Anorexia nervosa, bulimia

What is anorexia nervosa?

This is a “psychological” disorder where the person has a disturbed sense of body image. He/she has a morbid fear of obesity, refuses to maintain a minimally normal body weight, and in women, there is amenorrhea (absence of menstrual period).

What causes this condition?

The cause is still unknown, but it appears that social factors play a big role. In the western society, there is a pervasive obsession among people, especially among the young females, to stay thin. Obesity is looked at as unhealthy, undesirable, and unattractive. Roughly about 85 percent of prepubertal children are conscious of these attitudes and more than 50 percent of these children go on a diet themselves, or practice habits to control their weight. But since not many of them develop anorexia nervosa, it is obvious that there are other factors that play significant roles.

What other factors could be involved?

Some undefined psychologic, genetic or metabolic vulnerability might predispose some persons to develop anorexia nervosa. It is interesting to note that anorexia nervosa is most rare among the deprived sectors of the world, where there is food shortage.

Does peer pressure play a role?

Peer pressure and a sense of competition, especially among young girls, could play a role. The only chubby one in a circle of friends might feel uncomfortable and under stress to be “as shapely as all my friends.” The psychological impact of this could lead to misguided and unhealthy practice in dieting and weight control, more likely to happen among those with weaker personality and character.

Are females more prone?

Yes, roughly 95 percent of patients with anorexia nervosa are female. The usual onset is mostly during adolescence, much less often among adults. Majority of these people are in the middle to upper socioeconomic classes.

What are the symptoms of anorexia nervosa?

The manifestations could be mild and temporary, others severe and chronic. The classic victims are usually intelligent, high-achiever, compulsive, meticulous, very conscious of how they look, and success-driven. The initial indication is their extreme concern about their weight (even if their weight is normal) and their religious diet control practices. They study diets, measure everything and count every calorie consumed. There is an extreme anxiety and anger with any increase in weight, disproportional to the situation. There is lying and denial about what is going on and a great resistance to seeking medical treatment.

Isn’t anorexia a misnomer?

Yes, it is, in fact, a misnomer. Anorexia means lack of appetite. These patients have a normal appetite, but do not want to eat for fear of obesity. They only become anorexic once they are cachectic (extremely emaciated and wasted). These persons are manipulative and conceal their behavior, like binge eating followed by induced vomiting, which is called bulimia, a condition found in 50 percent of those with anorexia nervosa. These anorexia patients also lose interest in sex, have low heart rate, low blood pressure and slightly cooler body temperature. Malnutrition, dehydration and electrolyte imbalance can lead to serious complications.

What is the treatment for this illness?

The two-phase management consists of short term regimen to restore body weight and prevent death, and long term treatment to cure the psychological dilemma and prevent relapses. In severe cases, hospitalization may be required or even crucial for survival. Individual psychotherapy, psychodynamic, cognitive, behavioral, and even family therapy, are essential. Some oral medications have been used after the weight loss has been regained.

How does bulimia differ from anorexia?

Bulimia is an uncontrollable and recurrent binge eating (two to three times a week) where the individual consumes an enormous amount of food followed by remedial efforts to avoid weight gain, such as self-induced vomiting, vigorous exercises or fasting, use of diuretics and/or laxatives. Only about 50 percent of Anorexia Nervosa patients have bulimia. The other half simply eat very little or not at all for fear of gaining weight. About two percent of young women have bulimia, of varying severity. Bulimic patients have wide variation in their body weight. Because they frequently induce vomiting after binge eating, they have swollen parotid glands, scars on their knuckles and fingers, and dental erosion. Bulimic patients usually have normal weight, and more revealing of their problem and more likely to seek medical care, compared to anorexia patients.

What is the treatment for bulimia?

Psychotherapy and use of antidepressant drugs are the mainstay of the therapy for bulimia. Experts now believe that the combination of cognitive-behavioral psychotherapy and antidepressants is the treatment of choice. While antidepressants and diet suppressants help a lot, psychotherapy is more effective with more lasting results. The patient should be under the care of a specialist in diet disorders and a psychiatrist.

Any new development in the management?

Recent studies on the role of the family and social media have been found to have positive impact on the enhancement in the effectiveness of the overall management of anorexia nervosa and bulimia, on top of psychotherapy and pharmacologic treatment. Family support and compassion and beneficial social interaction with peers are of paramount value to individuals affected by these conditions, whose prognosis is generally good.

Any preventive measures?

Family and friends can help minimize the development of these eating disorders by showering our children early (starting in the crib) and often with love and reassuring words as they grow up. This will reduce the social and environmental stress on these young individuals, making them feel loved, secure and accepted. As they grow, children must learn that inner beauty and character are more attractive and more important than physical appearances. That while having a nicely shaped body is great, having a beautiful personality, good character and brain is more important, admired, and adored in today’s society.

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