1. New Eating Disorders
Anorexia and bulimia aren't the only dangerous eating behaviors
For decades, the eating disorder lexicon had two main entries: anorexia and bulimia. But modern
research reveals that these fall woefully short of encompassing the many facets of disordered eating. In
the early '90s, the American Psychiatric Association introduced a new diagnostic category: eating
disorders not otherwise specified (EDNOS). A catch-all label that includes dozens of subdiagnoses,
EDNOS applies to patients who don't meet the exact criteria for anorexia or bulimia but still have very
troubled relationships with food or distorted body images. Today, EDNOS diagnoses significantly
outnumber anorexia and bulimia cases. "The atypical has become the typical," says Ovidio Bermudez,
M.D. These define just a few atypical eating disorders.
Orthorexia
A fixation with healthy or righteous eating
Orthorexics often eat only organic foods, eliminate entire food groups, or refuse to eat anything that
isn't "pure" in quality, says clinical psychologist Sari Shepphird, Ph.D. Unlike anorexics, they don't
necessarily think they're fat or strive to be thin; some are motivated by a fear of bad health, a fixation
with complete control, or the desire to improve their own self-esteem. Ironically, severe orthorexia can
lead to malnourishment.
Pregorexia
Extreme dieting and exercising while pregnant to avoid gaining the 25 to 35 pounds of weight doctors
usually recommend
"There's more social pressure on women to look thin during and after pregnancy," says Shepphird. "But
pregorexia comes with very serious health problems." Starving moms-to-be are at risk for depression,
anemia, and hypertension, while their malnourished babies are often miscarried or born with birth
defects.
Binge Eating
Compulsive overeating, often to deal with negative emotions or stress
Binge eaters consume large amounts of food very quickly—until they're uncomfortably full. Most
sufferers eat in secret to hide their habits. Many feel powerless to stop eating and are disgusted with
themselves afterward; but unlike with bulimia, they don't attempt to reverse a binge by vomiting or
fasting. While not all patients are overweight, obesity—and its related health problems—are obviously a
risk.
"As early as age 30, many women hit a point at which they feel there are certain things they should have
accomplished," says Kronberg. "They evaluate their lives, and if they see a void, they look for something
that will make them feel good." In essence, a perceived lack of success can morph into a feeling of
failure and become an eating disorder catalyst. But emerging research shows that yet another factor
could turn an innocent desire for self-improvement into an unstoppable compulsion.

2. Anorexia Athletica
An addiction to exercise
Sufferers work out well beyond the requirements for good health, often to the point that their gym time
interferes with their job or relationships. "Instead of throwing up, so-called compulsive exercisers purge
calories by working out religiously," says Shepphird. "Often, if they don't keep up with their rigorous
routine, they feel tremendous anxiety or guilt." They're also at risk for potentially fatal cardiac problems
and depression.
Drunkorexia
Restricting food intake in order to reserve those calories for alcohol and binge drinking
A University of Missouri study found that almost 30 percent of female college students exhibit
drunkorexic behavior, "saving" their calories for booze in order to avoid gaining weight or to get drunk
faster. Bad idea: These women are upping their chances for alcohol poisoning, uninhibited sexual
behavior, and long-term consequences like heart and liver diseases.
Reference: http://www.womenshealthmag.com/health/new-eating-disorders

3. Young Binge Eaters Prone to Illicit Drug Use: Study
Overeating occurred first in large review of 17,000 boys and girls
December 10, 2012
By Alan Mozes
HealthDay Reporter
MONDAY, Dec. 10 (HealthDay News) -- Tweens, teens and young adults who routinely
overeat appear to be more likely to experiment with marijuana or other drugs, new research
suggests.
The observation stems from a decade-long research effort, during which nearly 17,000 boys
and girls were tracked to assess eating and drug-use patterns.
The bottom-line: Drug use increased among all overeaters, regardless of whether that
behavior took the form of relatively controlled overeating or binge-eating behavior, which
involves a loss of eating control.
"Previous research has demonstrated a link between overeating and binge eating and other
health concerns, so most of the results were as we expected," said Kendrin Sonneville, a
registered dietician in the division of adolescent/young adult medicine at Children's Hospital
Boston.
She did suggest, however, that some findings, including that "teens who binge eat were no
more likely to start binge drinking frequently than those who did not binge eat," were
somewhat surprising.
What's more, Sonneville noted, although "it may seem that overeating and binge eating
would only be a concern for individuals who are obese, this study shows that these
behaviors are problematic for all kids. No matter what they weighed, teens who reported
binge eating where more likely to start using drugs and to become depressed than those
who did not binge eat."
The study, which appears online Dec. 10 in the journal Archives of Pediatrics &
Adolescent Medicine, received funding from the U.S. National Institutes of Health.
All participants were between the ages of 9 and 16 when first enrolled in the study. Between
1996 and 2005, they completed questionnaires regarding their eating and drug-use habits
every one or two years.
At one point or another, the questionnaires asked about the use of marijuana, hashish,
cocaine, crack, heroin, ecstasy, PCP, GHB, LSD, psychedelic mushrooms, ketamine, crystal
meth and amphetamines, as well as nonprescription use of tranquilizers, painkillers,
sleeping pills and stimulants.
The authors found that binge eating was more common among girls, reaching just over 3
percent among girls and 1 percent among boys. In turn, binge eating was linked to a higher
risk for becoming overweight or obese, as well as for developing depressive symptoms.
However, simply overeating -- with self-control -- was not linked to either.
Both overeating and binge-eating behaviors were associated with a greater risk for drug-use
initiation, but not binge-drinking behavior.

4. "Based on the findings of this study alone, we can't explain why adolescents who overeat or
binge aren't at higher risk for binge drinking," Sonneville said. "It is important to note that
frequent binge drinking was common in our study, [as] 60 percent of the teens started
binge drinking during the course of the study."
"The fact that we didn't see an association between binge eating and the onset of frequent
binge drinking may have something to do with the fact that this behavior is so normative
among teens," she added.
Registered dietician Lona Sandon, assistant professor of clinical nutrition at the University of
Texas Southwestern Medical Center at Dallas, said the findings are in line with what she
would expect.
"Most people might not make that connection between binge eating and drug use, but
people often use food to address emotional states the same way they might use drugs," she
said. "They may be engaging in binge eating for a way to somehow improve their mood
or ... cover up negative emotions. That may be the same reason they also then turn to
marijuana or some other drug."
"We see this in cases when patients come in for bariatric surgery," Sandon added. "In many
of those cases the drug of choice, so to speak, was food. If you don't change their mindset
regarding food and out-of-control eating, they are going to keep having the same issues
after surgery."
"Often what happens is they turn to alcohol in place of food, because after bariatric surgery
it's much easier to down alcohol than it is food," she added.
Although the study showed an association between binge eating and increased risk of drug
use, it did not prove a cause-and-effect relationship.
More information
Visit the Nemours Foundation for more on binge eating and children.
Copyright © 2012 HealthDay. All rights reserved.
Reference: http://health.usnews.com/health-news/news/articles/2012/12/10/young-binge-eaters-
prone-to-illicit-drug-use-study?page=2

5. Posttraumatic Stress Disorder
and Eating Disorders
Unlocking past trauma that may
underlie an eating disorder
Reprinted from Eating Disorders Review
November/December 2012 Volume 23, Number 6
©2012 Gürze Books
Although posttraumatic stress disorder (PTSD) often brings to mind combat-related injury, PTSD can
affect anyone with a history of physical, emotional, or sexual abuse, or being exposed to a variety of
traumatic experiences. PTSD may also lead to eating disorders.
Disordered eating behaviors may represent an individual’s methods for coping with the uncomfortable
emotions and experiences correlated with all types of trauma. After trauma, she may begin restricting
food intake as a way of feeling in control and by doing so may gain a false sense of security. Or, she may
binge-eat as a way to seek comfort through food and to “stuff down” negative feelings.
Dr. Tim Brewerton, Clinical Professor of Psychiatry and Behavioral Sciences at the Medical University of
South Carolina, Charleston, an expert in PTSD and eating disorders, has noted that disordered eating
behaviors, especially purging, may be used as an avoidance mechanism by individual to numb painful
feelings and to block or forget painful memories. About 10% of women will develop PTSD at some time
in their lifetime (Arch Gen Psychiatry 1995; 52:1048).
In related findings, recent research at the San Francisco VA Medical Center has shown that rates of
eating disorders are significantly higher among returning female veterans with comorbid mental health
problems compared with those without mental health diagnoses (Women’s Health Issues 2012;
22:e403).
A Major Study Lays Important Groundwork
Fifteen years ago, researchers in the National Women’s Study evaluated a representative sample of
more than 3000 women who were interviewed at length about their traumatic experiences. More than
half of those meeting diagnostic criteria for bulimia nervosa (BN) reported having been raped, molested,
or physically assaulted; fewer than a third of those without eating disorders had experienced such
traumas (Int J Eat Disord 1997; 21:2130218). Dr. Brewerton, one of the authors of that study, pointed
out that in 84% of cases the first rape preceded the first binge-eating episode, establishing assault as a
potentially contributing if not causative factor for the development of BN. Similar results were found for
molestation and physical assault. He reported that 37% of women with BN also had full-blown histories
of PTSD, and many more had partial PTSD syndromes.
Psychologist Matthew T. Tull, PhD, associate professor and director of anxiety disorders research at the
University of Mississippi Medical Center, Jackson, conducts research on anxiety disorders centering
around PTSD and substance abuse. He and his colleagues have reported that those with PTSD are three
times more likely to develop bulimic behavior than those who do not have PTSD. And, according to Dr.
Jacqueline M. Hirth and her colleagues at the University of Texas Medical Branch, Galveston, nearly a

6. third of U.S. women have experienced traumatic experiences related to intimate partner violence during
their lifetimes and two-thirds of these women will develop at least some symptoms of PTSD. Others
have shown that patients with PTSD after childhood sexual abuse and a co-occurring eating disorder can
develop body image disorders. The results of one study show for the first time that the behavioral
component of body image is impaired in female patients with PTSD in addition to the cognitive-affective
component. This is not solely due to a comorbid eating disorder (Psychopathology 2012; Sept. 7 [Epub
ahead of print]. Few studies have examined the mediating effect of depressive symptoms and PTSD; in a
recent study researchers in France found that PTSD symptoms fully mediated the effects of early adult
sexual assault on disordered eating, and depressive symptoms were a partial mediator of this
relationship (J Trauma Stress 2012; 25:50; doi 10.1002/1002/jts.21664.)
Shame is another component. As Dr. Brewerton has pointed out, trauma-related shame is a major
feature of trauma-related conditions, and the reaction of mothers to their daughters’ disclosure of
abuse is a powerful predictor of subsequent PTSD and other post-traumatic problems. When the abused
person’s story is believed and he or she receives an empathetic, supportive, accepting and
nonjudgmental response, the patient can better deal with the traumatic events, and a more favorable
outcome results. In contrast, when the victim is challenged about the trauma, and not believed or
doubted, this can aggravate shame, self-loathing (including loathing directed at the body), and can lead
to a much poorer outcome.
PTSD among AN patients
When a large study, the NIH-sponsored Genetics of Anorexia Nervosa Collaborative Study, evaluated
753 women with AN, 13.7% (103) met DSM-IV criteria for PTSD (Psychosom Med 2011; 73: 291). In
pairwise comparisons across AN subtypes, the odds of having a PTSD diagnosis were significantly lower
in individuals with restricting AN (RAN) than individuals with purging AN without binge eating (PAN)
(OR=0.49, 95% CI=0.30, 0.80). The majority of participants with PTSD reported that the first traumatic
event occurred before the onset of AN (64.1%, n=66). The most common traumatic events reported by
those with a PTSD diagnosis were sexually related traumas during childhood (40.8%) and during
adulthood (35.0%).
Most participants with PTSD reported the first traumatic event before the onset of AN, and the most
common traumatic events reported were sexual-related trauma during childhood (40.8%) and during
adulthood (35.0%). However, the participants had experienced a wide range of traumatic events. The
authors made an important point, the importance of assessing a history of trauma and possible PTSD
among patients with AN.
Dr. Brewerton and others have also noted that certain elements have an impact on the success of
treatment, including adequate nutritional rehabilitation, with normalization of weight and eating before
any exposure work begins.
- MKS
Reference: http://www.eatingdisordersreview.com/nl/nl_edr_23_6_1.html

7. Eating Disorders And Women's Obsession With Thin Bodies Could Be
Addressed By Increasing The Amount Of Plus-Size Models
British women's obsession for thin bodies could potentially be changed if advertising showed more plus size models, suggests a
preliminary study just published.
The Durham University researchers, who studied over 100 women, provide evidence to back calls for models in adverts to be
more representative of the actual population. This move could ultimately help girls and women to develop a healthier attitude
to eating, the researchers say.
In the preliminary study, women who habitually strongly preferred thin body shapes were significantly less keen on thin bodies
after they had been shown pictures of plus size catalogue models. Conversely, showing slim models increased women's
preference for thin bodies.
The effects could be found whether the women were shown catalogue models or ordinary women of either size.
The findings provide research data for policy-makers and support for on-going calls from Government and health charities to
'normalise' female models in the media.
The research is published in the leading international academic journal, PLOS ONE, and was led by Durham University with
colleagues from Newcastle University and the VU University Amsterdam.
Follow up research will look in more detail at the change in preferences and will include both women and men.
Lead author Dr Lynda Boothroyd, from Durham University's Department of Psychology, said: "This really gives us some food for
thought about the power of exposure to super-slim bodies. There is evidence that being constantly surrounded through the
media by celebrities and models who are very thin contributes to girls and women having an unhealthy attitude to their bodies.
"Although we don't yet know whether brief exposure to pictures of larger women will change women's attitudes in the long
term, our findings certainly indicate that showing more 'normal' models could potentially reduce women's obsession for
thinness."
Susan Ringwood, Chief Executive from the leading UK eating disorders charity, Beat, commented: "This study points towards an
important aspect of our modern lives. We see an average of 2,000 images a day in advertising alone, and most of these include
bodies that are more slender than average. Increasing the diversity of body shapes and sizes portrayed in the media could
rebalance our views about our own bodies in an emotionally healthy way."
Dr Boothroyd added: "Thinner bodies are definitely in vogue and within western media, thinness is overwhelmingly idolised and
being overweight is often stigmatised. Although the media doesn't directly cause eating disorders, research suggests it is a very
powerful factor in creating body dissatisfaction.
"Furthermore, it seems that even so-called 'cautionary' images against anorexia might still increase our liking for thinner bodies,
such as those featuring the late French model Isabelle Caro, who gained worldwide publicity for posing nude for an anti-
anorexia campaign while suffering from the illness. These campaigns may not have the desired effect which is a sobering
thought."
The images used in the study were of thin and plus size models from high street catalogues and beauty contests, and of
ordinary women photographed in plain grey leotards. The thin models shown were a standard size for catalogue models and

8. the women in leotards had a Body Mass Index (BMI) of between 11 and 14. The plus size models were a minimum of clothes
size 16 and the women in leotards had a BMI of between 36 and 42¹.
The study also looked at the influence of positive and negative associations with weight. When women were shown the
'aspirational' images of larger models, paired with the plain images of underweight women, their preferences also shifted away
from thinness. This supports the idea that, in the West, our associations between thinness and good health and high status may
play a part in strong preferences for thin bodies.
This is in contrast to some developing countries where being overweight is generally perceived as an indicator of health, wealth
and femininity, and many people tend to prefer women who carry more fat.
Rachel Cowey
Rachel Cowey is 25 years old and from South Shields. She is the co-creator of Team Recovery Ninja, an online resource aimed at
supporting people through recovery from eating disorders, and is also a volunteer for Beat. Rachel developed anorexia when
she was 16 years old and now considers herself 90 per cent recovered.
Rachel said: "There were lots of factors which led to me developing my eating disorder such as school pressures and
expectations, bullying, family issues, not feeling good enough and the need to be 'perfect'.
"Just like there were many factors which led to the eating disorder, there have also been a number of elements which have
helped me recover. I am determined and stubborn in nature and I have used those character traits in my focus to recover. I
have also put myself out in the real world; at university, working for charities, travelling and ultimately accepted myself for who
I am.
"I was discharged from hospital treatment three years ago although I consider myself to be 90 per cent recovered. Recovery is
an ongoing process.
"In order for me to have got to where I am now, I have had to take very small steps and overcome huge challenges. The media's
portrayal of women has not helped in that.
"There is an immense pressure to be seen to have it all and be perfect at everything. Within the media, being thin and
attractive is linked to being successful.
"The doctors told me it was impossible to survive at the weight I was, yet the media constantly showed skinny celebrities who
were apparently absolutely fine. That was hugely unhelpful for my mindset and recovery.
"I think this research is incredibly important as anything that can help us understand eating disorders is valuable. It also helps to
highlight the media's impact on people, and that what they print can sometimes have devastating consequences.
"As well as the media's constant focus on weight loss and looking thin and 'perfect,' the often sensationalist portrayal of eating
disorders also makes it more difficult to speak out. The publication of people's lowest weights and their pictures when ill causes
damage, hurt and stigma. It gives the perception that eating disorders are only about weight and appearance which is not the
case."
Reference: http://www.medicalnewstoday.com/releases/252527.php