eating disorder
| Classification according to ICD-10 | |
|---|---|
| F50.0 | Anorexia nervosa |
| F50.1 | Atypical anorexia nervosa |
| F50.2 | Bulimia nervosa |
| F50.3 | Atypical bulimia nervosa |
| F50.4 | Binge eating in other mental disorders |
| F50.8 | Other eating disorders |
| ICD-10 online (WHO version 2019) | |
An eating disorder is a behavioral disorder in which constant mental and emotional preoccupation with the subject of "eating" plays a central role. Eating disorders affect eating or refusing to eat. They are mostly related to psychosocial problems and attitudes towards one's own body ( psychosomatics ) and can lead to serious and long-term damage to health.
Some consider eating disorders to be one of the diseases of civilization .
Main forms
The best known, the most common and recognized eating disorders are nonspecific Food cravings that anorexia (anorexia nervosa), the dining nervosa (bulimia nervosa) and binge eating (English "binge eating"). The individual disturbances cannot be clearly distinguished from one another. Often those affected switch from one form to another and the characteristics merge and mix. It is always central that those affected compulsively deal with the subject of food . With all eating disorders that have become chronic, life-threatening physical damage is possible ( malnutrition , malnutrition , obesity ). Women are more affected. Some women also experience disturbances in the menstrual cycle , up to and including the permanent cessation of menstruation ( amenorrhea ).
The transitions between “normal” and “pathological” depend on many factors. A person who has special forms of nutrition for religious or ideological reasons is not necessarily eating disorders. Some food addicts are completely inconspicuous physically and in their behavior - usually the subjective feeling of satiety does not occur with them at a physiologically sensible point in time; with them the addiction takes place exclusively in the head , namely in the brain ( addictive behavior ).
Food addiction
Food addicts compulsively eat and think about "food" and the consequences for their bodies. They either overeat or try to control their weight with inappropriate systems of eating, dieting , fasting, and exercise .
Food addiction often leads to overweight or obesity ( obesity ), with the associated health and social problems . Overweight people often feel like failures and outsiders. Malnutrition can lead to additional problems.
Anorexia nervosa
Anorexia nervosa is characterized by deliberate and self-induced weight loss. By starving and counting calories , the attempt is made to supply the body with as little food as possible , while physical activity is intended to increase energy consumption. The person concerned often does not see their own physical condition, they feel that they are too fat, even if they are extremely underweight ( body schema disorder ).
The consequences of anorexia are malnutrition , muscle wasting and malnutrition . Long-term consequences are for example osteoporosis and infertility . 5 to 15% of those affected usually do not die from starvation , but from infections of the weakened body or from suicide .
Eating addiction (bulimia nervosa)
In the case of eating and vomiting addiction (bulimia, bulimia nervosa), those affected are usually of normal weight, but are very afraid of gaining weight, of "becoming fat"; this can be described as "weight phobia". They therefore take unhealthy countermeasures such as vomiting , excessive exercise , use of laxatives , fasting or enemas . As a result, the body becomes deficient and so-called eating attacks occur , with large quantities of food being consumed at once. In addition to these cravings- related eating attacks, there are also stress-related ones . Overeating and vomiting are often experienced as "relaxing".
The dining nervosa may be susceptible to the electrolyte - metabolism to inflammation of the esophagus to tooth decay as well as deficiencies lead. Since the heart can be attacked by a disturbed electrolyte balance, it can lead to heart failure and thus death , especially if the addiction to eating and vomiting is accompanied by being underweight .
Binge Eating Disorder (BES)
Binge eating sometimes occurs in connection with addictive cravings , although the addictive nature of the eating disorder is controversial. A binge eating disorder is when an eating attack occurs on at least one day per week for at least three months, in which unusually large amounts of food are ingested in a short period of time . The affected person loses control over food intake.
In addition, at least three of the following five conditions must be met:
- eat without being hungry
- especially fast food
- eat until an uncomfortable feeling of fullness sets in
- eating alone, out of perceived guilt and shame
- after dining attack occur feelings of disgust , shame or depression on
The eating attacks are perceived as stressful. Although the binge eating disorder is brief, the binge eating disorder can lead to obesity . From the bulimia , the BES is distinguished by the lack of measures to prevent weight gain by vomiting, exercise or fasting.
Pica syndrome
Pica syndrome (also: picazism ) is a psychiatric symptom and occurs more frequently in people with intellectual disabilities , developmental disorders or dementia . Pregnant women can also be affected. It is not known how common the disorder is. People eat unusual things, for example earth , starch, ice (in large quantities), scraps of paper , clay , blackboard chalk or excrement ( coprophagia ). Consumption can lead to poisoning , malnutrition or constipation , among other things . Infections are also possible with otherwise harmless materials .
Babies and toddlers explore with their mouths. The diagnosis of pica should therefore only be made from the age of two. The child must specifically eat substances that are not suitable for consumption. Basically, the level of mental development must be taken into account when making a diagnosis.
Orthorexia nervosa
Orthorexia nervosa means pathological healthy eating . Affected people spend several hours a day compulsively calculating vitamin content and nutritional values and choosing foods , whereby the selection of "permitted" foods is decreasing more and more. The consequences are malnutrition , malnutrition and social isolation . Those affected sometimes show fear of foods that they consider unhealthy. Orthorexia also shows characteristics of a delusional or obsessive-compulsive disorder due to the urge to proselytize and the cognitively inaccessible symptoms .
In clinical psychology and in psychiatry it is disputed whether such an independent clinical picture even exists. It has not been included in either the ICD International Classification System or the United States Classification System ( DSM-5 ).
Anorexia athletica
The sufferers try to lose weight through excessive sport and the associated higher energy expenditure. This disorder is known as sports addiction and is seen as an accompanying disorder of eating addiction. It is not recognized as an independent clinical picture .
An increased incidence of eating disorders among competitive athletes has been reported since the 1980s and 1990s . The term anorexia athletica is mentioned as such in 2004 in a work by Sudi from Graz . What is meant is a form of eating disorders that does not meet all the characteristics of a true anorexia nervosa and is therefore classified diagnostically as atypical anorexia nervosa ( ICD-10 ) or as EDNOSs ( DSM-IV ). It is characterized by an insufficient supply of energy (see: physiological calorific value ), which leads to serious health problems (including a decrease in bone density ( osteoporosis ), broken bones and amenorrhea ).
Feeding disorders in early childhood, rumination and vomiting
Even babies and young children can develop eating disorders, but in a different way than in adults.
In the ICD-10 -Classification be the cipher ICD-10 P92 the nutritional problems in neonatal listed, such as vomiting in the newborn (ICD-10 P92.0), regurgitation and rumination (repeated Up choking of liquid or food ) (P92.1 ), aversion to drinking in the newborn (P92.2), malnutrition in the newborn (P92.3), overeating in the newborn (P92.4), difficulties in the newborn with breast diet (P92.5) and others.
The ICD-10 code ICD-10 F98.2 describes a feeding disorder in early childhood with different symptoms . For example, there is a refusal to eat or extremely picky eating behavior if there is sufficient food available without an organic disease being present. Accompanying it may be rumination (repeated choking up of food without nausea or digestive tract disease ). Eating disorders can also occur in early childhood. According to the definition according to ICD-10 (F98.2), the physician speaks of a feeding disorder with different symptoms. The child refuses to eat and shows picky eating behavior. This clinical picture can be accompanied by possible rumination or a disease of the gastrointestinal tract . The eating disorder begins before the age of 6 and cannot be explained by other psychological causes or lack of food. This disorder can be caused by genetic, psychological, motor or mental disorders. The focus is on the child's reluctance, refusal, or inability to take in the food offered. This can disrupt the feeding interaction between mother and child. This results in an overload syndrome of the feeding person with a lack of awareness of the child's signals and an intensification of the problem. A feeding probe is often used in the child. This should not be used exclusively for up to two years, as it can otherwise lead to considerable impairments (e.g. lack of oral motor experience, sensory disturbance, increased risk of reflux after PEG, difficult development of the feeling of hunger).
therapy
eating disorder
Most successful treatments are based on a multimodal approach. This means that different treatment strategies are used at the same time. The focus is usually on psychotherapy . Both cognitive and psychodynamic therapies can be used here. For some eating disorders, family therapy programs have also proven useful. Counseling and psycho-education of the parents is always necessary for children and adolescents . At the same time, a nutrition log can be kept. With certain eating disorders, regular weighing is necessary, but also support with a balanced diet. Additional drug therapy can also be helpful in some cases. Antidepressants are used for anorexia and bulimia .
In a self-help group , those affected can learn to recognize the causes and processes from the reports of other affected persons. In the community, new attitudes and values and new behavior patterns derived from them can be learned and stabilized. There are several self-help organizations in Germany. Anyone can participate, regardless of a therapy, or as a preparatory, accompanying and after therapy. The groups Food Addicts In Recovery Anonymous and Overeaters Anonymous, which are based on the twelve-step program of Alcoholics Anonymous , deal specifically with eating disorders .
If outpatient treatment is unsuccessful, inpatient or partial inpatient treatment is usually required. Inpatient treatment as a life-sustaining measure is necessary, especially for anorexia,
- when a critical underweight is reached and / or
- if consequential physical damage is to be expected, for example if the person is not drinking enough fluids or vomiting frequently.
Those affected by an eating disorder are often negative or ambivalent about specific treatment.
Overweight and underweight
Overweight or underweight are independent clinical pictures and in over 95% of all cases the result of an incorrect energy balance as a ratio of eating and exercise. For therapy see: Obesity , Change of Diet and Nutrition .
Medical classification
Diagnosis
The diagnosis is made by interviewing the patient and using questionnaires. Underweight, overweight and obesity are measured using the body mass index and other indicators.
classification
Diseases are categorized worldwide according to the diagnostic guidelines of the ICD-10 . The ICD-10 is a descriptive collection of diseases. Eating disorders are described there under the code F50 and following. In the ICD-10-GM, eating disorders are behavioral disorders with physical disorders and factors .
| Colloquial term | ICD-10 code | Accurate diagnosis |
|---|---|---|
| eating disorder | F50 | eating disorder |
| anorexia | F50.0
F50.1 |
Anorexia nervosa
Atypical anorexia nervosa |
| Bulimia nervosa | F50.2
F50.3 |
Bulimia nervosa
Atypical bulimia nervosa |
| Binge eating | - | (Currently no diagnosis, but F50.4 or F50.9 possible) |
| - | F50.4 | Binge eating in other mental disorders |
| - | F50.5 | Vomiting in other mental disorders |
| Other eating disorders | F50.8
F50.9 |
Other eating disorders Eating disorders, unspecified |
Frequency and consequences
Because the forms of the individual eating disorders often merge and blend, they are difficult to separate. Therefore, individual numbers should be viewed with caution.
- Here are some numbers for Germany :
- Anorexia : affects around 100,000 people. 90% of those affected are women between 15 and 35 years of age. 10% are men. Eating disorders in men have so far been little researched.
- Eating and vomiting addiction : around 600,000 people are affected.
- Binge eating : about 2% of the population is affected, making it the most common eating disorder.
- A study by the Robert Koch Institute with over 17,000 participants between the ages of 11 and 17 showed eating disorders such as anorexia, vomiting and obesity in almost 30% of the girls. In boys, 15% were still affected. In addition, according to the study, children from socially disadvantaged families were affected almost twice as often as children from the upper social class.
- An Austrian study (2006) on eating disorders in models found a prevalence of eating disorders of 11.4% of the respondents, over 40% were on a diet at the time of the study.
- The obesity is in a proportion of cases result of an eating disorder and sets in their total number worldwide growing problem. So speak World Health Organization and the CDC now a global epidemic , or pandemic , which should be taken as seriously as any leading to death infectious disease . Around one billion people worldwide are severely overweight (WHO). If this trend continues, the number of obese people will rise to 1.5 billion within the next 10 years. The health, financial and economic consequences of being overweight are enormous.
history
Hilde Bruch , author of Eating disorders: obesity, anorexia nervosa, and the person within (1973), pioneered psychotherapeutic research on eating disorders.
Since 1980 there have been specific addiction clinics and self-help groups in Germany.
In 1999, the Society for Nutritional Medicine and Dietetics was founded in Germany .
Cultural history, literature and modern media
Eating disorders play a role in narrative culture, for example in the fairy tale " The sweet porridge " or the land of milk and honey .
In literature they are dealt with in Franz Kafka's “ A Hunger Artist ” (early 20th century) or in François Villon's Ballade (adaptation by Paul Zech ) with the well-known line: “In front of a full table I have to die of hunger ...”. A detailed description of familial bulimia perceptions is contained in “Lange Tage” by Maike Wetzel . In 2002 Ulrike Draesner presented the novel “Mitgift” on the same topic. The well-known classical violinist Midori Gotō describes in her biography how she overcomes bulimia (German 2004).
A cinematic adaptation is " The Big Eating ".
See also: Anorexia in Art and Music
Internet forums and special websites are now an easily accessible source of information, advice and help for those affected, relatives and practitioners.
Causes and Prevention
Mechanisms of Action
The neurophysiological regulation of eating behavior occurs in healthy people through an intact interplay between hunger or appetite and satiety . In medical terms, eating disorders usually lead to a disruption of the energy balance :
- energy supply too high with too little energy consumption, e.g. B. due to lack of exercise, leads to obesity due to permanent positive balance
- Too little energy supply with relatively too high energy consumption leads to malnutrition due to permanent negative balance
- Improper nutrition leads to vitamin deficiency, mineral deficiency and a disruption of the electrolyte balance in the body
Physiological control mechanisms can adjust the body's energy expenditure over a certain period of time and to a limited extent to the energy supply. In the event of a lack of energy, metabolic regulations are used to, for. B. to use existing energy supplies more efficiently and save energy.
Eating disorders in the light of the concept of emotional intelligence
As an apologist for the concept of emotional intelligence , the psychologist Daniel Goleman interprets eating disorders as an expression of poor emotional education . He refers u. a. based on a long-term study by Gloria Leon ( University of Minnesota ) with 900 high school students in the 1990s. In this study, two abnormalities in particular turned out to be strong predictors of future anorexia or bulimia: firstly, a lack of resilience and secondly, impaired emotional self-perception . Girls who later developed an eating disorder tended, years earlier, to react to trivial problems and annoyances with inappropriately negative feelings about which they could not calm themselves; Second, they did not understand their feelings, but were overwhelmed by them and could not manage them efficiently. When these two emotional tendencies coincided with dissatisfaction with one's own body, either anorexia or bulimia developed. Leon's study did not confirm that - as is often assumed - strongly controlling parents, sexual anxiety or a reduced sense of self-worth contribute to the disorders.
Goleman suspects that a disturbed emotional self-perception also plays a decisive role in overeating : Some overweight people eat so much because they cannot adequately differentiate between fear, anger and hunger.
Wendy Mogel
The American family therapist Wendy Mogel dedicated a chapter in her 2001 book The Blessings of a Skinned Knee to the prevention of eating disorders . She sees the cause of many eating problems in the compulsive habit of well-meaning, overprotective parents to observe and regulate their child's eating; at the same time, these parents fail to develop the child's capacity to enjoy food and to enjoy the community at the table. The parents who come to Mogel's practice are regularly very sensitive to the fact that children and especially certain foods should not be forced on children; At the same time, however, they are extremely health conscious, have strong opinions about good and bad foods and as a result are constantly worried about possible over-, undernourishment or malnutrition of their child. In doing so, they are faced with the dilemma that children neither naturally have a preference for healthy food nor develop it on their own initiative, they want their child to eat healthily, but also do not want to force it. Since children feel such ambivalences and insecurities exactly and are always on the lookout for opportunities to give weight to their will, the dining table in many families becomes a battlefield in which emotionally charged disputes are waged; Picky and picky eaters in particular have great power over their parents.
The search for a corrective for such educational scenarios leads Mogel to the Jewish tradition , which attaches very central importance to eating and eating together; Since the destruction of the Jerusalem Temple , their own dining table has been the holiest place for Jewish families. The extent of the cultural knowledge with which Judaism can help with nutrition education includes, first, the concept of moderation ; This means that the human being should enjoy food on the one hand (because God gave it), on the other hand (because God gave him free will ) but also should exercise self- control. The key to the agreement of these two seemingly disparate tendencies offer the Jewish concepts of celebration ( celebration ) and the consecration ( sanctification ): who is celebrating the meal and sanctifies both maximum pleasure can it have exercise and moderation. For families this means u. a. to prepare meals together, to eat together at the table in a non-distracting setting, to maintain table conversation and good table manners , to say table prayers and to celebrate holidays with a special meal.
See also
literature
Eating disorders in the medical sense
- Iris Absenger: The Embodied Eating Disorder. Anorexia - bulimia - obesity; To experience. Comprehensive therapy overview and a body expression model , Centaurus, Herbolzheim 2005, ISBN 3-8255-0520-0 .
- Anja Hilbert: Body image in women with 'binge eating' disorder . University of Marburg 2000. ( Dissertation )
- Lyn Patrick: Eating disorders: a review of the literature with emphasis on medical complications and clinical nutrition (PDF; 108 kB). Altern Med Rev . 3/2002, pp. 184-202. PMID 12126461
- Stefanie Richter: eating disorder. A case reconstructive study based on the life stories of affected women , Transcript, Bielefeld 2006, ISBN 3-89942-464-6 .
- Herpertz, Stephan; Hagenah, Ulrich; Vocks, Silja; Wietersheim, Jörn von; Cuntz, Ulrich; Zeeck, Almut: Diagnosis and therapy of eating disorders . In: Dtsch Arztebl Int . No. 108 (40) , 2011, pp. 678-85 ( clinical guideline ).
Picky eaters
- Annette Kast-Zahn , Hartmut Morgenroth: Every child can eat right , Oberstebrink, 1999, ISBN 978-3-9804493-9-7 .
Cultural history
- Walter Vandereycken, Ron van Deth: hunger artists, fasting miracles, anorexia. A Cultural History of Eating Disorders. Edited and translated by Rolf Meermann, Zülpich 1990 and Munich 1992.
Web links
- bzga-essstoerungen.de independent information service of the Federal Center for Health Education (BZgA)
Individual evidence
- ↑ a b Nichole R. Kelly, Lisa M. Shank, Jennifer L. Bakalar, Marian Tanofsky-Kraff: Pediatric Feeding and Eating Disorders: Current State of Diagnosis and Treatment . In: Current Psychiatry Reports . tape 16 , no. 5 , May 1, 2014, ISSN 1523-3812 , p. 446 , doi : 10.1007 / s11920-014-0446-z ( springer.com [accessed August 5, 2017]).
- ^ Sera L. Young: Craving earth. Understanding pica. The urge to eat clay, starch, ice, and chalk . Columbia University Press, New York, ISBN 978-0-231-51789-8 , pp. 16 .
- ↑ Volker Faust : Mental health 143: Eating disorders. Liebenau Foundation, Mensch - Medizin - Wirtschaft, Meckenbeuren-Liebenau, 2018. In: Psychiatric-neurological information offered by the Liebenau Foundation. With the collaboration of Walter Fröscher and Günter Hole. (Anorexia nervosa with restricted food intake, bulimia nervosa with binge eating, binge eating disorder with binge eating and loss of control over eating).
- ↑ Hans-Ulrich Wittchen: Diagnostic classification of mental disorders . In: Hans-Ulrich Wittchen & Jürgen Hoyer (Eds.): Clinical Psychology & Psychotherapy . 2nd, revised and expanded edition. Springer-Verlag, Berlin / Heidelberg 2011, p. 40 .
- ↑ ICD-10 F50 (overeating) and subcategories ( Memento of 28 November 2016 Internet Archive )
- ↑ Message on www.tagesschau.de of September 25, 2006 ( Memento of February 22, 2009 in the Internet Archive )
- ↑ from: Diploma thesis by Katharina Stempfl, Institute for Medical Psychology and Psychotherapy at the University of Innsbruck
- ↑ Obesity and overweight (2006) ( Memento of November 24, 2010 in the Internet Archive )
- ↑ US researchers calculate billions in damage caused by obesity , 2010 ( Memento from September 3, 2012 in the web archive archive.today )
- ↑ Gloria R. Leon et al .: Personality and Behavioral Vulnerabilities Associated with Risk Status for Eating Disorders in Adolescent Girls , Journal of Abnormal Psychology, Volume 102, 1993; Daniel Goleman: Emotional Intelligence . Why It Can Matter More Than IQ. 1st edition. Bantam, New York 1995, ISBN 0-553-09503-X , pp. 246-249 .
- ^ Daniel Goleman: Emotional Intelligence . Why It Can Matter More Than IQ. 1st edition. Bantam, New York 1995, ISBN 0-553-09503-X , pp. 248 . ; PE Sifneos: Affect, Emotional Conflict, and Deficit: An Overview , Psychotherapy and Psychosomatics, Volume 56, Issue 3, 1991, pp. 116-122
- ↑ Wendy Mogel: The Blessings of a Skinned Knee: Using Jewish Teachings to Raise Self-Reliant Children , New York, London, Toronto, Sydney, Singapore: Scribner, 2001, ISBN 0-684-86297-2 , pp. 161-163 (Hardcover; limited online version in Google Book Search - USA )
- ^ The Blessings of a Skinned Knee, p. 161
- ↑ The Blessings of a Skinned Knee, pp. 162f, 175
- ↑ The Blessings of a Skinned Knee, pp. 159f; The Blessing of Food ( Memento from February 19, 2012 in the Internet Archive )
- ^ The Blessings of a Skinned Knee, pp. 165f
- ↑ The Blessings of a Skinned Knee, pp. 165, 169-173, 180f
