Eating Disorders: Anorexia Nervosa and Bulimia

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 23 Eating Disorders: Anorexia Nervosa and Bulimia

INTRODUCTION

Description: Anorexia nervosa is a syndrome characterized by an altered body image, significant weight loss, and amenorrhea that are not caused by physical disease. Bulimia is an eating disorder characterized by an altered body image and recurrent binge eating, with or without purging through self-induced vomiting, laxative abuse, or diuretics. Exercise excess is often a part of after-binge behavior. Both affect more women than men.
Prevalence: Females, 1% to 3%. Subclinical eating disorders are common in university populations.
Predominant Age: Teens to early 20s.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Unknown (emotional).
Risk Factors: Anorexia nervosa—perfectionistic personality (high expectations, personal or external). Bulimia—impulsive character, low self-esteem, stress (e.g., multiple responsibilities, tight schedules), early puberty. At high risk for both: dancers, models, cheerleaders, athletes.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Insidious onset (occasionally stress related)
• Significant weight loss (15% below expected weight)
• Denial of problem
• Preoccupation with weight or body image
• Anorexia nervosa—impression of obesity rather than objective view of weight

• Reduced food intake or refusal (often associated with elaborate eating rituals)
• Excessive exercise (marathon running)

• Bulimia—high-calorie binges followed by severe restriction

• Food collections or hoarding
• Medication abuse (laxatives, diuretics, ipecac, thyroid medication)
• Dental erosion and scarred knuckles (secondary to finger-induced vomiting)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Wasting disease (tumors)
• Depression
• Hypothalamic tumor
• Food phobia
• Gastrointestinal disease
• Other emotional disorders (conversion disorder, schizophrenia, body dysmorphic disorder)

Associated Conditions: Major depression (50% to 75% of patients), obsessive-compulsive disorders (10% to 13% of patients), bipolar disorders, sexual disinterest, depression, growth arrest, hypotension and bradycardia, hypothermia, peripheral edema. Prolonged amenorrhea is associated with an increased risk of osteoporosis, which may not be reversible. Bulimia—social phobia and anxiety disorders, substance abuse, shoplifting common.

Workup and Evaluation

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