Eating Disorders and the Dietitian


11


that the neurochemical changes associated with eating disorder behaviors are similar to those induced by drugs of abuse.23,24


ing disorders often struggle with other addictions.25


This may explain why individuals with eat- Eating


disorders also co-occur with anxiety, depression, obsessive- compulsive disorder (OCD), post-traumatic stress disorder (PTSD), attention-deficit disorder (ADD), and borderline personality disorder (BPD),15


but whether the connections


are cause and effect, genetic, environmental, or all of these, is yet unknown. Connections have also been suggested be- tween eating disorders and hormonal imbalances, includ- ing polycystic ovary syndrome (PCOS), hypoglycemia, and menstrual irregularities not specifically related to nutrition.


Nonbiological Factors


In addition to a biological susceptibility, the formation of most eating disorders seems to require some environmental stimulus. Eating disorders are often reported to develop in proximity to a weight change, whether intentional or unin- tentional; to be injury-, illness-, or catastrophe-related; or to develop as an aftereffect of an emotional shock. It is well understood that restriction of energy intake


leads to biochemical and psychological changes that resem- ble eating disorders.26


What is not understood is why some


individuals who undertake low-calorie diets develop eat- ing disorders while others do not. Often the social effects of weight changes are dramatically negative or positive, so regardless of an individual’s original intention to lose or gain weight, criticism or praise for doing so can trigger an eating disorder if the biological susceptibility exists. In some cases, weight changes that lead to eating disor-


ders are preceded by one or more physically or emotionally disorienting events, referred to in the mental health field as “emotional trauma.”27,28


It is unknown if the biochemi- cal effects of starvation are more strongly felt by those in


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