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[Lyric]

I had a long post all typed out on this one... Including my own experience with BDD and how it can tie into eating disorders.  Where an 87lb adult woman looks in the mirror and sees fat..

Well, the forum ate it..  So, I will have to rewrite it.   I promise we'll get to this one.  Perhaps at the very end of Eating Disorders.  
I hope that it will help click on a lightbulb for some people.

[Lyric]

Okay...  I am going to share my experience with BDD(Body Dismorphic Disorder)

We have touched on Anorexia, and the question came up.
"How does someone with this disorder, and is frighteningly thin continue to see themselves as fat"

There is something in the mind, that doesn't seem to 'update' what you currently look like.  (that's how I view it)

My experience from this came from being a Body Builder.  I was nothing but a 165lb wall of muscle with close to 5% or less body fat(down to 2%when I was going to compete).
The common reaction to this is " Wow, you must have been in awesome shape"
The answer.  " It appeared that way, I was fit, lean had an awesome resting heart rate and great blood pressure.  My cholesterol wasn't bad either"

What no one saw, until my body sent a screaming alarm at me, by making my hair fall out, was that, while my workout regime was good.  My body fat was dangerously low.
I was on a total protein diet and drinking only water.  There was no fat, no dairy, barely any vegetables.  

However, when I looked in the mirror at the gym.  I saw me as overweight, unhealthy, and on a good day when I didn't see the overweight.   I saw that I wasn't 'big enough'.  I would push harder and harder to get in 5-10 more pounds in the weights or to just squeeze out that extra rep.  Because I didn't feel that I was big enough....

It was as though my brain wasn't updating my body about how I look...
It still doesn't, or now, it thinks I am bigger than I am.
(Since I have quit body building and have packed on a considerable amount of body fat since).
When dancing... I am constantly being pushed back into formation because I have moved away from the other members of the troupe or class, because when I look in the mirror, I see me as big and move away to give the dancer next to me more room.  
I have to constantly ask Serrena how I look, and often see other big women on the street and have to ask.. " Am I that big"  The answer is always the same.  "No, you're not"..  But, that is how I view myself.

There are still more extreme examples and stories about this.   This is only my own personal experience with it.

[Jeff]

I've never quite figured it out; I eat the same amount of food that I used to, and now I actually eat healthier, but I gave up the smokes.  Even my doctor's confused at why I gained the weight.  I've never even attempted a diet before, so I have no clue what I'm getting into.

A  lot of people who qwit smoking gain wait for some reason.

[Lynne]

http://www.medscape.com/viewarticle/487413
Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries
Posted 09/27/2004
Mariko Makino, MD, PhD; Koji Tsuboi, MD, PhD; Lorraine Dennerstein, AO MBBS, PhD, DPM, FRANZCP

Prevalence rates in Western countries for anorexia nervosa ranged from 0.1% to 5.7% in female subjects. Prevalence rates for bulimia nervosa ranged from 0% to 2.1% in males and from 0.3% to 7.3% in female subjects in Western countries. Prevalence rates in non-Western countries for bulimia nervosa ranged from 0.46% to 3.2% in female subjects. Studies of eating attitudes indicate abnormal eating attitudes in non-Western countries have been gradually increasing.

[Lynne]

http://www.medscape.com/viewarticle/502619

Nonspecific Supportive Clinical Management May Be Effective for Anorexia  

April 7, 2005 — Nonspecific supportive clinical management is better than specialized psychotherapies for anorexia nervosa, according to the results of a randomized trial published in the April issue of the American Journal of Psychiatry.

Am J Psych. 2005;162:741-747

[Lynne]

http://www.medscape.com/medline/abstract/16485270?queryText=anorexia%202006

Why do individuals with anorexia die? A case of sudden death.
Int J Eat Disord.  2006; 39(3):260-2 (ISSN: 0276-3478)
Derman T; Szabo CP
Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa.

OBJECTIVE: The mechanism of death in anorexia nervosa (AN) is unclear.
METHOD: We present a case of sudden death in AN with unexpected autopsy findings. A 36-year-old woman with long-standing AN presented to the eating disorders unit. She was severely underweight with a body mass index of 12.5. Ten days after admission, she went into coma with no obvious precipitant.
RESULTS: Clinical examination and investigations failed to reveal its cause. Despite attempts at resuscitation, she died the following morning. A postmortem examination revealed multiple bilateral pulmonary thromboemboli and bilateral calf vein thrombosis.
CONCLUSION: This case illustrates that in AN, pathology may not manifest with obvious clinical features. A high level of clinical vigilance is required. The cause of death in AN cannot reliably be established from antemortem clinical features. We recommend that any AN death be reported and that, where possible, an autopsy be performed. This may lead to advances in knowledge and treatment practices.

[Lynne]

Habit learning and anorexia nervosa: A cognitive neuroscience hypothesis.
Int J Eat Disord.  2006; 39(4):267-75 (ISSN: 0276-3478)
Steinglass J; Walsh BT
Department of Psychiatry, College of Physicians and Surgeons of Columbia University /New York State Psychiatric Institute, New York, New York.

OBJECTIVE: Anorexia nervosa (AN) is characterized by abnormal behaviors involving eating and weight that are impressively resistant to change. The persistence of these behaviors likely plays an important role in the high relapse rate after initial treatment. Persistent, stereotyped behaviors are also characteristic of obsessive-compulsive disorder (OCD). This article presents a neurocognitive model of AN, based on comparisons with OCD.

METHOD: This article reviews clinical, neuropsychological, and neuroimaging findings in both OCD and AN relevant to a neurobiological understanding of a potential mechanism of the perpetuation of AN.
RESULTS: The identification of specific neurocognitive disturbances in individuals with OCD has led to a compelling hypothesis of the neural mechanisms mediating this disorder. Evidence suggests that similar disturbances, involving neural circuits between the cortex and the basal ganglia, may be present in individuals with AN.
CONCLUSION: Research on such neurocognitive disturbances has the potential both to inform understanding of neural mechanisms underlying AN and to lead to advances in treatment.

[Lynne]

I was always taught that anorexia and bulimia were psychological in origin.  Of course, this was back when we believed in multiple personaility disorders and repressed memory syndrome.   :wink:   I've tried to stay somewhat current with the literature, so here is the latest I could find that had its basis in research rather than just theory:

1.  Eating Disorders May Run in Families
Miranda Hitti

March 6, 2006 -- The eating disorders anorexia and binge eating may run in families, according to two new studies.
 Both studies appear in the Archives of General Psychiatry. The first study showed that genetic factors accounted for more than half of anorexia cases among more than 31,000 twins in Sweden.
 "We were able to show for the first time that there is a substantial genetic component to anorexia nervosa," researcher Cynthia Bulik, PhD, tells WebMD.
 The second study showed that binge eating tends to run in families. Genes might be at work, but the study doesn't prove that.
 "Basically, what we're finding out is that eating disorders are familial disorders," says Bulik, who worked on both studies and is an eating disorders expert at the University of North Carolina (UNC).
http://www.medscape.com/viewarticle/525009

2. Anorexia Nervosa Largely a Genetic Disease
By Anthony J. Brown, MD

 NEW YORK (Reuters Health) Mar 06 - Genetic factors account for 56% of the risk for developing anorexia nervosa, according to a report in the March issue of the Archives of General Psychiatry. This information should provide some reassurance to patients and families that the disease is not the result of something they did wrong.
 The findings are based on a comparison of disease concordance between monozygotic and dizygotic twins logged in the Swedish Twin Registry. The study featured 31,406 subjects, born between 1935 and 1958, who were screened for anorexia nervosa and other disorders from 1999 through 2002. Detailed information on all subjects was also provided in 1972 to 1973.
 The overall prevalence of anorexia nervosa in women was 1.20% and in men, 0.29%, lead author Dr. Cynthia M. Bulik, from the University of North Carolina at Chapel, said during a media briefing. She added that during the birth period there was a rise in the anorexia nervosa rate among women, but not men.
 As noted, the heritability of anorexia nervosa was estimated to be 0.56. "The remaining liability was due to environmental factors," Dr. Bulik said. Specifically, the variance attributable to shared environment was 0.05, and to unique environment it was 0.38.
 The presence of neuroticism at the 1972-1973 assessment increased the likelihood of later anorexia nervosa by 62%, the report indicates. By contrast, a low body mass index and excessive exercise levels were not predictive of later disease.
 "These findings are really good news for patients and really good news for families," Dr. Bulik told Reuters Health. "We have gone through far too much time where parents are blamed for causing this disorder because of how they behave." Findings from this study and others help eliminate the blame, she added.
 The results are also important because they have implications for "targeted prevention efforts" and may "open up new areas of biological intervention," Dr. Bulik emphasized.
Arch Gen Psychiatry 2006;63:305-312.
http://www.medscape.com/viewarticle/524991[/i]

[JohnBlack]

Lynne,

Is it a fair crticism to say that the Swedish twins study is not terribly conclusive because the twins are probably encountering the same environmental conditions and are therefore probably subjected to the same psychological stresses?  i.e.  If they grow up in a family with an unhealthy view on body shape/eating habits then it is as equally valid to say that the problem is environmental vs genetic as they may acquire the same attitudes/views from their parents.  The argument could use the same data to support either conclusion.

The study would be more conclusive to me if it was a study of twins separated at birth from their parents and each other.   i.e. While not realistic it would ensure that they grow up in different family environments before measuring the number of cases of Anorexia Nervosa.  If it is a case a genetics then family location/environment should have minimal effect on the trend towards eating disorders.

I'm not saying that there is no genetic link.  I'm saying that a study of twins growing up in the same household does not prove anything.

[JohnBlack]

This just randomly occurred to me.

Have their been any studies done on whether giving marijuana/cannibais to folks who have certain types of eating disorders causes them to want to eat??

Not being wiseguy here - I know that marijuana has been tested in recent years to for a number of medical conditions including appetite loss.

My source for this information is a laymans article titled: "What are the long term effects of marijuana?"

http://www.straightdope.com/columns/060414.html

As a side note:  the word dope in the above url has nothing to do with pot.  The site is dedicated to giving truthful answers to whatever questions the audience may write in with.

[Dr Sketch]

Makes sense to me... Keep them stoned for long enough and they will HAVE to give in to the munchies!

[JohnBlack]

One more observation.

"These findings are really good news for patients and really good news for families," Dr. Bulik told Reuters Health. "We have gone through far too much time where parents are blamed for causing this disorder because of how they behave." Findings from this study and others help eliminate the blame, she added.

I certainly disagree that this is good news for families and patients.  Genetic science is too new.  For the most part we cannot fight our own genetics very much right now.

I think that at the current time it is easier to treat attitudes rather than genetics.  While blame may be eliminated by this finding (if its true) - the probability of a cure also is eliminated.

[Luthien Rogue]

Hey guys.

I have Body Dysmorphic Disorder, so I figured I'd share my own personal experience.

Since I was young, I've always considered myself fat. Now that my 13-year-old sister wears the same clothes I did at her age, I realize I wasn't--she's actually underweight. I still feel I'm fat. By grade 7 I had quit school. At this point, I rarely go out.

At one point, I was comfortable around my family. Now, I'm not. My first thought when I wake up is to make sure I have my covers on so that no one can see me. Even in the summer, I use a blanket when I'm sitting around, to hide my body. I'm convinced that anyone near me is focusing on me and how I look, thinking I'm fat and ugly. I cannot look into people's eyes anymore--not even my own family's. I won't let anyone hug me or touch me. I constantly fiddle with my hair. I wear clothes too big for me. I don't wear hats, make-up, or glasses, because I think it just makes people look at me more. I have long hair, and keep it over my face. When I'm around people, I focus on the position I'm in more than anything, trying to make sure I don't look horrible. I won't eat with anyone near me, because I'm sure they're thinking "no wonder she's so fat."

At this point, I go without eating a lot, and then back to regular eating.. back and forth. I don't eat at all if others are around.

I believe it's genetic. My mom is always talking about how fat and ugly she looks, even though she's thin and beautiful. My sister's the same way, but it's not as prominent.

There aren't many treatments, and I'm still looking for one that works.

[invisiblechick83]

Wow, all of this is really interesting.  Whats on the agenda for next week?

[Knot]

Basically, while I was in the mental institution, they "knew" something was "wrong" with me but never seemed to be able to pinpoint it. They did a series of tests, and yet nothing. Makes me wonder who the "sane" one really is.

So, my diagnosis remains:

Unknown.