Binge Eating Disorder

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fat-foods-binge-eatingBy Nikita Katz, MD, PhD

Binge eating disorder is an illness that resembles bulimia nervosa.  Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging—occurring, on average, at least once a week for three months, according to DSM-5.  However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. While they commonly eat fewer meals than people without eating disorders.  When they do eat, they eat rapidly, consuming large quantities of food and do not stop until they are uncomfortably full.  When binging, they typically do so alone because they feel embarrassed by how much they are eating, and they tend to feel disgusted with themselves, depressed, or very guilty afterward.  Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

Binge eating disorder is found in about two percent of the general population—more often in women than men.  Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically supervised weight-control programs.

Because people with binge eating disorder are usually overweight, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at the National Institutes of Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses, especially depression.

Cognitive behavioral therapy and interpersonal therapy are the treatments found to produce the greatest degree of remission in patients with binge eating disorder.  Also, there can be improvements in specific eating-disorder psychopathology, associated psychiatric problems such as depression and psychosocial functioning.

Epidemiology of Eating Disorders

Estimates of the incidence or prevalence of eating disorders vary depending on the sampling and assessment methods.

  • Eating disorders have generally been recognized as affecting a narrow population of Caucasian adolescent or adult young women from developed Western countries.  In recent years, data are steadily accumulating to document that:
  • The prevalence of anorexia nervosa and bulimia nervosa in children and younger adolescents is unknown.
  • Approximately 0.5–1 percent of adolescents suffer from anorexia nervosa and 1–5 percent suffer from bulimia nervosa. Female college students are at highest risk of the latter.
  • An estimated 85 percent of eating disorders have their onset during adolescence.
  • Estimates of the lifetime prevalence of bulimia nervosa among women have ranged from 1.1 to 4.2 percent. Some studies suggest that the prevalence of bulimia nervosa in the United States may have decreased slightly in recent years.
  • The reported lifetime prevalence of anorexia nervosa among women has ranged from 0.5 percent for narrowly defined to 4 percent for more broadly defined anorexia nervosa.
  • Estimates of the male-female prevalence ratio range from 1:5 to 1:10 (although 19-30 percent of younger patient populations with anorexia nervosa are male).
  • An estimated five million Americans suffer from eating disorders at any given time, including approximately 5 percent of women and <1 percent of men with either anorexia nervosa, bulimia nervosa, or binge eating disorder.
    • eating disorders have become more common in pre-pubertal children and women in middle and late adulthood in such countries
    • ethnic and racial minority groups in these countries are vulnerable to eating disorders, and
    • there is nothing uniquely “Western” about eating disorders, which are a global health problem.

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Seasonal Affective Disorder

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By Nikita Katz, MD, PhD

Seasonal affective disorder (SAD), also known as winter depression and winter blues, is a type of mood disorder that is typically caused by low light levels. SAD generally begins in the fall and worsens during the winter months.  The rarer, reverse seasonal affective disorder (summer blues, summer depression) begins in the spring and worsens in the in the summer.

SAD is generally found more frequently in people who live in latitudes far north or south of the equator (for example, one percent in Florida; four percent in Washington, D.C.; 10 percent in Alaska).  Some patients experience a serious mood change when the seasons change. They may sleep too much, have little energy, and crave sweets and starchy foods. They may also feel depressed. Although symptoms may be severe, they generally resolve over several months.

SAD can be a serious disorder that may require hospitalization. There is a potential risk of suicide among some individuals experiencing SAD. The symptoms of SAD mimic those of clinical depression or dysthymia. The prevalence of SAD in the adult American population has been estimated at between 1.5 percent in Florida and about nine percent in the northern US.  Overall, 6.1 percent of the US population is affected by SAD. Subsyndromal seasonal affective disorder is a milder form of SAD estimated to affect 14.3 percent of the American population.

Seasonal affective disorder is more common in women than men and in people between the ages of 15 and 55 years. The risk of developing SAD for the first time decreases with age. People who have a close relative with SAD are also at greater risk.

CAUSES

There is strong evidence that SAD is caused by a lack of available sunlight. Decreased exposure to sunlight may have an effect on the body’s biological clock, which regulates mood, sleep, and hormone production. Exposure to light may reset the biological clock. Melatonin and serotonin synthesis may be altered in individuals with SAD. Exposure to light appears to correct both neurotransmitter deficits and changes in the biological clock.

SYMPTOMS

Symptoms of SAD include difficulty waking up in the morning, a tendency to oversleep, to overeat, and to crave carbohydrate-rich foods, often leading to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. Individuals with SAD are characterized by depression, pessimism, and a lack of pleasure in usual activities. Symptoms of SAD can include heightened anxiety as well as depression. For most people with SAD, symptoms start in September or October and end in April or May  and tend to occur at the same time every year.

TREATMENT

There are several treatment options for classic SAD. Bright-light treatment uses a specially designed lamp (or light box) — with an intense “full spectrum” or blue light at doses of 2,500 to 10,000 lux. The patient sits at a prescribed distance, usually 30 to 60 cm, in front of the box with eyes open but not staring at the light source for 30 to 60 minutes. Many individuals use the light box in the morning, and there is evidence that morning light is superior to evening light  although people may respond to evening light as well. One study found that up to 69 percent of patients find the treatment inconvenient, and as many as 19 percent stop use because of this.

There is evidence that dawn simulation is effective as well. In some studies, this has been found to be 83 percent more effective than other bright-light therapies. Most studies have found light therapies to work well — for several weeks — as seasonal treatment until greater amounts of natural light are available.

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What is Fibromyalgia?

Posted on Posted in Continuing Education, Homestudy, Pain, Seminars, Webinars

alone-62253_640By Nikita Katz, M.D., Ph.D.

The word “fibromyalgia” is derived from the Latin roots “fibro” (connective tissue), “my” (muscles), “al” (pain), and “gia” (condition of).  As a syndrome, fibromyalgia is composed of a specific, often complex, set of signs and symptoms that complicate diagnosis and treatment. Before official recognition as a disorder by the American Medical Association (AMA) in 1987, fibromyalgia was considered a “wastebasket” diagnosis, but lately there has been a “paradigm shift,” and fibromyalgia is being recognized as a true illness and a major cause of disability.

Fibromyalgia is a disorder characterized by chronic widespread musculoskeletal pain with associated fatigue, insomnia, and multiple somatic complaints such as stiffness, headache, and chest pain, with no evidence of disease.  It occurs mostly in women but does occur in men.  Most of the pain involves several tender points in the body, which are targeted areas where people with fibromyalgia feel an exaggerated sense of physical pain upon the slightest application of pressure. Fibromyalgia is neither degenerative nor progressive, and there is no inflammation.  In fact, it used to be called fibrositis, but the name was changed to fibromyalgia when evidence showed no inflammation in the disease process.  It is non-articular, meaning it does not involve the joints, and there is no swelling in the joints or tissues.  Descriptions of conditions consistent with what we now call fibromyalgia have been found in the medical literature as far back as the early 17th century.

Although there is no cure for fibromyalgia, several treatments can alleviate the multiple symptoms of this complex disorder, thus making it easier for patients to live a near-normal life.  Treatments include pharmacological interventions, dietary counseling, alternative medicine, relaxation techniques, and moderate exercise.  Many authors recommend combined management of fibromyalgia rather than just one treatment alone.

Fibromyalgia is not a life-threatening, deforming, or progressive disease.  Although lack of proper treatment may lead to the illusion of disease progression, this illusion is not supported by scientific evidence.  Compensation of sleep deprivation and physical reconditioning should, at least in some patients, lead to reversal of the disease or improvement of function and reduction of pain.

Numerous modalities available can reduce pain and other debilitating symptoms; these include electrotherapy, cryotherapy, and therapeutic heat. The clinician should teach patients how and when to use therapeutic modalities as part of their maintenance program. A multidimensional clinical approach including behavioral therapy, exercise, and pharmacological intervention is essential.

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Chronic Insomnia

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sleeping-child-812181_640By Nikita Katz, M.D., Ph.D.

Chronic insomnia is associated with an increased risk of depression, anxiety, excess disability, reduced quality of life, and increased use of health care resources.

Insufficient sleep can result in industrial and motor vehicle accidents, somatic complaints, cognitive dysfunction, depression, and decrements in daytime work performance owing to fatigue or sleepiness. It is also associated with hypertension, heart disease, and greater risk of mortality.

Statistical evidence highlights the scope and gravity of the problem of sleep loss among Americans.

  • More than one-third of all Americans suffer from sleep disorders at some point in their lives.
  • Up to two-thirds of adults report difficulty sleeping at some point each year. Approximately 20 percent of adults consider the problem to be serious.
  • Twenty percent of adults (approximately 40 million) report having a chronic sleep disorder.
  • The prevalence of insomnia is about 1.4 times higher among women than among men.
  • Mature age predisposes one to sleep disorders. The rate increases from 5 percent in persons aged 30 to 50 to approximately 30 percent in those more than 50 years old. In the National Institute on Aging’s Established Populations for Epidemiologic Studies of the Elderly, 42 percent of senior citizens who participated in the survey had difficulty falling and staying asleep.
  • Twenty-three percent of adults report having difficulties concentrating because they do not get enough sleep: For this reason, 18 percent say they have trouble remembering things; 38 percent report unintentionally falling asleep during the day at least once in the preceding month; and 5 percent, while driving, report nodding off or falling asleep at least once in the prior month.
  • Up to one in four adults reports using a “sleep aid” at least a few nights a week.
  • According to the 2011 Sleep In America Poll, conducted by the National Sleep Foundation, the growing use of cell phones and electronic devices (for phone calls, texting, or emailing) — shortly before going to bed and being awakened after going to sleep by one of these forms of communication — is causing individuals to get less sleep at night, negatively affecting millions of Americans’ functioning the next day.

Although insomnia is very common, evidence suggests that only a small proportion of people who suffer from sleep disturbance report it to their physicians. Moreover, physicians may not detect or adequately assess or treat insomnia. Factors that contribute to under-diagnosis and under-treatment of insomnia include reluctance on the part of patients to discuss it; physicians’ limited training in this condition; time constraints in medical practice; misperceptions about the impact poor sleep can have on patients’ daytime functioning, health, and safety (such as putting insomnia sufferers at risk for serious accidents); and misconceptions about the benefits and risks associated with the use of hypnotic medications.

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