Anorexia and Bulimia

1.Anorexia or anorexia nervosa

Anorexia is an eating disorder characterized by low weight, fear of gaining weight, and a strong
desire to be thin, resulting in food restriction. Many people with anorexia see themselves as
overweight even though they are in fact underweight. If asked they usually deny they have a
problem with low weight. Often they weigh themselves frequently, eat only small amounts, and
only eat certain foods. Some will exercise excessively, force themselves to vomit, or use
laxatives to produce weight loss. Complications may include osteoporosis, infertility and heart
damage, among others. Women will often stop having menstrual periods.
The cause is not known. There appear to be some genetic components with identical twins
more often affected than non-identical twins. Cultural factors also appear to play a role with
societies that value thinness having higher rates of disease. Additionally, it occurs more
commonly among those involved in activities that value thinness such as high-level athletics,
modelling, and dancing. Anorexia often begins following a major life-change or stress-inducing
event. The diagnosis requires a significantly low weight.
Treatment of anorexia involves restoring a healthy weight, treating the underlying
psychological problems, and addressing behaviors that promote the problem. While
medications do not help with weight gain, they may be used to help with associated anxiety or
depression. A number of types of therapy may be useful including an approach where parents
assume responsibility for feeding their child, known as Maudsley family therapy and cognitive
behavioral therapy. Sometimes people require admission to hospital to restore weight.
Evidence for benefit from nasogastric tube feeding, however, is unclear. Some people will just
have a single episode and recover while others may have many episodes over years. Many
complications improve or resolve with regaining of weight.
Anorexia nervosa, and the associated malnutrition that results from self-imposed starvation, can
cause complications in every major organ system in the body. Hypokalaemia, a drop in the level
of potassium in the blood, is a sign of anorexia nervosa. A significant drop in potassium can cause abnormal
heart rhythms, constipation, fatigue, muscle damage and paralysis.

Symptoms of anorexia may include:

- Depression, anxiety disorders and insomnia;
- Rapid, continuous weight loss;
- Intolerance to cold and frequent complaints of being cold; body temperature may lower
(hypothermia) in an effort to conserve energy due to malnutrition etc.

Globally, anorexia is estimated to affect 2.9 million people as of 2015. It is estimated to occur in
0.9% to 4.3% of women and 0.2% to 0.3% of men in Western countries at some point in their
life. About 0.4% of young women are affected in a given year and it is estimated to occur ten
times less commonly in men. Rates in most of the developing world are unclear. Often it begins
during the teen years or young adulthood. While anorexia became more commonly diagnosed
during the 20th century it is unclear if this was due to an increase in its frequency or simply
better diagnosis. In 2013 it directly resulted in about 600 deaths globally, up from 400 deaths in
1990. Eating disorders also increase a person's risk of death from a wide range of other causes,
including suicide. About 5% of people with anorexia die from complications over a ten-year
period, a nearly 6 times increased risk. The term anorexia nervosa was first used in 1873 by
William Gull to describe this condition.

2. Bulimia or bulimia nervosa

Bulimia is an eating disorder characterized by binge eating followed by purging. Binge eating
refers to eating a large amount of food in a short amount of time. Purging refers to the
attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.
Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or
excessive exercise. Most people with bulimia are at a normal weight. The forcing of vomiting
may result in thickened skin on the knuckles and breakdown of the teeth. Bulimia is frequently
associated with other mental disorders such as depression, anxiety, and problems with drugs or
alcohol. There is also a higher risk of suicide and self-harm. Cognitive behavioral therapy is the
primary treatment for bulimia. Antidepressants of the selective serotonin reuptake inhibitors
(SSRI) or tricyclic antidepressant class may have a modest benefit. While outcomes with bulimia
are typically better than in those of anorexia, the risk of death among those affected is higher
than that of the general population. At 10 years after receiving treatment about 50% of people
are fully recovered.
Bulimia typically involves rapid and out-of-control eating, which may stop when the bulimic is
interrupted by another person or the stomach hurts from over-extension, followed by self-
induced vomiting or other forms of purging. This cycle may be repeated several times a week
or, in more serious cases, several times a day and may directly cause:
- Chronic gastric reflux after eating, secondary to vomiting;
- Constipation;
- Infertility;
- Esophagitis, or inflammation of the esophagus etc.
With regards to interoception, people with bulimia report reduced sensitivity to many kinds of
internal and external sensations. For example, some show increased thresholds to heat pain
compared and report the same level of satiety after consuming more calories than do healthy
subjects.
The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and
many cases have previously suffered from obesity, with many sufferers relapsing in adulthood
into episodic bingeing and purging even after initially successful treatment and remission.[26] A
lifetime prevalence of 0.5 percent and 0.9 percent for adult and adolescent sufferers,
respectively, is estimated among the United States population. Bulimia nervosa may affect up
to 1% of young women and, after 10 years of diagnosis, half will recover fully, a third will
recover partially, and 10–20% will still have symptoms.
Adolescents with bulimia nervosa are more likely to have self-imposed perfectionism and
compulsivity issues in eating compared to their peers. This means that the high expectations
and unrealistic goals that these individuals set for themselves are internally motivated rather
than by social views or expectations.