EATING DISORDERS: ANOREXIA NERVOSA AND BULIMIA NERVOSA
Eating Disorders are characterised by an alteration of eating behaviour and the patient’s perception of his or her body image. There are two types of disturbance in this category: Anorexia Nervosa and Bulimia Nervosa.
Even when these patients reach a point where they are drastically underweight they still cannot believe they have a problem, despite the fact they lead their lives constantly checking their weight, measuring various parts of their body and inspecting themselves in front of a mirror. Their levels of self-esteem (see glossary) are greatly influenced by their weight and the shape of their body. In the initial phases of the disorder, it is in fact possible to observe an increment in self-esteem linked to the loss of weight and positive reactions from the environment. In some cases patients present a state of euphoria, accompanied by a sensation of great mental and physical energy. However, after a short time the lack of satisfaction caused by the subject’s physical appearance reappears and is brought about by the person’s distorted perception of the body. The desire to lose more weight will then also reappear. In this manner, a vicious circle of eating restriction is created together with biological pressure to consume food, a fear of getting fat, further eating restrictions with an increase in physical exercise or purging, further biological and psychological pressure to eat and so on.
There are two types of Anorexia Nervosa:
Anorexia Nervosa with restriction, in which the patient does not present regular binge eating or purging;
Anorexia Nervosa with binge eating and/or purging, in which the individual normally presents this kind of behaviour.
The onset of Anorexia Nervosa generally occurs in early adolescence or in the intermediate period of adolescence, often after having followed a diet or a stressful event. The disorder is about ten times more frequent in female subjects than in male subjects (1)(2). It would appear that the differences between the sexes in the prevalence of the disorder can be attributed to the greater importance women place on the cultural criteria of beauty (which, in recent decades, have proposed an extremely slim figure as the ideal shape for women). Anorexia Nervosa presents comorbidity (see glossary) with depression, Obsessive-Compulsive Disorder, Phobias, Panic Disorder, Alcoholism and various Personality Disorders. Sexual disorders are also likely to be present (anorgasmy, reduced sexual desire)(2)(3).
Bulimia Nervosa. This disorder is characterised by recurrent episodes of binge eating. The term ‘binge eating’ refers to the rapid consumption (for example, within the space of two hours) of a quantity of food significantly greater than that which most people would consume in the same period of time and the simultaneous sensation of losing control. Such behaviour is followed by recurrent and disproportionate compensatory conduct to prevent an increase in weight, which would inevitably occur after the consumption of such large quantities of food. Compensatory conduct includes self-induced vomiting, an abuse of laxatives, diuretics, fasting or excessive physical exercise. Binge-eating usually occurs when the person is alone and in such a way that others will not be aware of the occurrence; it can be induced by stress and its negative emotional correlates, by social situations connected with the consumption of food or by worry linked to a possible increase in weight. It is often planned in advance and confusedly preceded by such states and moods as loneliness, sadness, boredom, anxiety or anger. The food is eaten voraciously and not in a way whereby the individual might enjoy its taste or pleasant characteristics.
There are two subtypes of Bulimia Nervosa:
Bulimia Nervosa with purging, in which the patient regularly presents self-induced vomiting, the use of laxatives or other elimination behaviour;
Bulimia Nervosa without purging, in which the subject presents behaviour such as fasting or excessive physical exercise to maintain body weight.
The disorder usually appears in late adolescence or in early adulthood, mainly in females, during a restrictive diet which the person reverts to on account of being overweight. There may be comorbidity with depression, anxiety disorders and personality disorders (3), and a tendency towards substance abuse and promiscuity (4). This combination of behaviour may reflect an impulsiveness or lack of self-control, characteristics which seem to be relevant in the onset of this disorder. It generally presents intermittently and relapses occur frequently.
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(1) Hsu, L.K.G., (1990). Eating disorders. New York: Guilford.
(2) Walters, E., & Kendler, K.S., (1994). Anorexia nervosa and anorexia-like symptoms in a population based twin sample. American Journal of Psychiatry, 152, 62-71.
(3) Kennedy, S.H., & Garfinkel, P.E. (1992). Advances in the diagnosis and treatment of anorexia nervosa and bulimia nervosa. Canadian Journal of Psychiatry, 37, 309-315.
(4) Ames-Frankel, J., Devlin, M. J., Walsh, B.T., Strasser, T.J. & Sadick, C. (1992). Personality disorder diagnoses in patients with bulimia nervosa. Journal of Clinical Psychiatry, 53, 90-96.
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