The eating disorders anorexia nervosa, bulimia nervosa, and binge-eating disorder, and their variants, all feature serious disturbances in eating behavior and weight regulation. They are associated with a wide range of adverse psychological, physical, and social consequences. A person with an eating disorder may start out just eating smaller or larger amounts of food, but at some point, their urge to eat less or more spirals out of control. Severe distress or concern about body weight or shape, or extreme efforts to manage weight or food intake, also may characterize an eating disorder.

Eating disorder treatment also involves addressing other health problems caused by an eating disorder, which can be serious or even life-threatening if they go untreated for long enough. If an eating disorder doesn’t improve with standard treatment or causes health problems, you may need hospitalization or another type of inpatient program.

Having an organized approach to eating disorder treatment can help you manage symptoms, regain a healthy weight, and maintain your physical and mental health.

Eating disorders are real, treatable medical illnesses. They frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders. Other symptoms can become life-threatening if a person does not receive treatment, which is reflected by anorexia being associated with the highest mortality rate of any psychiatric disorder.

Eating disorders affect both genders, although rates among women and girls are 2½ times greater than among men and boys. Eating disorders frequently appear during the teen years or young adulthood but also may develop during childhood or later in life.

How are eating disorders treated?

Typical treatment goals include restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binging and purging behaviors. Specific forms of psychotherapy, or talk therapy—including a family-based therapy called the Maudsley approach and cognitive behavioral approaches—have been shown to be useful for treating specific eating disorders. Evidence also suggests that antidepressant medications approved by the U.S. Food and Drug Administration may help for bulimia nervosa and also may be effective for treating co-occurring anxiety or depression for other eating disorders.

Treatment plans often are tailored to individual needs and may include one or more of the following:

• Individual, group, or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications (for example, antidepressants).

You may start by seeing your family doctor or mental health counselor, such as a psychologist. You may also need to see other health professionals who specialize in eating disorder treatment. Other members of your treatment team may include:

• A registered dietitian to provide nutritional counseling.
• A psychiatrist for medication prescription and management, when medications are necessary. Some psychiatrists also provide psychological counseling.
• Medical or dental specialists to treat health or dental problems that result from your eating disorder.
• Your partner, parents or other family members. For young people still living at home, parents should be actively involved in treatment and may supervise meals.

It’s best if everyone involved in your treatment communicates about your progress so that adjustments can be made to your treatment as needed.

Managing an eating disorder can be a long-term challenge. You may need to continue to see your doctor, psychologist or other members of your treatment team on a regular basis, even if your eating disorder and related health problems are under control.

Some patients also may need to be hospitalized to treat problems caused by malnutrition or to ensure they eat enough if they are very underweight. Complete recovery is possible.

“30 million people in the U.S. have an eating disorder.  95 percent of people with eating disorders are between the ages 12 and 25.  Eating disorders have the HIGHEST risk of death of any mental illness.  Eating disorders affect all genders, all races and every ethnic group.  Genetics, environmental factors and personality traits all contribute to the risk of developing an eating disorder.”.

John Hopkins All Children Hospital (https://www.hopkinsallchildrens.org/Services/Pediatric-and-Adolescent-Medicine/Adolescent-and-Young-Adult-Specialty-Clinic/Eating-Disorders/Eating-Disorder-Facts)

1.) Binge Eating

Binge Eating Disorder (BED) is newly-recognized and is characterized by recurrent episodes of binge eating that occur twice weekly or more for a period of at least six months. During bingeing, a larger than normal amount of food is consumed in a short time frame and the person engaging in the bingeing behavior feels a lack of control over the eating.

In BED, bingeing episodes are associated with at least three characteristics such as eating until uncomfortable, eating when not physically hungry, eating rapidly, eating alone for fear of being embarrassed by how much food is being consumed, or feeling disgusted, depressed or guilty after the episode of overeating. These negative feelings may in turn trigger more bingeing behavior. In addition, although BED behaviors may cause distress by those affected, it is not associated with inappropriate compensatory behaviors such as those found in Bulimia Nervosa or Anorexia Nervosa. Therefore, people with BED often present as either overweight or obese because they consume so many extra calories.

2.) Anorexia Athletica

Anorexia Athletica is a constellation of disordered behaviors on the eating disorders spectrum that is distinct from Anorexia Nervosa or Bulimia Nervosa. Although not recognized formally by the standard mental health diagnostic manuals, the term Anorexia Athletica is commonly used in mental health literature to denote a disorder characterized by excessive, obsessive exercise. Also known as Compulsive Exercising , Sports Anorexia, and Hypergymnasia, Anorexia Athletica is most commonly found in pre-professional and elite athletes, though it can exist in the general population as well.

People suffering from Anorexia Athletica may engage in both excessive workouts and exercising as well as calorie restriction. This puts them at risk for malnutrition and in younger athletes could result in endocrine and metabolic derangements such as decreased bone density or delayed menarche.

Symptoms of Anorexia Athletica may include over-exercising, obsession with calories, fat, and weight, especially as compared to elite athletes, self-worth being determined by physical performance, and a lack of pleasure from exercising. Advanced cases of Anorexia Athletica may result in physical, psychological, and social consequences as sufferers deny that their excessive exercising patterns are a problem.

3.) Over Exercise

 “Over exercise” is a general term referring to exercising to the point of exhaustion. Over exercise can occur once in a while as when someone overdoes it on a single work-out, or it can be a habitual behavior. When over exercising becomes the norm, this may be an indication that a person is actually suffering from what is called Obligatory Exercising, Compulsive Exercising, or Anorexia Athletica. When someone over exercises to the point where it is a problem, he or she may experience physical, psychological and social consequences.

4.) Overeating 

Overeating is not a specific diagnosis of any sort but may rather refer to a discrete incident of eating too much such as during holidays, celebrations, or while on vacation, or it may refer to habitual excessive eating.

People who engage in overeating regularly tend to eat when not hungry and may eat alone because they are embarrassed about the portions of food they are consuming. In addition, they may spend exorbitant amounts of time fantasizing about their next meal. Another sign that overeating has become a problem is if excessive amounts of money are wasted on food. In general, people who overeat are overweight or obese though people with normal body weights may overeat from time to time as well.

Overeating becomes problematic when it manifests as a compulsive or obsessive relationship with food. At this point it may be treated with behavior modification therapy or as a food addiction. One program available that supports people in recovering habitual, problematic overeating using the context of an addiction is Overeaters Anonymous (OA). OA is set up similarly to Alcoholics Anonymous (AA) and is a twelve step program in which members acknowledge that they are powerless over food. OA is open to anyone who has an unhealthy relationship with food and who wishes to stop.

5.) Night Eating

 Night Eating Syndrome (NES) is an emerging condition that is gaining increased recognition among medical professionals. Its clinical importance is in relation to obesity as many people who suffer from NES are overweight or obese and being overweight or obese comes with many negative health risks. Although not classified as one of the types of eating disorders, as a syndrome, NES is considered a constellation of symptoms of disordered eating characterized most prominently by a delayed circadian timing of food intake.

People with NES tend to not eat in the morning and consume very little during the first half of the day. The majority of their calories are then consumed in the evening hours, so much so that sleep may be disturbed so that a person can eat. People with NES may be unable to get back to sleep after eating or may experience frequent awakenings throughout the night for feedings. However, people with NES are fully awake and aware of their eating episodes.

It is distinct from bingeing disorders in that the portions consumed are generally those of snacks rather than huge meals. In addition, it differs from Bulimia Nervosa since there are no compensatory or purging behaviors present to offset increased calorie intake.

6.) Orthorexia

Orthorexia Nervosa (also known as “orthoexia”) is a term coined by physician Steven Bratman in an article he wrote for Yoga Journal in 1997. It is not a traditionally recognized type of eating disorder but it does share some characteristics with both Anorexia Nervosa and Bulimia, most specifically obsession with food.

Orthorexia refers to a fixation on eating “pure” or “right” or “proper” food rather than on the quantity of food consumed.

Having Orthorexia Nervosa is like suffering from Workaholism or Exercise Addiction in which something that is normally considered good or healthy is done in excess and to the point that a person becomes obsessed with the activity. Like other obsessive disorders people with Orthorexia Nervosa experience cyclical extremes, changes in mood, and isolate themselves. Most of their life is spent planning and preparing meals and resisting temptation to the exclusion of other activities. They may even go to the extreme of avoiding certain people who do not share in their dietary beliefs or carry their own supply of food wherever they go.

Like other eating disorders, Orthorexia Nervosa may result in negative consequences. Social isolation, physical deterioration, and a failure to enjoy life can occur. There have even been a few deaths related to Orthorexia Nervosa when a person becomes so low in body weight due to restrictive eating or fasting that the heart fails.

7.) EDNOS – Eating Disorder Not Otherwise Specified

According to the Diagnostic and Statistical Manual, 4th Edition there exists a category of eating disorders that do not meet the specific criteria for the two defined disorders, Anorexia Nervosa and Bulimia. When people exhibit behaviors in the spectrum of disordered eating but do not meet all the criteria for Anorexia Nervosa or Bulimia, they are given a diagnosis of an Eating Disorder Not Otherwise Specified (EDNOS). Over one-half to two-thirds of people diagnosed with eating disorders fall into the category of EDNOS. More people are diagnosed with EDNOS than Anorexia Nervosa and Bulimia combined.

Binge Eating Disorder (BED) is the only type of eating disorder under the category of EDNOS. A person meets the definition of having EDNOS if they have exhibit all the criteria for Anorexia Nervosa but have regular menstruation or a normal body weight, or if they exhibit all the criteria for Bulimia but purge less than two times per week or for a duration shorter than three months, or if only small amounts of food are purged, or if a person spits out food rather than swallowing it.

People diagnosed with EDNOS can experience the same negative psychological, social, and physical consequences as a person diagnosed with Anorexia Nervosa or Bulimia. The seriousness of their condition is no different than that for people diagnosed with specific disorders. The only difference is that the person may experience a spectrum of disordered eating behaviors and these behaviors may change over time.

Although BED is the only one of the types of eating disorders categorized under EDNOS, people who are considered to have Sub Therapeutic Anorexia Nervosa or Sub Therapeutic Bulimia are also given a diagnosis of EDNOS. To have Sub Therapeutic Anorexia Nervosa or Bulimia means that a person displays some but not all of the criteria for the full-blown condition.

Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that’s far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively.

Anorexia (an-oh-REK-see-uh) nervosa isn’t really about food. It’s an unhealthy way to try to cope with emotional problems. When you have anorexia nervosa, you often equate thinness with self-worth.

Anorexia nervosa can be difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia’s serious complications.

Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge — eating large amounts of food — and then purge, trying to get rid of the extra calories in an unhealthy way. For example, someone with bulimia may force vomiting or do excessive exercise. Sometimes people purge after eating only a small snack or a normal-size meal.

Bulimia can be categorized in two ways:

• Purging bulimia. You regularly self-induce vomiting or misuse laxatives, diuretics or enemas after bingeing.
• Nonpurging bulimia. You use other methods to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.

However, these behaviors often overlap, and the attempt to rid yourself of extra calories is usually referred to as purging, no matter what the method.

If you have bulimia, you’re probably preoccupied with your weight and body shape, and may judge yourself severely and harshly for your self-perceived flaws. Because it’s related to self-image — and not just about food — bulimia can be difficult to overcome. But effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications.

Anorexia signs and symptoms may include:

• Refusal to eat and denial of hunger
• An intense fear of gaining weight
• A negative or distorted self-image
• Excessive exercise
• Flat mood or lack of emotion
• Irritability
• Fear of eating in public
• Preoccupation with food
• Social withdrawal
• Thin appearance
• Trouble sleeping
• Soft, downy hair present on the body (lanugo)
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constipation
• Abdominal pain
• Dry skin
• Frequently being cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration

Bulimia signs and symptoms may include:

• Eating until the point of discomfort or pain, often with high-fat or sweet foods
• Self-induced vomiting
• Misuse of laxatives, diuretics, or enemas after eating.
• Excessive exercise
• An unhealthy focus on body shape and weight
• A distorted, excessively negative body image
• Low self-esteem
• Going to the bathroom after eating or during meals
• A feeling that you can’t control your eating behavior
• Abnormal bowel functioning
• Damaged teeth and gums
• Swollen salivary glands in the cheeks
• Sores in the throat and mouth
• Dehydration
• Irregular heartbeat
• Sores, scars or calluses on the knuckles or hands
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constant dieting or fasting
• Possibly, drug or alcohol abuse. Also Being preoccupied with your body shape and weight , living in fear of gaining weight.  It is necessary to help others, not only in our prayers, but in our daily lives.

“Every year from February 14-21, we at Planned Parenthood observe National Condom Week. This is a great time to learn more about the importance of using condoms and other barrier methods and to educate others, because everyone deserves to have a worry-free and healthy sex life. Condoms are the only form of birth control that also prevent sexually transmitted infections (STIs). ”

Planned Parenthood of the Pacific Southwest Inc (https://www.plannedparenthood.org/planned-parenthood-pacific-southwest/blog/celebrating-national-condom-week-2022)

“TED – also known as Graves’ Orbitopathy or Ophthalmopathy – is an autoimmune condition. It occurs when the body’s immune system attacks the tissue surrounding the eye causing inflammation in the tissues around and behind the eye. In most patients, the same autoimmune condition that causes TED also affects the thyroid gland, resulting in Graves’ disease. Graves’ disease most commonly causes thyroid overactivity (hyperthyroidism).”

British Thyroid Foundation – BTF (https://www.btf-thyroid.org/thyroid-eye-disease-leaflet)

TED is an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed. This inflammation can push the eyes forward (“staring” or “bulging”) or cause the eyes and eyelids to become red and swollen. In some individuals, the inflammation may involve the eye muscles, causing the eyes to become out of line, leading to double vision. In rare cases, TED can cause blindness from pressure on the nerve in the back of the eye or ulcers that form on the front of the eye (cornea).

TED is an autoimmune disease, meaning that the inflammation and scarring are caused by an attack from the body’s immune system. TED is primarily associated with an over-active thyroid gland due to Graves’ disease, although it can rarely occur in patients with an under-active or normally functioning thyroid gland. About a quarter of patients with Graves’ disease develop TED before, during or after the diagnosis of a thyroid disorder. TED is also known as Graves’ orbitopathy (GO) or Graves’ eye disease (GED).

Smokers are two to eight times more likely to develop TED.  Smoking causes vasoconstriction of the vessels.

The most common symptoms of TED include:

• Bags under the eyes
• Blurred/double vision
• Change of the eyes’ appearance (usually staring/bulging)
• Difficulty moving the eyes
• Dry or watery eyes
• Gritty feeling in the eyes
• Low tolerance of bright lights
• Pain in or behind the eye — especially when looking up, down, or sideways
• Redness of the lids and eyes
• Swelling or fullness in one or both upper eyelids
• Signs that your condition may be more due to TED include:
  • Symptoms occur in the wrong season for hay-fever.
  • Symptoms include eye ache/pain, especially with eye movement.
  • You develop double vision. This is serious and is likely from TED.

Treatment of TED:

When symptoms of TED develop, they can be progressive for the first six to twelve months. So, early diagnosis and treatment is important to prevent the condition from worsening. For mild TED, artificial tear drops will help with dry eye relief. Selenium supplements can also be beneficial. For severe TED, steroids and/or orbital radiotherapy may be considered. Some patients with TED are left with permanent double vision or a change in the appearance of their eyes, for which surgery may be recommended. Surgery is typically performed as a part of rehabilitative therapy once the inflammation has resolved and may involve:

• Decompression surgery, which removes bone and soft tissue from behind the eye to create more space.
• Eye muscle surgery, which corrects severe double vision.
• Eyelid surgery, which improves the appearance and function of the eyelids.

Other recommendations for TED patients can include:

• Prism glasses for double vision
• High-dose steroid medications and/or radiation to improve inflammation and double vision
• Support groups/counseling to address the social and psychological effects of the appearance of the eyes

Patients can control the severity of TED symptoms by:

• Quitting smoking. TED treatments are less effective for current smokers.
• Taking selenium supplements, which are available over the counter.
• Maintaining normal levels of thyroid hormones. Test your blood regularly and follow your doctor’s instructions, including taking prescribed medications.

“February is national age related macular degeneration (AMD) and low vision awareness month. AMD is the leading cause of low vision and blindness in Americans age 60 years and older and affects 1.6 million Americans.  As the Baby Boomer generation ages, the rates of AMD are expected to reach “epidemic proportions”.  AMD is a progressive disease with no known cure. It slowly steals vision as it affects the retina, a paper-thin tissue lining the back of the eye, and causes the cells in the area to die. As a result, if you have AMD, you see blind spots, grayness and other distortions in the center frame of your vision.”

UF Health – Department of Ophthalmology college of medicine                                                                       (https://eye.ufl.edu/2021/02/01/february-is-amd-macular-degeneration-low-vision-awareness-month/)

Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye’s macula. The macula is a small area in the retina — the light-sensitive tissue lining the back of the eye. The macula is the part of the retina that is responsible for your central vision, allowing you to see fine details clearly.

The macula makes up only a small part of the retina, yet it is much more sensitive to detail than the rest of the retina (called the peripheral retina). The macula is what allows you to thread a needle, read small print, and read street signs. The peripheral retina gives you side (or peripheral) vision. If someone is standing off to one side of your vision, your peripheral retina helps you know that person is there by allowing you to see their general shape. 

Many older people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration.

Signs and symptoms of Macular Degenerative Disease:

With macular degeneration, you may have symptoms such as blurriness, dark areas or distortion in your central vision, and perhaps permanent loss of your central vision. It usually does not affect your side, or peripheral vision. For example, with advanced macular degeneration, you could see the outline of a clock, yet may not be able to see the hands of the clock to tell what time it is.

• Blurry distance and/or reading vision
• Need for increasingly bright light to see up close
• Colors appear less vivid or bright
• Hazy vision
• Difficulty seeing when going from bright light to low light (such as entering a dimly lit room from the bright outdoors)
• Trouble or inability to recognize people’s faces
• Blank or blurry spot in your central vision. *                                                                                                                The risks of Macular Degeneration:                                      For Developing Age-Related Macular Degeneration

The risk factors we can control=Modifiable Rish Factors:

1. Smoking: Current smokers have a two-to-three times higher risk for developing age-related macular degeneration than people have who never smoked.
2. Artificial fats: Usually labeled “partially-hydrogenated vegetable oils,” these artificial fats are pervasive in foods and particularly in low-fat bakery goods. Low-fat foods are good options if they’ve achieved their low-fat status through a process that physically removes the fat, as in skim milk or low-fat cottage cheese. Low-fat bakery goods are different, however. If you remove all or half the fat from a cake recipe, it won’t turn into a cake; thus, when cakes and bakery goods are labeled low-fat or no-fat, it means they contain artificial fats, or laboratory-produced chemicals. These chemicals are not food and our bodies can’t metabolize them.
3. Sunlight: It is the blue wavelengths from the sun that damage the macula, not the ultraviolet (UV) rays.
4. A diet high in processed, packaged foods and low in fresh vegetables: Vegetable oils are added in the packaging process. These oils are rich in omega-6 fatty acids, which promote inflammation.
5. Uncontrolled hypertension and high cholesterol: Research by the National Eye Institute indicates that persons with hypertension are 1.5 times more likely to develop wet macular degeneration than persons without hypertension.
6. Obesity: Being overweight doubles the risk of developing advanced macular degeneration.

The four risk factors we can’t control=Unmodifiable Risk Factors:

1. Advanced age: Although AMD may occur earlier, studies indicate that people over age 60 are at greater risk than those in younger age groups. For instance, a large study found that people in middle age have about a 2% risk of getting AMD, but this risk increased to nearly 30 percent in those over age 75.
2. Race: Whites are much more likely to lose vision from age-related macular degeneration than are Blacks or African-Americans.
3. A gene variant that regulates inflammation: While not all types of macular degeneration are hereditary, certain genes have been strongly associated with a person’s risk of age-related macular degeneration, and genetic predisposition may account for half the cases of age-related macular degeneration in this country.
4. Family history: Studies indicate that your chances of developing age-related macular degeneration are three to four times higher if you have a parent, child, or sibling with macular degeneration.

Treatment of Macular Degeneration:

People who develop significant age-related macular degeneration (AMD) typically compensate with large-print publications and magnifying lenses for everyday activities. In addition, evidence suggests that certain vitamins and antioxidants — vitamins C and E, beta-carotene, and zinc — may help reduce or delay the risk of severe vision loss. Ask your eye doctor about using nutritional supplements.

1. Treatment for Dry Macular Degeneration

Dry macular degeneration, the most common form of AMD, cannot be cured at this time, but patients with the condition should continue to remain under an ophthalmologist’s care to monitor both eyes. If the one eye is healthy, screening should still continue.

2. Treatment for Wet Macular Degeneration

A variety of treatments are available for wet AMD. Successful treatment may not restore normal vision, but it will improve sight and prevent central vision loss from worsening. While laser procedures can destroy the abnormal blood vessels, they also damage neighboring retinal tissue.

Medications, such as Eylea, Lucentis, and Macugen, have become the preferred treatment for acute wet macular degeneration, helping to prevent the growth of leaky blood vessels in your eye. Lucentis is given once every month, although some patients may need treatment only once every three months. Macugen is given every six weeks. Eylea is given once every two months after three once-monthly injections.

Laser photocoagulation destroys leaking blood vessels that have grown under the macula and halts the leakage. Laser therapy is helpful for about 10%-20% of people with wet macular degeneration. Some vision loss may occur, because this treatment creates scar tissue that is perceived as blind spots; however, even more vision would be lost if nothing is done at all. Up to half of patients who elect laser therapy may need repeat treatments.

Photodynamic therapy (PDT) uses a different, non-heat-generating laser to treat abnormal blood vessels. Visudyne is injected into the patient’s arm and flows through the vessels in the eye. Upon exposure to the laser, a chemical reaction occurs that seals off the leaky vessels. Since the dye is light sensitive, you must stay out of the sun or bright light for several days until the dye has passed from your system. Laser photocoagulation must be done before the abnormal blood vessels cause irreversible damage to the retina. More blood vessels could grow later on, so people who undergo this treatment also need to continue with regular follow-up appointments.

Vitamins. A large study performed by the National Eye Institute of the National Institutes of Health, called AREDS (Age-Related Eye Disease Study), showed that for certain individuals, vitamins C, E, beta-carotene, zinc and copper can decrease the risk of vision loss in patients with intermediate to advanced dry macular degeneration. In addition, there was a correlation between the hormone DHEA and the degree of macular degeneration. DHEA can be purchased over-the-counter.