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Anorexia and eating disorders
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'''Anorexia nervosa''' is a [[:Category:Mental disorders|mental and behavioral disorder]] involving refusing or reducing food, distorted thoughts around eating or body weight for example fear of getting "fat" when underweight, and/or other thoughts and behaviors that lead to sufferer being significantly underweight.<ref name="neda-anorexia">{{Cite web | url = https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia | title = Anorexia Nervosa | date = 2017-02-25 | website = National Eating Disorders Association|language=en | access-date = 2019-02-25}}</ref><ref name="mayo-anorexia">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591 | title = Anorexia nervosa - Symptoms and causes | website = Mayo Clinic|language=en | access-date = 2019-02-25}}</ref><ref name="MosbyDictionary">{{Cite book | title = Mosby's Dictionary of Medicine, Nursing and Health Professions | pages = 102|isbn=978-0-7295-8691-7|edition=Revised 3rd Anz | volume = |language=en| title-link = | url = https://books.google.co.uk/books?id=z46ADwAAQBAJ&newbks=0&lpg=PA102&dq=anorexia%20appetite%20loss%20intitle:dictionary&pg=PA102#v=onepage&q&f=true|access-date= | date = 2018| publisher = Elsevier Health Sciences|editor-last = Harris|editor-first = Peter|editor-link = |editor-last2 = Nagy|editor-first2 = Sue|editor-link2 = |editor-last3 = Vardaxis|editor-first3 = Nicholas|editor-link3=|veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date= |location=Australia}}</ref> Other eating disorders include: *'''bulimia nervosa''', which involves intentional [[vomiting]] or purging food to avoid [[weight gain]];<ref name="neda-bulimia">{{Cite web | url = https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia | title = Bulimia Nervosa | date = 2017-02-26 | website = National Eating Disorders Association|language=en | access-date = 2019-02-25}}</ref><ref name="mayo-bulimia">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615 | title = Bulimia nervosa - Symptoms and causes | website = Mayo Clinic|language=en | access-date = 2019-02-25}}</ref> *'''binge eating disorder''',<ref name="neda-binge">{{Cite web | url = https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed | title = Binge Eating Disorder | date = 2017-02-26 | website = National Eating Disorders Association|language=en | access-date = 2019-02-25}}</ref><ref name="webmd-binge">{{Cite web | url = https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/mental-health-binge-eating-disorder | title = Mental Health and Binge Eating Disorder | website = WebMD|language=en | access-date = 2019-02-25}}</ref> *'''orthorexia''': eating an extremely restricted diet based on fear of eating "unhealthy" foods,<ref name="webmd-orthorexia">{{Cite web | url = https://www.webmd.com/mental-health/eating-disorders/what-is-orthorexia | title = What is Orthorexia? | website = webMD.com | access-date = 2021-02-21}}</ref><ref name="guardian-2009">{{Cite news |url =https://www.theguardian.com/society/2009/aug/16/orthorexia-mental-health-eating-disorder | title = Pure food obsession is latest eating disorder | last = Hill | first = Amelia | date = 2009-08-15|work=The Observer | access-date = 2019-02-25|language=en-GB|issn=0029-7712}}</ref><ref name="orthorexiacom">{{Cite web | url = http://www.orthorexia.com/what-is-orthorexia/ | title = What is Orthorexia? {{!}} Orthorexia | last = Bratman | first = Steven | author-link = | date = Jan 23, 2014 | website = orthorexia.com|archive-url=|archive-date=|url-status= | access-date = 2019-02-25}}</ref> and * '''other specified feeding or eating disorder''' (OSFED).<ref name="neda-other">{{Cite web | url = https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed | title = Other Specified Feeding or Eating Disorder | date = 2017-03-21 | website = National Eating Disorders Association|language=en | access-date = 2019-02-25}}</ref> {{See also description|1=appetite loss causing an inability to eat, caused by a physical illness|2=Anorexia (appetite loss)}} ==Signs and symptoms == ==Treatment == ==Exclusion in ME/CFS diagnostic criteria== Eating disorders including anorexia nervosa can be extremely [[fatigue|fatiguing]], as can morbid obesity without an eating disorder. A pre-existing diagnosis of anorexia nervosa means that ME/CFS cannot be diagnosed, although an eating disorder could develop after onset of ME/CFS.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | author-link2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | author-link3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | author-link4 = Nancy Klimas | last5 = Broderick | first5 = G | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = T | author-link6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 =N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | author-link14 = John Chia | last15 = Darragh | first15 = A | author-link15 = Austin Darragh | last16 = Gerken | first16 = A | author-link16 = Anne Gerken | last17 = Jo | first17 = D | author-link17 = Daehyun Jo | last18 = Lewis | first18 = DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 = KC | author-link20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | author-link21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | author-link22 = John McLaren-Howard | last23 = Mena | first23 = I | author-link23 = Ismael Mena | last24 = Miwa | first24 = K | author-link24 = Kunihisa Miwa | last25 = Murovska | first25 = M | author-link25= Modra Murovska | last26 = Stevens | first26 = SR | author-link26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><ref name="canadianconsensus">{{Citation | last1 = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | author-link2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | author-link3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | author-link4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | author-link5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 =Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10= Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11= Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12= van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande| title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 |pmid = | doi = 10.1300/J092v11n01_02 | url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref><ref name="fukuda1994">{{Cite journal | last = Fukuda | first = K. | author-link = Keiji Fukuda | last2 = Straus | first2 = S.E. | author-link2 = Stephen Straus | last3 = Hickie | first3 = I. | author-link3 = Ian Hickie | last4 = Sharpe | first4 = M.C. | author-link4 = Michael Sharpe | last5 = Dobbins | first5 = J.G. | author-link5 = James Dobbins | last6 = Komaroff | first6 = A. | author-link6 = Anthony Komaroff | date = 1994-12-15 | title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url =https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf | journal=Annals of Internal Medicine | volume = 121 | issue = 12 | pages = 953–959|issn=0003-4819|pmid=7978722|via=| publisher = American College of Physicians}}</ref><ref name="CDC-SEID">{{Cite web | url = https://www.cdc.gov/me-cfs/healthcare-providers/diagnosis/iom-2015-diagnostic-criteria.html | title = Systemic Exertional Intolerance Disease | website = [[Centers for Disease Control and Prevention]] | last = Institute of Medicine|access-date = 2021-02-24}}</ref> ==<span id="anorexianervosa">Anorexia and ME/CFS</span> == Anorexia nervosa and eating disorders are not common in people with [[ME/CFS]]. The ''symptom'' [[Anorexia (appetite loss)|anorexia (appetite loss or abnormal appetite)]] is listed as a possible ''neuroendocrine'' of ME/CFS in the [[Canadian Consensus Criteria]] but is not regarded as a diagnostic symptom in [[ME/CFS]].<ref name="canadianconsensus" /> ==Children and "refusal" to eat == Some parents have reported that their child’s swallowing difficulties or vomiting have resulted in medical professionals interpreting these ME/CFS as an indicator of a mental disorder, for example some children originally diagnosed with [[chronic fatigue syndrome]] have had their diagnosis changed to [[Pervasive Refusal Syndrome]] because they were wrongly judged as "refusing" to eat, wash, or increase their activity levels.<ref name="kos">https://www.dailykos.com/stories/2018/10/10/1803351/-Karina-Hansen-is-FREE</ref> {{Quote frame |text=Our son’s main symptom was dizziness / orthostatic intolerance and abnormal gait which he adopted because of his dizziness. We were told that as neurological examination was normal there must be a psychological element to his problems (this was from a very eminent Consultant Paediatric Neurologist). When we finally had to give in and admit him to hospital he was too weak to swallow his own saliva and had lost 20% of his body weight. Within 24 hours of admission he developed myoclonic jerks. We were asked whether he had a negative body image (ie was he anorexic) and whether we thought he was ‘putting on’ the [[myoclonus|muscle jerks]]. HELP! Please educate the Doctors and Nurses. | author =From a family outside Essex, [[UK]]|source=Our needs, our lives (2003)<ref name="ourneedsourlives">{{Cite web | date = 2003 | url = http://www.tymestrust.org/pdfs/ourneedsourlives.pdf | last = Tymes Trust| title = Our Needs Our Lives}}</ref>}} ==Prevalence== Unknown. ==Symptom recognition== Very little research has been published about eating disorders in people with [[ME/CFS]]. There is some awareness of anorexia nervosa and eating disorders being misdiagnosed in a few people with [[ME/CFS] who had symptoms that severely disrupt their ability to eat, their choices of food, or caused them to [[vomiting|vomit]] very frequently. [[Whitney Dafoe]] is an American photographer who has [[Severe_and_very_severe_ME#verysevere |very severe ME]], which causes him very severe [[digestive problems|gastrointestinal symptoms]], because of this he is tube fed and remain severely underweight. Whitney can no longer speak, eat, or have contact with anyone but his parents due to [[visual dysfunction]] and very severe ME. Whitney was previously misdiagnosed with the eating disorder anorexia, which resulted in him being refused the surgery needing for a feeding tube and in-patient psychiatric care recommended instead. Whitney is now fed via a PEG, is still unable to even drink water, and he needs full time care.{{Citation needed | date = February 2021}} [[Merryn Crofts]] was bedbound and unable to eat when she died of [[Severe and very severe ME|very severe ME]] at just 21 years old. Merryn weighed six stone (84 lbs) at her death but did not have an eating disorder, she had severe [[digestive problems|gastrointestinal symptoms]] causing weight loss. Merryn's autopsy revealed [[Dorsal root ganglia|ganglia]] [[inflammation]]. It is suspected that in the later years of her illness Merryn also suffered from [[Ehlers-Danlos syndrome|EDS]] and [[Mast cell activation disorder|MCAD]]. Her death certificate is the second in the [[United Kingdom|UK]] publicly known to have been attributed to ME.{{Citation needed | date = February 2021}} Anorexia (meaning weight loss) is recognized as an optional diagnostic symptom in the [[Canadian Consensus Criteria]] for ME/CFS, but is not recognized in the later [[International Consensus Criteria]] for ME.<ref name="canadianconsensus" /><ref name="ICC2011primer" /> A number of patient groups have raised concerns that anorexia nervosa may be a misdiagnosis in some patients with ME, particularly children or young people, and the [[Severe and very severe ME|severely ill]].<ref name="kos" /> [[Digestive problems|Digestive symptoms]] problems are well recognized, particularly [[irritable bowel syndrome]], and [[Food sensitivities|food intolerances]], and are optional diagnostic criteria. Common ME/CFS symptoms which may cause changes in eating or weight include: * [[digestive problems]] * [[nausea]] * abdominal pain * new [[Food sensitivities|food or medication sensitivities]] * [[irritable bowel syndrome]]<ref name="canadianconsensus" /> ==Notable studies== There do not appear to be any significant studies assessing swallowing or eating issues in patients with ME/CFS, or investigating the presence of comorbid eating disorders, or the potential misdiagnosing of eating disorders, although there are many different accounts from patients or their carers/parents. [[Byron Hyde]] has stated that enteroviruses may disrupt swallowing reflexes in ME/CFS.{{Citation needed | date = April 2021}} ==See also== * [[Mental illness]] * [[Ethical issues]] * [[Psychologization]] * [[Pervasive Refusal Syndrome]] * [[Dysphagia]] - swallowing difficulties * [[Anorexia (appetite loss)]] - symptom of a medical illness * [[Digestive problems]] ==Learn more== * [https://25megroup.org/download/2527/ KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING] - [[25 Percent ME Group |The 25% ME Group]] *[https://www.tymestrust.org/pdfs/metheillness.pdf ME - The Illness and Common Misconceptions: Abuse, Neglect, Mental Incapacity. A summary originally produced for the legal profession] - [[Tymes Trust]] ==References== {{reflist}} [[Category:Mental disorders]] [[Category:Diagnoses]] [[Category:Potential comorbidities]]
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