Eating Disorders: Anorexia Nervosa

 

 

Anorexia Nervosa

Anorexia nervosa is a serious, occasionally chronic, and potentially life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15 percent of an individual's normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, denial of the seriousness of the illness, and amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur). 

There are two subtypes of anorexia nervosa. In the restricting subtype, people maintain their low body weight purely by restricting their food intake and, possibly, by excessive exercise. Individuals with the binge eating/purging subtype also restrict their food intake, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Many people move back and forth between subtypes during the course of their illness. Starvation, weight loss, and related medical complications are quite serious and can result in death. People who have an ongoing preoccupation with food and weight even when they are thin would benefit from exploring their thoughts and relationships with a therapist. The term anorexia literally means loss of appetite, but this is a misnomer. In fact, people with anorexia nervosa often ignore hunger signals and thus control their desire to eat. Often they may cook for others and be preoccupied with food and recipes, yet they will not eat themselves. Obsessive exercise that may accompany the starving behavior can cause others to assume falsely that the person must be healthy.

Common Signs of Anorexia Nervosa

The hallmark of anorexia nervosa is a preoccupation with food and a refusal to maintain minimally normal body weight. One of the most frightening aspects of the disorder is that people with anorexia nervosa continue to think they look fat even when they are bone-thin. Their nails and hair become brittle, and their skin may become dry and yellow. People with anorexia nervosa often complain of feeling cold (hypothermia) because their body temperature drops. They may develop lanugo (a term used to describe the fine hair on a new born) on their body.

Persons with anorexia nervosa develop odd and ritualistic eating habits such as cutting their food into tiny pieces, refusing to eat in front of others, or fixing elaborate meals for others that they themselves don't eat. Food and weight become obsessions as people with this disorder constantly think about their next encounter with food. Generally, if a person or their family fears he or she has anorexia nervosa, a doctor knowledgeable about eating disorders should make a diagnosis and rule out other physical disorders. Other psychiatric disorders can occur together with anorexia nervosa, such as depression, anxiety disorders and substance abuse disorders.


Binge Eating Disorder (BED)

Individuals with binge eating disorder (BED) engage in binge eating, but in contrast to people with bulimia nervosa (BN) they do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging to lose weight. Binge eating, by definition, is eating that is characterized by rapid consumption of a large amount of food by social comparison and experiencing a sense of the eating being out of control. Binge eating is often accompanied by uncomfortable fullness after eating, and eating large amounts of food when not hungry, and distress about the binge eating. There is no specific caloric amount that qualifies an eating episode as a binge. A binge may be ended by abdominal discomfort, social interruption, or running out of food. Some who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge and is not part of binge eating disorder. 

When the binge is over, the person often feels disgusted, guilty, and depressed about overeating.  For some individuals, BED can occur together with other psychiatric disorders such as depression, substance abuse, anxiety disorders, or self-injurious behavior.  The person suffering from BED often feels caught up in a vicious cycle of negative mood followed by binge eating, followed by more negative mood.  Over time, individuals with BED tend to gain weight due to overeating; therefore, BED is often, but not always, associated with overweight and obesity. Previous terms used to describe these problems included compulsive overeating, emotional eating, or food addiction.

When identifying and diagnosing BED, doctors and mental health professionals refer to the criteria in the Diagnostic and statistical Manual IV (DSM-IV) which says, a person must have had, on average, a minimum of two binge-eating episodes a week for at least six months. Although this is a somewhat arbitrary criterion and any amount of binge eating should be attended to.

Common Signs of BED

Most people who suffer from BED tend to do so in secret.  They tend to limit their binge episodes to when they are alone, thus it is not easy to identify someone with BED.  Weight gain is a common sign, but not everyone who gains weight does so because they binge eat.  Many people with BED struggle with depressed and/or anxious mood.  Some individuals with BED can develop strict rules about what foods are ?good? vs. ?bad? to eat. In turn, they become preoccupied with enforcing these rules as a means for distracting from their painful feelings, tension, and anxiety. In the end, this preoccupation only serves to perpetuate the need for these rigid rule-based behaviors.

Bulimia Nervosa

Bulimia nervosa is a serious eating disorder marked by a destructive pattern of binge-eating and recurrent inappropriate compensatory behaviors to control one's weight. It can occur together with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance dependence, or self-injurious behavior. Bulimia nervosa is an invisible eating disorder, because patients are of normal weight or overweight. Binge eating is the rapid consumption of an unusually large amount of food in a short period of time. Unlike simple overeating, the hallmark feature of a binge is feeling out of control. This means that one cannot stop the urge to binge once it has begun or that one has difficulty ending the eating episode even when far past being full. "Inappropriate compensatory behavior" to control one's weight may include purging behaviors (such as self-induced vomiting, abuse of laxatives, diuretics, or enemas) or non-purging behaviors (such as fasting or excessive exercise). Some people who have placed strict restrictions on what and when it is OK to eat might feel like they have binged after only a small amount of food (like a cookie). Since this is not an objectively large amount of food by social comparison, it is called a subjective binge. 

There are two types of bulimia nervosa. In the purging type, the person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In the nonpurging type, the individual uses fasting or excessive exercise to control weight, but does not regularly purge.

People with bulimia nervosa often feel a lack of control during their eating binges. Food is often eaten secretly and rapidly. A binge is usually ended by abdominal discomfort, social interruption, or running out of food. When the binge is over, the person with bulimia often feels guilty and purges to rid his or her body of the excess calories. To be diagnosed with bulimia nervosa, a person must have had, on average, a minimum of two binge-eating episodes a week for at least three months. However any amount of binge eating and purging is unhealthy and is worthy of an evaluation.

Common Signs of Bulimia Nervosa

Constant concern about food and weight is a primary sign of bulimia. Common indicators of self-induced vomiting are the erosion of dental enamel (due to the acid in the vomit) and scarring on the backs of the hands (due to repeatedly pushing fingers down the throat to induce vomiting).

A small percentage of people with bulimia show swelling of the glands near the cheeks called parotid glands. People with bulimia may also experience irregular menstrual periods and a decrease in sexual interest. A depressed mood is also commonly observed as are frequent complaints of sore throats and abdominal pain. Despite these telltale signs, bulimia nervosa is difficult to catch early. Binge eating and purging are often done in secret and can be easily concealed by a normal-weight person who is ashamed of his or her behavior. Characteristically, these individuals have many rules about food -- e.g. good foods, bad foods -- and can be entrenched in these rules and particular thinking patterns. This preoccupation and these behaviors allow the person to shift their focus from painful feelings and reduce tension and anxiety perpetuating the need for these behaviors.

 

 

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