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Psychiatric Descriptions

Eating Disorders

  • Anorexia Nervosa
  • Bulimia Nervosa

Anorexia Nervosa

In the late nineteenth century two physicians, the British Sir William Gull and the French Ernest Charles Laseque, independently published observations of self-starving in adolescent girls. This condition was termed "anorexia nervosa." The term "anorexia" (derived from the Greek an meaning "without" and orexis meaning "desire for") was used to describe the starvation and "nervosa" was used to imply involvement of the brain rather than dysfunction of the gastrointestinal tract in the illness.

Anorexia nervosa is actually a misnomer. Anorexic patients do not lack a desire for food. Their starvation causes hunger, yet their illness will not allow them to eat. Anorexic patients will reduce food intake or increase physical activity that overrides their hunger and causes a serious decline in weight. Presently, there are four criteria used to diagnosis the condition. The first two are physical observations: bodyweight that is fifteen percent below normal and loss of menstruation. Starvation impairs the regularity of the menstrual cycle in women. Obviously, this criterion is not used for males. The second two criteria are assessments of patients' perceptions. Patients need to have an intense fear of gaining weight or becoming fat, even though underweight. Also, patients have a misperception of their physical appearance in that they may even perceive themselves as overweight even though they are emaciated. This misperception contributes to the denial that many anorexic patients have. Many patients really do not believe they are ill.

Anorexia nervosa usually develops during the teenage years and affects about one half of a percent of adolescents. Around ninety to ninety-five percent of the cases are in females, though the disorder is being recognized more and more in males. Interestingly, anorexia nervosa is only found in industrialized nations. However, studies have revealed that when immigrants move from an unindustrialized society to an industrialized one, they have an increased risk for developing anorexia. This observation gives some insight into the possible causes of anorexia nervosa. Social factors contribute to an individual's predisposition to developing anorexia nervosa. This is easily demonstrated by the above mentioned immigrant observation and the presence of the illness almost exclusively in Westernized cultures where dieting is common behavior. Recently, Westernized cultures have acclaimed thinness. The media and other societal influences use thinness to promote and advertise. It represents accomplishment, beauty, and desirability. This portrayal of the feminine ideal may instill a desire to reach such a state. This ideal is impractical and unhealthy in most and has nothing to do with accomplishment, beauty or desirability. It is a cultural convention that has become more and more prominent and is thought to be contributing to the increase of anorexia nervosa that has been observed in the past decades.

Westernized culture is not the only contributor, as study reveals other factors that play a role in the onset of the illness. Genetic studies show a familial factor, in that risk for developing anorexia is increased if one has a family member with the illness. Also anorexic patients may have a biological predisposition to eating deficits. Psychological factors may include poor recognition of the normal increase in body fat that accompanies puberty. It is not know which factors are most important, but all need to be taken into account when diagnosing and recommending treatment for an anorexic patient.

Bulimia Nervosa

Bulimia is derived from the Greek boulimos literally meaning "ox hunger" (bous meaning "ox" and limos meaning "hunger.") In the medical literature, dating all the way to the ancient Greeks, ravenous hunger has always been considered a symptom of other diseases. This observation has continued, as hunger and associated binge-eating behavior is noted in conditions, such as, diabetes, depression, and Kleine-Levin syndrome (A rare episodic illness that is characterized by periods of excessive binging and sleeping, which usually resolves by early adulthood and is thought to be caused by disruption of the hypothalamic system). However, not until the late twentieth century has medicine recognized binge eating as a core symptom of a disorder. The hallmark of bulimia nervosa is binge eating.

Bulimia nervosa consists of episodes of binge eating that are characterized by a sense of a lack of control of what or how much one is eating. This is followed by a maneuver to try to prevent weight gain after the episode. Self-induced vomiting, the misuse of laxatives, diuretics, and enemas, fasting, and excessive exercise are typical means to compensate for the binge eating physically and emotionally. Similar to anorexic patients, bulimic patients have misperceptions concerning their body weight and shape. However, unlike in anorexia nervosa, the weight of bulimic patients is usually normal; though patients may have marked fluctuations in weight. Making the diagnosis more difficult is that bulimic patients are often embarrassed about their eating habits and rarely binge or purge in the presence of others.

Bulimia nervosa develops somewhat later than anorexia nervosa, and most cases develop during the late teens and early twenties: affecting about two percent of this population. Like in anorexia nervosa, most cases are in females, and it is only noted in Westernized cultures. Due to the similarities between the two conditions, it is thought that the share the same predispositions to development. To note, the binge eating and/or compensating of bulimia nervosa may be seen in some anorexic patients. The difference between the two conditions is that anorexic patients will be underweight.