Eating Disorders

There are three main types of eating disorder:

·         Anorexia Nervosa

·         Bulimia, and

·         Compulsive Eating

History of the Classification of Eating Disorders

The first cases of anorexia nervosa were described as far back as 1694 by a Dr. Morton. The name “Anorexia Nervosa” was described by a French doctor, Lasegue, in 1873 and an English doctor named Gull of Guy’s Hospital in 1874. It was not until 1979 that Professor Gerald Russell of the Maudsley, described Bulimia Nervosa. Finally, “compulsive eating” is a further category of eating disorder.

Anorexia Nervosa

Features

Anorexia Nervosa is an eating disorder in which the patient has a morbid “fear of fatness” and acts to reduce their weight and prevent weight gain to a relatively excessive degree. Patients with Anorexia Nervosa have difficulty with accurately gauging their body size. They may consider body sensations such as satiety and fullness as being indicative of a tendency towards obesity. They often have conflicting relationships with themselves and with others and may attempt to exert control over their distress through their weight restriction. Under conditions of weight restriction, the body tries to adapt by, for example, slowing down the rate of metabolism. As a consequence concentration and sleep quality can be affected. In the case of female sufferers, the menstrual cycle may also be affected so that menstruation becomes irregular and periods may even cease. The person’s general health may deteriorate as a result of the severe restriction of food often seen in Anorexia Nervosa. This may manifest overtly, for example, through the person's skin and hair becoming less healthy looking.

It is important to be aware of its principle features which are:

·         Refusing food

·         Using laxatives

·         Over-exercising

·         Vomiting

·         Weight loss

Patients with Anorexia Nervosa can often have obsessive traits. In particular, such traits may serve to exacerbate their illness and these patients may be resistant to change, including professional and family attempts to try and help them deal constructively with their difficulties. Family relationships can therefore suffer. 

Nowadays, Anorexia Nervosa is a well known illness and is being seen at a progressively earlier age. For example, it is being seen in children as young as 8. It is most common in teenage girls but is also found in boys, men and older women to a lesser extent.  The only illnesses that are more common among teenage girls are obesity and asthma.

Management

Anorexia Nervosa is treatable and with successful intervention over half of all patients will make a complete recovery. However, some patients with Anorexia Nervosa become chronic sufferers. There is a significant risk of death with this illness, should it be persistent, and up to 20% of chronic patients have been reported to die in some studies. Death can be due to malnutrition, infection, metabolic and blood abnormalities and heart problems all of which occur as a direct or indirect cause of malnutrition and the methods the sufferer uses to keep their weight down.

It is important to realise that society and families do not cause Anorexia Nervosa. Today's society can, however, promote certain body types as being desirable. This body image promotion can be a factor in influencing people towards excessive diet restriction etc. While difficult relationships within the family unit have often been associated with Anorexia Nervosa, this is not always the case.  However, people who develop Anorexia Nervosa often have a poor sense of self esteem and self confidence and this may arise from a number of different factors. It is important that these factors that influence or may serve to maintain Anorexia Nervosa are identified and taken into account when assessing and treating somebody with Anorexia Nervosa. Treatment is primarily focused on attaining and promoting positive physical and mental health in relation to this condition. This treatment is often best provided by specialist mental health services.

In Ireland the main self help group is BodyWhys, help line 01 2835126; email bodywhys@clubi.ie In the UK, the main self help group is the Eating Disorders Association, help line +44 8456341414; website: www.edauk.com ; email info@edauk.com

Bulimia Nervosa

Features

Bulimia Nervosa differs from Anorexia Nervosa in a number of different ways. People who suffer Bulimia Nervosa are often of a normal weight whereas people with Anorexia Nervosa suffer significant weight loss. With Bulimia Nervosa, there are cycles of over-eating followed by vomiting and other weight restriction methods, such as the use of laxatives and over-exercising.  It is estimated that up to 5% of the female population between the ages of 15 and 24 years suffer from this disorder. It is potentially less conspicuous than Anorexia Nervosa in that the person who suffers from Bulimia Nervosa may not be obviously underweight and may go to great lengths to keep their behaviour secretive.

The physical complications of this disorder are in some ways similar to Anorexia Nervosa. Restricting eating patterns, induced vomiting, the use of laxatives, diet pills and other weight reducing medications can often lead to malnutrition and electrolyte disturbance.  As a result of these disturbances to the body’s natural chemistry balance, the body can become weak and prone to problems such as heart arrhythmias, reduction in the body’s normal immune response (leading to infections, for example), and this can lead to collapse and even death as a result of these complications. Vomiting in this condition is often more prevalent than in Anorexia Nervosa and the sufferer may suffer from dental problems as a result of gastric acid eroding dental enamel. Furthermore, tummy and throat inflammation can also be a consequence of repeated vomiting.

As in the case with Anorexia Nervosa, patients who suffer from this disorder have often low levels of self esteem and self confidence, and self image is often poor. A person may often feel extremely guilty after taking a meal and may act to reduce this guilt through acting in the various ways mentioned above to reduce their weight and prevent what they may perceive as “fatness”. However, this practice may often be followed by an intense desire to binge eat and subsequently the cycle is repeated again and again.

Bulimia Nervosa (and indeed Anorexia Nervosa), may often be associated with other mental health difficulties such as depression and anxiety. It is important that significant depressive and anxiety symptoms are identified and treated as early as possible.

Self esteem in patients with Bulimia Nervosa is often poor and it is important to identify potential factors which may exacerbate this eating disorder. There may be many personal, interpersonal and social factors involved in maintaining this illness. However, interpersonal factors are particularly important and people who suffer from Bulimia Nervosa may have difficulties in their interpersonal relationship.

Management.

It is important that sufferers of Bulimia Nervosa are assessed and treated by adequately trained mental health professionals, so as to maximise the chances of treatment success. Treatment occurs mostly on an outpatient basis. It is aimed at educating the person with Bulimia Nervosa to understand and cope with their disorder in a constructive and positive way. This should involve a focus on establishing and maintaining healthy eating patterns and psychological support/therapy in helping the person attain positive physical and mental health. Positive self image and self esteem are important issues that should be addressed in treatment. The results of treatment are very good and 80 – 90% of patients do very well.

Compulsive Eating

Features

Compulsive eating is a disorder in which sufferers find it very difficult to resist eating to excess, often resulting in obesity.

Food can help relax us. However, people who feel anxious, depressed, frustrated or bored for example, can eat food as a way of making themselves feel better. However, compulsive eating can arise when the person who feels anxious or low over-eats in response to this mood change. This is called “reactive hyperphagia”.

Treatment for this problem is aimed at promoting positive eating patterns. Evaluation of factors which maintain or precipitate this eating pattern through psychological means (psychotherapy and/or family therapy) is also necessary. Treatment results are generally very positive.