M05.09.31 Eating Disorders

Eating disorders are serious mental health conditions characterized by abnormal eating habits that negatively impact physical and psychological health. Here’s a detailed breakdown of three common eating disorders encountered in medical practice:

Anorexia Nervosa (AN)

Main Characteristics:

• Self-starvation: Restriction of food intake leading to significant weight loss (>15-20% of ideal body weight or BMI <17).
• Distorted body image: Preoccupation with weight and intense fear of gaining weight despite being underweight.
• Amenorrhea: Cessation of menstrual periods in females.
• Medical complications: Electrolyte imbalance, lanugo hair growth, hormonal disruptions, low blood pressure, heart problems, and osteoporosis.

Points to Remember:

• More common in females than males.
• Difficult to treat due to the patient’s distorted body image and resistance to weight gain.
• Early intervention is crucial to prevent serious health consequences.

Treatment:

• Hospitalization for severe cases with medical complications.
• Nutritional rehabilitation to restore healthy eating habits.
• Individual and family therapy to address underlying psychological issues and improve coping mechanisms.
• Selective serotonin reuptake inhibitors (SSRIs) for managing anxiety and depression are often associated with AN.

Bulimia Nervosa (BN)

Main Characteristics:

• Binge-purge cycle: Episodes of uncontrolled, excessive food intake (binge eating) followed by purging behaviors to prevent weight gain.
• Purging behaviors: Self-induced vomiting, laxative abuse, diuretic use, excessive exercise, or fasting.
• Dental complications: Eroded tooth enamel, cavities, and parotid gland enlargement due to frequent vomiting.
• Electrolyte imbalance: Dehydration, potassium deficiency, and irregular heartbeat.

Points to Remember:

• More common in females than males.
• Purging behaviors often leave physical signs like calloused fingers from induced vomiting.
• Higher recovery rates compared to anorexia nervosa.

Treatment:

• Cognitive-behavioral therapy (CBT) to identify and change negative thoughts and behaviors related to food and weight.
• Interpersonal therapy (IPT) to improve social functioning and address underlying emotional issues.
• Medications like SSRIs may be used to manage depression or anxiety.

Binge Eating Disorder (BED)

Main Characteristics:

• Recurrent episodes of binge eating: Similar to bulimia nervosa but without purging behaviors.
• Loss of control during binges: Feeling unable to stop eating despite feeling uncomfortably full.
• Shame and guilt after binge eating episodes.
• Weight: Can be normal weight, overweight, or obese.

Points to Remember:

• Increasingly recognized eating disorders.
• Binge eating can lead to obesity and associated health problems like diabetes and heart disease.

Treatment:

• CBT to develop healthy eating patterns and coping mechanisms to avoid binge episodes.
• Interpersonal therapy to address underlying emotional issues.
• Medications like stimulants (e.g., lisdexamfetamine) may be used to regulate appetite and reduce binge frequency.

Bibliography:

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
• National Eating Disorders Association. National Eating Disorders Association website