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Anorexia and Bulimia


Anorexia and Bulimia

Anorexia nervosa describes an eating disorder characterized by low body weight and body image distortion.  Anorexia is a complex condition, involving psychological, neurobiological, and sociological factors.  Anorexia is more than just a problem with food. It's a way of using food or starving oneself to feel more in control of life and to ease tension, anger, and anxiety.

Understanding Anorexia

For people with anorexia nervosa, eating and not eating becomes an obsession. Typically, unusual or particular eating habits and other weight control habits develop. These can include avoiding food and meals, picking out a few foods and eating only these foods in small quantities, repeatedly checking body weight, intense and compulsive exercise, purging by means of vomiting, abuse of laxatives, enemas, and consuming diet pills or diuretic drugs. Weight loss is usually 15% below the person's normal body weight. People suffering from anorexia are very painfully thin yet are convinced that they are overweight.

Anorexia primarily affects young adolescent girls in the Western world with females aged between 15 and 19 making up 40% of all cases. As a whole, about 90% of people with anorexia are female.  It should be noted, however, that males and children as young as seven years old have been diagnosed with anorexia, and women 50, 60, 70, and even 80 years of age have fit the diagnosis.

Anorexia has one of the highest mortality rates of any psychiatric condition, with approximately 10% of people diagnosed with the condition eventually dying due to related factors.  The suicide rate of people with anorexia is also higher than that of the general population. The incidence of anorexia is estimated to be between 8 and 13 cases per 100,000 persons per year.

In popular culture, and especially with anorexics themselves, the term is often shortened to "ana" to avoid sounding clinical and impersonal. "Pro-ana" groups often use the terms "ana" and "mia" (referring to bulimia nervosa) to describe their conditions.

Anorexia is one of the main types of eating problems as defined by the DSM 1V-TR of the American Psychiatric Association.  In addition to anorexia, the others are obesity and excess weight, bulimia nervosa, and binge-eating. Most often, eating problems develop during the childhood and teenage years, but many people do not experience these problems until adulthood. Eating disorders frequently show up along with other mental health issues, such as depression, alcohol or drug abuse, and anxiety disorders. People who suffer from eating disorders also risk serious, and sometimes fatal, health complications.

Causal Factors of Anorexia

It is clear that there is no single cause for anorexia nervosa and that it stems from a mixture of social, psychological and biological factors. There is considerable debate over how much each of the the following causal factors contribute to the development of anorexia nervosa.

Culture and environmental factors:  Women in the U.S. are under constant pressure to fit a certain ideal of beauty. Seeing images of flawless, thin females everywhere makes it hard for women to feel good about their bodies. People especially at risk due to this societal pressure are young women, athletes, actors, dancers, models, and TV personalities for whom thinness has become a professional requirement.

Family environmental factors: If you have a mother or sister with anorexia nervosa, you are more likely to develop the disorder. Parents who think looks are important, diet themselves, or criticize their children's bodies are more likely to have a child with anorexia nervosa.

Life changes or stressful events: Traumatic events like sexual child abuse and rape as well as stressful things like starting a new job, can lead to the onset of anorexia nervosa.

Personality traits: People with anorexia nervosa have been found to have certain personality traits that are thought to predispose them to develop eating disorders. High levels of obsessionality (being subject to intrusive thoughts about food and weight-related issues), restraint (being able to fight temptation), and clinical levels of perfectionism (the pathological pursuit of personal high-standards and the need for control) have been cited as commonly reported factors in research studies.

Biological factors: Genes, hormones, and chemicals in the brain may be factors in developing anorexia nervosa.

Psychological factors: Anorexic eating behavior is thought to originate from feelings of fatness and unattractiveness and is maintained by various thought processes that alter how the individual evaluates and thinks about their body, food and eating. 

It is often the case that other psychological difficulties and mental health problems exist alongside anorexia nervosa in the sufferer. Clinical depression, obsessive compulsive disorder, high-levels of anxiety and depression, and substance abuse are among the most likely conditions to be found along with anorexia nervosa.

Clinical Features of Anorexia

The most commonly used criteria for diagnosing anorexia are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The DSM-IV-TR specifies two subtypes:

Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating OR purging behavior (that is, self-induced vomiting, over-exercise or the misuse of laxatives, diuretics, or enemas).

There are a number of features, that although not necessarily diagnostic of anorexia, have been found to be commonly present in those with this eating disorder.

Psychological features include:

Distorted body image and poor insight
Self-evaluation almost exclusively in terms of their shape and weight
Pre-occupation or obsessive thoughts about food and weight
OCD (obsessive compulsive disorder) behaviors

Emotional features include:

Low self-esteem and self-efficacy
Clinical depression or chronically low mood
Intense fear about becoming overweight

Interpersonal and social features:

Poor or deteriorating school performance
Withdrawal from previous friendships and other peer-relationships
Deterioration in relationships with the family

Physiological features:

Extreme weight loss
Endocrine disorder, leading to cessation of menstural periods in girls
Growth of lanugo hair (fine, downy hair) over the body
Abnormalities of mineral and electrolyte levels in the body
Zinc deficiency and a reduction in white blood cell count
Reduced immune system function
Possibly with pallid complexion and sunken eyes
Creaking joints and bones
Collection of fluid in ankles during the day and around eyes at night
Very dry/chapped lips and headaches due to malnutrition
Poor circulation' and purple extremities
Starvation symptoms, such as reduced metabolism, slow heart rate, hypotension, hypothermia and anemia.

Behavioral features:

Excessive exercise, food restriction
Secretive about eating or exercise behavior
Possible self-harm, drug abuse, alcohol abuse, and suicide attempts

Treatment of Anorexia

Treatment of anorexia nervosa requires a program that involves restoring weight that has been lost to severe dieting and purging, treating any psychological disturbances, such as distortion of body image, low self-esteem, and interpersonal or emotional conflicts, and achieving long-term remission and rehabilitation. Use of medications in people with anorexia nervosa is usually considered only after the patient has started to regain weight.

Most of the complications experienced by persons with anorexia nervosa are reversible when they restore weight. People with this disorder should be diagnosed and treated as soon as possible because eating disorders are most successfully treated when diagnosed early. Some patients can be treated as outpatients with input from physicians, psychiatrists, clinical psychologists and other mental health professionals, but some may need hospitalization to stabilize their weight.

To help people with anorexia nervosa overcome their disorder, a variety of approaches are used. Some form of psychotherapy is needed to deal with underlying emotional issues, but no specific type of psychotherapy seems to show any overall advantage when compared to other types. Cognitive-behavioral therapy is sometimes used to change abnormal thoughts and behaviors. Group therapy is often advised so people can share their experiences with others. Family therapy is important particularly if the individual is living at home and is a young adolescent. A physician or advanced-practice nurse is needed to prescribe medications and hormones that may needed in treating the disorder. Finally, a nutritionist may be necessary to advise the patient about proper diet and eating regimens.

Often, eating disorders like anorexia happen along with mental health problems such as depression, anxiety, and obsessive-compulsive disorder. These problems need to be treated along with the anorexia.

Additional Information

For more information about anorexia nervosa, bulimia nervosa, eating problems, and weight control issues, please visit the websites listed below and the glossary that follows.

 4woman: anorexia nervosa
 National Eating Disorders WebPage
 NIH.gov medlineplus: eating disorders
 Eating Disorders Association Home Page
 NIMH gov Publication on eating disorders

Anorexia Glossary of Terms

Anorexia Glossary of Terms (adapted from Medicinenet anorexia nervosa glossary) is provided below.  You can also see a weight control glossary adapted from the U.S. government"s National Institutes of Health website on pages binge eating or excess weight and weight control.

Abdominal: Relating to the abdomen, the belly, that part of the body that contains all of the structures between the chest and the pelvis. The abdomen is separated anatomically from the chest by the diaphragm , the powerful muscle spanning the body cavity below the lungs

Addiction: A chronic relapsing condition characterized by compulsive drug-seeking and abuse and by long-lasting chemical changes in the brain. Addiction is the same irrespective of whether the drug is alcohol, amphetamines, cocaine, heroin, marijuana, or nicotine. Every addictive substance induces pleasant states or relieves distress. Continued use of the addictive substance induces adaptive changes in the brain that lead to tolerance, physical dependence, uncontrollable craving and, all too often, relapse. Dependence is at such a point that stopping is very difficult and causes severe physical and mental reactions from withdrawal. The risk of addiction is in part inherited. Genetic factors, for example, account for about 40% of the risk of alcoholism. The genetic factors predisposing to addiction are not yet fully understood.

Amenorrhea: Absence or cessation of menstruation . Amenorrhea is conventionally divided into primary and secondary amenorrhea.
See the entire definition of Amenorrhea

Anemia: The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.

Anorexia: An eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder. It is a condition that goes well beyond out-of-control dieting. The person with anorexia, most often a girl or young woman, initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is thought to be secondary to concerns about control and fears relating to one's body. The individual continues the endless cycle of restrictive eating, often to a point close to starvation. This becomes an obsession and is similar to an addiction to a drug. Anorexia can be life-threatening. Also called anorexia nervosa.

Anorexic: Pertaining to anorexia, lack of appetite; or a drug or other agent that causes anorexia and so diminishes the appetite.

Antidepressant: Anything, and especially a drug, used to prevent or treat depression.

Arrhythmia: An abnormal heart rhythm.

Blood pressure: The blood pressure is the pressure of the blood within the arteries. It is produced primarily by the contraction of the heart muscle. It's measurement is recorded by two numbers. The first (systolic pressure) is measured after the heart contracts and is highest. The second (diastolic pressure) is measured before the heart contracts and lowest. A blood pressure cuff is used to measure the pressure. Elevation of blood pressure is called "hypertension".

Bone density: Bone density is the amount of bone tissue in a certain volume of bone. It can be measured using a special x-ray called a quantitative computed tomogram.

Bradycardia: A slow heart rate, usually defined as less than 60 beats per minute.

Cardiac: Having to do with the heart.

Cardiac arrest: A medical emergency with absent or inadequate contraction of the left ventricle of the heart that immediately causes body wide circulatory failure. The signs and symptoms include loss of consciousness; rapid shallow breathing progressing to apnea (absence of breathing); profoundly low blood pressure ( hypotension ) with no pulses that can be felt over major arteries; and no heart sounds.

Circulatory system: The system that moves blood throughout the body. The circulatory system is composed of the heart, arteries, capillaries, and veins. This remarkable system transports oxygenated blood from the lungs and heart throughout the body via the arteries. The blood goes through the capillaries which are situated between the arteries and veins. And the blood that has been depleted of oxygen by the body is then returned to the lungs and heart via the veins.

Clinical: 1. Having to do with the examination and treatment of patients. 2. Applicable to patients. A laboratory test may be of clinical value (of use to patients).

Cognitive: Pertaining to cognition , the process of knowing and, more precisely, the process of being aware, knowing, thinking, learning and judging. The study of cognition touches on the fields of psychology , linguistics, computer science, neuroscience , mathematics, ethology and philosophy.

Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV.

Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs). Disruption sequence: The events that occur when a fetus that is developing normally is subjected to a destructive agent such as the rubella (German measles) virus.

DSM-IV: The 4th edition of "Diagnostic and Statistical Manual of Mental Disorders" (DSM) a comprehensive classification of officially recognized psychiatric disorders. DSM-IV was issued in 1993.

Dysfunction: Difficult function or abnormal function.

Electrolyte: An electrolyte is a substance that will dissociate into ions in solution and acquire the capacity to conduct electricity. The electrolytes include sodium, potassium, chloride, calcium and phosphate. Informally, called lytes. (The clue to the word electrolyte is in the lyte which comes from the Greek lytos meaning that may be dissolved.)

Endocrine: Pertaining to hormones and the glands that make and secrete them into the bloodstream through which they travel to affect distant organs. The endocrine sites include the hypothalamus, pituitary gland, pineal gland, thyroid, parathyroids, heart (which makes atrial-natriuretic peptide), the stomach and intestines, islets of Langerhans in the pancreas, the adrenal glands, the kidney (which makes renin, erythropoietin, and calcitriol), fat cells (which make leptin). the testes, the ovarian follicle (estrogens) and the corpus luteum in the ovary). Endocrine is as opposed to exocrine. (The exocrine glands include the salivary glands, sweat glands and glands within the gastrointestinal tract.)

Enzyme: A protein (or protein-based molecule) that speeds up a chemical reaction in a living organism. An enzyme acts as catalyst for specific chemical reactions , converting a specific set of reactants (called substrates) into specific products. Without enzymes, life as we know it would not exist.

Fat: 1 Along with proteins and carbohydrates, one of the three nutrients used as energy sources by the body. The energy produced by fats is 9 calories per gram. Proteins and carbohydrates each provide 4 calories per gram. 2 Total fat; the sum of saturated, monounsaturated and polyunsaturated fats. Intake of monounsaturated and polyunsaturated fats can help reduce blood cholesterol when substituted for saturated fats in the diet. 3 A slang term for obese or adipose. 4 In chemistry, a compound formed from chemicals called fatty acids. These fats are greasy, solid materials found in animal tissues and in some plants. Fats are the major component of the flabby material of a body, commonly known as blubber.

Fatigue: A condition characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness and tiredness. Fatigue can be acute and come on suddenly or chronic and persist.

Fertility: The ability to conceive and have children, the ability to become pregnant through normal sexual activity. Infertility is defined as the failure to conceive after a year of regular intercourse without contraception.

Gastrointestinal: Adjective referring collectively to the stomach and small and large intestines.

Gene: The basic biological unit of heredity . A segment of deoxyribonucleic acid (DNA) needed to contribute to a function.

Genetic: Having to do with genes and genetic information.

Heart rate: The number of heart beats per unit time, usually per minute. The heart rate is based on the number of contractions of the ventricles (the lower chambers of the heart). The heart rate may be too fast ( tachycardia ) or too slow ( bradycardia ). The pulse is bulge of an artery from the wave of blood coursing through the blood vessel as a result of the heartbeat. The pulse is often taken at the wrist to estimate the heart rate.

Hormone: A chemical substance produced in the body that controls and regulates the activity of certain cells or organs.

Hypotension: Any blood pressure that is below the normal expected for an individual in a given environment. Hypotension is the opposite of hypertension (abnormally high blood pressure).

Hypothalamus: The area of the brain that controls body temperature, hunger, and thirst.

Immunity: The condition of being immune. Immunity can be innate (for example, humans are innately immune to canine distemper) or conferred by a previous infection or immunization.

Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a "germ") growing within him, drawing its nourishment from the person.

Inpatient: A patient whose care requires a stay in a hospital. As opposed to an outpatient. The term inpatient dates back to at least 1760. The case of an inpatient was referred to an incase.

Intervention: The act of intervening, interfering or interceding with the intent of modifying the outcome. In medicine, an intervention is usually undertaken to help treat or cure a condition. For example, early intervention may help children with autism to speak. "Acupuncture as a therapeutic intervention is widely practiced in the United States," according to the National Institutes of Health. From the Latin intervenire, to come between.

Intravenous feeding: Feeding through a vein. Also called parenteral alimentation or parenteral nutrition.

Kidney: One of a pair of organs located in the right and left side of the abdomen which clear "poisons" from the blood, regulate acid concentration and maintain water balance in the body by excreting urine. The kidneys are part of the urinary tract. The urine then passes through connecting tubes called "ureters" into the bladder. The bladder stores the urine until it is released during urination.

Liver: An organ in the upper abdomen that aids in digestion and removes waste products and worn-out cells from the blood. The liver is the largest solid organ in the body. The liver weighs about three and a half pounds (1.6 kilograms). It measures about 8 inches (20 cm) horizontally (across) and 6.5 inches (17 cm) vertically (down) and is 4.5 inches (12 cm) thick.

Low blood pressure: Any blood pressure that is below the normal expected for an individual in a given environment. Low blood pressure is also referred to as hypotension.

Menstrual: Pertaining to menstruation (the menses), as in last menstrual period, menstrual cramps, menstrual cycle, and premenstrual syndrome. From the Latin menstrualis, from mensis meaning month.

Menstrual cycle: The monthly cycle of changes in the ovaries and the lining of the uterus (endometrium), starting with the preparation of an egg for fertilization. When the follicle of the prepared egg in the ovary breaks, it is released for fertilization and ovulation occurs. Unless pregnancy occurs, the cycle ends with the shedding of part of the endometrium, which is menstruation. Although it is actually the end of the physical cycle, the first day of menstrual bleeding is designated as "day 1" of the menstrual cycle in medical parlance.

Metabolic: Relating to metabolism, the whole range of biochemical processes that occur within us (or any living organism). Metabolism consists of anabolism (the buildup of substances) and catabolism (the breakdown of substances).

Mortality: A fatal outcome or, in one word, death. The word "mortality" is derived from "mortal" which came from the Latin "mors" (death). The opposite of mortality is, of course, immortality. Mortality is also quite distinct from morbidity (illness).

Mortality rate: A death rate. There are a number of different types of mortality rates as, for examples, the following:

The fetal mortality rate : The ratio of fetal deaths to the sum of the births (the live births + the fetal deaths) in that year.

The infant mortality rate : The number of children dying under a year of age divided by the number of live births that year.

The maternal mortality rate : The number of maternal deaths related to childbearing divided by the number of live births (or by the number of live births + fetal deaths) in that year.

Neurotransmitter: A chemical that is released from a nerve cell which thereby transmits an impulse from a nerve cell to another nerve, muscle, organ, or other tissue. A neurotransmitter is a messenger of neurologic information from one cell to another.

NIMH: Stands for the National Institute of Mental Health, one of the National Institutes of Health in the U.S., whose mission is to "provide national leadership dedicated to understanding, treating, and preventing mental illnesses through basic research on the brain and behavior, and through clinical, epidemiological, and services research."

Organic: 1. A chemical compound that contains carbon.
2. Related to an organ.
3. Grown or prepared without the use of chemicals or pesticides, as in organic food.

Outpatient: A patient who is not an inpatient (not hospitalized) but instead is cared for elsewhere -- as in a doctor's office, clinic, or day surgery center. The term outpatient dates back at least to 1715. Outpatient care today is also called ambulatory care.

Potassium: The major positive ion (cation) found inside of cells. The chemical notation for potassium is K+.

Potassium deficiency: Inadequate potassium intake and hence potassium levels in the blood that are abnormally low. This state is termed hypokalemia. For further information, see:

Prognosis: 1. The expected course of a disease .
2. The patient's chance of recovery.
The prognosis predicts the outcome of a disease and therefore the future for the patient . His prognosis is grim, for example, while hers is good.

Progressive: Increasing in scope or severity. Advancing. Going forward. In medicine, a disease that is progressive is going from bad to worse.

Psychiatric: Pertaining to or within the purview of psychiatry , the medical specialty concerned with the prevention, diagnosis , and treatment of mental illness.

Relapse: The return of signs and symptoms of a disease after a patient has enjoyed a remission . For example, after treatment a patient with cancer of the colon went into remission with no sign or symptom of the tumor, remained in remission for 4 years, but then suffered a relapse and had to be treated once again for colon cancer.

Renal: Having to do with the kidney. From the Latin renes (the kidneys), which gave the French les reins which mean both the kidneys and the lower back.

Reuptake: The reabsorption of a secreted substance by the cell that originally produced and secreted it. The process of reuptake, for example, affects serotonin.

Serotonin: A hormone , also called 5-hydroxytryptamine , in the pineal gland , blood platelets, the digestive tract, and the brain. Serotonin acts both as a chemical messenger that transmits nerve signals between nerve cells and that causes blood vessels to narrow.

SSRI: Abbreviation for selective serotonin reuptake inhibitors, commonly prescribed drugs for treating depression . SSRIs affect the chemicals that nerves in the brain use to send messages to one another. These chemical messengers, called neurotransmitters, are released by one nerve and taken up by other nerves. Neurotransmitters that are not taken up by other nerves are taken up by the same nerves that released them. This process is termed "reuptake." SSRIs work by inhibiting the reuptake of serotonin, an action which allows more serotonin to be available to be taken up by other nerves.

Thyroid: 1. The thyroid gland. Also, pertaining to the thyroid gland. 2. A preparation of the thyroid gland used to treat hypothyroidism. 3. Shaped like a shield. (The thyroid gland was so-named by Thomas Wharton in 1656 because it was shaped like an ancient Greek shield.)

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