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ENVIRONMENTALAL
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mas. Atypical anorexia nervosa involves meeting all criteria for AN, ciated with body image concerns and eating disorders. Trends such
except that the individual’s weight remains around or above the normal as fitspiration, which may cause an overreliance on “clean eating” or
range, as measured by BMI. excessive exercise, or thinspiration, which may encourage starvation
BN involves recurrent episodes of binge eating, which is described with a goal of a thin body habitus, may reinforce disordered views of
as eating an amount of food that is definitely larger than what most one’s body.
individuals would eat and a sense of lack of control over eating during From a psychiatric perspective, certain mental health conditions
the episode. Additionally, there are recurrent inappropriate compen- and personality traits elevate the likelihood of developing an eating
satory behaviors in order to prevent weight gain, such as self-induced disorder. Major depressive disorder is found in 75 percent of those
vomiting or misuse of laxatives, diuretics or enemas. with eating disorders that involve binging and purging. Furthermore,
BED is centered on recurrent episodes of binge eating without social anxiety disorder impacts about 42 percent of individuals suffer-
inappropriate compensatory behaviors. These episodes are associat- ing with an eating disorder.
ed with eating much more rapidly than normal, eating until feeling
uncomfortably full, eating large amounts of food when not feeling Discussion
physically hungry, eating alone because of feeling embarrassed by how The signs and symptoms of eating disorders impact multiple organ
much one is eating, and/or feeling disgusted with oneself, depressed systems and the development of eating disorders is dependent on a
or very guilty afterward. variety of risk factors. This highlights the importance that all physi-
cians, regardless of specialty, screen for eating disorders and refer to
Risk Factors an eating disorder specialist for collaborative treatment. This is par-
Genetics, as in most medical and psychiatric conditions, increas- ticularly important when patients possess non-modifiable risk factors.
es the overall risk of developing an eating disorder. Although there is Additionally, community awareness strategies and education to alter
a higher degree of heritability for AN, BN and BED have elevated modifiable risk factors can mitigate the likelihood of individuals devel-
heritability rates themselves. As suspected, females are more likely to oping an eating disorder.
develop an eating disorder compared to males. Disturbances in leptin,
melanocortin and neurotrophin molecules and variations in dopa-
mine, serotonin and cannabinoid levels have also been implicated.
The presence of an autoimmune disease is linked to a higher risk of
developing BN.
Certain early childhood experiences, including elevated maternal References:
expectations, lower parental emotional connectedness and negative 1. American Psychiatric Association. (2022). Diagnostic and statis-
tical manual of mental disorders (5th ed., text rev.). https://doi.
parental comments related to weight increases the risk of developing
Environmental Factors eating disorders. Furthermore, victims of physical or sexual abuse are org/10.1176/appi.books.9780890425787
associated with a higher prevalence of BN and related eating disorders 2. Barakat, S, McLean, SA, Bryant, E. et al. Risk factors for eating
disorders: findings from a rapid review. J Eat Disord 11, 8 (2023).
Contributing to Eating Disorders that particularly involve binging and purging. 3. Dane, A, & Bhatia, K. (2023). The social media diet: A scoping
Certain sociocultural and ethnic factors play a part as well. Evi-
https://doi.org/10.1186/s40337-022-00717-4
dence suggests that BN is more prevalent in minority ethnicities.
Relative to other ethnic groups, Black Americans possess higher rates review to investigate the association between social media, body
By Ami Chatrath, MD of BED. LGBTQIA+ identifying individuals have an elevated risk of image and eating disorders amongst young people. PLOS global
developing an eating disorder. Restrictive behaviors are associated with public health, 3(3), e0001091. https://doi.org/10.1371/journal.
higher education levels and binging is associated with historical or cur- pgph.0001091
ating disorders are a group of conditions that involve distorted Diagnosis rent food insecurity. 4. Eating Disorders: A Guide to Medical Care (Fourth edition).
views of one’s body paired with behaviors that impact eating or Clinicians currently utilize the Diagnostic and Statistical Manual As it pertains to personality traits, perfectionism is most com- (2021). (Ser. AED Report). Academy for Eating Disorders
Elead to weight loss. A few of these conditions include anorex- of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), pub- monly found in individuals with AN and BN whereas obsessiveness 5. Mitchison, D, & Hay, PJ. (2014). The epidemiology of eating
ia nervosa (AN), bulimia nervosa (BN), and binge eating disorder lished in 2022, to assess and diagnose various mental health-related is associated with AN. Emotional dysregulation and impulsivity are disorders: genetic, environmental, and societal factors. Clinical
(BED). conditions. associated with BN and related eating disorders that involve binging epidemiology, 6, 89–97. https://doi.org/10.2147/CLEP.S40841
Eating disorders often lead to numerous medical and psychiatric AN involves restriction of energy intake relative to requirements, and purging.
complications. Relative to other psychiatric conditions, eating disor- leading to a significantly low body weight. There is intense fear of gain- From an environmental perspective, eating disorders are more
ders have a greater risk of suicide attempts and have the second highest ing weight or of becoming fat, or persistent behavior that interferes prevalent in models and athletes that participate in certain activities, Ami Chatrath, MD, is a board-certified psychiatrist that is the
mortality rate, after opioid use disorders. Symptoms that require med- with weight gain. Furthermore, there is a disturbance in the way in including wrestling, dance and gymnastics. The increased rates of dis- co-founder of wiseMIND based in San Antonio, Texas and one
ical management include bradycardia, syncope, seizures, dehydration, which one’s body weight or shape is experienced, undue influence of ordered eating in these specific activities can be attributed to strict of the staff psychiatrists for Esperanza Eating Disorder Center.
growth concerns, failure to thrive, gastroparesis, osteoporosis and/or body weight or shape on self-evaluation, or persistent lack of recogni- dieting expectations and pressure to maintain low body fat levels. He completed his residency at UT Health Science Center - San
amenorrhea. tion of the seriousness of the current low body weight. Social influences have the ability to negatively impact an individ- Antonio and served as chief resident of psychiatry for University Hospital
Unfortunately, symptoms occur for many years before treatment The restricting type describes weight loss obtained through meth- ual’s perception of their body image. Historical traditional media has in his final year of training. Dr. Chatrath chose to pursue psychiatry as
is either sought or implemented. Identifying risk factors, specifically ods such as dieting, fasting or excessive exercise. Binge eating/purg- typically valued a thin body habitus as the ideal body shape and cur- a profession due to the valuable relationships he formed working with
biological, psychologic and social influences, can lead to earlier diag- ing type involves binge eating with resultant purging by methods that rent social media trends continue to perpetuate this ideal. Platforms patients and helping them live rewarding and satisfying lives. He is a
nosis and treatment. include self-induced vomiting or misuse of laxatives, diuretics or ene- that rely on images, such as Snapchat and Instagram, have been asso- member of the Bexar County Medical Society.

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