13.1 Anorexia Nervosa and Bulimia Nervosa
3 min read•july 9, 2024
Eating disorders like anorexia and bulimia can seriously impact health. These conditions involve distorted body image, , and harmful behaviors around food. They often begin in adolescence and are more common in females and certain high-pressure environments.
Physical effects range from to heart problems, while psychological consequences include and isolation. Anorexia involves extreme restriction, while bulimia cycles between binging and purging. Both disorders require professional treatment to address the complex underlying issues.
Eating Disorders: Anorexia Nervosa and Bulimia Nervosa
Diagnostic criteria of eating disorders
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- (AN) involves a significant restriction of energy intake resulting in low body weight, an intense fear of gaining weight or becoming fat, and a disturbance in the way one experiences their body weight or shape
- Subtypes include Restricting type which primarily involves dieting and fasting, and ###/purging_type_0### which includes episodes of binge eating or purging behaviors (, )
- (BN) is characterized by recurrent episodes of binge eating large amounts of food in a short period of time with a sense of lack of control, followed by inappropriate to prevent weight gain at least once a week for three months
- Compensatory behaviors can include self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise
- Self-evaluation is excessively influenced by body shape and weight
Consequences of anorexia and bulimia
- Physical consequences of AN include and malnutrition, in females, cardiovascular problems (, ), gastrointestinal issues (delayed gastric emptying, constipation), and bone density loss increasing the risk of fractures
- Psychological consequences of AN involve depressed mood, irritability, and isolation, obsessive thoughts about food, weight, and body shape, and in concentration
- Physical consequences of BN include () from purging, and tooth decay from repeated vomiting, swelling of salivary glands (parotid glands), and (, )
- Psychological consequences of BN involve shame, guilt, and self-criticism related to the binge-purge cycle, (depression, anxiety), and
Anorexia vs bulimia
- AN involves significant weight loss while BN may not result in an underweight status
- AN is characterized by restriction of intake while BN involves cycles of binge eating and purging
- Compensatory behaviors are essential for a BN diagnosis but are not required for AN
- Both involve a disturbance in the perception of body weight and shape, a fear of gaining weight, serious physical and psychological consequences, and are more prevalent in females
Prevalence of eating disorders
- AN affects approximately 0.4% and BN affects 1-1.5% of young females, with lower rates in males that may be underestimated due to diagnostic bias
- AN and BN are more common in industrialized countries and Western cultures, typically onset during adolescence or young adulthood
- Higher prevalence is seen in individuals involved in activities emphasizing thinness (modeling, gymnastics, long-distance running)
- Increased risk is associated with a family history of eating disorders
Key Terms to Review (34)
Amenorrhea: Amenorrhea is the absence of menstruation, which can occur for various reasons, including hormonal imbalances, excessive weight loss, or stress. This condition is often associated with eating disorders, particularly when significant weight loss or malnutrition occurs, leading to physiological changes that disrupt the normal menstrual cycle. It can serve as a critical indicator of underlying health issues and is frequently observed in individuals with restrictive eating behaviors or purging practices.
Anorexia Nervosa: Anorexia nervosa is a serious eating disorder characterized by an intense fear of gaining weight, a distorted body image, and self-imposed starvation leading to significant weight loss. This condition not only affects physical health but also has profound psychological impacts, often connecting with other mental health issues like depression and anxiety.
Anxiety Disorders: Anxiety disorders are a group of mental health conditions characterized by excessive fear or worry that disrupts daily functioning. They encompass various disorders that can lead to physical symptoms like increased heart rate and sweating, and can significantly impact a person's quality of life.
Binge-eating: Binge-eating is a pattern of eating characterized by consuming large quantities of food in a short period of time, often accompanied by feelings of loss of control and distress. This behavior is distinct from other eating disorders because it does not involve regular compensatory actions, such as vomiting or excessive exercise. It can be a significant factor in the development and maintenance of various eating disorders, particularly those associated with emotional distress and unhealthy coping mechanisms.
Binge-eating/purging type: The binge-eating/purging type is a subtype of eating disorders characterized by recurrent episodes of binge eating followed by behaviors to prevent weight gain, such as self-induced vomiting or misuse of laxatives. This type is often associated with feelings of loss of control during the binge episodes and significant distress regarding body shape and weight. Individuals with this subtype may be underweight or at a normal weight, which differentiates it from other forms of eating disorders.
Body Image Distortion: Body image distortion refers to a significant discrepancy between an individual’s perception of their own body and their actual physical appearance. This distorted view can lead individuals to perceive themselves as overweight or unattractive, even when they may be of normal weight or underweight. It is a core feature in eating disorders, where the altered self-image drives unhealthy behaviors and attitudes towards food, weight, and body shape.
Bradycardia: Bradycardia is a medical condition characterized by an unusually slow heart rate, typically defined as fewer than 60 beats per minute in adults. This condition can have various causes, including physical fitness, medication effects, and underlying health issues. In the context of eating disorders, it is often observed in individuals with severe anorexia nervosa due to malnutrition and electrolyte imbalances, while it can also occur in those with bulimia nervosa, especially after purging behaviors that affect electrolyte levels and overall heart health.
Bulimia Nervosa: Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors, such as vomiting, excessive exercise, or the misuse of laxatives. This disorder reflects a cycle of extreme food intake followed by attempts to prevent weight gain, often driven by a distorted body image and feelings of shame or guilt. The connection between bulimia nervosa and other conditions, including self-injury, restrictive eating disorders, and binge eating disorders, illustrates the complexity of eating disorders and their treatment.
Clinical Interviews: Clinical interviews are structured or semi-structured conversations between a clinician and a patient designed to gather comprehensive information about the patient's psychological state, history, and symptoms. They are essential for diagnosing mental health disorders and assessing risk factors, as well as exploring behavioral patterns and underlying issues related to conditions like eating disorders or behavioral addictions.
Cognitive Impairments: Cognitive impairments refer to a decline in cognitive functions such as memory, attention, and decision-making abilities. These impairments can significantly affect an individual’s ability to process information and perform daily tasks, and are often observed in individuals with eating disorders like anorexia nervosa and bulimia nervosa. Cognitive impairments can result from nutritional deficiencies, psychological stress, and the impact of disordered eating behaviors on brain function.
Compensatory Behaviors: Compensatory behaviors are actions taken to counteract the effects of eating too much or to prevent weight gain, often seen in eating disorders. These behaviors can include extreme exercising, vomiting, using laxatives, or fasting, and they serve to alleviate feelings of guilt or anxiety associated with food intake. Individuals may resort to these behaviors in an attempt to regain control over their body image and weight, which is a significant aspect of disorders like anorexia nervosa and bulimia nervosa.
Dental Erosion: Dental erosion refers to the gradual loss of tooth enamel due to chemical processes, often influenced by acidic substances. This condition is particularly relevant in the context of eating disorders like anorexia nervosa and bulimia nervosa, where individuals may engage in behaviors such as self-induced vomiting or dietary restrictions that lead to acid exposure, damaging the teeth over time.
Depression: Depression is a common and serious mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. It can significantly impair daily functioning and is often linked to various biological, psychological, and social factors that contribute to its onset and maintenance.
Electrolyte Imbalances: Electrolyte imbalances refer to disruptions in the normal levels of electrolytes in the body, which are crucial for various physiological functions, including muscle contractions and nerve signaling. In individuals suffering from eating disorders, such as those characterized by severe restriction or purging behaviors, these imbalances can lead to serious health complications, including cardiac issues, muscle weakness, and neurological disturbances. Understanding how electrolyte imbalances occur and their effects on the body is vital for recognizing the physical dangers associated with certain eating disorders.
Esophageal Tears: Esophageal tears are serious injuries to the esophagus, often resulting from forceful vomiting or excessive pressure in the chest. These tears can lead to severe complications, including infections and perforations, especially in individuals with eating disorders. The connection between esophageal tears and eating disorders highlights the physical dangers associated with behaviors like purging and the importance of understanding these medical consequences.
Fear of Weight Gain: Fear of weight gain is an intense anxiety and preoccupation with the possibility of becoming overweight, which often leads to extreme behaviors aimed at preventing weight increase. This fear is a core characteristic in eating disorders, particularly those focused on food intake and body image, where individuals may engage in drastic dieting, excessive exercise, or purging to avoid gaining weight. This overwhelming fear can significantly impact a person's mental health and daily life, contributing to the development and maintenance of disorders related to eating and body image.
Gastric Rupture: Gastric rupture is a serious medical condition characterized by a tear in the stomach wall, which can lead to the spilling of stomach contents into the abdominal cavity. This condition is often associated with extreme forms of eating disorders, particularly bulimia nervosa, where episodes of binge eating followed by purging can increase the risk of rupture. Anorexia nervosa may also indirectly contribute to gastric rupture due to malnutrition and weakened stomach tissue, making it more susceptible to injury.
Gastrointestinal Problems: Gastrointestinal problems refer to a range of disorders affecting the digestive system, which can lead to discomfort, pain, and various physical symptoms. In the context of eating disorders, such as anorexia nervosa and bulimia nervosa, these issues often arise due to extreme dietary restrictions or compensatory behaviors like purging. Such gastrointestinal disturbances can complicate the health outcomes for individuals suffering from these disorders and impact their recovery processes.
Hypokalemia: Hypokalemia refers to a condition characterized by low levels of potassium in the bloodstream, which is critical for proper muscle function, nerve signaling, and overall cellular health. This electrolyte imbalance is often seen in individuals with eating disorders, particularly due to behaviors such as excessive purging or inadequate nutritional intake, which can lead to severe complications like cardiac issues and muscle weakness.
Hypotension: Hypotension is a medical term used to describe abnormally low blood pressure. This condition can lead to insufficient blood flow to the organs, which is particularly concerning in individuals with eating disorders, as they may already be experiencing malnutrition and other health complications. In cases of anorexia nervosa and bulimia nervosa, hypotension can arise due to dehydration, electrolyte imbalances, and starvation, making it an important factor to monitor in these populations.
Impulsivity: Impulsivity refers to a tendency to act on a whim, displaying little forethought or consideration of the consequences of actions. This trait can lead to hasty decisions, risky behaviors, and challenges in self-regulation. It is often linked to various psychological disorders and can significantly impact emotional regulation, social interactions, and overall mental health.
Malnutrition: Malnutrition refers to the condition that occurs when a person's diet does not provide adequate nutrients or when the body cannot absorb the nutrients effectively. This can lead to both undernutrition, where there is a deficiency in essential nutrients, and overnutrition, which involves excessive intake of certain nutrients leading to health issues. Understanding malnutrition is crucial for addressing its role in various psychological and physical health conditions, particularly in the context of eating disorders and cognitive impairments.
Media Influence: Media influence refers to the way in which various forms of media, including television, social media, and print, shape public perceptions, attitudes, and behaviors. It plays a significant role in the development of societal standards and norms, particularly around body image and self-esteem, which are crucial factors in the understanding of eating disorders like anorexia nervosa and bulimia nervosa. The pervasive portrayal of idealized body types can lead to unhealthy comparisons and unrealistic expectations, significantly impacting individuals' relationships with food and their bodies.
Misuse of laxatives: Misuse of laxatives refers to the inappropriate or excessive use of laxative medications to control body weight, often seen in individuals with eating disorders. This behavior is primarily associated with the desire to lose weight quickly or manage the symptoms of binge eating, leading to potential physical and psychological harm. The misuse can result in serious health issues, including electrolyte imbalances, dehydration, and damage to the digestive system, further complicating the individual's relationship with food and body image.
Mood Disturbances: Mood disturbances refer to significant changes in a person's emotional state that can interfere with daily functioning and overall well-being. These disturbances can manifest as prolonged feelings of sadness, anxiety, or irritability and are often associated with eating disorders, where the individual's relationship with food and body image significantly impacts their mood. Understanding these disturbances is crucial, as they can affect treatment outcomes and the individual's ability to recover from conditions such as anorexia nervosa and bulimia nervosa.
Purging Behavior: Purging behavior refers to the intentional act of expelling food from the body, typically after binge eating, as a means of controlling weight or body shape. This behavior is often associated with eating disorders, particularly bulimia nervosa, but can also appear in other conditions like anorexia nervosa and binge eating disorder. Purging can take various forms, including self-induced vomiting, misuse of laxatives, diuretics, or enemas, and is driven by psychological factors such as anxiety about weight and distorted body image.
Restrictive type: The restrictive type is a subtype of anorexia nervosa characterized by severe limitation of food intake and an intense fear of gaining weight. Individuals with this type exhibit behaviors such as excessive dieting, fasting, or exercising, without engaging in binge-eating or purging episodes. This form of anorexia often leads to significant weight loss and can have severe physical and psychological consequences.
Salivary Gland Swelling: Salivary gland swelling refers to the enlargement or inflammation of the salivary glands, which can occur due to various factors including dehydration, nutritional deficiencies, or specific eating disorders. This condition is particularly significant in the context of eating disorders, where it serves as a physical manifestation of the physiological impact that severe caloric restriction or purging behaviors have on the body. The swelling can be indicative of underlying health issues and is often accompanied by other symptoms related to these disorders.
Self-Induced Vomiting: Self-induced vomiting is the act of deliberately expelling the contents of one's stomach through the mouth, often as a compensatory behavior following food intake. This behavior is commonly associated with certain eating disorders, as individuals may use it to control weight, manage anxiety related to body image, or cope with feelings of guilt after eating. It is a significant symptom in the context of specific eating disorders, where it reflects deeper psychological issues and can lead to severe physical health complications.
Self-Report Questionnaires: Self-report questionnaires are assessment tools that ask individuals to provide information about their thoughts, feelings, behaviors, and experiences through a series of questions. These questionnaires can be used to gather data on various psychological constructs, enabling researchers to explore relationships between variables, assess mental health conditions, and identify patterns of behavior. They are particularly useful in research settings for collecting large amounts of subjective data efficiently and can vary in format from open-ended questions to standardized scales.
Significant Weight Loss: Significant weight loss refers to an individual losing a substantial amount of body weight, typically defined as 10% or more of their starting body weight, within a relatively short period. This term is particularly relevant in understanding eating disorders, where drastic changes in weight can be a key indicator of underlying psychological issues such as distorted body image and unhealthy eating behaviors. It is often associated with severe health risks and can be a critical diagnostic criterion for conditions related to inadequate nutritional intake.
Social Withdrawal: Social withdrawal refers to the tendency of individuals to isolate themselves from social interactions and relationships, often as a result of psychological distress or disorders. This behavior can lead to feelings of loneliness and exacerbate existing mental health issues, making it a significant concern in various psychological conditions.
Substance Abuse: Substance abuse refers to a pattern of harmful use of psychoactive substances, including alcohol and illicit drugs, leading to significant adverse consequences in various aspects of life. This condition often manifests through physical, psychological, and social impairments, affecting individuals' ability to function normally and maintain healthy relationships. Understanding substance abuse is crucial because it intersects with mental health issues, suicidal behaviors, and eating disorders.
Weight Stigma: Weight stigma refers to the negative attitudes and beliefs directed at individuals based on their weight or body size. This societal bias often results in discrimination, marginalization, and psychological distress for those affected. It is particularly relevant in understanding eating disorders, where the pressure to conform to societal ideals of thinness can exacerbate conditions such as anorexia nervosa and bulimia nervosa, leading to harmful behaviors and attitudes toward food and body image.