English Project

S.S JAIN SUBODH LAW COLLEGE, MANSAROVAR, JAIPUR

SESSION: 2018-2019 SUBJECT: ENGLISH TOPIC: EATING DISORDER

SUBMITTED TO: DR. PRERNA AGARWAL ASSISTANT PROFESSOR OF ENGLISH

SUBMITTED BY: PUSHPENDRA SHARMA (BA.LLB) SEM.-I (B)

SUPERVISOR’S CERTIFICATE

This is to certify that the Project Assignment of English entitled- “EATING DISORDER” submitted by Pushpendra Shrma of BA.LLB Semester-I (B) for the partial fulfillment of the requirements of the degree of BA.LLB in S.S Jain Subodh Law College, Jaipur embodies the bonafide work done under the supervision of Dr. Prerna Agarwal (Assistant Professor) during the academic year 2018-19.

Place: Date:

Signature:

ACKNOWLEDGEMENT

The success and final outcome of this project required a lot of guidance and assistance from many people and I am extremely fortunate to have got this all along the completion of my assignment work. I respectfully thank Asst.Professor Dr. Prerna Agarwal for giving me this opportunity to do this assignment work and providing me all support and guidance which made me to complete the assignment in time. I hope the project will be knowledgeable and helpful in my future.

Thank You.

PAGES

TOPIC

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INTRODUCTION CLASSIFICATION

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CAUSES

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SYMPTOMS

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DIAGNOSIS TREATMENT OUTCOME

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BIBLIOGRAPHY

INRODUCTION

An eating disorder is a mental disorder defined by abnormal eating habits that negatively affect a person's physical or mental health. They include binge eating disorder where people eat a large amount in a short period of time, anorexia nervosa where people eat very little and thus have a low body weight, bulimia nervosa where people eat a lot and then try to rid themselves of the food, pica where people eat non-food items, rumination disorder where people regurgitate food, avoidant/restrictive food intake disorder where people have a lack of interest in food, and a group of other specified feeding or eating disorders. Anxiety disorders, depression, and substance abuse are common among people with eating disorders. These disorders do not include obesity.

The cause of eating disorders is not clear. Both biological and environmental factors appear to play a role. Cultural idealization of thinness is believed to contribute. Eating disorders affect about 12 percent of dancers. Those who have experienced sexual abuse are also more likely to develop eating disorders. Some disorders such as pica and rumination disorder occur more often in people with intellectual disabilities. Only one eating disorder can be diagnosed at a given time.

Treatment can be effective for many eating disorders. This typically involves counselling, a proper diet, a normal amount of exercise, and the reduction of efforts to eliminate food. Hospitalization is occasionally needed. Medications may be used to help with some of the associated symptoms. At five years about 70% of people with anorexia and 50% of people with bulimia recover. Recovery from binge eating disorder is less clear and estimated at 20% to 60%.Both anorexia and bulimia increase the risk of death.

In the developed world binge eating disorder affects about 1.6% of women and 0.8% of men in a given year. Anorexia affects about 0.4% and bulimia affects about 1.3% of young women in a given year. Up to 4% of women have anorexia, 2% have bulimia, and 2% have binge eating disorder at some point in time. Anorexia and bulimia occur nearly ten times more often in females than males. Typically they begin in late childhood or early adulthood. Rates of other eating disorders are not clear. Rates of eating disorders appear to be lower in less developed countries.1

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Eating Disorder available at https://en.wikipedia.org/wiki/Eating_disorder

CLASSIFICATION

1. Anorexia nervosa Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is a potentially lifethreatening eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. People with anorexia use extreme efforts to control their weight and shape, which often significantly interferes with their health and life activities. When you have anorexia, you excessively limit calories or use other methods to lose weight, such as excessive exercise, using laxatives or diet aids, or vomiting after eating. Efforts to reduce your weight, even when underweight, can cause severe health problems, sometimes to the point of deadly self-starvation. 2. Bulimia nervosa Bulimia (boo-LEE-me-uh) nervosa — commonly called bulimia — is a serious, potentially life-threatening eating disorder. When you have bulimia, you have episodes of bingeing and purging that involve feeling a lack of control over your eating. Many people with bulimia also restrict their eating during the day, which often leads to more binge eating and purging. During these episodes, you typically eat a large amount of food in a short time, and then try to rid yourself of the extra calories in an unhealthy way. Because of guilt, shame and an intense fear of weight gain from overeating, you may force vomiting or you may exercise too much or use other methods, such as laxatives, to get rid of the calories. If you have bulimia, you're probably preoccupied with your weight and body shape, and may judge yourself severely and harshly for your self-perceived flaws. You may be at a normal weight or even a bit overweight. 3. Binge-eating disorder When you have binge-eating disorder, you regularly eat too much food (binge) and feel a lack of control over your eating. You may eat quickly or eat more food than intended, even when you're not hungry, and you may continue eating even long after you're uncomfortably full. After a binge, you may feel guilty, disgusted or ashamed by your behavior and the amount of food eaten. But you don't try to compensate for this behavior with excessive exercise or purging, as someone with bulimia or anorexia might. Embarrassment can lead to eating alone to hide your bingeing. A new round of bingeing usually occurs at least once a week. You may be normal weight, overweight or obese.

4. Rumination disorder Rumination disorder is repeatedly and persistently regurgitating food after eating, but it's not due to a medical condition or another eating disorder such as anorexia, bulimia or bingeeating disorder. Food is brought back up into the mouth without nausea or gagging, and regurgitation may not be intentional. Sometimes regurgitated food is rechewed and reswallowed or spit out. The disorder may result in malnutrition if the food is spit out or if the person eats significantly less to prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in people who have an intellectual disability.

5. Avoidant/restrictive food intake disorder 1. Avoidance of specific foods or restriction of intake because of a lack of interest, the sensory characteristics of food, or averse consequences of eating 2. Includes 1 or more factors: significant weight loss (or failure to gain), significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, marked interference with psychosocial functioning, or no evidence of body dysmorphism2

Causes of Eating Disorder 2

Classification of Eating disorder available at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/eatingdisorders/ Explanations available at https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptomscauses/syc-20353603

Many people with eating disorders also have body dysmorphic disorder, altering the way a person sees themselves. Studies have found that a high proportion of individuals diagnosed with body dysmorphic disorder also had some type of eating disorder, with 15% of individuals having either anorexia nervosa or bulimia nervosa. This link between body dysmorphic disorder and anorexia stems from the fact that both BDD and anorexia nervosa are characterized by a preoccupation with physical appearance and a distortion of body image. There are also many other possibilities such as environmental, social and interpersonal issues that could promote and sustain these illnesses. Also, the media are oftentimes blamed for the rise in the incidence of eating disorders due to the fact that media images of idealized slim physical shape of people such as models and celebrities motivate or even force people to attempt to achieve slimness themselves. The media are accused of distorting reality, in the sense that people portrayed in the media are either naturally thin and thus unrepresentative of normality or unnaturally thin by forcing their bodies to look like the ideal image by putting excessive pressure on themselves to look a certain way. While past findings have described the causes of eating disorders as primarily psychological, environmental, and sociocultural, new studies have uncovered evidence that there is a prevalent genetic/heritable aspect of the causes of eating disorders Some of the causes of eating disorder are as follows:-

Genetics Increasing numbers of family, twin, and adoption research studies have provided compelling evidence to show that genetic factors contribute to a predisposition for eating disorders. 1 In other words, individuals who are born with certain genotypes are at heightened risk for the development of an eating disorder. This also means that eating disorders are heritable. Individuals who have had a family member with an eating disorder are 7-12 times more likely to develop one themselves. Newer research is exploring a possible epigenetic influence on eating disorder development.  Epigenetics is a process by which environmental effects alter the way genes are expressed.

Temperament Some of the genes that have been identified to contribute to eating disorders are associated with specific personality traits. These aspects of personality are thought to be highly heritable and often exist before the eating disorder and can persist after recovery. The following traits are common among people who develop an eating disorder but all of these personality characteristics can exist in the absence of an eating disorder as well.3

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Causes available at https://eatingdisorder.org/eating-disorder-information/underlying-causes/

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obsessive thinking perfectionism sensitivity to reward and punishment,  harm avoidance neuroticism6 (emotional instability and hypersensitivity) impulsivity, especially in bulimia nervosa rigidity and excessive persistence, especially in anorexia nervosa

Biology Even in healthy individuals without eating disorders, states of semi-starvation have been shown to trigger obsessive behavior around food, depression, anxiety and neuroticism that promote a continued cycle of starvation.  Additionally, brain imaging studies have shown that people with eating disorders may have altered brain circuitry that contributes to eating disorders.  Differences in the anterior insula, striatal regions, and anterior ventral striatal pathway have been discovered.  Problems with the serotonin pathway have also been discovered. These differences may help to explain why people who develop anorexia nervosa are able to inhibit their appetite, why people who develop binge eating disorder are vulnerable to overeating when they are hungry, and why people who develop bulimia nervosahave less ability to control impulses to purge.

Trauma Traumatic events such as physical or sexual abuse sometimes precipitate the development of an eating disorder. Survivors of trauma often struggle with shame, guilt, body dissatisfaction and a feeling of a lack of control.  The eating disorder may become the individual’s attempt to regain control or cope with these intense emotions. In some cases, the eating disorder is an expression of self-harm or misdirected self-punishment for the trauma.  As many as 50% of those with eating disorders may also be struggling with trauma disorders.  It’s important to treat both conditions concurrently in a comprehensive and integrated approach which is why The Center for Eating Disorders offers a specialized treatment track for women and men with eating disorders who’ve also experienced trauma.

Coping Skill Deficits Individuals with eating disorders are often lacking the skills to tolerate negative experiences.  Behaviors such as restricting, purging, bingeing and excessive exercise often develop in response to emotional pain, conflict, low self-esteem, anxiety, depression, stress or trauma.  In the absence of more positive coping skills, the eating disorder behaviors may provide acute relief from distress but quickly lead to more physical and psychological harm.  4

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Trauma and Coping skill available at

https://www.eatingdisorderhope.com/information/eating-disorder

Instead of helping, the eating disorder behaviors only serve to maintain a dangerous cycle of emotional dysregulation and numbing feelings.  Effective treatment for the eating disorder involves education about and practice of alternative coping mechanisms and self-soothing techniques such as in Dialectic Behavior Therapy.

Sociocultural Ideals Our media’s increased obsession with the thin-ideal and industry promotion of a “perfect” body may contribute to unrealistic body ideals in people with and without eating disorders.15,16 An increase in access to global media and technological advances such as Photoshop and airbrushing have further skewed our perception of attainable beauty standards.   In 1998, a researcher documented the response of adolescents in rural Fiji to the introduction of western television. This new media exposure resulted in significant preoccupations related to shape and weight, purging behavior to control weight, and negative body image. This landmark study illustrated a vulnerability to the images and values imported with media. Given that many individuals exposed to media and cultural ideals do not develop clinical eating disorders, it may be that individuals already at-risk, have increased vulnerability to society’s messages about weight and beauty and, perhaps, seek out increased exposure to them.

Dieting Dieting is the most common precipitating factor in the development of an eating disorder. In the U.S., more than $60 billion is spent every year on diets and weight-loss products. Despite dieting’s 95-98% failure rate, people continue to buy dangerous products and take extreme measures to lose weight. Restrictive dieting is not effective for weight loss and is an unhealthy behavior for anyone, especially children and adolescents.  For individuals who are genetically predisposed to eating disorders, dieting can be the catalyst for heightened obsessions about weight and food.  Dieting also intensifies feelings of guilt and shame around food which may ultimately contribute to a cycle of restricting, purging, bingeing or excessive exercise. 9.5 out of 10 people who lose weight through dieting gain back all of their weight within 1-5 years; half of them gain back to a weight that’s above their starting weight. More worrisome though is that dieting is associated with higher rates of depression and eating disorders and increased health problems related to weight cycling. Intuitive eating and the health-at-every size paradigms are recommended as alternatives to diets for people looking to improve their health and overall well-being. 5

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Sociocultural ideas and Dieting points available at https://www.eatingdisorderhope.com/information/eatingdisorder

COMMON SYMPTOMS OF AN EATING DISORDER

Emotional and behavioral       

In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.) Appears uncomfortable eating around others Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch) Skipping meals or taking small portions of food at regular meals Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

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Withdrawal from usual friends and activities

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Frequent dieting

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Extreme concern with body size and shape 

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Frequent checking in the mirror for perceived flaws in appearance

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Extreme mood swings

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Noticeable fluctuations in weight, both up and down

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Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

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Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

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Difficulties concentrating Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)

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Dizziness, especially upon standing

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Fainting/syncope

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Feeling cold all the time

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Sleep problems

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Cuts and calluses across the top of finger joints (a result of inducing vomiting)

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Dental problems, such as enamel erosion, cavities, and tooth sensitivity

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Dry skin and hair, and brittle nails

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Swelling around area of salivary glands

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Fine hair on body (lanugo)

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Cavities, or discoloration of teeth, from vomiting

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Muscle weakness

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Yellow skin (in context of eating large amounts of carrots)

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Cold, mottled hands and feet or swelling of feet

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Poor wound healing

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Impaired immune functioning6

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Symptoms available at https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

DIAGNOSIS OF EATING DISORDER The initial diagnosis should be made by a competent medical professional. "The medical history is the most powerful tool for diagnosing eating disorders"(American Family Physician). There are many medical disorders that mimic eating disorders and comorbid psychiatric disorders. All organic causes should be ruled out prior to a diagnosis of an eating disorder or any other psychiatric disorder. In the past 30 years eating disorders have become increasingly conspicuous and it is uncertain whether the changes in presentation reflect a true increase. Anorexia nervosa and bulimia nervosa are the most clearly defined subgroups of a wider range of eating disorders. Many patients present with subthreshold expressions of the two main diagnoses: others with different patterns and symptoms.

MEDICAL The diagnostic workup typically includes complete medical and psychosocial history and follows a rational and formulaic approach to the diagnosis. Neuroimaging using fMRI, MRI, PET and SPECT scans have been used to detect cases in which a lesion, tumor or other organic condition has been either the sole causative or contributory factor in an eating disorder. "Right frontal intracerebral lesions with their close relationship to the limbic system could be causative for eating disorders, we therefore recommend performing a cranial MRI in all patients with suspected eating disorders" "intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective".

PSYCHOILOGICAL After ruling out organic causes and the initial diagnosis of an eating disorder being made by a medical professional, a trained mental health professional aids in the assessment and treatment of the underlying psychological components of the eating disorder and any comorbid psychological conditions. The clinician conducts a clinical interview and may employ various psychometric tests. Some are general in nature while others were devised specifically for use in the assessment of eating disorders. Some of the general tests that may be used are the Hamilton Depression Rating Scale and the Beck Depression Inventory. longitudinal research showed that there is an increase in chance that a young adult female would develop bulimia due to their current psychological pressure and as the person ages and matures, their emotional problems change or are resolved and then the symptoms decline.7

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https://en.wikipedia.org/wiki/Eating_disorder#

TREATMENT The main components of professional treatment for eating disorders are: physical health management, nutritional advice and mental health management.  In addition, drug treatment, support groups and some alternative therapies may be useful. Physical Health Management Although an eating disorder is a mental illness, it often has major impacts on physical health. There are many physical complications that can result from an eating disorder. Left unattended, these can lead to serious health problems or can even be fatal.  It is important that physical health is monitored, preferably by a medical practitioner with experience in the area of eating disorders. For adolescents and children with eating disorders, a paediatrician is normally involved in the medical care. A medical examination may involve a large number of tests. Medical problems that may require treatment and care include anaemia, heartburn, disturbances in heart rhythm, low bone density (osteoporosis), kidney problems, dental problems.

Nutritional Counselling and Advice Establishment of a well-balanced diet is essential to recovery.  For this reason dietitians or nutritionists are usually involved in the treatment, working in conjunction with other professionals in the treatment team. Nutritional counselling and advice may be useful to help the person identify their fears about food and the physical consequences of not eating well. Education about the nutritional values of food can be beneficial particularly when the person has lost track of what ‘normal eating’ is. 

Mental Health Management In addition to medical and dietary management, most people with eating disorders will need some kind of therapy, counselling or psychological intervention. This section below explains the basis of the most commonly employed approaches to mental health management for eating disorders.

Psychotherapy The basis of psychological treatment is in forming a trusting relationship with the therapist and addressing pertinent issues to the person such as the thoughts, feelings and behaviours that led to the development and maintenance of the eating disorder. This may include issues with anxiety, depression, poor self esteem and self confidence and difficulties with interpersonal relationships.  The treatment is ultimately aiming to empower the person to realise their own resources to overcome their difficulties. Psychotherapy aims to identify the psychological stresses that may have contributed to the onset of the eating disorder. Through talking and other techniques (personal development exercises, etc) the aim of this process is to reduce the feelings of inadequacy, low self-esteem, negative body image and guilt etc and help people to develop their life skills.

Cognitive Behavioural Therapy CBT has become a popular form of treatment for people experiencing eating disorders. Based on the premise that thoughts and feelings are inter-dependent, CBT encourages people to reexamine and challenge existing thought and behaviour patterns. Challenging distorted or unhelpful ways of thinking can allow healthier behaviours to emerge. In relation to eating disorders, CBT aims to change the way the person thinks about food and themselves. It aims to identify the characteristic thoughts that reinforce disordered eating behaviour and encourage more positive ways of thinking. Some thought patterns that CBT may challenge include black and white thinking, magnification (of importance of events etc) and errors in attribution (misunderstanding of the relationship between cause and effect).

Interpersonal Psychotherapy IPT has been used successfully in the treatment of eating disorders, particularly bulimia and binge eating problems. IPT focuses on interpersonal difficulties in the person’s life which are considered to be the basis of the eating disorder. Generally, therapy involves three phases including the identification of interpersonal difficulties, the development of a contract to work on several specific issues and the assessment of changes. The therapy is usually medium term (16-20 weeks). In the initial stage, the therapist will generally explore the history of eating problems, interpersonal relationships prior to and after the development of an eating disorder, significant life events and self-esteem and depression issues. Major problem areas are identified and typically fall into four categories; grief, role disputes with other people, role transitions and interpersonal skills. A therapeutic contract is developed between the client and

the therapist based on the major problem areas in the person’s life.Mindfulness traces its origins to Buddhism. Dialectical Behavioural Therapy (DBT) DBT is also a popular form of therapy used to assist people with eating disorders. Based on an emotion regulation model, the idea is that eating disorders (and disordered eating) are a way to deal with emotional distress in the absence of more appropriate coping strategies. DBT aims to help people manage, process and deal with their emotions in a healthy and productive way. Most studies so far have looked at people with Bulimia Nervosa and Binge Eating Disorder. Intensive Short-Term Dynamic Psychotherapy (ISTDP) ISTDP is a brief, focused therapy designed to help people deal with a number of mental health issues. It uses an interactive approach where the professional and the client work together to identify unhelpful ‘defences’ and emotional triggers that can lead to disordered eating and other problems. ISTDP aims to help the person focus on how they experience emotions, and skills are then developed to help the person change the way they think, feel and behave.

Mindfulness Based Therapy Mindfulness based therapies have in common an emphasis on the practice of mindful meditation, mindful eating, yoga and a range of other techniques, aimed at increasing awareness and acceptance of eating behaviour and the self. Unlike CBT, the aim of mindfulness is 'letting go' or disengaging with negative thoughts, rather than learning to challenge them. Mindfulness based therapies include Acceptance and Commitment Therapy (ACT), Mindfulness Based Stress Reduction (MBSR), Mindfulness Based Cognitive Therapy (MBCT), Dialectical Behaviour Therapy (DBT) and Mindfulness Based Eating Awareness Therapy (MB-EAT). All these approaches have been investigated empirically and have been found to benefit individuals with eating disorders.

Family Based Therapy Family based therapy (FBT) is based on the idea that changes within the family unit will result in a reduction of eating disordered behaviour.  It usually involves the people that are living with or are very close to the person with the eating disorder. This commonly includes parents, siblings and/or spouses, although it can also involve grandparents, aunts or other close carers.

The family, as a unit, is encouraged to develop ways to cope with issues that may be causing concern including, but not limited to, the eating disorder. The success of this treatment is dependent upon the family being willing to participate, often in weekly therapy sessions for a number of weeks or months, and make changes to their behaviours. Family therapy can also offer education to other family members about the eating disorder and how better to support the person they care about. Overall the family is encouraged to develop healthy ways to deal with the eating disorder. Family based therapy does not imply that family factors were involved in the development of the eating disorder, but  acknowledges that every family has issues that are difficult to deal with, and that the family can work together to help overcome these issues.  As a part of a person’s recovery from an eating disorder, it can be useful to address issues in the family context such as conflict or tension between members, communication problems, difficulty expressing feelings, substance abuse or physical or sexual abuse.8

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https://www.eatingdisorders.org.au/eating-disorders/treatment/types-of-treatment

OUTCOME Outcome estimates 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 (ED) vary among the cases. For many, it can be a lifelong struggle or it can be overcome within months. In the United States, twenty million women and ten million men have an eating disorder at least once in their lifetime. The mortality rate for those with anorexia nervosa is 5.4 per 1000 individuals per year. Roughly 1.3 deaths were due to suicide. A person who is or had been in an inpatient setting had a rate of 4.6 deaths per 1000. Of individuals with bulimia nervosa about 2 persons per 1000 persons die per year and among those with EDNOS about 3.3 per 1000 people die per year. 

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Miscarriages: Pregnant women with a Binge Eating Disorder have shown to have a greater chance of having a miscarriage compared to pregnant women with any other eating disorders. According to a study done, out of a group of pregnant women being evaluated, 46.7% of the pregnancies ended with a miscarriage in women that were diagnosed with BED, with 23.0% in the control. In the same study, 21.4% of women diagnosed with Bulimia Nervosa had their pregnancies end with miscarriages and only 17.7% of the controls. Relapse: An individual who is in remission from BN and EDNOS (Eating Disorder Not Otherwise Specified) is at a high risk of falling back into the habit of self-harming themselves. Factors such as high stress regarding their job, pressures from society, as well as other occurrences that inflict stress on a person, can push a person back to what they feel will ease the pain. A study tracked a group of selected people that were either diagnosed with BN or EDNOS for 60 months. After the 60 months were complete, the researchers recorded whether or not the patients were suffering from a relapse. The results found that the probability of a person previously diagnosed with EDNOS had a 41% chance of relapsing; a person with BN had a 47% chance. Attachment insecurity: People who are showing signs of attachment anxiety will most likely have trouble communicating their emotional status as well as having trouble seeking effective social support. Signs that a person has adopted this symptom include not showing recognition to their caregiver or when he/she is feeling pain. In a clinical sample, it is clear that at the pretreatment step of a patient's recovery, more severe eating disorder symptoms directly corresponds to higher attachment anxiety. The more this symptom increases, the more difficult it is to achieve eating disorder reduction prior to treatment.

Anorexia Nervosa symptoms include the increasing chance of getting osteoporosis. This disease causes the bones of an individual to become brittle, weak, and low in density. Thinning of the hair as well as dry hair and skin is also very common. The muscles of the heart will also start to change if no treatment is inflicted on the patient. This causes the heart to have an abnormally slow heart rate along with low blood pressure. Heart failure becomes a major consideration when this begins to occur. Muscles throughout the body begin to lose their strength. This will cause the individual to begin feeling faint, drowsy, and weak. Along

with these symptoms, the body will begin to grow a layer of hair called lanugo. The human body does this in response to the lack of heat and insulation due to the low percentage of body fat. Bulimia nervosa symptoms include heart problems like an irregular heartbeat that can lead to heart failure and death may occur. This occurs because of the electrolyte imbalance that is a result of the constant binge and purge process. The probability of a gastric rupture increases. A gastric rupture is when there is a sudden rupture of the stomach lining that can be fatal.The acids that are contained in the vomit can cause a rupture in the esophagus as well as tooth decay. As a result, to laxative abuse, irregular bowel movements may occur along with constipation. Sores along the lining of the stomach called peptic ulcers begin to appear and the chance of developing pancreatitis increases. Binge eating symptoms include high blood pressure, which can cause heart disease if it is not treated. Many patients recognize an increase in the levels of cholesterol. The chance of being diagnosed with gallbladder disease increases, which affects an individual’s digestive tract.9

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https://en.wikipedia.org/wiki/Eating_disorder

BIBLIOGRAPHY OTHER REFERENCES:  

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Eating Disorder available at https://en.wikipedia.org/wiki/Eating_disorder Classification of Eating disorder available at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatrypsychology/eating-disorders/ Explanations available at https://www.mayoclinic.org/diseases-conditions/eatingdisorders/symptoms-causes/syc-20353603 Causes available at https://eatingdisorder.org/eating-disorder-information/underlyingcauses/ Symptoms available at https://www.nationaleatingdisorders.org/warning-signs-andsymptoms Trauma and Coping skill available at https://www.eatingdisorderhope.com/information/eating-disorder Sociocultural ideas and Dieting points available at https://www.eatingdisorderhope.com/information/eating-disorder https://en.wikipedia.org/wiki/Eating_disorder# https://www.eatingdisorders.org.au/eating-disorders/treatment/types-of-treatment https://en.wikipedia.org/wiki/Eating_disorder