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By Maninder Singh, MD

Eating Disorders

Eating disorders affect 5 million Americans /year. Typically affect adolescent girls and young women though 5-15% cases of anorexia and bulimia occur in males.

Binge eating disorder is the most common eating disorder in males-up to 40 % Eating disorders may be understood in the same general context as pathological gambling or substance use as an impulse control disorder.

Essential feature of these is the failure to resist an impulse, drive or temptation to perform an act that is harmful to the person or others, and I want to stress the "failure to resist".

Also to be able to diagnose this failure to resist as a mental disorder it has to either devastate the person internally or has to result in decrease in function.

It also relates well to the concept of the three parts to an impulsive act:
• What happens before the act?
• What happens during the act?
• What happens after the act?

Usually before the act the individual feels an increasing sense of tension and arousal, scans the world around and looks for something that stands out.

During the act the individual experiences pleasure and gratification and during the third part which is after the act-there is relief or resolution from the anxiety and tension. This is also accompanied most times with regret and self reproach.

Next week I will discuss the impulsive vs compulsive acts and how they are on a continuum and the end point for both is the same even though the paths are distinctly separate.

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