MEANING OF PSYCHIATRIC DISORDERS ASSOCIATED WITH OBESITY

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Just as behaviors involving utilization 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 countless 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 a basic biologic drive, and abstinence is 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 totally all overeating is the same. Individuals identified as having 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 periods of time, marked with a sense of lack of control. Periods of binging may work for a whole day, and the binging may be superimposed on a background of overeating.14 A study that compared dopamine and opioid receptors in binging and nonbinging obese adults implies that BED might be biologically based and driven by way of a heightened a reaction to the pleasurable properties of food.15 Binging is sometimes connected to purging behaviors, which tend toward weight neutrality or even anorexia in patients with binging, purging, and restriction, or bulimia nervosa. Episodes may haven’t any clearly demarcated beginning or end and may last for a whole day. Even though the prevalence of binge eating among the obese population is debated, with estimates which range from 1 to 30%, it does be seemingly more prevalent in women, and identification with this eating pattern is essential in treatment considerations, as it may 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 followed by depression, which also follows a circadian pattern, with symptoms more prominent during evening and nighttime hours. Problematic night-eating sometimes appears more frequently 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 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 intake between 10 p.m. and 6 a.m., weighed against obese control subjects who consume 15% of the calories during that time frame. The night-eaters do have more disrupted sleep and awaken significantly more than three 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’s interesting to consider the links between eating behaviors and a few 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 may have an association with weight gain or inappropriate eating behaviors. Increased obesity and visceral adiposity have now been present in some examples of medication-naive schizophrenics,17 whereas the behavior dysregulation and impulsivity seen in manic bipolar patients can cause 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 alleviate 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, having its powerful effects on neurotransmitters, would be a final common pathway for self-soothing or even self-medication.

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