Nocturnal sleep related eating disorder (NSRED).

Nocturnal Sleep-Related Eating Disorder (NSRED), also known as simply Sleep-Related Eating disorder (SRED), sleep eating, or somnambulistic eating, is a combination of a parasomnia and an eating disorder. Dr. John W Winkelman described this disorder as being in a specific category within somnambulism or a state of sleepwalking that includes behaviors connected to a person’s conscious wishes or wants. Thus many times NSRED is a person’s fulfilling of their conscious wants that they suppress; however, this disorder is difficult to distinguish from other similar types of disorders.

According to doctors and psychiatrists including Dr. J. Winkelman; Dr. Robert Auger, Dr. Carlos H. Schenck and Dr. Mark W. Mahowald, NSRED is closely related to Night Eating Syndrome (NES) except for the fact that those suffering from NES are completely awake and aware of their eating and bingeing at night while those suffering from NSRED are sleeping and unaware of what they are doing. NES is primarily considered an eating disorder while NSRED is primarily considered a parasomnia; however, both are a combination of parasomnia and eating disorders since those suffering from NES usually have insomnia or difficulty sleeping and those suffering from NSRED experience symptoms similar to binge eating. Some even argue over whether NES and NSRED are the same or distinct disorders.

Doctors and psychologists have difficulty differentiating between NES and NSRED, but the distinction of a person’s level of consciousness is what doctors chiefly rely on to make a diagnosis. One mistake that is often made is the misdiagnosis of NSRED for NES. However, even though NSRED is not a commonly known and diagnosed disease, many people suffer from it in many differing ways while doctors work to find a treatment that works for everyone; several studies have been done on NSRED. These studies, in turn, provides the basic information on this disorder including the symptoms, behaviors, and possible treatments that doctors are using today

Symptoms and behaviors

Over the past thirty years, several studies have found that those afflicted with NSRED all have different symptoms and behaviors specific to them, yet they also all have similar characteristics that doctors and psychologists have identified to distinguish NSRED from other combinations of sleep and eating disorders such as Night Eating Syndrome. Dr. John W. Winkelman says that typical behaviors for patients with NSRED include: “Partial arousals from sleep, usually within 2 to 3 hours of sleep onset, and subsequent ingestion of food in a rapid or ‘out of control’ manner.”

They also will attempt to eat bizarre amalgamations of foods and even potentially harmful substances such as glue, wood, or other toxic materials. In addition, Schenck and Mahowald noted that their patients mainly ate sweets, pastas, and both hot and cold meals, and also improper substances such as “raw, frozen, or spoiled foods; salt or sugar sandwiches; buttered cigarettes; and odd mixtures prepared in a blender.”

During the handling of this food, patients with NSRED distinguish themselves, as they are usually messy or harmful to themselves. Some eat their food with their bare hands while others attempt to eat it with utensils. This occasionally results in injuries to the person as well as other injuries. After completing their studies, Schenck and Mahowald said, “Injuries resulted from the careless cutting of food or opening of cans; consumption of scalding fluids (coffee) or solids (hot oatmeal); and frenzied running into walls, kitchen counters, and furniture.”

A few of the more notable symptoms of this disorder include large amounts of weight gain over short periods of time, particularly in women; irritability during the day, due to lack of restful sleep; and vivid dreams at night. It is easily distinguished from regular sleepwalking by the typical behavioral sequence consisting of “rapid, ‘automatic’ arising from bed, and immediate entry into the kitchen.” In addition, throughout all of the studies done, doctors and psychiatrists discovered that these symptoms are invariant across weekdays, weekends, and vacations as well as the eating excursions being erratically spread throughout a sleep cycle. Most people that suffer from this disease retain no control over when they arise and consume food in their sleep. Although some have been able to restrain themselves from indulging in their unconscious appetites, some have not and must turn to alternative methods of stopping this disorder.

Conclusion

In conclusion, Nocturnal Sleep Related Eating Disorder has affected thousands of people in an adverse way while others suffer from it their whole lives not even knowing they have it and not suffering any major side effects; however, those that are truly suffering from it have been helped through doctors and psychiatrists studies on the characteristics of NSRED and the best treatments for those that have this disorder. At the same time some symptoms are different in the various individuals that have NSRED, their treatments also differ in the same way. This makes it difficult for doctors to treat NSRED, but they are attempting to help all of those that realize and know they suffer from this disorder.

Night eating syndrome (NES).

Night eating syndrome, or NES, is an emerging eating disorder diagnosis, which primarily characterizes an ongoing, persistent pattern of late-night binge eating. NES was originally described by Dr Albert Stunkard in 1955 and is currently proposed for inclusion in the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

The diagnosis is controversial; its validity and clinical utility have been questioned and there are currently no official diagnostic criteria. It affects between 1 and 2% of the population. Although it can affect all ages and both sexes, it is more common in young women. People with NES were shown to have higher scores for depression and low self-esteem, and it has been demonstrated that nocturnal levels of the hormones melatonin and leptin are decreased. NES is often accompanied by or confused with nocturnal sleep related eating disorder, which is primarily a sleep disorder rather than an eating disorder, in which people are unaware of having eaten while asleep. There is debate as to whether these should be viewed as separate diseases, or part of a continuum.

Symptoms and behavior

People who suffer from night eating syndrome generally:

• Skip breakfast, and go several hours after waking before their first meal.
• Consume at least half their calories after dinner. (Many sources would list this as after 9 or 10 pm; dessert is generally not included, if one is eaten.)
• Late-night binges almost always consist of consuming carbohydrates. However, this eating is typically spread over several hours, which is not consistent with a typical eating binge as evidenced by other eating disorders. Episodes of sleep-eating can be repeated throughout the night, with many separate visits to the fridge or cupboard.
• Suffer from depression or anxiety, often in connection with their eating habits.
• These night eating episodes typically bring guilt rather than hedonistic enjoyment.
• Have trouble sleeping in general; see insomnia.
• Are more likely than the general public to sleepwalk.

To be considered a bona fide disorder, this pattern should continue for two months or more.

Treatment

Night eating disorder tends to lead to weight gain; as many as 28% of those seeking gastric bypass surgery were found to suffer from NES in one study. The disorder is accompanied by what sufferers describe as an uncontrollable desire to eat, akin to addiction, and is often treated chemically.

The selective serotonin reuptake inhibitor, Sertraline (or Zoloft) has shown some ability to help NES sufferers.

Therapy to increase the natural nocturnal rise in melatonin, reduce the body's adrenal stress response and raise leptin levels or improve leptin sensitivity are options that may help these patients overcome the disorder. Another key may involve the availability of tryptophan, an important amino acid, in the body.

Orthorexia nervosa.

Orthorexia, or orthorexia nervosa is a term coined by Steven Bratman, a Colorado MD, to denote an eating disorder characterized by excessive focus on eating healthy foods. In rare cases, this focus may turn into a fixation so extreme that it can lead to severe malnutrition or even death.

Bratman coined the term in 1997 from the Greek orthos, "correct or right", and orexis for "appetite". Literally "correct appetite", the word is modeled on anorexia, "without appetite", as used in definition of the condition anorexia nervosa. Bratman describes orthorexia as an unhealthy obsession (as in obsessive-compulsive disorder) with what the sufferer considers to be healthy eating. The subject may avoid certain foods, such as those containing fats, preservatives, animal products, or other ingredients considered by the subject to be unhealthy; if the dietary restrictions are too severe or improperly managed, malnutrition can result.

Diagnostic criteria

Although it is not an official medical diagnosis, and it is not listed in the DSM-IV or planned to be included in the DSM-V to be published May 2013, it is still used as a diagnosis by some practitioners who have documented the damaging results of the condition as they have seen in their practices.

Sufferers of orthorexia often display symptoms consistent with obsessive-compulsive disorder and have an exaggerated concern with healthy eating patterns. Like anorexia, however, these obsessive compulsive symptoms may be an effect of starvation rather than a cause of the disorder.

Bratman proposes an initial self-test composed of two direct questions: "Do you care more about the virtue of what you eat than the pleasure you receive from eating it?... Does your diet socially isolate you?

Other questions concerning those who may be suffering from orthorexia provided by Davis on the WebMD (2000) website are: Do they spend more than 3 hours a day thinking about healthy foods? When they eat the way they're supposed to, do they feel in total control? Are they planning tomorrow's menu today? Has the quality of their life decreased as the quality of their diet increased? Have they become stricter with themselves? Does their self-esteem get a boost from eating healthy? Do they look down on others who don't eat this way? Do they skip foods they once enjoyed in order to eat the "right" foods? Does their diet make it difficult for them to eat anywhere but at home, distancing them from family and friends? Do they feel guilt or self-loathing when you stray from their diet? If yes was answered to two or more questions, the person may have a mild case of orthorexia.

Symptoms and theory

Symptoms of orthorexia nervosa may include obsession with healthy eating, and emaciation among other things. Orthorexic subjects typically have specific feelings towards different types of food.

The obsession for healthy foods could come from a number of sources such as family habits, society trends, economic problems, recent illness, or even just hearing something negative about a food type or group, which then leads them to ultimately eliminate the food or foods from their diet.

Pica.

Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal (coins, etc), clay, coal, soil, feces, chalk, paper, soap, mucus, ash, gum, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, raw rice, starch, ice cubes, salt).

In order 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.

The condition's name comes from the Latin word for magpie, a bird which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women, small children, and those with developmental disabilities.

Causes

The scant research that has been done on the causes of pica suggests that the disorder is a specific appetite caused by mineral deficiency in many cases, typically iron deficiency which is sometimes a result of celiac disease. Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and there is a move to consider OCD in the etiology of pica; however, pica is not currently recognized by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being a mental disorder. Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica.

Treatment

Treatment for pica will vary based on the patient's category (child, developmentally disabled, pregnant, or psychopathic) and may emphasize psychosocial, environmental, and family guidance approaches. An initial approach often involves screening for and, if necessary, treating any mineral deficiencies or other comorbid conditions. For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully. However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.

Behavior-based treatment options can be useful for developmentally disabled or mentally retarded individuals with pica. These may involve associating negative consequences with eating non-food items or good consequences with normal behavior, and may be contingent on pica being attempted or initiated regardless of a pica attempt. A recent study classified nine such classes of behavioral intervention:

• Presentation of attention, food, or toys, not contingent on pica being attempted
• Differential reinforcement, with positive reinforcement if pica is not attempted and negative reinforcement if pica is attempted
• Discrimination training between edible and inedible items, with negative consequences if pica is attempted
• Visual screening, with eyes briefly for a short time after pica is attempted

• Aversive presentation, contingent on pica being attempted:
• oral taste (e.g., lemon)
• smell sensation (e.g., ammonia)
• physical sensation (e.g., water mist in face)

• Physical restraint:
• self-protection devices that prohibit placement of objects in the mouth
• brief restraint contingent on pica being attempted

• Time-out contingent on pica being attempted
• Overcorrection, with attempted pica resulting in required washing of self, disposal of nonedible objects, and chore-based punishment
• Negative practice (nonedible object held against patient's mouth without allowing ingestion)

Eating disorder not otherwise specified (EDNOS).

EDNOS is described in the DSM-IV-TR as a "category of disorders of eating that do not meet the criteria for any specific eating disorder".

Characteristics

This category is frequently used for people who meet some, but not all, of the diagnostic criteria for anorexia nervosa or bulimia nervosa. For example, a person who shows almost all of the symptoms of anorexia nervosa, but who still has a normal menstrual cycle and/or body mass index, can be diagnosed with EDNOS. A sufferer may experience episodes of binging and purging, but may not do so frequently enough to warrant a diagnosis of bulimia nervosa. A person may also engage in binging episodes without the use of inappropriate compensatory behaviors; this is referred to as binge eating disorder. It still is, however, a very real disorder.

People diagnosed with EDNOS may frequently switch between different eating patterns, or may with time fit all diagnostic criteria for anorexia or bulimia.

People who eat a normal amount of food, but become exceedingly obsessed with healthy eating, or strictly categorize normal foods or entire food groups as "safe" and "off-limits", may be referred to as having orthorexia. However, this diagnosis is not formally accepted by the psychiatric community.

Different forms

"Chew and spit" refers to chewing food followed by spitting it out, done with the intention of sating hunger by giving a chewing sensation without swallowing the food, thus avoiding the calories.

EDNOS are usually in the normal weight range but have 'issues with food' they eat and fast/purge but do not have the serious critiques of a anorexic or bulimic sufferer.

They usually can hide the ED, as their weight range is normal. They do, in fact, do a large amount of exercise e.g. hundreds of sit-ups, and some suffer from OCD.

Female athlete triad.

Female Athlete Triad is a syndrome in which eating disorders (or low energy availability), amenorrhoea/oligomenorrhoea and decreased bone mineral density (osteoporosis and osteopenia) are present. Also know simply as the Triad, this condition is seen in females participating in sports that emphasize leanness or low body weight. The Triad is a serious illness with lifelong health consequences and can potentially be fatal

Symptoms

Clinical symptoms of the Triad may include disordered eating, fatigue, hair loss, cold hands and feet, dry skin, noticeable weight loss, increased healing time from injuries, increased incidence of bone fracture and cessation of menses. Affected female may also struggle with low-self esteem and depression.

Upon physical examination, a physician may also note the following symptoms: elevated carotene in the blood, anemia, orthostatic hypotension, electrolyte irregularities, hypoestrogenism, vaginal atrophy, and bradycardia.

Triad Components

• Low Energy Availability
  Energy availability is defined as energy intake minus energy expended. Energy is taken in through food consumption. Our bodies expend energy through normal functioning as well as through exercise. In the case of female athlete triad, low energy availability may be coupled with eating disorders, but not necessarily so. Athletes may experience low energy availability by exercising more without a concomitant change in eating habits, or they may increase their energy expenditure while also eating less.
  
  While most athletes do not meet the criteria to be diagnosed with an eating disorder such as anorexia nervosa or bulimia nervosa, many will exhibit disordered eating habits. Some examples of disordered eating habits are fasting; binge-eating; purging; and the use of diet-pills, laxatives, diuretics, and enemas. By restricting their diets, athletes worsen the problem of low energy availability.

• Amenorrhea
  Amenorrhea, defined as the cessation of a woman’s menstrual cycle for more than three months, is the second disorder in the Triad. Weight fluctuations from dietary restrictions and/or excessive exercise affect the hypothalamus’s output of gonadotropic hormones. Gonadotropic hormones “stimulate growth of the gonads and the secretion of sex hormones.” (e.g. gonadotropin-releasing hormone, lutenizing hormone and follicle stimulating hormone.) These gonadotropic hormones play a role in stimulating estrogen release from the ovaries. Without estrogen release, the menstrual cycle is disrupted.
  
  There are two types of amenorrhea. A woman who has been having her period and then stops menstruating for ninety days or more is said to have secondary amenorrhea. Primary amenorrhea is characterized by delayed menarche. Menarche is the onset of a girl’s first period. Delayed menarche may be associated with delay of the development of secondary sexual characteristics.

• Osteoporosis
  Osteoporosis is defined by the National Institutes of Health as "a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture."

Treatment

• Multidisciplinary Approach. Athletes diagnosed with female athlete triad should be treated using a multidisciplinary approach. Patients are recommended to work with a dietician who can monitor their nutritional status and help the patient work towards a healthy goal weight. Patients should also meet with a psychiatrist or psychologist to address the psychological aspects of the Triad. Finally, it is generally recommended that athletes reduce the amount of time they spend exercising by 10-12 percent. Therefore, it is important that trainers and coaches are made aware of the athlete’s condition and be part of her recovery.

• Pharmacologic Treatment. Patients are also sometimes treated pharmacologically. To both induce menses and improve bone density, doctors may prescribe cyclic estrogen or progesterone as is used to treat post-menopausal women. Patients may also be put on oral contraceptives to stimulate regular periods. In addition to hormone therapy, nutrition supplements may be recommended. Doctors may prescribe calcium supplements. Vitamin D supplements may be also used because this vitamin aids in calcium absorption. Biphosphates and calcitonin, used to treat adults with osteoporosis, may be prescribed, although their effectiveness in adolescents has not yet been established. Finally, if indicated by a psychiatric examination, the affected athlete may be prescribed anti-depressants and in some cases benzodiazepines to help in alleviating severe distress at mealtimes.

Polyphagia and Food Maintenance Syndrome.

Polyphagia

Polyphagia means "eating too much." It derives from the Greek words πολύ (poli) which means "very much", and φαΐ (fai) which means "food".

In medicine, polyphagia (sometimes known as hyperphagia) is a medical sign meaning excessive hunger and abnormally large intake of solids by mouth.

Disorders such as diabetes, Kleine Levin Syndrome (a malfunction in the hypothalamus), the genetic disorders Prader-Willi Syndrome and Bardet Biedl Syndrome can cause hyperphagia (compulsive hunger).

Food Maintenance Syndrome

Food Maintenance Syndrome is characterized by a set of aberrant eating behaviors of children in foster care it is "a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity", it resembles "the behavioral correlates of Hyperphagic Short Stature". It is hypothesised that this syndrome is triggered by the stress and maltreatment these children are subjected to.

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Note: I had much difficulty finding information about these two disorders. If you have any suggestions, please do comment. I'd be very glad indeed to be able to improve this post!

Diabulimia.

Diabulimia refers to an eating disorder in which people with type 1 diabetes deliberately give themselves less insulin then they need, for the purpose of weight loss.

The symptoms

Short term

These are the short term symptoms of patients with diabulimia.

• Constant urination
• Constant thirst
• Excessive appetite
• High blood glucose levels (often over 600)
• Weakness
• Fatigue
• Large amounts of glucose in the urine
• Inability to concentrate
• Electrolyte disturbance
• Severe ketonuria, and, in DKA, severe ketonemia
• Low sodium levels

Medium term

These are the medium term symptoms of patients with diabulimia. They are prevalent when diabulimia has not been treated and hence also includes the short term symptoms.

• Muscle atrophy
• GERD
• Indigestion
• Severe weight loss
• Proteinuria
• Moderate to severe dehydration
• Edema with fluid replacement
• High cholesterol
• Death

Long term

If a person with type 1 diabetes who has diabulimia suffers from the disease for more than a short time - usually due to alternating phases during which insulin is injected properly, and relapses, during which they have diabulimia - then the following longer-term symptoms can be expected:

• Severe kidney damage
• Blindness
• Severe neuropathy (nerve damage to hands and feet)
• Extreme fatigue
• Edema (during blood sugars controlled phases)
• Heart problems
• High cholesterol
• Osteoporosis
• Death

What is diabulimia?

Diabulimia is not currently recognized as a formal diagnosis by the medical or psychiatric communities. However, the phrases “disturbed eating behavior” or “disordered eating behavior” (DEB in both cases), or disordered eating (DE) are quite common in medical and psychiatric literature which addresses the condition of patients who have type 1 diabetes and who also intentionally manipulate insulin doses to control weight.

Failure to administer insulin places the body in a starvation state, resulting in breakdown of muscle and fat into ketone bodies and subsequently ketoacids, while at the same time making the body unable to process sugars that have been consumed, so the sugars are excreted in the urine rather than being used by the body for energy or stored as fat. This typically results in significant weight loss but also places the patient at risk of a life-threatening condition known as diabetic ketoacidosis. Prolonged failure to administer insulin results in long-term complications such as diabetic neuropathy. Insulin restriction is associated not only with increased rates of diabetes complications but increased mortality risk as well. Diabetics who restrict insulin die at earlier ages on average than those diabetics who use insulin properly.

Often, people with type 1 diabetes who omit insulin injections will have already been diagnosed with an eating disorder such as anorexia nervosa, bulimia nervosa and/or compulsive eating. In cases where a person with type 1 diabetes has another eating disorder, there is a tendency to discuss the other eating disorder more openly than they discuss diabulimia, as many people with diabetes are embarrassed or don't want to deal with the reality that they have lost control of their diabetes. These individuals are often not aware that diabulimia is more common than they think and is also very difficult to overcome. Unlike anorexia and bulimia, diabulimia sometimes requires the afflicted individual to stop caring for a medical condition. Unlike vomiting or starving, there is sometimes no clear action or willpower involved. Diabulimia may be more appealing to individuals who want to lose weight and do not want to feel hungry, or do not want to engage in purging via vomiting. Often there is an obsessive compulsive urge to engage in this activity for the purpose of emotional disassociation or a need to satisfy feelings of control.

Diabetic ketoacidosis (DKA) is very common in persons with type 1 diabetes who have diabulimia. This is due to the body's need for a constant supply of energy, which lack of insulin prevents. DKA is a very serious condition that occurs when one doesn't have enough insulin; without treatment it results in death within a very short span of time.

Diabulimia tends to start in adolescence and is more likely to occur in women than men. One can identify a patient as having diabulimia if there are many unexplainable spikes in their Hemoglobin A1c, weight loss, lack of marks from fingerpricks, lack of prescription refills for diabetes medications, and records that do not match the HbA1c.

Rumination syndrome.

What is Rumination syndrome?

Rumination syndrome, or Merycism is an under-diagnosed chronic eating disorder, characterized by effortless regurgitation of most meals following consumption. There is no retching, nausea, heartburn, odours, or abdominal pains 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.

Rumination syndrome presents itself in a variety of ways, especially when comparing an adult without a mental disability to an infant or to a mentally impaired individual. Like most eating disorders, rumination can adversely affect normal functioning and the social lives of individuals. It has been linked with depression.

There is little comprehensive data regarding rumination syndrome in otherwise healthy individuals. Most people with the disorder are private about their illness, and are often misdiagnosed due to the number of symptoms, and the clinical similarities between rumination syndrome and other disorders of the stomach and esophogus, such as gastroparesis and bulimia nervosa. These include the acid-induced erosion of the esophagus and teeth (causing dental decay), halitosis, malnutrition, 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.

Signs and symptoms

While the number and severity of symptoms varies among individuals, repetitive regurgitation of undigested food (known as rumination) after the start of a meal is always present.

In some individuals, the regurgitation is small, occurring over a long period of time following ingestion, and can be rechewed and swallowed. In others, the amount can be bilious and short lasting, and must be expelled. While some only experience symptoms following some meals, most experience episodes following any ingestion, from a single bite to a massive feast.

Unlike typical vomiting, the regurgitation is typically described as effortless and unforced. There is seldom nausea preceding the expulsion, and the undigested food lacks the bitter taste and odour of stomach acid and bile.

Symptoms can begin to manifest at any point from the ingestion of the meal to 120 minutes thereafter. However, the more common range is between 30 seconds to 1 hour after the completion of a meal. Symptoms tend to cease when the ruminated contents become acidic.

Abdominal pain, lack of fecal production or constipation, nausea, diarrhea, bloating, and dental decay are also described as common symptoms in day-to-day life. These symptoms are not necessarily prevalent during regurgitation episodes, and can happen at any time. Weight loss is often observed at an average loss of 9.6 kilograms, and is more common in cases where the disorder has gone undiagnosed for a longer period of time, though this may be expected of the nutrition deficiencies that often accompany the disorder as a consequence of its symptoms. Depression has also been linked with rumination syndrome, though the effects of it on rumination syndrome are unknown.

Causes

The cause of rumination syndrome is unknown. However, studies have drawn a correlation between hypothesized causes and the history of patients with the disorder. In infants and the cognitively impaired, the disease has normally been attributed to over-stimulation and under-stimulation from parents and caregivers, causing the individual to seek self-gratification and self-stimulus due to the lack or abundance of external stimuli. The disorder has also commonly been attributed to a bout of illness, a period of stress in the individual's recent past, and to changes in medication.

In adults and adolescents, hypothesized causes generally fall into one of either category: habit-induced, and trauma-induced. Habit-induced individuals generally have a past history of bulimia nervosa or of intentional regurgitation (magicians and professional regurgitators, for example), which though initially self-induced, forms a subconscious habit that can continue to manifest itself outside the control of the affected individual. Trauma-induced individuals describe an emotional or physical injury (such as recent surgery, psychological distress, concussions, deaths in the family, etc.), which preceded the onset of rumination, often by several months.

Treatment and prognosis

There is presently no known cure for rumination. Proton pump inhibitors and other medications have been used to little or no effect.

In patients of normal intelligence, rumination is not an intentional behavior and is habitually reversed using diaphragmatic breathing to counter the urge to regurgitate. Alongside reassurance, explanation and habit reversal, patients are shown how to breathe using their diaphragms prior to and during the normal rumination period. A similar breathing pattern can be used to prevent normal vomiting. Breathing in this method works by physically preventing the abdominal contractions required to expel stomach contents.

Supportive therapy and diaphragmatic breathing has shown to cause improvement in 56% of cases, and total cessation of symptoms in an additional 30% in one study of 54 adolescent patients who were followed up 10 months after initial treatments. Patients who successfully use the technique often notice an immediate change in health for the better. Individuals who have had bulimia or who intentionally induced vomiting in the past have a reduced chance for improvement due to the reinforced behavior.

Binge Eating Disorder (BED)

Signs

• Periodically does not exercise control over consumption of food.
• Eats an unusually large amount of food at one time, far more than a normal person would eat in the same amount of time.
• Eats much more quickly during binge episodes than during normal eating episodes.
• Eats until physically uncomfortable and nauseated due to the amount of food just consumed.
• Eats when depressed or bored.
• Eats large amounts of food even when not really hungry.
• Usually eats alone during binge eating episodes, in order to avoid discovery of the disorder.
• Often eats alone during periods of normal eating, owing to feelings of embarrassment about food.
• Feels disgusted, depressed, or guilty after binge eating.
• Rapid weight gain, and/or sudden onset of obesity.

Complications

Weight gain, obesity, depression, malnourishment, type 2 diabetes, high blood pressure, high blood cholesterol levels, gallbladder disease, heart disease, cancer.

What is binge eating disorder?

BED is the most common eating disorder and in the US alone it affects 3.5% of females and 2% of males, it's prevalent in up to 30% of those seeking weight loss treatment.

It was first described in 1959 by Albert Stunkard as “Night Eating Syndrome” before the term Binge Eating Disorder was coined. It is still not classified as a separate eating disorder though.

Dieting

People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting here means skipping meals, not eating enough calories each day, or avoiding certain kinds of food, such as carbohydrates or fats. Many people with binge eating disorder are obese and have health problems because of their weight. People with binge eating disorder who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly due to a slowing of the metabolism. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for binge eating disorder before they try to lose weight. Dieting is usually not successful for those with BED, as they will usually gain back all of the weight lost, and sometimes more. Those with BED have more difficulty adhering to traditional weight-loss treatment.

Treatment

Physicians, nutritionists, psychiatrists, clinical social workers and the Overeaters Anonymous' 12-step program is the most effective when it comes to treating binge eating. Since it's not recognized as a psychiatric disorder it's difficult to obtain insurance reimbursement for treatments.

Cognitive behavioural therapy (CBT), interpersonal psychotherapy and drug therapy is also known to help some binge eaters.

Researchers are still trying to find the most effective way to beat the disorder, though so far these above seem to be equally helpful.

Bulimia Nervosa.

Bulimia nervosa is believed to be on of the most common eating disorders, though there is little data to support this. It's characterized by recurrent binge eating, followed by compensatory behaviors. The most common form is defensive vomiting (sometimes called purging)Fasting, the use of laxatives, enemas, diuretics and over exercising are also common.

The disorder is most common between the ages of 13 and 20 years, though many adults later on experience relapses with episodic binging and purging, even though they've been through a successful treatment and remission. Often, the person suffering from bulimia have previously suffered from obesity.

It's hard to detect bulimia because most who suffers from the disorder tend to be either average och slightly above or below average weight.

The diagnostic criteria includes repetitive episodes of binge eating compensated for by excessive or inappropriate measures taken to avoid gaining weight. The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia and when the behavior reflects an overemphasis on physical mass or appearance.

Bulimia is divided into two sub-types:

• The purging type
  Self-induced vomiting to rapidly remove food from the body before it can be digested, or use laxatives, diuretics or enemas.
• The non-purging type
  Exercise or fast excessively after a binge to offset the caloric intake after eating. Purgin-type bulimics may also exercise or fast, but as a secondary form of weight control.

The consequences

Gastric reflux, dehydration and hypokalemia, electrolyte imbalance, cardiac arrhythmia, cardiac arrest, death, esophagitis, oral trauma (lacerations), gastroparesis, constipation, infertility, enlarged glands in the neck, peptic ulcers, calluses or scars on back of hands, constant weight fluctuations, severe dental caries, perimolysis, swollen salivary glands.

The causes

There is no know cause to this or any other eating disorder, but there are though theories.

Some researchers have hypothesized a relationship to mood disorders. There have also been seen a relationship to seizure disorders. Bulimia have also been characterized as an addiction disorder.

Treatment

• Tricyclic antidepressants
  Such as MAO inhibitors, mianserin, fluoxetine, lithium carbonate, nomifensine, trazodone and bupropion.
  
  
• Topiramate
  Blocks cravings for opiates, cocaine, alcohol and food.
  
  
• Cognitive behavioral therapy (CBT)
  Teaching clients to challenge automatic thoughts and engage in behavioral experiments.

• Family Based Treatment (FBT)
  Has been shown to have positive results for the treatment of bulimia nervosa.

Some researchers have also claimed positive outcomes in hypnotherapy treatment

Anorexia Nervosa (AN)

Signs and symptoms

• Obvious, rapid, dramatic weight loss.
• Scarring on the knuckles from placing fingers down the throat to induce vomiting (Russell's sign).
• Soft, fine hair grows on face and body (lanugo).
• Obsession with calories and fat content.
• Preoccupation with food, recipes, or cooking. May cook elaborate dinners for others but not eat themselves.
• Dieting despite being thin or dangerously underweight.
• Fear of gaining weight or becoming overweight.
• Cuts food into tiny pieces, refuses to eat around others, hides or discards food.
• Uses laxatives, diet pills, ipecac syrup, or water pills. May engage in self-induced vomiting. May run to the bathroom after eating in order to vomit and quickly get rid of the calories (purging).
• May engage in frequent, strenuous exercise.
• Perceives self to be overweight despite being told by others they are too thin.
• Becomes intolerant to cold. Frequently complains of being cold due to loss of insulating body fat. Body temperature lowers (hypothermia) in effort to conserve calories.
• May frequently be in a sad, lethargic state (depression).
• May avoid friends and family, becomes withdrawn and secretive.
• May wear baggy, loose-fitting clothes to cover weight loss.
• Cheeks may become swollen due to enlargement of the salivary glands caused by excessive vomiting.

Dermatologic signs

Xerosis, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticilaris, interdigital intertrigo, paronychia, generalized pruritus, acquired striae distensae, angular stomatitis, prurigo pigmentosa, edema, linear erythema craquele, acrodermatitis enteropathica, pellagra.

Possible medical complications

Constipation, diarrhea, electrolyte imbalance, cavities, tooth loss, cardiac arrest, amenorrhoea, edema, osteoporosis, osteopenia, hyponatremia, hypokalemia, optic neuropathy, brain atrophy, leukopenia.

What is anorexia nervosa (AN)?

Anorexia is probably one of the most common eating disorders out there. It's characterized by refusal to maintain a healthy body weight, and an obsessive fear of gaining weight due to a distorted self image. It is a serious mental illness with as high morbidity and mortality rates as any other psychiatric illnesses.

The term anorexia nervosa was established in 1873 by Sir William Gull. The word originate from from Greek and means lack of desire to eat. In the published medical papers of Sir Gull one can read about Miss A and her treatment in 1866-1870. She was one of the earliest AN case studies.

The history of anorexia nervosa began earlier than that though. There were early descriptions dating from the 16th and 17th century and the first recognition and description of AN as a disease was in the late 19th century.

The causes

There's a lot of theories to what causes AN, and other eating disorders, but there is so far no actual proof. Studies have hypothesized that the continuance of disordered eating patterns may be epiphenomena of starvation. The results of the Minnesota Starvation Experiment showed that normal controls exhibit many of the behavioral patterns of anorexia nervosa when subjected to starvation. This may be due to the numerous changes in the neuroendocrine system, which results in a self perpetuating cycle. Studies have suggested that the initial weight loss such as dieting may be the triggering factor in developing AN in some cases, possibly due to an already inherent predisposition toward AN. One study reports cases of AN resulting from unintended weight loss that resulted from varied causes such as a parasitic infection, medication side effects, and surgery. The weight loss itself was the triggering factor.

Treatment

The treatment of AN tries to address three main areas:

1. Restoring the person to a healthy weight
2. Treating the psychological disorders related to the illness
3. Reducing or eliminating behaviors or thoughts that originally led to the disordered eating.

• Diet and nutrition
  Zinc and essential fatty acids have been shown to be very helpful in the treatment of AN. One is often also helped by a medical nutrition therapist. The therapy is based on a detailed assessment of the person's medical history, psychosocial history, physical examination and dietary history.

• Medication
  Olanzapine has been shown to be effective in treating certain aspects of AN including to help raise the BMI (Body Mass Index) and reduce obsessionality, such as the thoughts about food.

• Psychotherapy/Cognitive remediation
  CBT (Cognitive Behavioral Therapy) is an evidence based approach which in studies to date has shown to be useful in adolescents and adults with AN. So has various forms of family therapy.

The eating disorders.

So, what is an eating disorder? In short terms it's when a person have abnormal eating habits. It often involves insufficient or excessive food intake to the detriment of the persons physical and emotional health. Most common among the eating disorders are binge eating, bulimia and anorexia.

It's known to affect more women then men. Statistics show that in the US alone 5-10 million females suffer from eating disorders, while it's only estimated that 1 million males are affected.

What causes eating disorders are still too complex and too poorly understood to determine. The consequences however is not. They are severe and can lead to an early death, whether because of direct medical effects or due to suicide.

The causes

While there is no certain causes when it comes to eating disorders, there are many theories to why they occur.

• The biological causes:
  Genetic, epigenetics, biochemical, leptin and ghrelin, immune system, infection, lesions, tumors, brain celcification, somatosensory homunculus, obsetric.

• Psychological:
  
  (Should not be used to diagnose yourself. There have been considerable controversy over the diagnostic criteria used for various diagnoses)
  
  
  Depression, substance abuse, alcoholism, anxiety disorders, obsessive compulsive disorder, attention-deficit hyperactivity disorder, obsessive compulsive personality disorder, borderline personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant personality disorder.

• Personality traits:
  There are varios childhood personality traits associated with the development of eating disorders. During adolescence these traits may become intensified due to a variety of physiological and cultural influences such as the hormonal changes associated with puberty, stress related to the approaching demands of maturity and socio-cultural influences and perceived expectations, especially in areas that concern body image.
  
  The big five personality traits (Openness, conscientiousness, extraversion, agreeableness, neuroticism), self esteem, harm avoidance, novelty seeking, perfectionism, alexithymia, rigidity, impulsivity, disinhibition, obsessionality.
  
  
• Environmental:
  Child maltreatment, social isolation, parental influence, peer pressure, cultural pressure.

Symptoms-complications

Symptoms and complications vary according to the nature and severity of the eating disorder.

Acne, xerosis, amenorrhoea, toothloss/cavities, constipation, diarrhea, water retention/edema, lanugo, telogen effluvium, cardiac arrest, hypokalemia, death, osteoporosis, electrolyte imbalance, hyponatremia, brain atrophy, pellagra, scurvy, kidney failure, suicide.

Polycystic ovary syndrome is the most common endocrine disorder to affect women.

The specific eating disorders (The following posts will contain more information on each of them)

Anorexia nervosa

Bulimia nervosa

Binge eating disorder (BED), not yet classified as a separate disorder

Rumination syndrome

Diabulimia, not currently recognized as a medical condition

Food maintenance syndrome

Female athlete triad

Eating disorder not otherwise specified (EDNOS)

Pica

Orthorexia

Night eating syndrome

Nocturnal Sleep Related Eating Disorder

Hyperphagia

This is my story.

It's a constant battle, eating disorders. Whether it is bulimia, anorexia or any of the other numerous disorders, it's still one of the hardest things one ever have to deal with. They say that you can never really rid yourself of an eating disorder, that there always will be a part of it within you. But then again, isn't that just like every other battle we go through within ourselves?

And so it began...
At the young age of nine my world went tumbling down which left me open and vulnerable. And the less friendly people around me wasted no time using that for their own gain. It began as a small comment, that I had put on some weight. From that moment and for months to come, all I heard were how fat I'd become and that I should go on a diet. And so I did. But for them it wasn't enough, they kept telling me I was fat and ugly. That's when the starving began.

Now, almost twelve years later, I can say I was a fool. Before it all began I was very thin. I've always been underweight, back then I weighed about ten kilos (22 lbs) less then I should. And thanks to those I once called my friends, I stayed that way. The closest to the weight I should have that I've ever been was still five kg (11 lbs) too little.

It wasn't that bad in the beginning. I started to skip breakfast. That left three meals per day. Then I stopped eating lunch. Then the afternoon-meal. And in the end I stopped eating all together. By that time I was thirteen.
It wasn't an easy thing to do. Not the not-eating part. But the part of hiding it. My teachers noticed it first, that I never ate in school. But they chose to talk to me first which helped a lot. It's easier to lie when your parents isn't there.
My mother was quite easy to fool. She worked a lot and had too many problems herself to notice what was going on with me. It was easy for me to lie and tell her that I had eaten at my friends place, because she never had the energy to question it.

The consequences
The years past by and I advanced. I realized my limit quite quick and I started to push it. Once I could only go three days in a row without food, by the end I could manage seven. All I needed was water, cigarettes and gum. It had it's consequences of course. Those times I went that far my energy was dangerously low. I could barely get out of bed. The nausea was horrible, the constant pains shooting up and down my stomach was blinding. The consequences was great. I still have problems with my stomach, and most doctors I've spoken to about it say it's because of those times. The stomach-acid made quite a lot of damage and it might never get completely healed again.

Somehow it didn't change much for me, to know what it did to my body. It was so obvious - the pain, the cramps - my body was screaming at me to stop. But I didn't listen. I did become a little nicer though. I began to eat again, one meal per day and I rarely went more then two days without food. It wasn't much but my body was thankful. Even though it protested at first. It was pure hell to begin to eat again. Everything I ate came back up again and it hurt a lot. It was as if my body was paying me back for all those days I didn't give it anything. And wow, did it pay me back a lot.

Waking up

That was one of my wake-up calls. That, and the man I dated at that time. He made it clear to me that it wasn't working and that I needed help. I wouldn't survive if I didn't, he said. I heard him and so I made the call.

I began talking to a therapist about it and she agreed with my boyfriend, it wasn't looking good. I was about ten kg (22 lbs) underweight at that time and I was starting to lose weight without doing anything. I still don't know what actually happened with my body at that time. I ate one meal a day as usual, I took a 30 minute walk every day as I had done for some time and my sleep was as bad as ever. By all logic my body should have stayed the way it was. Yet, it did not.

Unfortunately my time with the therapist soon came to an end. We had hardly begun the treatment but I had to move due to the break-up between me and my partner. And with that relationship my motivation died.

I moved back home to live with my family and went on with my ways. What saved me was what I was eating. Before I mostly ate light, small portions of either vegetables or vegetarian meals. But my mothers cooking was all but that. It often contained most of the things a human being should eat every day, also a lot of fat gravy and milk with 3% fat. My body hated it, especially since it had developed an intolerance for lactose and milk protein. But it gained some weight.

The road begins

I gained weight, but not enough. I couldn't bring myself to eat more and some days I kept on starving myself. I realized that I yet again needed help. After all weight was gained on my own, I still only measured 47 kg (103 lbs) when it should be 55 kg (121 lbs). With one meal, 1 hour walk and a 30 minute workout at home every day, I hardly gained weight.

And so I called a booked a meeting with a new therapist. Today, about four months later, I've gained one kilo (2 lbs).

When I met Jonna for the first time we began soon afterwards with an eating-schedule. First I filled in a paper every day for a week, writing down what time and what I ate. Most days I ate once a day, often late. After that week it got serious. I was to do this every day from now on, giving her the papers every Monday. That was the easy part. The hard part was that I was to eat three times a day, the same time each day.

The goals

There's another two months or so left until my time with Jonna will come to an end. By August the goal is for me to, on my own, eat those three meals. Breakfast between 10-11 AM (very hard indeed, since it was about 11 years since I did so the last time), then lunch at 2 PM and dinner at about 6 PM. By August that should come naturally for me.

And now I've created another "goal". I started this blog in the hopes of helping others struggling with eating disorders, as well as I started it to help myself. Each week I will post copies of my eating-schedules, so that you (and I) can see the progress. I'll make small notes telling how it's been going and I hope that in some way it will somehow inspire others fighting the same fight.

Even though we don't share the same eating-disorders (Eating disorder not otherwise specified) I think it can help in other ways. Give you an idea of how you could beat your problems, motivate you, inspire you.

If you ever feel the need

If you ever have any questions, or ever feel like you need someone to talk to - do contact me. Either here or send me an email to pyongie@gmail.com.

I've spent years suffering alone, trying to help myself by reading about my problems. I do not know everything, but at least some. I'm a good listener and I always want to help anyway I can. So don't hesitate if you ever feel the need.

And so I begin. I really do hope this will help and I wish you all the luck in the world with your own fight, whatever it might be.