EXPLANATION OF PSYCHIATRIC DISORDERS ASSOCIATED WITH OBESITY

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Just as 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 forms of obesity as mental disorders of addiction and dependence, citing the many physiologic and behavioral overlaps with one other addictive disorders. Yet eating clearly differs from the other disorders of abuse, as most of us must eat to live. Eating is just a basic biologic drive, and abstinence can be an impossible goal. Thus, the study of overeating and morbid obesity must concentrate on an extremely complex behavior that’s influenced by a wide selection of biopsychosocial factors, from genetics, to brain chemistry, to family pressures, to self-image. All obese patients overeat, but not totally all overeating could be the same. Individuals diagnosed with binge-eating disorder (BED) 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 amounts of time, marked by way of a sense of loss in control. Periods of binging may last for a complete 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 shows that BED might be biologically based and driven by way of a heightened response to the pleasurable properties of food.15 Binging might be connected to purging behaviors, which tend toward weight neutrality or even anorexia in patients with binging, purging, and restriction, or bulimia nervosa. Episodes may have no clearly demarcated beginning or end and may work for an entire day. Even though the prevalence of binge eating on the list of obese population is debated, with estimates ranging from 1 to 30%, it will look like more prevalent in women, and identification of this eating pattern is very important in treatment considerations, as it can be connected to more severe obesity, earlier onset of both obesity and dieting, and more severe psychopathology.14 Another, more recently identified, eating disorder is night-eating, a triad of morning anorexia, evening hyperphagia, and insomnia.16 This pattern may be associated with 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 the attending an obesity clinic, 27% of those in surgical weight-loss programs, and 5% of the presenting for treatment of insomnia.14,16 Such individuals take in significantly more than 50% of these daily calorie consumption between 10 p.m. and 6 a.m., weighed against 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 times as frequently as controls, with almost 50% of those awakenings resulting in food intake. Confirming the association with stress, cortisol levels are higher on the list of night-eaters.14 It is interesting to consider the links between eating behaviors and some of the major Axis I psychiatric disorders. Although metabolic disorders, including weight gain, is seen with the usage 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 found in some examples of medication-naive schizophrenics,17 whereas the behavior dysregulation and impulsivity observed in manic bipolar patients can lead to overdoing anything, including food. Although patients with major depression typically lose appetite and weight, you can find atypical depressions marked by overeating and weight gain. Patients with anxiety disorders may eat to relieve stress generally speaking or in particularly stressful situations. As these major psychiatric disorders are the outcome of dysfunction in the regulation of brain chemistry, it is not surprising that overeating, using its powerful effects on neurotransmitters, will be a final common pathway for self-soothing or even self-medication.

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