development of abnormal eating patterns. brain calcification: a study highlights a case in which prior calcification of the right thalumus may have contributed to development of anorexia nervosa. somatosensory homunculus: is the representation of the body located in the somatosensory cortex, first described by renowned neurosurgeon wilder penfield. the illustration was originally termed "penfield's homunculus", homunculus meaning little man. "in normal development this representation should adapt as the body goes through its pubertal growth spurt. however, in an it is hypothesized that there is a lack of plasticity in this area, which may result in impairments of sensory processing and distortion of body image". (bryan lask, also proposed by vs ramachandran) obstetric complications: there have been studies done which show maternal smoking, obstetric and perinatal complications such as maternal anemia, very pre-term birth (less than 32 weeks), being born small for gestational age, neonatal cardiac problems, preeclampsia, placental infarction and sustaining a cephalhematoma at birth increase the risk factor for developing either anorexia nervosa or bulimia nervosa. some of this developmental risk as in the case of placental infarction, maternal anemia and cardiac problems may cause intrauterine hypoxia, umbilical cord occlusion or cord prolapse may cause ischemia, resulting in cerebral injury, the prefrontal cortex in the fetus and neonate is highly susceptible to damage as a result of oxygen deprivation which has been shown to contribute to executive dysfunction, adhd, and may affect personality traits associated with both eating disorders and comorbid disorders such as impulsivity, mental rigidity and obsessionality. the problem of perinatal brain injury, in terms of the costs to society and to the affected individuals and their families, is extraordinary. (yafeng dong, phd) symptom of starvation: evidence suggests that the symptoms of eating disorders are actually symptoms of the starvation itself, not of a mental disorder. in a study involving thirty-six healthy young men that were subjected to semi-starvation, the men soon began displaying symptoms commonly found in patients with eating disorders. in this study, the healthy men ate approximately half of what they had become accustomed to eating and soon began developing symptoms and thought patterns (preoccupation with food and eating, ritualistic eating, impaired cognitive ability, other physiological changes such as decreased body temperature) that are characteristic symptoms of anorexia nervosa. the men used in the study also developed hoarding and obsessive collecting behaviors, even though they had no use for the items, which revealed a possible connection between eating disorders and obsessive–compulsive disorder. diagnosis according to pritts and susman "the medical history is the most powerful tool for diagnosing eating disorders". there are many medical disorders that mimic eating disorders and comorbid psychiatric disorders. early detection and intervention can assure a better recovery and can improve a lot the quality of life of these patients. in the past 30 years eating disorders have become increasingly conspicuous and it is uncertain whether the changes in presentation reflect a true increase. anorexia nervosa and bulimia nervosa are the most clearly defined subgroups of a wider range of eating disorders. many patients present with subthreshold expressions of the two main diagnoses: others with different patterns and symptoms. as eating disorders, especially anorexia nervosa, are thought of as being associated with young, white females, diagnosis of eating disorders in other races happens more rarely. in one study, when clinicians were presented with identical case studies demonstrating disordered eating symptoms in black, hispanic, and white women, 44% noted the white woman's behavior as problematic; 41% identified the hispanic woman's behavior as problematic, and only 17% of the clinicians noted the black woman's behavior as problematic (gordon, brattole, wingate, & joiner, 2006). medical the diagnostic workup typically includes complete medical and psychosocial history and follows a rational and formulaic approach to the diagnosis. neuroimaging using fmri, mri, pet and spect scans have been used to detect cases in which a lesion, tumor or other organic condition has been either the sole causative or contributory factor in an eating disorder. "right frontal intracerebral lesions with their close relationship to the limbic system could be causative for eating disorders, we therefore recommend performing a cranial mri in all patients with suspected eating disorders" (trummer m et al. 2002), "intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective".(o'brien et al. 2001). psychological eating disorder specific psychometric tests eating attitudes testscoff questionnaire body attitudes testbody attitudes questionnaire eating disorder inventoryeating disorder examination interview after ruling out organic causes and the initial diagnosis of an eating disorder being made by a medical professional, a trained mental health professional aids in the assessment and treatment of the underlying psychological components of the eating disorder and any comorbid psychological conditions. the clinician conducts a clinical interview and may employ various psychometric tests. some are general in nature while others were devised specifically for use in the assessment of eating disorders. some of the general tests that may be used are the hamilton depression rating scale and the beck depression inventory. longitudinal research showed that there is an increase in chance that a young adult female would develop bulimia due to their current psychological pressure and as the person ages and matures, their emotional problems change or are resolved and then the symptoms decline. several types of scales are currently used – (a) self-report questionnaires –edi-3, bsq, tfeq, mac, bulit-r, qewp-r, ede-q, eat, neq – and other; (b) semi-structured interviews – scid-i, ede – and other; (c) clinical interviews unstructured or observer-based rating scales- morgan russel scale the majority of the scales used were described and used in adult populations. from all the scales evaluated and analyzed, only three are described at the child population – it is eat-26 (children above 16 years), edi-3 (children above 13 years), and ansocq (children above 13 years). it is essential to develop specific scales for people under 18 years of age, given the increasing incidence of ed among children and the need for early detection and appropriate intervention. moreover, the urgent need for accurate scales and telemedicine testing and diagnosis tools are of high importance during the covid-19 pandemic (leti, garner & al., 2020). differential diagnoses there are multiple medical conditions which may be misdiagnosed as a primary psychiatric disorder, complicating or delaying treatment. these may have a synergistic effect on conditions which mimic an eating disorder or on a properly diagnosed eating disorder. lyme disease is known as the "great imitator", as it may present as a variety of psychiatric or neurological disorders including anorexia nervosa. gastrointestinal diseases, such as celiac disease, crohn's disease, peptic ulcer, eosinophilic esophagitis or non-celiac gluten sensitivity, among others. celiac disease is also known as the "great imitator", because it may involve several organs and cause an extensive variety of non-gastrointestinal symptoms, such as psychiatric and neurological disorders, including anorexia nervosa. addison's disease is a disorder of the adrenal cortex which results in decreased hormonal production. addison's disease, even in subclinical form may mimic many of the symptoms of anorexia nervosa. gastric adenocarcinoma is one of the most common forms of cancer in the world. complications due to this condition have been misdiagnosed as an eating disorder. hypothyroidism, hyperthyroidism, hypoparathyroidism and hyperparathyroidism may mimic some of the symptoms of, can occur concurrently with, be masked by or exacerbate an eating disorder. toxoplasma seropositivity: even in the absence of symptomatic toxoplasmosis, toxoplasma gondii exposure has been linked to changes in human behavior and psychiatric disorders including those comorbid with eating disorders such as depression. in reported case studies the response to antidepressant treatment improved only after adequate treatment for toxoplasma. neurosyphilis: it is estimated that there may be up to one million cases of untreated syphilis in the us alone. "the disease can present with psychiatric symptoms alone, psychiatric symptoms that can mimic any other psychiatric illness". many of the manifestations may appear atypical. up to 1.3% of short term psychiatric admissions may be attributable to neurosyphilis, with a much higher rate in the general psychiatric population. (ritchie, m perdigao j,) dysautonomia: a wide variety of autonomic nervous system (ans) disorders may cause a wide variety of psychiatric symptoms including anxiety, panic attacks and depression. dysautonomia usually involves failure of sympathetic or parasympathetic components of the ans system but may also include excessive ans activity. dysautonomia can occur in conditions such as diabetes and alcoholism. psychological disorders which may be confused with an eating disorder, or be co-morbid with one: emetophobia is an anxiety disorder characterized by an intense fear of vomiting. a person so impacted may develop rigorous standards of food hygiene, such as not touching food with their hands. they may become socially withdrawn to avoid situations which in their perception may make them vomit. many who have emetophobia are diagnosed with anorexia or self-starvation. in severe cases of emetophobia they may drastically reduce their food intake. phagophobia is an anxiety disorder characterized by a fear of eating, it is usually initiated by an adverse experience while eating such as choking or vomiting. persons with this disorder may present with complaints of pain while swallowing. body dysmorphic disorder (bdd) is listed as an obsessive-compulsive disorder that affects up to 2% of the population. bdd is characterized by excessive rumination over an actual or perceived physical flaw. bdd has been diagnosed equally among men and women. while bdd has been misdiagnosed as anorexia nervosa, it also occurs comorbidly in 39% of eating disorder cases. bdd is a chronic and debilitating condition which may lead to social isolation, major depression and suicidal ideation and attempts. neuroimaging studies to measure response to facial recognition have shown activity predominately in the left hemisphere in the left lateral prefrontal cortex, lateral temporal lobe and left parietal lobe showing hemispheric imbalance in information processing. there is a reported case of the development of bdd in a 21-year-old male following an inflammatory brain process. neuroimaging showed the presence of a new atrophy in the frontotemporal region. prevention prevention aims to promote a healthy development before the occurrence of eating disorders. it also intends early identification of an eating disorder before it is too late to treat. children as young as ages 5–7 are aware of the cultural messages regarding body image and dieting. prevention comes in bringing these issues to the light. the following topics can be discussed with young children (as well as teens and young adults). emotional bites: a simple way to discuss emotional eating is to ask children about why they might eat besides being hungry. talk about more effective ways to cope with emotions, emphasizing the value of sharing feelings with a trusted adult. say no to teasing: another concept is to emphasize that it is wrong to say hurtful things about other people's body sizes. body talk: emphasize the importance of listening to one's body. that is, eating when you are hungry (not starving) and stopping when you are satisfied (not stuffed). children intuitively grasp these concepts. fitness comes in all sizes: educate children about the genetics of body size and the normal changes occurring in the body. discuss their fears and hopes about growing bigger. focus on fitness and a balanced diet. internet and modern technologies provide new opportunities for prevention. online programs have the potential to increase the use of prevention programs. the development and practice of prevention programs via online sources make it possible to reach a wide range of people at minimal cost. such an approach can also make prevention programs to be sustainable. treatment treatment varies according to type and severity of eating disorder, and often more than one treatment option is utilized. various forms of cognitive behavioral therapy have been developed for eating disorders and found to be useful. if a person is experiencing comorbidity between an eating disorder and ocd, exposure and response prevention, coupled with weight restoration and serotonin reputake inhibitors has proven most effective. other forms of psychotherapies can also be useful. family doctors play an important role in early treatment of people with eating disorders by encouraging those who are also reluctant to see a psychiatrist. treatment can take place in a variety of different settings such as community programs, hospitals, day programs, and groups. the american psychiatric association (apa)