Eating Disorders

Eating disorder is characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and emotional health. Eating is a normal social activity but sometimes individuals follow eating habits and food patterns in abnormal ways, which might cause complications in their future life.

Incidence

The incidence and prevalence of eating disorders depend, as always, on the definition used and the population being considered. The peak incidence of Anorexia Nervosa is around the age of 18, while for bulimia nervosa it is slightly higher.

Eating disorder affects all socioeconomic levels. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. The mortality rate for anorexia nervosa is 4% and for bulimia nervosa is 3.9%.

Anorexia is a syndrome characterized by three essential criteria:

• The first is self-induced starvation, to a significant degree.
• The second is a relentless drive for thinner or a morbid fear of fatness.
• The third is the presence of medical signs and symptoms resulting from starvation.

Anorexia Nervosa is often associated with a disturbance of body image, the perception that one is distressingly large despite obvious thinness. It occurs most often in adolescent girls. The problem is characterized by a refusal of food to maintain normal body weight by reducing food intake, especially fats and carbohydrates.

Types

1. Anorexia Nervosa Binge / Purge Type

   The individual suffering from anorexia nervosa binge/purge type will purge when he or she eats. This is typically a result of the overwhelming feelings of guilt a sufferer would experience in relation to eating; they compensate by vomiting, abusing laxatives, or excessively exercising.

2. Restrictive Anorexia Nervosa

   In this form of anorexia nervosa, the individual will fiercely limit the quantity of food consumed, characteristically ingesting a minimal amount that is well below their body’s caloric needs, effectively slowly starving him or herself.

Etiology

The main etiological factors are:

• Biological,
• Social, and
• Psychological factors are implicated in the cause of anorexia nervosa.

Risk Factors

• Accepting society’s attitudes about thinness.
• Being a perfectionist.
• Experiencing childhood anxiety.
• Feeling increased concern or attention to weight and shape.
• Having a family history of addictions or eating disorders.
• Having a negative self-image.

Symptoms/Complications

• CVS – Bradycardia, hypotension, ECG abnormalities, myocarditis.
• SKIN – Dry skin, hair loss, etc.
• ENDOCRINE – Amenorrhea, hypoglycemia, irregular menses, imbalance of LH.
• FLUID AND ELECTROLYTE – Dehydration, vomiting, alkalosis.
• GI – Constipation, esophagitis, hypertrophy.
• HEMATOLOGICAL – Anemia, leucopenia.

Physical Examination and Investigations

1. Complete physical examination including laboratory tests to rule out endocrine, metabolic, and central nervous system abnormalities or other disorders.
2. Complete blood testing, including:
• Hb level
• Platelet count
• Cholesterol level
• Calcium, etc.
3. ECG reading irregular.
4. Thyroid function Tests.
5. Urinalysis.

Treatment

• The goal of treatment is to first restore normal body weight and eating habits and then to address psychological issues.
• A hospital stay may be needed if:
• The person has lost a lot of weight (Below 30% of ideal body weight).
• Weight loss continues despite treatment.
• Medical complications such as heart rate problems, changes in mental status, and low potassium levels.
• The person has severe depression or thinks about committing suicide.
• Short-term management aims to ensure weight gain and correct nutritional deficiencies.
• Long-term treatment aims to maintain a normal weight achieved through short-term management.
• Other treatments may include:
• Antidepressant drug therapy.
• Behavioral therapy.
• Psychotherapy.
• Supportive care.
• Cognitive-behavioral therapy (CBT).

Conclusion

• Anorexia Nervosa is an eating disorder that occurs most often in adolescent girls. The problem is characterized by a refusal of food to maintain normal body weight by reducing food intake, especially fats and carbohydrates.
• Anorexia is a syndrome characterized by three essential criteria:
• The first is self-induced starvation, to a significant degree.
• The second is a relentless drive for thinner or a morbid fear of fatness.
• The third is the presence of medical signs and symptoms resulting from starvation.

Introduction

• Bulimia nervosa is an eating disorder in which a person creates a destructive pattern of eating in order to control their weight.
• People with bulimia tend to go on eating binges, consuming large amounts of food in a short period of time.

Bulimia is an illness in which a person binges on food or has regular episodes of significant overeating and feels a loss of control. The affected person then uses various methods such as vomiting or laxative abuse to prevent weight gain.

• People with bulimia tend to show signs of depression, anxiety, or obsessive-compulsive disorders.
• Bulimia may cause moodiness and irritability.
• Feelings of embarrassment and shame.
• They’re also at risk for substance abuse problems and suicidal behavior.

Major Types of Bulimia

• Bulimia Nervosa Purging Type – This type of bulimia nervosa accounts for the majority of cases of those suffering from this eating disorder.
• In this form, individuals will regularly engage in self-induced vomiting or abuse of laxatives, diuretics, or enemas after a period of bingeing.
• Bulimia Nervosa Non-purging Type – In this form of bulimia nervosa, the individual will use other inappropriate methods of compensation for binge episodes, such as excessive exercising or fasting.

Causes

• There is no single cause of bulimia, but there are some factors which are responsible for bulimia.
• Culture:
• Families: If you have a mother or sister with bulimia, you are more likely to develop bulimia.
• Life Changing or Stressful Events: Traumatic events as well as stressful situations can lead to bulimia.
• Personality Traits:
• A person with bulimia may not like herself. She hates the way she looks or feels hopeless.
• She may be very moody and have problems expressing anger.
• Biology:
• Genes, hormones, or chemicals in the brain may be factors in developing bulimia.

Symptoms

• Binges regularly (eats large amounts of food over a short period) and purges often.
• Diet and exercises often but maintains or regains weight.
• Becomes a secret eater.
• Has swollen neck glands.
• Has scars on the back of hands from forced vomiting.
• May experience:
• Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest.
• Chronic dehydration.
• Inflammation of the esophagus.

Diagnosis

• Medical evaluation to rule out upper gastrointestinal disorders.
• Mental State Examination (MSE).
• History.
• Laboratory tests (Hb% level, blood glucose, and baseline ECG).

Treatment

Psychotherapy

1. Cognitive Behavioral Therapy
• Cognitive Behavioral Therapy should be considered the benchmark first-line treatment of bulimia nervosa.
• Manual-guided treatments that include about 18–20 sessions over 5 to 6 months.

Pharmacotherapy

• Antidepressant medications have been shown to be helpful in treating bulimia. This includes the selective serotonin reuptake inhibitors such as "fluoxetine".

Conclusion

• Bulimia nervosa is an eating disorder in which a person creates a destructive pattern of eating in order to control their weight.
• People with bulimia tend to go on eating binges, consuming large amounts of food in a short period of time.
• People with bulimia tend to show signs of depression, anxiety, or obsessive-compulsive disorders.
• Bulimia may cause moodiness and irritability.
• Feelings of embarrassment and shame.
• They’re also at risk for substance abuse problems and suicidal behavior.