a healthy development before the occurrence of eating disorders. It also intends early identification of an eating disorder before it is too late to treat. Children as young as ages 5–7 are aware of the cultural messages regarding body image and dieting. Prevention comes in bringing these issues to the light. The following topics can be discussed with young children (as well as teens and young adults).

Internet and modern technologies provide new opportunities for prevention. On-line programs have the potential to increase the use of prevention programs. The development and practice of prevention programs via on-line sources make it possible to reach a wide range of people at minimal cost. Such an approach can also make prevention programs to be sustainable.

Binge eating disorder

Obesity as common complication of binge eating disorder can also affect fertility. People in the obese category are much more likely to suffer from fertility problems than people of normal healthy weight. There is an increased risk of anovulation in women with an increasing BMI (body mass index) value. Its major effects include a reduction in ovulation rate, a decline in oocyte quality, menstrual irregularities, a decreased pregnancy rate, changes in hormone levels and a rise in miscarriages. Obesity can have particularly damaging effects in young women as they begin menstruating earlier than normal girls, essentially enhancing the defects associated with obesity and fertility.

Because BED is often associated with significant weight gain, it can also affect fertility of men. There is a long known relationship between obesity and infertility in men. 

Obese men have lower circulating testosterone which affects sperm production known as spermatogenesis. This affects the quantity and quality of a mans sperm. 

Obese men have increased risk of oligozoospemia, having fewer than 15 million sperm per millilitre of semen, and far fewer motile sperm than a man of healthy weight. Sperm with high amounts of damaged DNA are significantly more common in obese men than in normal weight men. Ejaculate volume is also affected. With lower count of sperm and their quality, there is lower possibility to concieve naturally.

Altered male hormones will can also give erectile dysfunction which is the major cause of infertility in obese men.
Current studies revealed that the risk of infertility increases with obesity grade regardless of age and female partner’s BMI and smoking habits of both partners. It has also been shown that obese couples where both partners are affected are less fertile than those with normal body mass.

Anorexia nervosa

Secondary amenorrhea (the absence of menses for three months in a woman with previously normal menstruation) is a hallmark of anorexia nervosa. The development of amenorrhea is most strongly correlated to loss of body weight.
Despite lack of menses, it is possible for women with anorexia nervosa to become pregnant, and therefore it should not be assumed that contraception is unnecessary in these patients.
However, women with a history of anorexia are more likely to have future problems with fertility because there is a reduction of the secretion of gonadotropin releasing hormone in the central nervous system, preventing ovulation. Without ovulation, there is no egg realsed from the ovary. Without egg, the fertilization is not possible. More likely women have persistent amenorrhea regardless of weight restoration, as compared to the general population. 

Bulimia nervosa

Obviously bulimia has a great impact on function of whole body and the function of reproductive system is not an exception. Among other factors, the proper function of reproductive system is dependent on the homeostasis (the tendency of a system to maintain internal stability), hormonal balance and mental health of the body. All these aspects are negatively influenced by bulimia directly or indirectly, as described above. This means that bulimia is to be connected with lower conception rates and some reproduction related disorders such as polycystic ovary syndrome (PCOS). 

Polycystic ovary syndrome causes more than 75% of cases of anovulatory infertility. The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development (a certain latter stage of egg development),which, in turn, may be caused by abnormal interaction of insulin and luteinizing hormone (LH) on granulose cells. Without ovulation, there is no egg to be fertilized, therefore, the pregnancy is not possible.

Not all women with PCOS have difficulty becoming pregnant. 

It is suggested that bulimia is the risk factor of PCOS development as overeating and starving episodes impair insulin sensitivity and are associated with ovarian morphology changes. The impact of bulimia on reproduction capability depends on the severity of bulimia and the time of its lasting. If successful conception happens, there is still a great health risk to the fetal development if bulimia is not treated properly. 

Although the relation between eating disorders, mood disorders and fertility in men is still poorly understood, it is obvious that bulimia in man may also have negative impact on fertility similarly to bulimia in women. Impulsive overeating and purging impairs hormonal metabolic balance which also affects sex hormone production important for proper function of gonads. As mentioned in description, bulimia often goes hand in hand with anxiety and depression. Both of this mental diseases are related with lower testosterone levels impairing spermatogenesis (development of sperms from reproductive cells) leading to reduced sperm concentration. Bulimia related depression may be also connected with reduced sperm motility or development of erectile dysfunction (a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis).

Pica

In case of pica, there is no connection between infertility and this kind of eating disorder. But pica can be threaten while the woman is pregnant. Eating nonfood substances can interfere with body’s ability to absorb nutrients and may cause deficiency. Deficiency may have impact on growth of baby and the development. Some nonfood items may lead to poisoning and bowel blockage, which cam be life threating situation and can cause abortion.

Rumination syndrome

Rumination syndrome does not have significant impact on fertility. In severe cases of malnutrition, it can lead to hormonal imbalance. With hormonal imbalance, there is possibility, that sometimes, there is no enough FSH and LH which are triggers of ovulation. Without ovulation, no egg can be fertilized and woman does not became pregnant.

Outcome of studies are complicated by non-uniform criteria used by various studies, but for anorexia nervosa, bulimia nervosa, and binge eating disorder, there seems to be general agreement that full recovery rates are in the 50% to 85% range, with larger proportions of people experiencing at least partial remission. The outcomes of eating disorders vary among the cases. For many, it can be a lifelong struggle or it can be overcome within months. 

There is evidence that previous or current eating disorders negatively impact women’s fertility. 

Women with a history of anorexia nervosa who do become pregnant are at greater risk for pregnancy complications. 

Even if bulimic women manages to conceive, it usually takes longer time to make it happen. Even though, it is possible for bulimic pregnant women to bear a child, if proper medical attention is given to her. 

An undiagnosed, undisclosed, or untreated eating disorder may interfere with the infertility treatment and place the mother and baby at risk for negative health outcomes. 

Eating disorders may result in miscarriages and fetal complications such as prematurity, , malformations, low Apgar scores (method to quickly summarize the health of newborn children), low maternal weight gain in pregnancy, small babies for gestational date, low birth weight of infants, increased neonatal morbidity, hyperemesis gravidarum (condition characterized by severe nausea, vomiting and weight loss) and problems in infant feeding.

The available information suggests that clinicians should inquire about nutritional intake, a history of eating disorders and weight reducing behaviours as part of the routine assessment of patients with the disorders of reproductive function listed above. If an eating disorder is discovered before conception, the woman should be encouraged to delay pregnancy until the eating disorder is treated and effectively under control. If the woman is pregnant, early diagnosis and treatment are essential to reduce maternal and fetal complications. The infants of eating-disordered women should be carefully followed to ensure adequate nutritional intake. 

Mothers who have or have had an eating disorder may also create abnormal behavioural patterns when feeding their children, such as irregular feeding schedules, detached non-interactive mealtimes, and use of food for non-nutritive purposes, which may lead to second-generation eating problems.