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Eating Disorders / BDD

Understanding “The 4 P’s” of Eating Disorders


Eating Disorder Therapy | Body Dysmorphic Disorder Therapy | Garden City NY | Long Island NYAn 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 mean they will get that illness. It is believed that may people may be genetically prone to conditions 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 stress factors 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 stress factors such as difficult interpersonal relationships or they may 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, group-work, and family therapy at times. A medical physician experienced in eating disorders often monitors vital signs, blood and urine chemistry, 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 eating disorders. And while many people who suffer from an eating disorder share some common feelings, obsessive thoughts and troubling behaviors, each individual has their own combination of the “4 P’s” which makes their condition unique to them.


Facts about Eating Disorders & Body Dysmorphic Disorder


  • 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 binge eating disorders 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 perfectionist, 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, etc.)
  • Nearly 30% of individuals with an eating disorder may have coexisting alcohol or illicit substance use issues.


What is an Eating Disorder?


Eating Disorder Therapy | Body Dysmorphic Disorder Therapy | Garden City NY | Long Island NYEating 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:


  • Restricting Type: Categorized as severe restriction of food intake with the absence of binge-eating or purging.
  • 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 (BN) is a disorder in which individuals eat excessive amounts of food in a short period of time and afterwords eliminate this food from their body through some type of purging behavior. It is estimated that 1.1 to 4.2% of the female population suffers from BN.Criteria for diagnosis of bulimia nervosa include:


  • Recurring episodes of binge eating, characterized as an uncontrollable consumption of food in a short period of time.
  • Episodes of purging behavior following binging episode in which the individual tries to prevent weight gain through self-induced vomiting, laxatives, diuretics, enemas, fasting, or excessive exercise.
  • Self-evaluation is influenced by weight and body shape.


Bulimia nervosa is specified into two types:


    • Purging Type: Characterized by self-induced vomiting or through the use of laxatives, diuretics, or enemas.
    • Nonpurging Type: Characterized by fasting or excessive exercise is the compensatory behavior that is used to prevent weight gain.

    Other Disordered Eating Patterns Binge Eating Disorder (BED)


          • Consuming large quantities of food in a short amount of time and feeling a lack of control in the process.
          • Compulsive Overeating – Eating excessive amounts of food frequently throughout the day or at specific times of the day.
          • Night Eating Syndrome – Waking up during sleep and compulsively eating usually not remembering the event the next day.
          • PICA – Pica is the persistent eating of non-nutritive substances at an age where the behavior may be considered inappropriate. Individuals with pica have been reported to mouth and/or ingest a wide variety of nonfood substances, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, foam rubber, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.


  • Upcoming Speaking Engagements

    • • MARCH 23, 2013 - IAEDP Conference - Las Vegas, NV
    • • April 27th, 2013 - The Long Island Conference on Eating Disorders - HOFSTRA UNIVERSITY
    • • MARCH 23, 2013 - IAEDP Conference - Las Vegas, NV
    • • MARCH2, 2013 - The 6th Annual Symposium on Mental Health Counseling, C.W. Post Campus/LIU: Eating Disorders:Challenges in Treatment
    • • April 27th, 2013 - The Long Island Conference on Eating Disorders - HOFSTRA UNIVERSITY
    • • MARCH 2, 2013 - The 6th Annual Symposium on Mental Health Counseling, C.W. Post Campus/LIU: Eating Disorders:Challenges in Treatment

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