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Eating disorders Chapter 9
Eating disorder: severe disturbance in eating behaviour
Anorexia nervosa, bulimia nervosa separate syndromes in the DSM-IV but
often co exist and can be deadly adult eating disorders
oFear of becoming fat, pursuit of thinness ect
Clinical aspects of eating disorder
oAnorexia nervosa : literally meanslack of appetite induced by
nervousness”
oMisnomer lack of appetite isn’t the real problem, problem is the
intense fear of becoming fat combined with refusal to maintain a
minimally low body weight
oFirst medical account of A/N in 1689 by Richard Morton described two
patients, 18 year old girl, 16 year old boy
Suffered from “nervous consumption” that caused wasting of
body tissue
oFemales to be diagnosed must have had one menstrual cycle, and their
cycles must stop to meet diagnostic criterion
Stopping of menstrual cycles however can obvi still have eating
disorder without amenorrhea, just as ill as those whose cycles
stop called ENDOS (covered in a few pages)
oExtreme denial may wear baggie clothes, hide objects to make self
look bigger and drink large amounts of water to weight is as more to
deny problem
o2 types of A/N restricting type(eat slow, small pieces, hide food) and
the binge eating/purging type
Binge or purge or both b/c relentless restriction of all food is not
possible for all anorexics, some make use of a binge purge
strategy
Binge: out of control eating of amounts of food greater than
normal ppl
Purge: remove the food from their body somehow vomit,
laxatives, diuretics, enemas
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30-50 % transition from restrictive A/N to binge/purge @
some point in their disorder
Ballet dancers @ high risk b/c emphasis on slender physique
Laxatives however do not actually produce weight loss, b/c food
digested and absorbed, just fluid lost
Death usually result of physiological consequences of starvation
or more intentional suicidal behaviour
Contrast bulimia b/c death as direct cause of eating disorder is
rare
oBulimia nervosa
Binge eating and efforts to prevent weight gain like self induced
vomiting and excessive excersize
Bulimia greek words ox and hunger meaning they can eat an ox
Much in common with binge/purge of anorexia
Difference is anorexics are severely underweight while
the bulimics are normal or can even be overweight
If a binge/purger also meets criteria for anorexia nervosa,
diagnosis is A/N
DSM-IV requires most severe eating pathology takes
precedence
Common overwhelming fear of being fat, bulimics typically of
normal weight
After a massive binge up to 5000 kcals they abuse purging
strategies which alleviates fear of weightgain regardless of the
disgust they feel from behaviour
High food bills
Steal food from roomates
Non purge bulimia doesn’t vomits/laxatives just excersize
excessively or diets
Typical patient with A/N denies seriousness of disorder and is
unaware of shcock/ concern that her peers/family experiences
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Bulimic patients are anything but complacent
oShameful, guilt, self depreciation, low self esteem,
efforts for concealment
oStruggles to master the urge to binge eat
READ CASE STUDIES ON PAGE 322/323
Attempts to diet, micromanaging dayplans, mind cannot
stop thinking about eating
oAge of onset and gender differences
Considered modern disorders but pathological conern for eating
dates back centuries ago
St Catherine of sienna died 15 years after onset (16 y/o) refused
to consume food/water
Galen reffered to a syndrome characterized by overeating
followed by vomiting and fainting
Average onset 18.9 years old for anorexia and bulimia avg
onset @ 19.7 y/old
Eating disorders of the elderly often missed or attributed to
other problems
Far more commen in women, ratio 10:1
oMedical complications of A/N and B/N
A/N one of most lethal psychiatric disorders patients look
extremely unwell/unhealthy
Hair and nails become thin and brittle
Skin dry, downy hair grows on
face/neck/arms/legs/back(furry hair where not supposed to
be)
Yellowish tinge to skin palm of hands, hands and feet
always cold due to lack of oxygen to extremities, purplish
blue tinge
Chronic low blood pressure patients tired, weak, dizzy, faint
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