Many people with bulimia nervosa also suffer from depression. Anorexia nervosa involves a pattern of self- starvation. Patients often have an accompanying anxiety disorder (such as obsessive compulsive disorder) or depression.
Patients with anorexia and depression have a high risk for suicide. Complications of Bulimia Nervosa. Many medical problems are directly associated with bulimic behavior, including: Tooth erosion, cavities, and gum problems. Water retention, swelling, and abdominal bloating. Low potassium levels.
Irregular menstrual periods. Swallowing problems and esophagus damage. Drug and alcohol abuse. Complications of Anorexia Nervosa. Anorexia nervosa can increase the risk for serious health problems such as: Hormonal changes including reproductive, thyroid, stress, and growth hormones.
Heart problems such as abnormal heart rhythm. Electrolyte imbalance. Fertility problems. Bone density loss.
Anemia. Neurological problems. Treatment of Bulimia Nervosa.
Bulimia nervosa is treated with a combination of psychotherapy and medication. Cognitive- behavioral therapy, which is given along with nutritional counseling, is the preferred psychotherapeutic approach. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, generic), are the first choice for drug therapy. Treatment of Anorexia Nervosa. Unlike bulimia nervosa, anorexia nervosa does not respond well to drug treatment, although SSRIs are sometimes used as an adjunct to psychotherapy. Nutritional rehabilitation therapy, which may include the entire family, is an important part of the treatment process. Patients who are severely underweight and who have other physical risks may need to be hospitalized while weight is restored.
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Introduction. Eating disorders are psychological problems marked by an obsession with food and weight. There are four general categories of eating disorders: Bulimia nervosa.
Anorexia nervosa. Binge eating. Eating disorders not otherwise specified. Bulimia Nervosa. Bulimia nervosa is more common than anorexia, and it usually begins early in adolescence. It is characterized by cycles of bingeing and purging, and typically takes the following pattern: Bulimia is often triggered when young women attempt restrictive diets, fail, and react by binge eating. Binge eating involves consuming larger than normal amounts of food within a 2- hour period. In response to the binges, patients compensate, usually by purging, vomiting, using enemas, or taking laxatives, diet pills, or drugs to reduce fluids.
Patients then revert to severe dieting, excessive exercise, or both. Some patients with bulimia follow bingeing only with fasting and exercise. They are then considered to have non- purging bulimia.
The cycle then swings back to bingeing and then to purging again. To be diagnosed with bulimia, a patient must binge and purge at least twice a week for 3 months. In some cases, the condition progresses to anorexia. Most people with bulimia, however, have a normal to high- normal body weight, although it may fluctuate by more than 1. Anorexia Nervosa. The term . Anorexia can be associated with medical conditions or medications that cause a loss of appetite.
Anorexia nervosa involves a psychological aversion to food that leads to a state of starvation and emaciation. In anorexia nervosa: At least 1. The patient with anorexia nervosa has an intense fear of gaining weight, even when severely underweight. Individuals with anorexia nervosa have a distorted image of their own weight or body shape and deny the serious health consequences of their low weight. Patients with this condition are often characterized as anorexia restrictors or anorexic bulimic. Each type is equally common.
Anorexia restrictors reduce their weight by severe dieting. Anorexic bulimic patients maintain emaciation by purging. Although both types are serious, the bulimic type, which imposes additional stress on an undernourished body, is the more damaging.
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Binge Eating (Binge Eating Disorder)Bingeing without purging is characterized as compulsive overeating (binge eating) with the absence of bulimic behaviors, such as vomiting or laxative abuse (used to eliminate calories). Binge eating usually leads to becoming overweight. To be diagnosed as a binge eater, a patient typically: Consumes 5,0.
Eats three meals a day plus frequent snacks. Overeats continually throughout the day, rather than simply consuming large amounts of food during binges. Treatment for binge eating is usually similar to treatment for bulimia. Since binge eating is often associated with obesity, it may also require weight and dietary management. This category includes: Infrequent binge- purge episodes (occurring less than twice a week or having such behavior for less than months)Repeated chewing and spitting without swallowing large amounts of food.
Normal weight and anorexic behavior. Such patients tend to be older at diagnosis. Although less serious than other eating disorders, these patients still face similar health problems, including a higher risk for fractures. Causes. There is no single cause for eating disorders. Although concerns about weight and body shape play a role in all eating disorders, the actual cause of these disorders appears to involve many factors, including those that are genetic and neurobiological, cultural and social, and behavioral and psychological. Although much has been written about the roles of families and parenting as causes of eating disorders, there is no solid evidence supporting this claim.
Genetic Factors. Anorexia is eight times more common in people who have relatives with the disorder. Studies of twins show they have a tendency to share specific eating disorders (anorexia nervosa, bulimia nervosa, and obesity). Researchers have identified specific chromosomes that may be associated with bulimia and anorexia. Biologic Factors. The body’s hypothalamic- pituitary- adrenal axis (HPA) may be important in eating disorders. This complex system originates in the following regions in the brain: Hypothalamus. The hypothalamus is a small structure that plays a role in controlling behaviors such as eating, sexual behavior, and sleeping, and regulates body temperature, hunger and thirst, and secretion of hormones.
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Pituitary gland. The pituitary gland is involved in controlling thyroid functions, the adrenal glands, growth, and sexual maturation. Amygdala. This small almond- shaped structure lies deep in the brain and is associated with regulation and control of major emotional activities including anxiety, depression, aggression, and affection.
The HPA system releases certain neurotransmitters (chemical messengers in the brain) that regulate stress, mood, and appetite. Abnormalities in the activities of three of them, serotonin, norepinephrine, and dopamine, may play a particularly important role in eating disorders. Serotonin is involved with well- being, anxiety, and appetite (among other traits), and norepinephrine is a stress hormone. Dopamine is involved in reward- seeking behavior. Imbalances with serotonin and dopamine may explain in part why people with anorexia do not experience a sense of pleasure from food and other typical comforts. Cultural Pressures. The media plays a role in promoting unrealistic expectations for body image and a distorted cultural drive for thinness.
At the same time, cheap and high- caloric foods are aggressively marketed. Such messages are contradictory and confusing. Risk Factors. In the United States, about 7 million females and 1 million males suffer from eating disorders. Age. Eating disorders occur most often in adolescents and young adults.
They are also becoming increasingly prevalent among young children. Eating disorders are more difficult to identify in young children because they are less commonly suspected. Gender. Eating disorders occur predominantly among girls and women. About 9. 0 - 9. 5% of patients with anorexia nervosa, and about 8. Race and Ethnicity. Most studies of individuals with eating disorders have focused on Caucasian middle- class females. However, eating disorders can affect people of all races and socioeconomic levels.
Personality Disorders. People with eating disorders tend to share similar personality and behavioral traits including low self- esteem, dependency, and problems with self- direction. Specific psychiatric personality disorders may put people at higher risk for eating disorders.
Avoidant Personality Disorder. Some studies indicate that many patients with anorexia nervosa have avoidant personalities. This personality disorder is characterized by: Being a perfectionist. Being emotionally and sexually inhibited.
Wanting to be perceived as always being . Obsessive- compulsive personality disorder defines certain character traits (being a perfectionist, morally rigid, or preoccupied with rules and order). This personality disorder is strongly associated with a higher risk for anorexia.
These traits should not be confused with the anxiety disorder called obsessive- compulsive disorder (OCD), although they may increase the risk for this disorder. Borderline Personality Disorder. Borderline personality disorder (BPD) is associated with self- destructive and impulsive behaviors. People with BPD tend to have other co- existing mental health problems, including eating disorders. Narcissistic Personality Disorder.
People with narcissistic personalities tend to: Have an inability to soothe oneself. Have an inability to empathize with others. Have a need for admiration. Be hypersensitive to criticism or defeat.
Accompanying Mental Health Disorders. Many patients with eating disorders experience depression and anxiety disorders. It is not clear if these disorders, particularly obsessive- compulsive disorder (OCD), cause the eating disorders, increase susceptibility to them, or share common biologic causes. Obsessive- Compulsive Disorder (OCD).
Obsessive- compulsive disorder is an anxiety disorder that may occur in up to two thirds of patients with anorexia and up to a third of patients with bulimia.