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dissolution of marriage suzanne attia date when
1 answer
Attia Hosain has written:
'Sunlight on a broken column'
1 answer
Ahmed Baha Attia died on August 9, 2007, in Tunis, Tunisia of cancer.
1 answer
Attia Mitwally Elfak has written:
'The effect of sugars and casein on the rheological properties of stabilizers'
1 answer
Attia Boudjemline has written:
'Studies on Co/Pt multilayers as second generation magneto-optic storage media'
1 answer
Farag Abdel-Salam Attia has written:
'On the distribution function of the interval between zero-crossings of a stationary Gaussian process' -- subject(s): Distribution (Probability theory), Gaussian processes
1 answer
Gamal el Din Attia is known for his work in Arabic literature, particularly poetry and literary criticism. Some of his notable works include poetry collections, essays, and academic articles on Arabic literature and culture.
2 answers
Lou Attia has: Played Gene Genie in "Skatoony" in 2010. Played Sven Strudel in "Skatoony" in 2010. Played David in "BeyWheelz" in 2012. Played Arabic Soldier 2 in "Splinter Cell: Blacklist" in 2013. Played Fungus in "Numb Chucks" in 2014.
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The cast of Skatoony - 2010 includes: Lou Attia as Gene Genie Lou Attia as Sven Strudel Dwayne Hill as Who Flung Poo Ronny Katzman as Contestant Julie Lemieux as Dabs Looman Ivan Sherry as Agent Carruthers Ivan Sherry as Guts Glory
1 answer
Peter Attia incorporates the use of a stationary bike into his fitness routine by using it for high-intensity interval training (HIIT) sessions. He alternates between periods of intense pedaling and rest, which helps improve cardiovascular fitness and burn calories efficiently.
1 answer
The cast of Citizen Hero - 2009 includes: Constantine Attia as Le videur Dioucounda Koma as Dylan
1 answer
John Okyere Attia has written:
'Saving time and money using the internet' -- subject(s): Electronic commerce, Teleshopping, Internet
'PSPICE and MATLAB for electronics' -- subject(s): PSpice, Design and construction, Very large scale integration Integrated circuits, MATLAB, Data processing, Electronic circuit design
'Solutions Manual for PSPICE and MATLAB for Electronics'
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The cast of Bolero pour les sourds - 2013 includes: Attia Barrere Le Roy
1 answer
The cast of Gaza on the Air - 2009 includes: Essam Attia Ajrami Atef Mahmoud Eissa Lana Naem Shaheen
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Constantine Attia has: Played Le costaud du Malibu in "Extension du domaine de la lutte" in 1999. Performed in "Le boulet" in 2002. Played Le Gros Bandit in "Les Dalton" in 2004. Played Rachid casting in "Ze film" in 2005. Played Radio King in "Empreintes criminelles" in 2009. Played Le videur in "Citizen Hero" in 2009.
1 answer
Naim G Attia is the author of "Chuckle A Bit: ... And Benefit From It" which is a collection of humorous essays and anecdotes. He has also written "Explaining the Unexplained: How to Break Tricks and Win a Bet."
9 answers
The cast of Numb Chucks - 2014 includes: Lou Attia as Fungus Joris Jarsky as Woodchuck Morris Julie Lemieux as Grandma Butternut Bryn McAuley as Quills Terry McGurrin as Dilweed Rob Tinkler as Hooves
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The cast of Dars khososy - 2005 includes: Salah Abdallah as Salah Hajjaj Abdul Azim Mohammad Attia as Khososy Hala Fakher as Husnia Hassan Hosny as Shehata Sherif Salama Hana Sheha as Gamila
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The cast of John - 1992 includes: Jonathan Attia as Enfant William Bonnier as Enfant Cyril Guillaume as Enfant Laurent Lacaussade as Enfant Guillaume Metzger as Enfant Alexandra Stewart as Jane Clayton Guillaume Thomas as Enfant
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People who have experienced lightning strikes include individuals who have been outdoors during a storm, athletes participating in outdoor activities, and individuals working in professions where they are exposed to the elements, such as construction workers or farmers. These experiences can result in injuries ranging from minor burns to cardiac arrest.
2 answers
The cast of Antoine - 1996 includes: Faisal Attia as Maxime Younesse Boudache as Laurent Zabou Breitman as Diane Marie Caries as Annette Julie Foulonneau as Marion Elisabeth Margoni as Madame Bombel Roger Mollien as Faber Aladin Reibel as Bouilhet Firmine Richard as Juana Gaina Tlemsani as Nedjma
1 answer
The cast of Delta Force - 1997 includes: Hany Attia Robert Brent Lappin Erwin Darmali Bryce Garcia Michael Glukov Ramy Hakim Tom Hays Chris Laun Malik Mourad Tonatiuh Pacheco Jamie Tardiff Alicia Taylor Max Walla Jim Yefgeniy Blekherman
1 answer
The cast of Sansa - 2003 includes: Georges Abe as Georges Martha Argerich as herself Silke as Paloma Amar Attia as Le CRS Valentina Cervi as Valentina Antoine du Merle Ayako Fujitani as June Ivry Gitlis as Monsieur Click Liz Lobato Zay Nuba Bassem Samra as Ahmed Roschdy Zem as Sansa
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The cast of Devdas - 1936 includes: Leela Rajkumari as Chandra Nemo as Dharmadas Sahana as Jasodha Roshanara as Maid Servant (as Maid Servent) Ramkumari as Padma Sultana as Parvati Zubeida as Parvati Kshetrabala as Piyari Kailash as Ramdas Yusuf Attia as Rai Saheb Biswanath Bhaduri as Narayan Krishna Chandra Dey as Bairagi Sitara Devi as Monorama Vikram Kapoor as Cart Driver Kidar Nath Sharma as Jagannath Pahadi Sanyal as A Friend
1 answer
The cast of BeyWheelz - 2012 includes: Lou Attia as David Scott Beaudin as Covery Horn Scott Beaudin as Covey Horn Zachary Bennett as Leon Ashley Botting as Nicole Spears Will Bowes as Jake Jason Deline as Glen Austin Dilulio as Jin Ryu Cory Doran as Tom Kris Ferguson as Sting Christopher Jacot as Sho Tenma Krystal Meadows as Marche Ovis Garth Naumoff as Narrator Andrew Sabiston as Ryan Nathan Stephenson as Ken
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The cast of Le train de 16h19 - 2003 includes: Walid Afkir as Camel Despina Athanassiadis Faisal Attia Benjamin Bellecour as Drecq Marie Berto as Marie-France Arezki Boudar Michal Dosedla Samuel Dupuy as Gus Jindrich Hinke Wenjun Jin Miroslav Krejca Christiane Ludot Daniel Margolius Ouchem Rachid Michal Rones Jan Rouiller as Policier civil Christophe Rouzaud as Imbert Veronika Sidovska Filip Tomsa
1 answer
this is an assignment question for tma-2 bege-108. The one asking the answer for this question is a big lazy brat unwilling to make any personal effort but trying the easy way of being given ready-made answers spoon-fed to him/her so that he/she can copy/paste and post it to the tutor and earn unmerited marks. So just take your tools and start working like all honest learners. Nothing can be gained without sweating it out. Life should be lived the hard way. A big recompense awaits us ahead if we adopt such a lifestyle. Bon courage! Ravi Ramdawor, your wellwisher...
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Faudel has: Played Himself - Interviewee in "20 heures le journal" in 1981. Played himself in "Questions pour un champion" in 1988. Played himself in "Les cachetonneurs" in 1998. Played himself in "Vivement dimanche" in 1998. Played himself in "Tout le monde en parle" in 1998. Played himself in "Exclusif" in 1999. Played Sami in "Sami" in 2002. Played Sami Attia in "Sami" in 2002. Played himself in "Live 8" in 2005. Played Bouzid in "Bab el web" in 2005. Played Himself (segment "Music Video - Je veux vivre") in "Sidaction 2009" in 2009.
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The cast of Jet Set - 2000 includes: Karim Attia as Karim Didier Brengarth as Le vendeur Gucci Laurent Brochand as Rodolphe de Botron Mireille Casanova as Dame kiosque 1 Guillaume Gallienne as Evrard Cathy Guetta as Mercedes Catherine Hirsh as Cliente kiosque courrier Adel Kachermi as himself Foc Khan as Foc Khan Estelle Larrivaz as Lydia Samuel Le Bihan as Mike Bernard Loiseau as himself Ornella Muti as Camilla Balbeck Fabienne Roux as Femme kiosque comtesse Bruno Solo as Jimmy Jovanka Sopalovic as Natacha Lambert Wilson as Arthus de Poulignac Alexandre Zouari as Kashayar
1 answer
The cast of Un balcon sur la mer - 2010 includes: Anju Allard as Ghislaine enfant Claude Attia as Avocat Michel Aumont as Robert Prat Michel Benizri as Le notaire Emilie Chesnais as Patricia Sami Chlagou as Jeune garagiste Muriel Combeau as Ghislaine Jean Dujardin as Marc Palestro Sandrine Kiberlain as Clotilde Palestro Emilie Lafarge as Suzanne Edgar Lascelesloyd as Homme attentat Sandrine Lepoutre as La danseuse de rock Nicolas Lestang as Ado chinois Jennyfer Lin as Liu Chang Romain Millot as Marc enfant Philippe Napias as Thierry Georges Neri as Fedida Nicole Riston as Bridoux Toni Servillo as Sergio Bartoli Jacques Valles as Jo Fuentes Jean Vincentelli as Vendeur bastide
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The cast of Amalies verden - 2010 includes: Mikkel Beha Erichsen as himself Tammie Bergholdt as herself Lisbet Dahl as herself Rasmus Dall as himself Karsten Delgado as himself Niels Ellegaard as himself Mathias Eskerod as himself Frederik Fetterlein as himself Jakob Green as himself Maria Guldager as herself Ditte Hansen as herself Mie Hansson as herself Claus Hjelmbak as himself Marie Hvidt as herself Mia Hvidt as herself Rune Johansen as himself Charlotte Kejser as herself Alexander Kejser as himself Pernille Klamer as herself Stine Kronborg as herself Amalie Lind as herself Henrik Lykkegaard as himself Stefan Makris as himself Josri Mio Attia as himself Michael Olesen as himself Camilla Ottesen as herself Ulf Pilgaard as himself Dennis Ravn as himself Michelle Sanders as herself Peter Schmeichel as himself Nicolai Schwartz as himself Kasper Skak as himself Anja Steensig as herself Samanta Stojkovic as herself Amalie Szigethy as herself
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The cast of Toul omry - 2008 includes: Mehammed Amadeus as Rami Maged as Atef Jwana as Dalia Louay as Kareem Wedad as Khadra Mazen as Rami Ayman as Walid Janaan Attia as Nurse Latifa Munir Bayyari as Hany Travis Creston as Tourist Hala Fauzi as Belly Dancer Julian Gonzalez Esparza as Ahmad Bassam Kassab as Hatem Ayman Kozman as Policeman Amar Puri as Amar Mykha Ram as Mostafa Seham Saneya Adelsalam as TV actress three Ashraf Sewailam as Rami Naglaa Younis as TV actress two
3 answers
The cast of Les Dalton - 2004 includes: Gadji Alibo as Le Garde 1 Prodromos Antoniadis as Le Gardien de Prison Javivi as El Tarlo Paillette as Le Juge Ikel as Un Chinois Constantine Attia as Le Gros Bandit Ramzy Bedia as Averell Jean Benguigui as Le Chef de Village Romain Berger as William Juan Carlos Merino as Man Andreu Castro as Puta Puta Darry Cowl as Le Viell Homme Jean Dujardin as Le Cow-Boy Vanneur Ismael Fritschi as Le Patron du Saloon Ginette Garcin as Ma James Christian Guillon as Le Colonel Sylvie Joly as Ma Billy Eric Judor as Joe Balbino Lacosta as Le Croquemort Patricia Mendy as La Mexicaine Kad Merad as Le Mexicain Cellule Michel Muller as Le Directeur de la Banque Jean Rochefort as Jolly Jumper Til Schweiger as Lucky Luke Benjamin Seznec as Le Badaud Marthe Villalonga as Ma Dalton
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The cast of Empreintes criminelles - 2009 includes: Ruben Alves as Robert Constantine Attia as Radio King Coumba Baradji as Antoinette Sophie Barjac as Madame Guillaume Hubert Benhamdine as Martello Hubert Benhamdine as Vincent Martello Carole Bianic as Eglantine Hugan Arnaud Binard as Cassini Frans Boyer as Journaliste Mathieu Buscato as Berlini Guillaume Carcaud as Marcel Laporte Pierre Cassignard as Julien Valour Pierre Cassignard as Valour Eric Chantelauze as Second de Gilardi Eric Collado as Louis Erwan Creignou as Veilleur de nuit Roland David as Charles Hugan Anne Delporte as Mathilde Lebrequier Natalia Dontcheva as Helena Rozinski Philippe du Janerand as Levasseur Jacques Fontanel as Blanchard Eric Godon as Homme au panama Isabelle Guiard as Madame Dumont Anan Gy Eboma as Moussa Gabrielle Lazure as Charlotte Sinclair Marie Le Cam as Louisette Bruno Le Millin as Policier bistrot Alexandre Le Provost as Adrien Nicky Marbot as George Armelin Serge Martina as Charles Saint-Brice Wioletta Michalczuk as Yvonne Rudy Milstein as Vendeur de journaux Eric Naggar as Conducteur wagons-lits Nathalie Nell as Henriette Lefranc Marco Panzani as Client du bar Marc Raffray as GArdien de prison Didier Sauvegrain as Gallois Timothy Sebag as Gavroche atelier Alexandrine Serre as Soeur sanatorium Christian Sinniger as Robert Grijol Isabelle Spade as Madame Saint-Brice Alexandre Steiger as Marius Bruno Uthurralt as Journaliste Radio Paris Cassandre Vittu de Kerraoul as Pauline Elef Zack as Bertin
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Racism, in its simplest form, is the dislike of another because of race, creed or color. It is as simple as that. People have, and will, always dislike others based on looks.
The Greeks, looked down on the Asian people, the Asian people down on the European people. The Romans on all that didn't come from Rome.
The 'normal' people dislike the handicapped, this is how Attia the Hun took power. He accepted the shunned, the handicapped 'mongoloid', known as the Mongol's. The Egyptian's hated the Jew's, all hated the Samaritans.
The Nazi's, (German's) so beheld looks that they raised the blond hair blue eyed, 'Aryan race', above all others. The Muslim Brotherhood hold's one shade of Brown skin over another. Some Psychiatrist's look at this as trained 'racism', while others believe it to be the 'fear' of difference.
In truth racism can never be ended, for in it's simplest form it is how one picks a mate over others. But this form of racism is good because it is not based in race, creed, or color; but of love.
In truth, we as a people are weak of flesh but, if we understand personal responsibility and hold all people to the valve of personal responsibility only then can we hold racism and all other evils to a minimum.
Sociologists believe that when light skin is valued in a culture, those who are darker skinned may become the victims of discrimination. In American culture, whiteness and a European "look" was considered the norm, and as a result, blackness was associated (unfairly) with lesser status. A by-product of favoring light skin is that darker skinned blacks were treated less favorably than lighter-skinned blacks (who had features more closely aligned with the European norm). Even today, there are lighter-skinned black people who consider themselves superior to (and more attractive than) darker-skinned blacks: film-maker Spike Lee commented about this phenomenon in the movie "School Daze."
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DSM-5 Proposed Diagnostic Criteria for Anorexia Nervosa
A. Restriction of food intake relative to caloric requirements leading to the maintenance of a body weight less than a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight, or persistent behavior to avoid weight gain, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Specify current type:
Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Rationale
Criterion A:
The word "refusal" in DSM-IV was viewed as possibly pejorative and difficult to assess, as it implies intention. Rewording of the criterion to focus on behaviors is recommended.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classiï¬cation of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).
Criterion B:
In DSM-IV, "fear of weight gain" is required. A significant minority of individuals with the syndrome explicitly deny such fear. Therefore, the addition of a clause to focus on behavior is recommended.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classiï¬cation of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).
Criterion D:
In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.
Deletion of this criterion is recommended.
Level of change: Modest/substantial.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf).
Subtyping
DSM-IV requires that sub-type (binge eating/purging or restricting) be specified for the current episode. While there are data that such sub-typing is useful clinically and for research purposes, there is significant cross-over between sub-types, and resultant difficulty in specifying the subtype for the "current episode" of illness. Therefore, it is recommended that the sub-typing be specified for the last 3 months; 3 months is the timeframe used for Bulimia Nervosa and proposed for Binge Eating Disorder.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf).
Literature Cited:
http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf
http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf
Bravender T, Bryant-Waught R, Herzog D, et al.: Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40 Suppl:S117-122, 2007.http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf
Peat C, Mitchell JE, Hoek HW, et al.: Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 42:590-594, 2009.
Severity Criteria:
BMI (assessed appropriately for developmental stage).
Anorexia Nervosa
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
Specify type:
Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
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Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Rationale
Criterion A:
The word "refusal" in DSM-IV was viewed as possibly pejorative and difficult to assess, as it implies intention. Rewording of the criterion to focus on behaviors is recommended.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classiï¬cation of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).
Criterion B:
In DSM-IV, "fear of weight gain" is required. A significant minority of individuals with the syndrome explicitly deny such fear. Therefore, the addition of a clause to focus on behavior is recommended.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classiï¬cation of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).
Criterion D:
In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.
Deletion of this criterion is recommended.
Level of change: Modest/substantial.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf).
Subtyping
DSM-IV requires that sub-type (binge eating/purging or restricting) be specified for the current episode. While there are data that such sub-typing is useful clinically and for research purposes, there is significant cross-over between sub-types, and resultant difficulty in specifying the subtype for the "current episode" of illness. Therefore, it is recommended that the sub-typing be specified for the last 3 months; 3 months is the timeframe used for Bulimia Nervosa and proposed for Binge Eating Disorder.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf).
Literature Cited:
http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf
http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf
Bravender T, Bryant-Waught R, Herzog D, et al.: Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40 Suppl:S117-122, 2007.http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf
Peat C, Mitchell JE, Hoek HW, et al.: Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 42:590-594, 2009.
Severity Criteria:
BMI (assessed appropriately for developmental stage).
Anorexia Nervosa
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
Specify type:
Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Want to comment on this proposal? Please Login or http://wiki.answers.com/Pages/Registration.aspx.
Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Restricting Type: during the last three months, the person has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the last three months, the person has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Rationale
Criterion A:
The word "refusal" in DSM-IV was viewed as possibly pejorative and difficult to assess, as it implies intention. Rewording of the criterion to focus on behaviors is recommended.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classiï¬cation of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).
Criterion B:
In DSM-IV, "fear of weight gain" is required. A significant minority of individuals with the syndrome explicitly deny such fear. Therefore, the addition of a clause to focus on behavior is recommended.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf). Also, Workgroup for Classiï¬cation of Eating Disorders in Children and Adolescents (WCEDCA) (Bravender et al., 2007).
Criterion D:
In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.
Deletion of this criterion is recommended.
Level of change: Modest/substantial.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf).
Subtyping
DSM-IV requires that sub-type (binge eating/purging or restricting) be specified for the current episode. While there are data that such sub-typing is useful clinically and for research purposes, there is significant cross-over between sub-types, and resultant difficulty in specifying the subtype for the "current episode" of illness. Therefore, it is recommended that the sub-typing be specified for the last 3 months; 3 months is the timeframe used for Bulimia Nervosa and proposed for Binge Eating Disorder.
Level of change: Clarification.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf).
Literature Cited:
http://wiki.answers.com/Documents/EatingDisorders Reviews/Attia ammenorrhea_IJED 2009.pdf
http://wiki.answers.com/Documents/EatingDisorders Reviews/Becker cognitive_IJED 2009.pdf
Bravender T, Bryant-Waught R, Herzog D, et al.: Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40 Suppl:S117-122, 2007.http://wiki.answers.com/Documents/EatingDisorders Reviews/Wonderlich subtyping_IJED 2009.pdf
Peat C, Mitchell JE, Hoek HW, et al.: Validity and utility of subtyping anorexia nervosa. Int J Eat Disord 42:590-594, 2009.
Severity Criteria:
BMI (assessed appropriately for developmental stage).
Anorexia Nervosa
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
Specify type:
Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
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DSM-5 Proposed Diagnostic Criteria for Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
(1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
(2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, or diuretics.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, or diuretics.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Rationale
Criterion C:
DSM-IV requires that episodes of binge eating and inappropriate compensatory behaviors both occur on average twice/week over the last three months. A literature review found that the clinical characteristics of individuals reporting a lower frequency of once/week were similar to those meeting the current criterion. Therefore, it is recommended that the required minimum frequency be reduced to once/week over the last three months.
Level of change: Modest.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Wilson binges_IJED 2009.pdf).
Subtyping
DSM-IV requires that sub-type (purging or non-purging) be specified. A literature review indicated that the non-purging subtype had received relatively little attention, and the available data suggested that individuals with this subtype more closely resemble individuals with Binge Eating Disorder. In addition, precisely how to define non-purging inappropriate behaviors (e.g., fasting or excessive exercise) is unclear.
Deletion of this subtype is recommended. This also requires rewording of Criterion B.
Level of change: Modest.
References: Literature review (http://wiki.answers.com/Documents/EatingDisorders Reviews/Hoek subtyping_IJED 2009.pdf).
Literature Cited:
http://wiki.answers.com/Documents/EatingDisorders Reviews/Hoek subtyping_IJED 2009.pdf
http://wiki.answers.com/Documents/EatingDisorders Reviews/Wilson binges_IJED 2009.pdf
Severity Criteria
Frequency of inappropriate compensatory behavior (episodes per week).
Bulimia Nervosa
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Specify type:
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
It is recommended that Binge Eating Disorder, described in this section of DSM-IV, be recognized as an independent disorder in DSM-5. Recommended changes in the criteria for Anorexia Nervosa, Bulimia Nervosa, and for eating and feeding disorders usually beginning in childhood should also reduce the need for Eating Disorder Not Otherwise Specified.
If these recommendations are accepted, the examples in Eating Disorder Not Otherwise Specified will be changed accordingly.
The work group is also considering whether it may be useful and appropriate to describe other eating problems (such as purging disorder--recurrent purging in the absence of binge eating, and night eating syndrome) as conditions that may be the focus of clinical attention. Measures of severity would be required, and these conditions might be listed in an Appendix of DSM-5. DSM-5 Proposed Diagnostic Criteria for Rumination Disorder
A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
B. There is no evidence that an associated gastrointestinal or other general medical condition (e.g., esophageal reflux) is sufficient to account alone for the repeated regurgitation.
C. The eating disturbance does not occur exclusively during the course of Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder.
D. If the symptoms occur exclusively in the context of another mental disorder (e.g. Mental Retardation or a Pervasive Developmental Disorder), they are sufficiently severe to warrant independent clinical attention
1 answer
Anorexia nervosa is an eating disorder that involves an inability to stay at the minimum body weight considered healthy for the person's age and height.
Persons with this disorder may have an intense fear of weight gain, even when they are underweight. They may use extreme dieting, excessive exercise, or other methods to lose weight.
See also:
Alternative NamesEating disorder - anorexia
Causes, incidence, and risk factorsThe exact causes of anorexia nervosa are unknown. Many factors probably are involved. Genetics and hormones may play a role. Social attitudes that promote unrealistically thin body types may also contribute.
More and more evidence points away from the idea that conflicts within a family may contribute to this or other eating disorders. Most mental health organizations no longer support this theory.
Risk factors include:
- Being a perfectionist
- Feeling increasing concern about, or attention to, weight and shape
- Having eating and digestive problems during early childhood
- Having a mother or father with anorexia or addictions
- Having parents who are concerned about weight and weight loss
- Having a negative self-image and a high level of negative feelings in general
- Undergoing a stressful life change, such as a new job or move, or events such as rape or abuse
Anorexia usually begins in adolescence or young adulthood. It is more common in females, but may also be seen in males. The disorder is seen mainly in Caucasian women who are high academic achievers and who have a goal-oriented family or personality.
SymptomsTo be diagnosed with anorexia, a person must:
- Have an intense fear of gaining weight or becoming fat, even when they are underweight
- Refuse to keep weight at what is considered normal or acceptable for her age and height (15% or more below the expected weight)
- Have a body image that is very distorted, be very focused on body weight or shape, and refuse to admit or acknowledge the seriousness of weight loss
- Have not had their period for three or more cycles (in women)
People with anorexia may severely limit the amount of food they eat, or eat and then make themselves throw up. Other behaviors include:
- Cutting food into small pieces or moving them around the plate rather than eating
- Exercising all the time, even when the weather is bad, they are hurt, or their schedule is busy
- Going to the bathroom right after meals
- Refusing to eat around others
- Using pills to make themselves urinate (water pills or diuretics), have a bowel movement (enemas and laxatives) or to decrease their appetite (diet pills)
Other symptoms of anorexia may include:
- Blotchy or yellow skin that is dry and covered with fine hair
- Confused or slow thinking, along with poor memory or judgment
- Depression
- Dry mouth
- Extreme sensitivity to cold (wearing several layers of clothing to stay warm)
- Loss of bone strength
- Wasting away of muscle and loss of body fat
Other causes of weight loss or muscle wasting must be ruled out with medical testing. Examples of other conditions that can cause these symptoms include:
- Addison's disease
- Celiac disease
- Inflammatory bowel disease
Tests should be done to help determine the cause of weight loss, or what damage the weight loss has caused. Many of these tests will be repeated over time to monitor the patient. These tests may include:
- Albumin
- Bone density tests to check for thin bones (osteoporosis)
- CBC
- Electrocardiogram (ECG or EKG)
- Electrolytes
- Kidney function tests
- Liver function tests
- Total protein
- Thyroid function tests
- Urinalysis
The biggest challenge in treating anorexia nervosa is having the person recognize that they have an illness. Most persons with anorexia nervosa deny that they have an eating disorder. Individuals often enter treatment only once their condition is fairly advanced.
The goals of treatment are to first restore normal body weight and eating habits. A weight gain of 1 - 3 pounds per week is considered a safe goal.
A number of different programs have been designed to treat anorexia. Sometimes weight gain is achieved using schedules for eating, decreased physical activity, and increased social activity, either on an inpatient or outpatient basis. Many patients start with a short hospital stay and continue to follow-up with a day treatment program.
Care providers who are usually involved in these programs include nurse practitioners, physicians, a nutritionist or dietitian, and mental health care providers.
Treatment is often very challenging, and it requires hard work by patients and their families. Many therapies are likely to be tried until the patient succeeds in overcoming this disorder.
Patients may drop out of programs if they have unrealistic expectations of being "cured" with therapy alone.
Although a short hospital stay is a common way to start treatment, a longer hospital stay may be needed if:
- The person has lost a lot of weight, such as being below 70% of their ideal body weight for their age and height. Severe and life-threatening malnutrition may require feedings through a vein or stomach tube.
- Weight loss continues despite treatment
- Medical complications, such as heart problems, confusion, or low potassium levels develop
- The person has severe depression or thinks about committing suicide
Different kinds of talk therapy are used to treat people with anorexia:
- Individual cognitive behavioral therapy, group therapy, and family therapy have all been successful.
- The goal of therapy is to change a patient's thoughts or behavior to encourage them to eat in a more healthy way. This kind of therapy is more useful for treating yougner patients who have not had anorexia for a long time.
- If the patient is young, therapy may involve the whole family. Newer approaches look at the family as a part of the solution, rather than as the cause of the eating disorder.
- Support groups may also be a part of treatment. In support groups, patients and families meet and share what they've been through.
Medications such as antidepressants, antipsychotics, and mood stabilizers may help some anorexic patients when given as part of a complete treatment program. Examples include: olanzapine (Zyprexa, Zydis), selective serotonin reuptake inhibitors (SSRIs), and antidepressants. These medicines can help treat depression or anxiety.
Although these drugs may help, no medication has been proven to decrease the desire to lose weight.
Support GroupsSee: Eating disorders - support group
Expectations (prognosis)Anorexia nervosa is a serious and potentially deadly medical condition. By some estimates, it leads to death in 10% of cases. Experienced treatment programs have a good success rate in restoring normal weight, but it is common for the disease to return.
Women who develop this eating disorder at an early age have a better chance of complete recovery. However, most people with anorexia will continue to prefer a lower body weight and be preoccupied with food and calories to some extent. Weight management may be difficult, and long-term treatment may be necessary to help maintain a healthy weight.
ComplicationsComplications can be severe. A hospital stay may be needed.
Complications may include:
- Bloating or swelling
- Bone weakening
- Electrolyteimbalance (such as low potassium)
- Dangerous heart rhythms
- Decrease in white blood cells which leads to increased risk of infection
- Severe dehydration
- Severe malnutrition
- Seizures due to fluid loss from excessive diarrhea or vomiting
- Thyroid gland problems, which can lead to cold intolerance and constipation
- Tooth erosion and decay
Talk to your doctor if a loved one is:
- Excessively preoccupied with weight
- Over-exercising
- Restricting his or her food intake
- Severely underweight
Getting early medical help can reduce the severity of an eating disorder.
PreventionIn some cases, prevention may not be possible. Encouraging healthy, realistic attitudes toward weight and diet may be helpful. Sometimes, talk therapy can help.
ReferencesAttia E, Walsh BT. Beahvioral management for anorexia nervosa. N Engl J Med. 2009;360:500-506.
Gowers SG. Management of eating disorders in children and adolescents. Arch Dis Child. 2008;93:331-334.
American Psychiatric Association. Treatment of patients with eating disorders, third edition. American Psychiatric Association. Am J Psychiatry. 2006;163(7 Suppl):4-54.
Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007;40(4):310-320.
le Grange D, Lock J, Loeb K, Nicholls D. Academy for eating disorders position paper: The role of the family in eating disorders. Int J Eat Disord. 2009;43:1-5.
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