Eating Disorders in Women

By Sharan, Pratap; Sundar, A. | Indian Journal of Psychiatry, July 2015 | Go to article overview

Eating Disorders in Women


Sharan, Pratap, Sundar, A., Indian Journal of Psychiatry


Byline: Pratap. Sharan, A. Sundar

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 and 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 form 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. Treatment of eating disorders can be quite challenging, given the dearth of established treatments and poor motivation/ insight in these conditions. Nutritional rehabilitation and psychotherapy remains the mainstay of treatment, while pharmacotherapy may be helpful in specific situations.

Introduction

Eating disorders are disorders of eating behaviors, associated thoughts, attitudes and emotions, and their resulting physiological impairments. [sup][1] Eating disorders are associated with a significant burden on patients [sup][2] and their family members [sup][3] and have among the highest mortality rate one of psychiatric disorders. [sup][4]

The eating disorders, especially anorexia nervosa and bulimia nervosa, have been classically described to occur in young females. Although recent research has shown that the prevalence in males was previously underestimated, these disorders do have a clear female preponderance. [sup][1] Various reasons have been ascribed for this finding, most of them being psychosocial. 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. These disorders were found to be more common in "Western nations" and have been hypothesized to be slowly spreading to "non-Western nations" as a result of the cultural transformation.

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.

History

Cases of emaciation without medical causation were first reported in the late 17 [sup]th century. The term anorexia nervosa was introduced by William Gull in 1874 to describe four cases of adolescent girls with deliberate weight loss. [sup][1] Weight phobia, which is considered central to the concept of eating disorders was described as a feature of eating disorders, only in the 1930s. [sup][5],[6] Hence, some (but not all [sup][7] ) authors suggest that weight concerns may be an artifact produced by cultural changes in the 1930s, and may not be a core feature of the disorder.

Bulimia nervosa was first described by Russell in 1979 [sup][8] as an "ominous variant of anorexia nervosa." Later descriptions have characterized bulimia nervosa as an independent disorder, with pathological eating behavior at a normal weight. Some authors [sup][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. …

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