Advertisement

Just like behaviors involving use of other substances warrant their own psychiatric diagnoses as disorders of dependence or abuse, some eating patterns warrant specific diagnoses as eating disorders, involving restriction, excess, or both. Volkow and O’Brien13 have proposed that the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), anticipated to be released in 2012, should recognize some kinds of obesity as mental disorders of addiction and dependence, citing the countless physiologic and behavioral overlaps with the other addictive disorders. Yet eating clearly differs from the other disorders of abuse, as most of us must eat to live. Eating is really a basic biologic drive, and abstinence is definitely an impossible goal. Thus, the study of overeating and morbid obesity must focus on an extremely complex behavior that’s influenced with a wide variety of biopsychosocial factors, from genetics, to brain chemistry, to family pressures, to self-image. All obese patients overeat, but not all overeating may be the same. Individuals diagnosed with binge-eating disorder (BED) do have more severe obesity, earlier onset of overweight and dieting, and more comorbidity with both other psychiatric disorders and substance abuse. Binge eating is defined as overeating for discrete intervals, marked by way of a sense of lack of control. Periods of binging may last for a whole day, and the binging might be superimposed on a background of overeating.14 A study that compared dopamine and opioid receptors in binging and nonbinging obese adults suggests that BED may be biologically based and driven with a heightened a reaction to the pleasurable properties of food.15 Binging may also be associated with purging behaviors, which tend toward weight neutrality as well as anorexia in patients with binging, purging, and restriction, or bulimia nervosa. Episodes may have no clearly demarcated beginning or end and may last for a whole day. Even though the prevalence of binge eating one of the obese population is debated, with estimates which range from 1 to 30%, it will seem to be more prevalent in women, and identification of the eating pattern is important in treatment considerations, as it can be associated with more severe obesity, earlier onset of both obesity and dieting, and more severe psychopathology.14 Another, recently identified, eating disorder is night-eating, a triad of morning anorexia, evening hyperphagia, and insomnia.16 This pattern might be accompanied by depression, which also follows a circadian pattern, with symptoms more prominent during evening and nighttime hours. Problematic night-eating is observed more often in the obese and during periods of stress and may remit when the stress is alleviated. It is rare in individuals of normal weight but has been reported in almost 9% of those attending an obesity clinic, 27% of the in surgical weight-loss programs, and 5% of the presenting for treatment of insomnia.14,16 Such individuals take in a lot more than 50% of these daily calorie consumption between 10 p.m. and 6 a.m., compared with obese control subjects who consume 15% of their calories during the period frame. The night-eaters have more disrupted sleep and awaken significantly more than 3 x normally as controls, with almost 50% of these awakenings resulting in food intake. Confirming the association with stress, cortisol levels are higher on the list of night-eaters.14 It’s interesting to take into account the links between eating behaviors and some of the major Axis I psychiatric disorders. Although metabolic disorders, including weight gain, is seen with the utilization of antipsychotic medications for schizophrenia or bipolar disorder and antidepressants for depression, these disorders themselves might have an association with weight gain or inappropriate eating behaviors. Increased obesity and visceral adiposity have been present in some examples of medication-naive schizophrenics,17 whereas the behavior dysregulation and impulsivity noticed in manic bipolar patients can lead to overdoing anything, including food. Although patients with major depression typically lose appetite and weight, there are atypical depressions marked by overeating and weight gain. Patients with anxiety disorders may eat to ease stress generally or in particularly stressful situations. As these major psychiatric disorders are the end result of dysfunction in the regulation of brain chemistry, it is not surprising that overeating, using its powerful effects on neurotransmitters, would be a final common pathway for self-soothing as well as self-medication.

Advertisement
Advertisement
Filed under : Bikers Health,