ANOREXIA

Anorexia is 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 lifethreatening.
Many individuals with anorexia will severely restrict their calories sometimes
taking in only a few hundred calories a day or just water. This is called the
RESTRICTING TYPE. Our bodies do not like to starve. Remember, the
individual with anorexia has an appetite; he/she just tries to control it. It is
very difficult when a person is starving not to want to eat. What happens to
many individuals is that they lose control, they eat, or eat something they
feel they should not have eaten. For these individuals, this might mean
something as simple as a cookie, a normal meal or even a binge. With the
fear of gaining weight, they may vomit or exercise. This type of anorexia is
called the BINGE-EATING/PURGING TYPE, one of the most dangerous forms
of an eating disorder.
There are no simple answers to the causes of anorexia and other eating
disorders. Anorexia is a complex condition that arises from a combination of
many social, emotional, and biological factors. Although our cultures
idealization of thinness plays a powerful role, there are many other
contributing factors, including your family environment, emotional
difficulties, low self-esteem, and traumatic experiences you may have gone
through in the past.

Psychological causes
People with anorexia are often perfectionists and overachievers.
Theyre the good daughters and sons who do what theyre told,
excel in everything they do, and focus on pleasing others. But while
they may appear to have it all together, inside they feel helpless,
inadequate, and worthless. Through their harshly critical lens, if
theyre not perfect, theyre a total failure.
Family and social pressures
In addition to the cultural pressure to be thin, there are other family
and social pressures that can contribute to anorexia. This includes
participation in an activity that demands slenderness, such as ballet,
gymnastics, or modeling. It also includes having parents who are
overly controlling, put a lot of emphasis on looks, diet themselves, or
criticize their childrens bodies and appearance. Stressful life events
such as the onset of puberty, a breakup, or going away to schoolcan
also trigger anorexia.

Biological causes of anorexia

Research suggests that a genetic predisposition to anorexia may run
in families. If a girl has a sibling with anorexia, she is 10 to 20 times
more likely than the general population to develop anorexia herself.
Brain chemistry also plays a significant role. People with anorexia
tend to have high levels of cortisol, the brain hormone most related to
stress, and decreased levels of serotonin and norepinephrine, which
are associated with feelings of well-being.

In anorexia nervosas cycle of self-starvation, the body is denied the

essential nutrients it needs to function normally. Thus, the body is forced to
slow down all of its processes to conserve energy, resulting in serious
medical consequences:

Abnormally slow heart rate and low blood pressure, which mean that the
heart muscle is changing. The risk for heart failure rises as the heart rate
and blood pressure levels sink lower and lower.

Reduction of bone density (osteoporosis), which results in dry, brittle

bones.

Muscle loss and weakness.

Severe dehydration, which can result in kidney failure.

Fainting, fatigue, and overall weakness.

Dry hair and skin; hair loss is common.

Growth of a downy layer of hair called lanugo all over the body, including
the face, in an effort to keep the body warm.

Anorexia can have dangerous psychological and behavioral effects on all

aspects of an individual's life and can affect other family members as well.

The individual can become seriously underweight, which can lead to or

worsen depression and social withdrawal.
The individual can become irritable and easily upset and have difficulty
interacting with others.
Sleep can become disrupted and lead to fatigue during the day.
Attention and concentration can decrease.
Most individuals with anorexia become obsessed with food and thoughts
of food. They think about it constantly and become compulsive about
their food choices or eating rituals. They may collect recipes, cut their
food into tiny pieces, prepare elaborate calorie-laden meals for other
people, or hoard food. Additionally, they may exhibit other obsessions
and/or compulsions related to food, weight, or body shape that meet the
diagnostic criteria for an obsessive compulsive disorder.
Other psychiatric problems are also common in people with anorexia
nervosa, including affective (mood) disorders, anxiety disorders, and
personality disorders.
Generally, individuals with anorexia are compliant in every other aspect
of their life except for their relationship with food. Sometimes, they are

overly compliant, to the extent that they lack adequate self-perception.

They are often eager to please and strive for perfection. They usually do
well in school and may often overextend themselves in a variety of
activities. The families of anorexics often appear to be "perfect." Physical
appearances are important to the anorexia sufferer. Performance in other
areas is stressed as well, and they are often high achievers in many
areas.
While control and perfection are critical issues for individuals with
anorexia, aspects of their life other than their eating habits are often
found to be out of control as well. Many have, or have had at some point
in their lives, addictions to alcohol, drugs, or gambling. Compulsions
involving sex, exercising, housework, and shopping are not uncommon.
In particular, people with anorexia often exercise compulsively to speed
the weight-loss process.
Symptoms of anorexia in men tend to co-occur with other psychological
problems and more commonly follow a period of being overweight than
in women. Men with anorexia also tend to be more likely to have a
distorted body image.
Compared to symptoms in men, symptoms of anorexia in women tend to
more frequently include a general displeasure with their body and a
possibly stronger desire to be thin. Women with anorexia also tend to
experience more perfectionism and cooperativeness.

In addition to the mental effects of anorexia, physical effects of this disorder

in children and teens include a number of issues that are associated with
growth and development inherent in this age group. Examples of symptoms
and signs of anorexia in childhood and adolescence can include a slowing of
the natural increase in height or a slowed development of other body
functions like menses.
All of these features can negatively affect one's daily activities. Diminished
interest in previously preferred activities can result or worsen. Some
individuals also have symptoms that meet the diagnostic criteria for a major
depressive disorder.
When you have anorexia, you may need several types of treatment. Here's a
look at what's commonly involved in treating people with anorexia.
Hospitalization and other programs
If your life is in immediate danger, you may need treatment in a hospital
emergency room for such issues as a heart rhythm disturbance,
dehydration, electrolyte imbalances or psychiatric problems. Hospitalization
may be required for medical complications, psychiatric emergencies, severe
malnutrition or continued refusal to eat. Hospitalization may be on a medical
or psychiatric ward. Some clinics specialize in treating people with eating
disorders. Some may offer day programs or residential programs rather than
full hospitalization. Specialized eating disorder programs may offer more
intensive treatment over longer periods of time.

Medical care
Because of the host of complications anorexia causes, you may need
frequent monitoring of vital signs, hydration level and electrolytes, as well
as related physical conditions. In severe cases, people with anorexia may
initially require feeding through a tube that's placed in their nose and goes
to the stomach (nasogastric tube).
A primary care doctor may be the one who coordinates care with the other
health care professionals involved. Sometimes, though, it's the mental
health provider who coordinates care.
Restoring a healthy weight
The first goal of treatment is getting back to a healthy weight. You can't
recover from an eating disorder without restoring an appropriate weight and
learning proper nutrition.
A psychologist or other mental health professional can work with you to
develop behavioral strategies to help you return to a healthy weight. A
dietitian can offer guidance getting back to regular patterns of eating,
including providing specific meal plans and calorie requirements that help
you meet your weight goals. Your family will also likely be involved in
helping you maintain normal eating habits.
Psychotherapy
These types of therapy may be beneficial:

Family-based therapy. This is the only evidence-based treatment

for teenagers with anorexia. Because the teenager with anorexia is
unable to make good choices about eating and health while in the
grips of this serious condition, this therapy mobilizes parents to help
their child with re-feeding and weight restoration until the child can
make good choices about health.

Individual therapy. For adults, cognitive behavioral therapy

specifically enhanced cognitive behavioral therapy has been shown
to help. The main goal is to normalize eating patterns and behaviors
to support weight gain. The second goal is to help change distorted
beliefs and thoughts that maintain the restrictive eating. This type of
therapy is generally done once a week or in a day treatment program,
but in some cases, it may be part of treatment in a psychiatric
hospital.

People with eating disorders can recover. However, they're at increased risk
of relapse during periods of high stress or during triggering situations.
Ongoing therapy or periodic appointments during times of stress may help
you stay healthy.

BULIMIA
Bulimia is also called bulimia nervosa. Its an eating disorder characterized
by episodes of secretive excessive eating (binge-eating) followed by
inappropriate methods of weight control, such as self-induced vomiting
(purging), abuse of laxatives and diuretics, or excessive exercise. The
insatiable appetite of bulimia is often interrupted by periods of anorexia.
Bulimia is generally thought to be a psychological eating disorder. It is
another condition that goes beyond out-of-control dieting. The cycle of
overeating and purging can quickly become an obsession similar to an
addiction to drugs or other substances. Although bulimia has been widely
considered to be psychological and sociocultural in origin, not everyone is
susceptible to developing bulimia.
As well as other eating disorders, there exist two types of bulimia.

Purging Type: in which individuals will have an episode of binge eating

followed by self-induced vomiting, abuse of laxatives and/or diuretics
(water-pills) to avoid gaining weight from the binge.
Non-Purging Type: in which individuals will have an episode of binge
eating and then use other behaviors to offset the behavior, such as
fasting or excessive exercise. Individuals with this type of bulimia
nervosa do not regularly engage in self-induced vomiting or the
misuse of laxatives and/or diuretics.

The exact cause of bulimia nervosa is currently unknown; though it is

thought that multiple factors contribute to the development of this eating
disorder, including genetic, environmental, psychological, and cultural
influences. Some of the main causes for bulimia include:

Stressful transitions or life changes

History of abuse or trauma

Negative body image

Poor self-esteem

Professions or activities that focus on appearance/performance

Unlike the eating disorder anorexia, people with bulimia may not appear to
have significant weight loss. However, complications due to bulimia are
serious and can put your life at risk.
Mental and Emotional Health
Bulimia is a mental health disorder. People with bulimia tend to show signs
of depression, anxiety, or obsessive-compulsive disorders. Theyre also at
risk for substance abuse problems and suicidal behavior. Constant
monitoring of food and weight can become an obsession. A person with
bulimia may binge in secret and hide evidence of food and laxatives. Having
to keep secrets contributes to the cycle of stress and anxiety. Bulimia may
cause moodiness and irritability. Compulsive exercising or preoccupation
with appearance are common symptoms. Its not unusual for someone with
bulimia to spend a lot of time thinking about food and how to control it. This

may be accompanied by feelings of embarrassment and shame. Its hard to

measure the emotional cost.
Digestive System
A sore throat or stomach pain may be the first obvious physical side effects
of bulimia.
Chronic self-induced vomiting can cause a variety of symptoms in the
digestive tract, beginning at the mouth. The high acid content of vomit can
damage teeth, causing enamel erosion, tooth sensitivity, and gum disease.
Puffy cheeks or jaws come from swollen salivary glands. Excessive vomiting
may cause a sore or swollen throat.
Acid can irritate or tear the esophagus. Blood in vomit may be a sign of a
ruptured esophagus. The stomach also becomes irritated. Stomachaches,
heartburn, and acid reflux are common.
Putting your finger down your own throat is one way that people with
bulimia induce vomiting. Doing this over and over can scar the skin on your
fingers and hands, due to exposure to acidity.
Another way to rid the body of food is to use diuretics, diet pills, or laxatives.
Overuse of these products can make it difficult to have a bowel movement
without them. Misdirected use of diuretics may also damage the kidneys.
Damage to the intestines can cause bloating, diarrhea, or constipation.
Straining to move your bowels can result in hemorrhoids.
Recurrent bingeing and purging is physically demanding and can bring on
general weakness and fatigue.
Circulatory System
Frequent purging can cause dehydration, leading to dry skin, weak muscles,
and extreme fatigue. Vomiting often can throw your electrolytes out of
balance. Low levels of potassium, magnesium, and sodium are not
uncommon. This is hard on the heart and can cause irregular heartbeat
(arrhythmia), weakened heart muscle, and heart failure.
Bulimia can cause low blood pressure, weak pulse, and anemia. Throwing up
can be a violent event. The sheer force of it can even cause blood vessels in
the eyes to rupture.
Reproductive System
Bulimia can interfere with your menstrual cycle or stop it altogether. A
hormonal imbalance and fatigue can kill your sex drive. If the ovaries no
longer release eggs, conceiving a child becomes impossible.
Pregnant women who continue to engage in bingeing and purging behaviors
face additional complications for themselves and their babies. These include
Maternal high blood pressure
Gestational diabetes
Miscarriage
Premature birth
Breech birth
Low birth weight babies
Birth defects
Stillbirth
Breastfeeding difficulties
Use of diuretics or laxatives during pregnancy may be harmful to your
unborn baby.
An individual suffering from bulimia nervosa may reveal several signs and
symptoms, many which are the direct result of self-induced vomiting or

other forms of purging, especially if the binge/purge cycle is repeated

several times a week and/or day.
Physical signs and symptoms of bulimia are:

Constant weight fluctuations

Electrolyte imbalances which can result in cardiac arrhythmia, cardiac
arrest or death
Broken blood vessels within the eyes
Enlarged glands in the neck and under the jaw line
Oral trauma, such as lacerations in the lining of the mouth or throat
from repetitive vomiting
Chronic dehydration
Inflammation of the esophagus
Chronic gastric reflux after eating
Ulcers
Infertility

Signs and symptoms of binge eating and purging are:

Disappearance of food
Eating in secrecy
Lack of control when eating
Switching between periods of overeating
Frequent use of the bathroom after meals
Having the smell of vomit

Bulimia nervosa can also create problematic strains between the sufferer
and family and friends, particularly as the individual has abnormal eating
behaviors and/or the avoidance of social activities to engage in binge/purge
episodes.
Since negative body image and poor self-esteem are often the underlying
factors at the root of bulimia, it is important that therapy is integrated in the
recovery process. Treatment for bulimia usually includes:

Discontinuing the binge-purge cycle: The initial phase of treatment

for bulimia nervosa involves breaking this harmful cycle and restoring
normal eating behaviors.

Improving negative thoughts: The next phase of bulimia treatment

concentrates on recognizing and changing irrational beliefs about
weight, body shape, and dieting.

Resolving emotional issues: The final phase of bulimia treatment

focuses on healing from emotional issues that may have caused the
eating disorder. Treatment may address interpersonal relationships
and can include cognitive behavior therapy, dialectic behavior therapy,
and other related therapies.