Chapter Notes: Eating Disorders

Anorexia Nervosa

•  The main signs and symptoms include: 
  •  A distorted body image where the person believes they are overweight even when they are very thin. 
  •  An intense fear of gaining weight and an extreme focus on being thin. 
  •  A significant reduction in food intake, leading to a much lower body weight than what is considered normal. 
  • Health issues related to starvation, such as: 
    • Amenorrhea (absence of menstrual periods)
    • Lanugo (fine hair growth similar to newborns)
    • Low body temperature (hypothermia)
    • Swelling due to fluid retention (dependent edema)
    • Slow heart rate (bradycardia)
•  Young patients often experience delayed sexual development, while adult patients typically report a decreased interest in sexual activities. 
• Individuals with anorexia often display unusual behaviors around food, such as: 
  • Hiding food in the house
  • Disposing of food in napkins
  • Cutting food into very small pieces
  • Constantly rearranging food on their plates
•  These patients are often preoccupied with food and may spend a lot of time collecting recipes or preparing meals for others. 
•  Patients tend to be secretive about their condition, often denying any symptoms and refusing to seek treatment. 

Subtypes of Anorexia Nervosa

• Restricting Type: This subtype is observed in approximately 50% of individuals with anorexia nervosa. It involves severe restrictions on food intake, where the person significantly limits the quantity and variety of food they consume.
• Binge eating/purging subtype: 
  •  It occurs in 25-50% of patients. 
  •  In this condition, the patient switches between strict dieting and binge eating followed by purging episodes. 
  • Binge eating means consuming a large quantity of food quickly, often accompanied by a feeling of loss of control during the episode. 
  • Purging is a way for the patient to try to make up for the extra calories consumed. 
    This may involve: 
    • Self-induced vomiting
    • Using laxatives
    • Taking diuretics
    • Using emetics
  •  Frequent vomiting can lead to serious health issues such as: 
    • Dental caries (tooth decay)
    • Parotitis (inflammation of the salivary glands)
    • Hypokalemic alkalosis (a condition caused by low potassium levels in the blood)

Treatment

• Behavioral Management: Encouraging healthy eating habits and discouraging harmful behaviors like self-induced vomiting.
• Individual Psychotherapy: Providing psychological support and therapy to address underlying issues related to the eating disorder.
• Family Education: Involving and educating family members about the disorder to create a supportive environment for recovery.

Medications such as cyproheptadine, tricyclic antidepressants (TCAs), and selective serotonin reuptake inhibitors (SSRIs) have been used in the treatment of anorexia nervosa with varying degrees of success.

Bulimia Nervosa

• This disorder is more frequent than anorexia nervosa and is mainly found in females, typically starting in late adolescence.
• Key characteristics include:
  • Binge Eating: Consuming a lot of food in a short period, often accompanied by a sense of being unable to control eating.
  • Compensatory Behaviors: Actions taken to avoid gaining weight after binge eating, which may involve:
    • Self-induced vomiting
    • Abuse of laxatives or diuretics
    • Use of emetics
    • Excessive exercising and strict dieting.
  • Like those with anorexia nervosa, individuals with bulimia have an intense fear of gaining weight and place a high value on being thin.
  • Typically, a person with bulimia has a normal weight, which is a key difference from anorexia nervosa.
• Individuals with bulimia may experience various physical issues due to purging, including:
  • Enamel erosion and dental caries
  • Inflammation of salivary glands
  • Calluses on knuckles from injury during vomiting.
  • Possible complications such as hypokalemia and hypochloremic alkalosis may occur, and in rare cases, gastric or esophageal tears from forceful vomiting.
• Patients generally have normal sexual function and are often open about their symptoms, unlike those with anorexia nervosa.

Treatment

• Treatment is typically done on an outpatient basis, meaning patients do not need to stay overnight in a hospital.
•  It often includes psychotherapeutic techniques, which are methods used to help people with their mental health. 
•  One of the main approaches used is cognitive behavioral therapy, which focuses on changing negative thought patterns and behaviors. 
•  Another method used is dynamic psychotherapy, which explores underlying emotional issues and past experiences. 
•  The most common medications prescribed for treatment are antidepressants. 
•  A specific type of antidepressant frequently used is known as selective serotonin reuptake inhibitors (SSRIs).