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Anorexia/Bulimia Disorder
- Introduction
Anorexia Nervosa is an illness that usually occurs in teenage girls, yet it can also occur in teenage boys, and adult women and men. People with anorexia are obsessed with being thin. They typically reduce their food intake and avoid high-calorie foods. These behaviors and the malnutrition that results can cause a number of serious complications (see Anorexia Nervosa Article). Anorexics have an intense fear of becoming fat or gaining any weight. They think they are fat, or are trying to lose weight, even when they are emaciated. Body weight and shape are of extreme importance in determining self-esteem. This emphasis on weight and self-esteem is a defining characteristic of anorexia nervosa. Anorexia has two subtypes: restricting type and binge eating/purging type. The restricting type does just that, restrict food. The binge eating/purging type will binge eat (consume a large amount of food in a discrete period of time) and then try to compensate for the food they ate by vomiting, using laxatives or a diuretic, or excessive exercise.
The term “eating disorder” encompasses several conditions. The one commonality is that the sufferer adopts harmful eating patterns. These patterns take on a life of their own and serve as coping mechanisms for dealing with emotional distress, and are considered maladaptive as they affect many different areas of the person’s life. The DSM-IV-TR classifies the most prominent eating disorders as Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder NOS (not otherwise specified).
1.1 Definition of Anorexia/Bulimia Disorder
Anorexia nervosa and bulimia nervosa are the two main types of eating disorders. Anorexia nervosa is an eating disorder that is most commonly found in adolescents, although it is also found in adults. Sufferers of this disorder have a severe fear of gaining weight and will go to extensive measures to lose weight. It is more accurately described as a self-starvation of the body, and there are two different types of anorexia. These are known as the restricting type and the purging type. People who suffer from anorexia find it very hard to deal with their emotions and often feel like the only thing they can control is their food intake. They use this as a way to cope with other feelings, yet it often makes the person more irritable and associates a negative mood state. These people are often found to be high-achievers, perfectionists, good and model children with a compliant temperament. Often parents are worried about their shy temperament and try to draw them out in an attempt to boost self-esteem and confidence. Treatment for this disorder often requires the help of a mental health professional as well as a doctor and a dietitian. The goal is to get the patient to a healthy weight and then to explore the psychological issues through insight-oriented psychotherapy. This may result in a referral to a family-based therapy program that has been proven to be effective in adolescents with anorexia nervosa. This therapy will last for about 6-12 months. People suffering from anorexia often deny their disease and never seek out medical care on their own. The illness does, however, have serious medical complications that may result in death, so it is often the decision of others to seek treatment on behalf of the affected person.
1.2 Prevalence and Impact
Anorexia/bulimia is a devastating illness that affects individuals mentally, emotionally, and physically. It has a high prevalence in Western countries such as the United States, Canada, Europe, and Australia. Statistics show that 0.5-1% of American women and adolescent girls suffer from anorexia, 2-3% of young women are bulimic, and a further 4-6% of young women are affected by some form of disordered eating. Anorexia/bulimia is prevalent in males as well, with an estimated 10% occurring in gay men. The average age of onset for anorexia is 17, and for bulimia, a couple of years older. Unfortunately, onset is occurring earlier and can affect children as young as 6 years old, with a 40% prevalence of eating disorder behavior. Anorexia has the highest mortality rate of any psychiatric disorder, with 20% of sufferers diagnosed with anorexia dying prematurely from complications related to their eating disorder, including suicide and self-starvation. Unfortunately, only 1/3 of individuals suffering from anorexia in the United States obtain treatment, 1/6 receive treatment in Australia, and the number is speculated to be even lower in other countries. A study published in Biological Psychiatry found that anorexia has a mortality rate of 5.1% per year, while bulimia has a mortality rate of 1.7% per year. The risk of suicide is increased in individuals with eating disorders, particularly in those with long-standing bulimia. It is associated with depression, alcohol and drug abuse, and personality disorders.
1.3 Causes and Risk Factors
Sociocultural factors are now known to be major contributors to the onset of eating disorders. The most vital risk factor in the development of eating disorders is body dissatisfaction. An extensive review of 25 years of research confirmed that the level of body dissatisfaction was the most powerful predictor of disordered eating. During the past three decades, particularly in Western society, a pervasive and increasingly unrealistic cultural ideal of thinness has emerged for women. This has led to an increasingly internalization of body ideals, and when women evaluate themselves at a discrepancy with this image, it results in an increase of negative affect and onset of eating disorder behaviors. The increasing rates of eating disorders in non-westernized societies and in different cultures within westernized societies have provided additional evidence that sociocultural factors are imperative. The cultural ideal of thinness is now a global phenomenon due to westernization and globalization. Algase research on globalization and eating pathology shared experiences of eating disorders in Fiji. In 1995, 80% of Fijian high school girls were dieting and 15% binging and vomiting. This was not the case prior to the introduction of western media.
The exact cause of eating disorders is unknown. However, it is generally believed that eating disorders are multifactorial in origin and not due to a single cause. It is now widely accepted that genetic, biological, and sociocultural factors are important in the development of eating disorders. Genetic factors have been proven to be relevant in a twin study. However, concordance rates for anorexia nervosa in female monozygotic twins were 56%, and dizygotic twins 5%, although the numbers are small. Thus, the significance of genetic factors remains uncertain. Biological factors, including endocrine and neurochemical irregularity, and hypothalamic dysfunction, have long been suspected in the etiology of anorexia nervosa, as many of the mental and physical features improve following weight gain. Serota et al (2003) conducted a study which showed that high activity levels and/or obsessionality may be risk factors for the development of anorexia. However, whether these traits are intrinsic to anorexia nervosa or are a result of starvation is unknown.
- Signs and Symptoms
2.1 Physical Signs and Symptoms
2.2 Behavioral Signs and Symptoms
2.3 Emotional Signs and Symptoms
- Diagnosis and Assessment
3.1 Medical Evaluation
3.2 Psychological Evaluation
3.3 Diagnostic Criteria
- Treatment Options
4.1 Medical Treatment
4.1.1 Nutritional Rehabilitation
4.1.2 Medication
4.2 Psychotherapy
4.2.1 Cognitive Behavioral Therapy
4.2.2 Family-Based Therapy
4.2.3 Interpersonal Therapy
4.3 Supportive Interventions
4.3.1 Support Groups
4.3.2 Nutritional Counseling
4.3.3 Hospitalization
- Recovery and Relapse Prevention
5.1 Goals of Recovery
5.2 Relapse Prevention Strategies
5.3 Long-Term Management
- Complications and Consequences
6.1 Physical Complications
6.2 Psychological Consequences
6.3 Social and Interpersonal Effects
- Prevention and Education
7.1 Early Intervention Programs
7.2 School-Based Education
7.3 Community Awareness Campaigns