Hope, compassion and understanding ...
Treatment for eating disorders & life enhancement.
The N.Y. Eating Disorder Medical Group
Dr. Jeffrey DeSarbo
(516)414-2545
Understanding "The 4 P's" of Eating Disorders
An eating disorder is a medical/psychiatric condition that requires treatment from health care professionals trained in this specialty. Perhaps the best way to understand an eating disorder and conditions that effect behavior, thoughts and mental state is to understand what Dr. DeSarbo refers to as “The 4 P’s.”
The 1st “P”are the Predisposing Factors. Eating disorders and other conditions are thought to have underlying genetic factors that are inherited at birth much in the same way that eye and hair color are determined by genetics. Several medical and psychiatric conditions, including eating disorders, have been shown to have suspected genetic markers that MAY predispose one to developing certain conditions.
The 2nd “P”are the Precipitating Factors. Just because one inherits the genetic properties that may make them prone to a certain illness, does not’t mean they will get that illness. It is believed that may people may be genetically prone toconditions such as heart disease. Still, if they eat healthy, exercise, avoid tobacco and generally take care of themselves, they may never develop the illness. Likewise with eating disorders, there are certain types of stressors and triggering events that can “set-off” disordered eating patterns in an individual. 
The 3rd “P”are the Perpetuating Factors. Perpetuating factors are conditions and situations that support and maintain the disordered eating patterns. Perpetuating factors may include environmental stressors such as difficult interpersonal relationships or they be of a biological nature such as changes that occur in neurotransmitters and the brain’s anatomy that can be affected by an eating disorder.
The 4th “P”is the Prescription. The prescription for an eating disorder is the treatment plan. With many eating disorder patients the prescription includes physician based treatment working in conjunction with other health care providers including qualified licensed therapists, nutritional consultations, groupwork, and family therapy at times. A medical physician experienced in eating disorders often monitors vital signs, blood and urine chemistries, cardiac and gastrointestinal functioning
and, at times,
prescribes medications
when indicated for co-
existing medical or
psychiatric conditions. Part of the prescription also involves helping the patient with emotional states associated with the significant distress found with eating disorders and psychotherapist often utilize cognitive behavioral therapy in treatment. Perhaps the most important part of the prescription is making sure that all involved in the treatment are very well trained and experienced with working with eatingdisorders.
And while many people who suffer from an eating disorder share somecommon feelings, obsessive thoughts and troubling behaviors, each individual has their own combination of the “4 P’s” which makes their condition unique to them.
Source: The Biology of Eating Disorder (DeSarbo)
* The prevalence of anorexia nervosa is
about 1-2.2% of the general population.
* The prevalence of bulimia nervosa is 1-2%
of the general population with 5-10% having
some symptoms.
* The prevalence of bing eating disorder is 1-5%
of the general population.
* The prevalence of body dysmorphic disorder
(BDD) is 7-12% of the general population and
is often associated with an eating disorder.
* About 7-12% of patients undergoing plastic
surgery suffer from BDD, and in follow-up
studies had greater BDD issues after surgery.
* The typical person who has an eating disorder
intelligent, often perfectionistic, from a family of
middle to high socioeconomic status and
* Eating disorders have the highest mortality rate
of any psychiatric disorder (10-15%).
* In deaths related to eating disorders, about 50%
are from medical complications and the other
50% are from suicide.
* Females account for about 90% of the cases of
eating disorders.
* Nearly 70-80% of individuals with eating
disorders also have another related psychiatric
condition (i.e. depression, anxiety, OCD, post-
traumatic stress disorder, ect.)
* Nearly 30% of individuals with an eating
disorder may have coexisting alcohol or
illicit substance use issues.
Eating disorders can present in a variety of forms
and symptoms. While many eating disorders fit
specific criteria for a medical diagnosis, many forms
of disordered eating patterns can present which do
not meet specific medical criteria yet cause
significant distress and disturbances to one's life.
Anorexia Nervosa
Anorexia nervosa (AN) is a disorder in which
individuals exhibit significant weight loss and
extreme restrictions in their food intake. Specific
criteria for the diagnosis of anorexia nervosa include:
• Weight loss and refusal to maintain what is
considered a normal body weight for that
person’s age and height (minimally 85% of
expected normal weight).
• Intense fear of gaining weight despite being
below expected weight.
• Distorted view or denial of their actual body
weight and/or shape.
• Loss of menstrual cycle.
Anorexia nervosa is specified into two types:
1. Restricting Type:
Categorized as severe restriction of
food intake with the absence of
binge-eating or purging.2. Binge/Purge Type:
Categorized as engaging in binge eating
or purging behavior while exhibiting
behaviors classified as anorexia. Purging
is characterized as a way to eliminate
food from your body either through
self-induced vomiting, excessive
exercise, or through laxatives, diuretics,
or enemas.
In addition to the diagnostic criteria, the following
are considered warning signs, or possible
precursors, of anorexia nervosa:
• Restricting certain types of food and the amount
of food intake.
• Preoccupation with weight, body shape, and
the calorie and fat content of food.
• Dramatic weight loss.
• Excessive exercise.
• Distress over body weight and shape.
• Withdrawal from previously enjoyed activities,
and from family and friends.
Bulimia Nervosa Bulimia nervosa is specified into two types:
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| Other Disordered Eating Patterns |
Binge Eating Disorder (BED) |
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