"Are hypochondriacs born or made? Is the product of your particular roll of the genetic dice, or the result of something in your childhood or environment? These questions are worth asking, because people like me cost the extra trouble and money. We're constantly making appointments for symptoms that feel real bur aren't. We doubt our s, so we seek second and third and even fourth opinions asking for (or demanding) unnecessary medical tests, and running up , too."

"In 1909, Sigmund Freud told the that "the position of hypochondria is still suspended in darkness," and more than a hundred years later it does not feel as if there is much light on the subject. Even in the most widely used and up-to-date clinical literature, its definition is still shifting and changing. For instance, for the latest edition of the ' ('), which was published in 2013 by the and is often referred to as "the bible of psychiatry," the diagnosis of hypochondria was entirely recategorized into two separate entities: and illness anxiety disorder. Both describe patients with "extensive worries about health," but the former features so-called somatic or physical symptoms the patient feels in their body that medicine cannot detect or explain, whereas the latter is focused solely on "preoccupation with having or acquiring a serious illness" and "excessive health-related behaviors.""

"After died in 1380, his 11-year-old son was next in line to inherit the throne. However, for the next 8 years it would be his uncles who ruled in his stead, spending money from the royal treasury and extorting heavy taxes from the common people. Overthrowing these avaricious regents and replacing them with highly competent advisors earned young Charles VI the title of ‘the Beloved’. Just a few years later, this title would be replaced by one not so kind: ‘le fou’ or ‘the mad’. In 1392, Charles had what was thought to be the first psychotic episode of many. During a military expedition he became paranoid, and when a servant accidently dropped a lance, Charles turned around and began attacking his own knights, some of whom died. In another episode Charles came to believe that he was made of glass – the , which would occur intermittently throughout his life. noted that Charles even had iron rods sewn into his clothes as reinforcement to stop him from breaking. Although perhaps the most famous person to suffer from the glass delusion, Charles was by no means the only one – in the 15th to 16th centuries it was not uncommon for such delusions to be reported. Case numbers dropped after this period, and cases of the glass delusion are now rare."

"Hypochondria seems to be a (that is, a response to) so many different kinds of troubles that the disorder assumes dozens of different forms. Taken together the hypochondrias are so common, in fact, that some doctors believe that they are among the most common symptoms of . ... Is this because among certain groups hypochondria is a more socially acceptable expression of distress than divorce, , alcoholism, and the like? Is it biologically or psychologically more efficient than other defenses?"

"He who, in the study or the treatment of the human machinery, overlooks the intellectual part of it, cannot but entertain very incorrect notions of its nature, and fall into gross and sometimes fatal blunders in the means which he adopts for its regulation and repair. Whilst he is directing his purblind skill to remove or relieve some more obvious and superficial , the worm of may be gnawing inwardly and undetected at the root of the constitution."

"Hypochondriacs tend to have a specific preoccupation – cancer, infertility, an – and scan their body for evidence to support this conviction, which sets off the “falling dominos of catastrophisation”. But hypochondria also overlaps with and (when or emotion manifests as pain, weakness or similar symptoms that don’t fit a pattern that can be readily explained)."

"... my therapist tells me that to worry unceasingly about getting cancer is as irrational as worrying about getting hit by a on . In fact, I am terrified of getting hit by a bus on Flatbush Avenue, and I think he is the madman for being so cavalier on the subject. Has he been out there recently? Belling says that hypochondria is “always ironic,” by which she means that, despite all its convolutions, hypochondria is always right. You will get sick and die. The question is only when and how. The bus is coming."

"People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement."

"The reality is that BPD is treatable and research shows that people can recover from BPD with various therapy approaches including Dialectical Behavior Therapy (DBT) and psychodynamic therapy, though DBT is considered the gold standard treatment for BPD. What breaks my heart is that BPD is maligned and pathologized. In reality, it is something that occurs when someone is highly sensitive and has been exposed to an invalidating or abusive environment. The sensitivity that people with BPD feel can also be a gift that allows them to feel love and joy more deeply than others."

"My skin is so thin that the innocent words of others burn holes right through me."

"I don’t know what living a balanced life feels like. When I am sad I don’t cry, I pour. When I am happy I don’t smile, I glow. When I am angry I don’t yell, I burn. The good thing about feeling in extremes is when I love I give them wings but perhaps that isn’t such a good thing, cause they always tend to leave and you should see me when my heart is broken I don’t grieve, I shatter."

"I don’t know what it’s like to not have deep emotions, even when I feel nothing, I feel it completely."

"Yet I also recognize this: Even if everyone in the world were to accept me and my illness and validate my pain, unless I can abide myself and be compassionate toward my own distress, I will probably always feel alone and neglected by others."

"What we experience as a 3 on the difficulty scale of 1-10, they likely experience as an 11. They might be smart and capable, which leads loved ones scratching their heads when something seemingly simple knocks them down. It can look like drama and folks with BPD are often labeled as being dramatic, but the pain is typically real for them."

"Certainly, it’s important to acknowledge and identify the effects of BPD on your life. It’s equally important to realize that it neither dictates who you are nor fixes your destiny."

"There is no single cause of an eating disorder. We know that genetics play a large role, but genetic vulnerability is only part of the story. Environment plays a role too, especially in triggering onset, which often occurs in adolescence. Pressure to diet or weight loss related to a medical condition can be the gateway to anorexia nervosa or bulimia. For those who are genetically vulnerable to anorexia nervosa, once they lose the first five to 10 lbs, dieting becomes increasingly compelling and rewarding. Looked at another way, if eating disorders were the result solely of social pressure for thinness we would expect eating disorder rates to have increased as obesity has in the past few decades, yet anorexia nervosa and bulimia remain relatively rare and often cluster in families."

"Treatment for an eating disorder is challenging. It involves interrupting behaviors that have become driven and compelling. Recovery takes a team, which includes family, friends and other social supports, as well as medical and mental health professionals. Be empathic, but clear. List signs or behaviors you have noticed and are concerned about. Help locate a treatment provider and offer to go with your friend or relative to an evaluation. Be prepared that the affected individual may be uncertain about seeking treatment. Treatment is effective, many are able to achieve full recovery and the vast majority will improve with expert care. Treatment assists affected individuals to change what they do. It helps them normalize their eating and reframe the irrational thoughts that sustain eating disordered behaviors. Food is central to many social activities and the practice of eating meals with supportive friends and family is an important step in recovery."

"The aim of this study was to describe patterns of personality disorders (PDs) in women with chronic eating disorders (EDs). An index group of nineteen women who have had EDs for an average of 8.5 years was compared with a control group of same-aged women from the general population. At the time of the study the index group received treatment at a tertiary treatment center in Stockholm. The PDs were assessed using the DSM-IV part of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). In the index group, eighteen of nineteen fulfilled the criteria for one or more PD. The number of PD diagnoses for each women ranged from zero (n = 1) to eight (n = 2) with a median of three. Among the controls, only one woman fulfilled the criteria for one or more PD. The most prevalent disorders in the index group were Borderline, Avoidant, and Obsessive-Compulsive. The index group had significantly higher DIP-Q dimensional scores than the controls in the Paranoid, Schizoid, Schizotypal, Borderline, Histrionic, Avoidant, and Dependent scales. Although the assessment of PD symptoms was limited to self-reports, the high prevalence of PD diagnoses and PD symptoms most probably reflects the severe psychiatric impairments in patients suffering from chronic ED."

"Peer context may represent a key opportunity for intervention, as peer groups represent the nexus in which individual differences in psychological risk factors shape the social environment and social environment shapes psychological risk factors. Thus, peer-based interventions that challenge internalization of the thin ideal can protect against the development of eating pathology."

"Disturbances of volume-regulating mechanisms have already been implicated in the pathophysiology of eating disorders like anorexia or bulimia nervosa with the peptide hormones vasopressin and atrial natriuretic peptide (ANP) being of special interest. Aim of the present study was to investigate, whether the expression of the corresponding genes was altered and if so, if these changes could be explained by epigenetic mechanisms such as DNA methylation. We analyzed blood samples of 46 women suffering from anorexia (n=22) or bulimia nervosa (n=24) as well as of 30 healthy controls. Peripheral mRNA expression and DNA methylation of the vasopressin and the ANP precursor genes were assessed using real-time PCR. We found significantly lower levels of ANP mRNA in patients with eating disorders. This downregulation was accompanied by a hypermethylation of the ANP gene promoter in the bulimic subgroup. We did not find differences regarding expression or methylation of the vasopressin gene. ANP mRNA expression was inversely associated with impaired impulse regulation. We conclude that epigenetic mechanisms may contribute to the known alterations of ANP homeostasis in women with eating disorders."

"Eating disorders do not discriminate and can affect anyone. Although they are most common in young women, it is not unusual for older women to have an eating disorder. Some have had one all their life, others were only mildly affected until some life event triggers clinical worsening – a stressor, physical illness or a co-occurring psychiatric illness, such as depression or anxiety. Recent evidence strongly suggests that anxiety disorders, especially social anxiety disorder, and obsessive compulsive personality traits increase individual vulnerability to an eating disorder. Eating disorders occur in men too. An estimated 10 percent of people with anorexia nervosa and bulimia and a third or more of people with binge eating disorder are male. More"

"Data described earlier are clear in establishing a role for genes in the development of eating abnormalities. Estimates from the most rigorous studies suggest that more than 50% of the variance in eating disorders and disordered eating behaviors can be accounted for by genetic effects. These high estimates indicate a need for studies identifying the specific genes contributing to this large proportion of variance. Twin and family studies suggest that several heritable characteristics that are commonly comorbid with AN and BN may share genetic transmission with these disorders, including anxiety disorders or traits, body weight, and possibly major depression. Moreover, some developmental research suggests that the genes involved in ovarian hormones or the genes that these steroids affect also may be genetically linked to eating abnormalities. Molecular genetic research of these disorders is in its infant stages. However, promising areas for future research have already been identified (e.g., 5-HT2A receptor gene, UCP-2/UCP-3 gene, and estrogen receptor beta gene), and several large-scale linkage and association studies are underway. These studies likely will provide invaluable information regarding the appropriate phenotypes to be included in genetic studies and the genes with the most influence on the development of these disorders."

"Our study shows a disturbed expression of dopaminergic genes that is accompanied by a dysregulation of the epigenetic DNA methylation. Further studies are necessary to provide more insight into the epigenetic dysregulation of the dopaminergic neurotransmission in the pathophysiology of eating disorders."

"The pathophysiology of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) has been linked to an impaired dopaminergic neurotransmission, still the origin of this disturbance remains unknown. The aim of the present study was, therefore, to evaluate whether the expression of dopaminergic genes is altered in the blood of patients suffering from eating disorders and if these alterations can be explained by changes in the promoter specific DNA methylation of the genes."

"Epidemiological, cross-cultural, and longitudinal studies underscore the importance of the idealization of thinness and resulting weight concerns as psychosocial risk factors for eating disorders. Personality factors such as negative emotionality and perfectionism contribute to the development of eating disorders but may do so indirectly by increasing susceptibility to internalize the thin ideal or by influencing selection of peer environment. During adolescence, peers represent self-selected environments that influence risk."

"There is no one sign of an eating disorder, however there are red flags. These can include excessive “fat, weight or calorie talk,” a pattern of eating a limited choice of low-calorie food or a pattern of occasional binge eating of calorie-dense foods. People with anorexia nervosa may excessively exercise or excessively stand, pace or fidget. Affected individuals may severely limit the amount of calories they consume or may avoid weight gain following meals by inducing vomiting or abusing laxative, diuretic and diet pills. Feeling self-conscious about one’s eating behavior is common. Affected individuals often avoid social eating settings and eat alone."

"Because eating disorders (EDs) and obsessive compulsive disorder (OCD) co-occur at high rates and can have functionally similar clinical presentations, it has been suggested that both constructs might be part of a common spectrum of disorders. Identifying the relationship between EDs and OCD may lead to the discovery of important shared core disease processes and/or mechanisms for maintenance. The objective of this paper is to understand the relationship between EDs and OCD by systematically reviewing epidemiological, longitudinal and family studies guided by five models of comorbidity posited by Klein and Riso (1993) and others. Though this literature is relatively small, the preponderance of evidence from these studies largely suggests that OCD/ED co-occur because of a shared etiological relationship."

"There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder."

"Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular."

"Thin body preoccupation and social pressure are important risk factors for the development of eating disorders in adolescents. Some Hispanic groups are at risk of developing eating disorders. Efforts to reduce peer, cultural, and other sources of thin body preoccupation may be necessary to prevent eating disorders."

"About 60% of eating disorder cases are attributable to biological and genetic components. Other cases are due to external reasons or developmental problems."

"Adams and Crane (1980), have shown that parents are influenced by stereotypes that influence their perception of their child's body. The conveyance of these negative stereotypes also affects the child's own body image and satisfaction. Hilde Bruch, a pioneer in the field of studying eating disorders, asserts that anorexia nervosa often occurs in girls who are high achievers, obedient, and always trying to please their parents. Their parents have a tendency to be over-controlling and fail to encourage the expression of emotions, inhibiting daughters from accepting their own feelings and desires. Adolescent females in these overbearing families lack the ability to be independent from their families, yet realize the need to, often resulting in rebellion. Controlling their food intake may make them feel better, as it provides them with a sense of control."

"Anxiety disorders commonly had their onset in childhood before the onset of an eating disorder, supporting the possibility they are a vulnerability factor for developing anorexia nervosa or bulimia nervosa."

"Body dissatisfaction, disordered eating and depression differentially affect adolescent girls (compared to boys); however, these variables have not been examined in relation to ethnicity. A review of the literature finds that Black adolescent girls are more satisfied with their bodies than White adolescent girls and engage much less frequently in dieting or disordered eating than do White girls in the US. A central question raised by this review is whether body dissatisfaction and pubertal timing are as relevant to our understanding of the etiology of depression in Black girls as they appear to be in White girls. Based on the available data, it does not seem that a risk factor model supporting the role of early pubertal timing, weight increases and body dissatisfaction in the development of depression applies to Black adolescent girls. This review underscores the need for future research with a variety of ethnic minority groups to better understand the etiology of adolescent depression."

"ADHD girls were 3.6 times more likely to meet criteria for an eating disorder throughout the follow-up period compared to control females. Girls with eating disorders had significantly higher rates of major depression, anxiety disorders, and disruptive behavior disorder compared to ADHD girls without eating disorders. Girls with ADHD and eating disorders had a significantly earlier mean age at menarche than other ADHD girls. No other differences in correlates of ADHD were detected between ADHD girls with and without eating disorders."

"Parental influence has been shown to be an intrinsic component in the development of eating behaviors of children. This influence is manifested and shaped by a variety of diverse factors such as familial genetic predisposition, dietary choices as dictated by cultural or ethnic preferences, the parents' own body shape and eating patterns, the degree of involvement and expectations of their children's eating behavior as well as the interpersonal relationship of parent and child. This is in addition to the general psychosocial climate of the home and the presence or absence of a nurturing stable environment. It has been shown that maladaptive parental behavior has an important role in the development of eating disorders."

"Osteoporosis has been reported in anorexia nervosa (AN), but not in other eating disorders. Thirty-three patients, 8 AN, 17 bulimia nervosa (BN), and 8 eating disorder not otherwise specified (EDNOS), were evaluated by bone densitometry (radius, spine, femur) to determine the prevalence and distribution of osteoporosis and the role of physical parameters, exercise and estrogen. All three diagnostic subgroups had evidence of decreased bone density, worst in the EDNOS subgroup and least in the BN subgroup. The most affected site was the femur, least the spine; the radius was intermediate. Age, body surface area, age of onset, and length of illness weakly correlated with the femur and spine density in the BN and EDNOS subgroups. Exercise was related to bone density in the AN subgroup in the femur, moderate exercise having a protective effect and strenuous exercise being detrimental. No significant correlation of bone density measurements with estradiol levels and/or history of amenorrhea was identified. Eating disorder patients are at risk for osteoporosis, which has multiple contributing factors including physical parameters and exercise. Estrogen deficiency by itself may not be a major causative factor."

"Kaye, WH; Bulik, CM; Thornton, L; Barbarich, N; Masters, K (2004). "Comorbidity of anxiety disorders with anorexia and bulimia nervosa". The American Journal of Psychiatry. 161 (12): 2215–21. doi:10.1176/appi.ajp.161.12.2215. PMID 15569892."

"Social cognitive theory would warn that the high prevalence of interaction opportunities in the pro–eating disorder community has the potential to be extremely harmful if viewers are learning dangerous behaviors from one another, particularly if they are similar in age and gender. Other studies suggest that discussing techniques and perceived benefits may also have contagious effects on those not yet committed to the behaviors.5 The disclaimers included on pro–eating disorder Web sites may warn unsuspecting readers away from distressing content but also may entice vulnerable individuals to read further. Although there is no evidence as to the impact of warnings or disclaimers on pro–eating disorder sites, research on other media such as movies and video games with adult ratings suggests that labels might entice young viewers to want to see media that are not appropriate for them. Behavioral and communication theories, such as the social cognitive and cultivation theories mentioned earlier,8,9 would also suggest that the most deleterious components of these sites are the evocative images depicted coupled with constant social support encouraging extreme behaviors. On these Web sites, striving to be underweight is deemed not only as normative but as a signal of success. Only 13% of site maintainers offered an overt statement indicating that their own eating disorder was a problem. In addition, the Internet's easy accessibility allows users to tap into a site's features at any time of day or night. Social interaction is the most common reason young people use the Internet. This may be particularly relevant to the eating disorder online community, as research shows that individuals suffering from eating disorders have difficulty relating with same-age peers, attempt to hide their eating disorder behaviors, and often experience shame and isolation. Online venues for interaction with friends or strangers may seem like a safer and even appropriate place to disclose personal information. Furthermore, the Internet allows one to not only maintain relative anonymity but also easily retreat from criticism or uncomfortable situations."

"The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81.9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions. Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder."

"Alcohol use disorders were significantly more prevalent in women with ANBN and bulimia nervosa than in women with anorexia nervosa (p =.0001). The majority of individuals reported primary onset of the eating disorder, with only one third reporting the onset of the AUD first. After eating disorder subtype was controlled for, AUDs were associated with the presence of major depressive disorder, a range of anxiety disorders, and cluster B personality disorder symptoms. In addition, individuals with AUDs presented with personality profiles marked by impulsivity and perfectionism."

"Individuals with eating disorders and AUDs exhibit phenotypic profiles characterized by both anxious, perfectionistic traits and impulsive, dramatic dispositions. These traits mirror the pattern of control and dyscontrol seen in individuals with this comorbid profile and suggest that anxiety modulation may be related to alcohol use in this group."

"Eating disorders and alcohol use disorders (AUDs) commonly co-occur, although the patterns of comorbidity differ by eating disorder subtype. Our aim was to explore the nature of the co-morbid relation between AUDs and eating disorders in a large and phenotypically well-characterized group of individuals."

"In a large study of psychiatric outpatients, their eating disorders were mainly classed as "not otherwise specified" (NOS) — rather than as bulimia, anorexia, or binge eating — and most patients failed to meet the full diagnostic criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition ( DSM-IV). This suggests that DSM-IV diagnostic thresholds for eating disorders are too restrictive, the researchers, led by Mark Zimmerman, MD, from Brown University School of Medicine, in Providence, Rhode Island, write. Dr. Zimmerman told Medscape that their findings "strongly suggest that there are problems with the diagnostic criteria in the DSM category for eating disorders, because most individuals with an eating disorder don't meet the formal diagnostic criteria." He added that this contrasts with other categories of diagnosis — such as anxiety, personality, and depressive disorders — where "the overwhelming majority" of individuals meet the formal diagnostic criteria. "The conclusion is that there are significant problems with the eating-disorder diagnostic category in the DSM," he said."

"Personality traits have been implicated in the onset, symptomatic expression, and maintenance of eating disorders (EDs). The present article reviews literature examining the link between personality and EDs published within the past decade, and presents a meta-analysis evaluating the prevalence of personality disorders (PDs) in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) as assessed by self-report instruments versus diagnostic interviews. AN and BN are both consistently characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant PD. Consistent differences that emerge between ED groups are high constraint and persistence and low novelty seeking in AN and high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline PD in BN. The meta-analysis, which found PD rates of 0 to 58% among individuals with AN and BN, documented that self-report instruments greatly overestimate the prevalence of every PD."

"BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs."

"Both depressive disorders and eating disorders are multidimensional and heterogeneous disorders. This paper examines the nature of their relationship by reviewing clinical descriptive, family-genetic, treatment, and biological studies that relate to the issue. The studies confirm the prominence of depressive symptoms and depressive disorders in eating disorders. Other psychiatric syndromes which occur with less frequency, such as anxiety disorders and obsessive-compulsive disorders in anorexia nervosa, or personality disorders, anxiety disorders, and substance abuse in bulimia nervosa, also play an important role in the development and maintenance of eating disorders. Since few studies have controlled for starvation-induced physical, endocrine, or psychological changes which mimic the symptoms considered diagnostic for depression, further research will be needed. The evidence for a shared etiology is not compelling for anorexia nervosa and is at most suggestive for bulimia nervosa. Since in contemporary cases dieting-induced weight loss is the principal trigger, women with self-critical or depressive features will be disproportionately recruited into eating disorders. The model that fits the data best would accommodate a relationship between eating disorders and the full spectrum of depressive disorders from no depression to severe depression, with somewhat higher rates of depression in bulimic anorectic and bulimia nervosa patients than in restricting anorexia nervosa patients, but the model would admit a specific pathophysiology and psychopathology in each eating disorder."

"The Stroop task has been adapted from cognitive psychology to be able to examine attentional biases in various forms of psychopathology, including the eating disorders. This paper reviews the research on the Stroop task in the eating disorders research area in both descriptive and meta-analytic fashions. Twenty-eight empirical studies are identified, which predominantly examine food and body/weight stimuli in bulimic, anorexic, or dieting/food-restricted samples. It is concluded that there is evidence of an attentional bias in bulimia for a range of stimuli but that the effect seems to be limited to body/weight stimuli in anorexia. The evidence to date is that there is no attentional bias in dieting samples."

"The ubiquitous nature of the gastrointestinal complaints requires the clinician to consider a broad differential diagnosis when evaluating a patient for an eating disorder."