“It’s killing me seeing Michael in such agony. His eating disorder is like a runaway train. What’s causing this nightmare? Am I to blame?”
In yesterday’s article we began our need-to-know series on the eating disorders by identifying those that are most common – anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED).
Today we’re going to chat cause.
But before we get on-topic, I want to discuss two important subjects I didn’t get to yesterday – eating disorder mimickers and complications.
Eating Disorder Mimickers
Diagnosing an eating disorder can’t be done in a knee-jerk manner. Thorough physical, emotional, and mental assessments have to be performed. And a differential diagnoses and rule-out protocol is crucial.
Here are just some of the disorders that can be mistaken for an eating disorder (or can make diagnosing an eating disorder all the more difficult)…
- Lyme Disease
- Addison’s Disease
- Emetophobia (fear of vomiting)
- Phagophobia (fear of eating)
- Body Dysmorphic Disorder
An eating disorder in and of itself doesn’t maim and kill – it’s the complications. And, of course, the more severe and lasting the disorder, the more potential danger. Here are but a few…
- Heart disease
- Amenorrhea (absense of menstruation)
- Bone loss
- GI and kidney dysfunction/damage
- Stunted growth
- Severe tooth decay and loss
- Type 2 diabetes
- Gallbladder disease
- Depression and suicidal thoughts/behavior
When it comes to a disorder with an emotional/mental component, cause is a tough word to use. In my opinion it indicates a degree of certainty. And that’s hard to come by when it comes to the brain. Perhaps contributors is a better term.
With that in mind, here’s a very simple listing of the biological and psychological contributors to the eating disorders…
- Genetics: We’re taking predisposition here, not a locked-in future diagnosis. However, tt’s known that first-degree relatives of someone who’s been correctly diagnosed with an eating disorder may be more likely to develop one, as well.
- HPA axis: It plays a primo role in eating behavior, hence its dysregulation has to be a factor in the eating disorders. The dysregulation manifests in issues with the manufacture and transmission of assorted neurotransmitters, hormones, and other chemicals. If you haven’t already read my article on the HPA axis, click here. It’s essential reading for anyone enduring a mood or anxiety disorder.
- The Big 3 mood neurotransmitters: serotonin (inhibitory effect upon eating behavior), norepinephrine (a neurotransmitter and hormone), and dopamine (involved in the rewarding property of food) play a part.
- The amino acid homocysteine is likely involved, as elevated levels are found in those enduring AN and BN.
- Leptin and Ghrelin: Leptin is a hormone that has an inhibitory effect on appetite by inducing a feeling of satiety. Ghrelin is an appetite inducing hormone. Circulating levels of both are an important factor in weight control. Both have been implicated in AN and BN.
- The hormonal and physiological changes associated with puberty.
- Infection: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) may be a precipitant in the development of AN. No room to explain here, but I provided a nice explanation of PANDAS in this article on OCD.
- Lesions to the brain’s right frontal lobe or temporal lobe can contribute to the pathological symptoms of an eating disorder.
- Brain calcification: A study highlights a case in which prior calcification of the right thalumus may have contributed to development of AN.
- A lack of plasticity and adaptation in the brain’s somatosensory cortex, resulting in impairments of sensory processing and distortion of body image.
- Obstetric complications: Maternal smoking, obstetric and perinatal complications such as maternal anemia, very pre-term birth.
- Eating disorders may coexist with other emotional/mental disorders – depression, bipolar disorder, an anxiety disorder (especially OCD), a personality disorder. Note! Though an eating disorder and a personality disorder often co-exist, research has yet to find a sure relationship. It’s not an automatic.
- Adolescence: Stress related to the approaching demands of maturity and societal/cultural influences and perceived expectations – especially as it applies to body image.
- Child abuse: Physical, emotional, mental, sexual abuse, and neglect can be precipitants of any emotional/mental disorder – including an eating disorder.
- Unstable home environment
- Social isolation: It’s especially a factor with pre-existing medical and psychiatric issues. Especially a factor in BED.
- Parental influence: Dietary choices, the parents’ own body shape and eating patterns, the degree of involvement and expectations of their children’s eating behavior, the interpersonal relationship of parent and child. A direct link has been shown between obesity and parental pressure to eat more.
- Peer and cultural pressure: Isn’t it always about thinness?!
- Existing poor self-esteem, perfectionism, impulsive behavior, anger management difficulties, family conflicts, and troubled relationships.
Until Part 3…
Was that a load of information, or what? What more can I say? I urge you to take the time to do some independent research!
Be sure to join us again tomorrow, as we’ll tie a bow on the series by chating how to treat an eating disorder.
Would you like to read more about the biology of the mood and anxiety disorders? Click here for a listing of all chipur articles.