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Eating Disorders: Anorexia Nervosa and Bulimia Nervosa

Posted Jun 09 2012 12:27pm

As I prepare for my upcoming preceptorship working with adolescents in the Seattle area, I am reminded to know an extensive amount about the various eating disorders, particularly Anorexia nervosa and Bulimia nervosa.

Anorexia nervosa is classified as “refusal to maintain body weight at or above a minimally normal weight for that person’s specific age and height” (DSM IV). There are two types of anorexia nervosa: the restricting type and the binge-eating/purging type, which the latter is not to be confused with Bulimia nervosa. There may also be an intense fear of becoming overweight, a distortion of actual weight vs. perceived weight when looking into a mirror, or amenorrhea (lack of menstrual cycle) in females. However, individuals suffering from anorexia are not just females, but can be males as well. A typical phrase heard from someone who may be anorexic may be that they look 20 lbs heavier than they really are, despite that their actual weight may be less than 100 lbs. Another indication may be sensitivity about eating in front of other people, having specific eating routines, etc.

Anorexia is a really serious health condition, in that the caloric intake is not enough to sustain normal cellular functioning, leading to wasting of muscles, fat stores, and finally organs at the late stages of the disease. Within the DSM IV, statistics show that anorexia nervosa has the highest morbidity and mortality rate among the other mental health conditions. It’s simply due to the fact that for sustained periods of abstaining from food intake, important organs such as the liver, lung, kidneys, heart, and brain will shut down functioning. Famous French model, Isabelle Caro , died at the age of 28, due to her lifelong struggle with anorexia. She became an advocate against anorexia by bringing awareness and education about her condition, through pictures of her body to be put on posters and magazines worldwide.

Bulimia nervosa is another type of eating disorder that is classified as, “recurrent episodes of eating more in a discrete time period that is larger than what most would consume; feeling a lack of control to stop how much or what is being eaten” (DSM IV). A normal diet may include caloric intake of somewhere around 1500-1800 calories per day. An individual suffering from bulimia may have a purge of eating 4000-6000 calories in one sitting, then act to void, or quickly remove, this ingestion. Other classifications of bulimia also include recurrent compensatory behaviors, such as laxatives, vomiting, enemas, etc, occurring for a defined period of time (everyday to 1 or 2 times per week), and may be paired with anorexia nervosa symptoms as well. In addition, there are also purging and non-purging subtypes of bulimia.

One difference you can notice between the two conditions is that individuals suffering from anorexia will be grossly underweight, while individuals suffering from bulimia may be of normal weight, or even slightly overweight. Some of the major concerns with bulimia include decreased gag reflex or spontaneous vomiting, cuts on hands, dental caries (hydrochloric acid from the stomach eroding the teeth), depression, suicidality, or drug/alcohol abuse.

Major similarities between Anorexia and Bulimia > Strong need for control over some aspect of life
> Distorted body image
> Family history
> Socialization of women to have an ideal, unrealistic, thin body type

Major differences between Anorexia and Bulimia:
> Those with anorexia may binge occasionally, but fast or starve primarily.
> Those with bulimia eat ‘huge’ amounts of food, then purge in some way
> Those with bulimia often normal weight, less likely to have menstrual irregularities.
> Those with bulimia more likely to admit to having disordered eating than those with anorexia.

Many people discount the benefit of using a Body Mass Index ( BMI ) calculator as an appropriate measuring tool, yet for patients who may be struggling (or on the brink) with an eating disorder, the BMI offers a valuable way to note if someone is “underweight”, “normal”, or “overweight”, in a gross estimation. A practitioner may or may not choose to use this screening tool in their office.

After talking with some individuals about having eating disorders, one person in particular reminded me that as with other conditions, they are triggered by a stimulus. Unfortunately for someone who has been suffering with an eating disorder picture, this stimulus occurs 3 times a day: every meal. For example, a person with a shopping addiction, it is a voluntary choice to go to the mall or to the store and buy something, and, although difficult at times, it can be avoided. However, eating is something that needs to occur in order to sustain life, it is hard to stray away from this on a daily basis. I thank this person for allowing me this great insight as to what it might be like, the type of struggle that individuals endure, and the constant battle within their head vs. their body image entails.

I have known many people in my lifetime who have experienced one form, or another, of disordered eating patterns: whether they fill up on water during the day that they do not feel hungry, constantly chewing gum, religiously counting calories, exercising to have a net negative calorie intake, long-term fasting, avoiding fatty foods, addiction to colonics or dieting pills, obsession with eating healthy foods ( orthorexia ), etc. It is a very common condition, which can affect both males and females, as I mentioned before. Support your friend, family member, loved one during this process, and seek medical attention where appropriate.

This information is NOT intended as medical advice or a substitute for medical diagnosis of either eating disorder. It is intended as informational purposes only. Please consult a licensed medical practitioner or nutritionist if you or someone you care about is suffering from an eating disorder. Both anorexia and bulimia are both serious conditions, not to be taken lightly.

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