EATING DISORDERS in their pockets and purses.

While eating
meals, they try to dispose food in their
ANOREXIA NERVOSA napkins or hide it in their pockets. They cut
meals into very small pieces and spend a
 Willful and purposeful behavior directed great deal of time rearranging the pieces on
toward losing weight, weight loss, their plates.
preoccupation with body weight and food,
peculiar patterns of handling food, intense DSM-IV-TR Diagnostic Criteria for Anorexia
fear of gaining weight, disturbance of body Nervosa
image and amenorrhea  Refusal to maintain body weight at or
 They lose weight by: above a minimally normal weight for
o Reducing their food intake age and height (eg. Weight loss <85% of
o Develop rigorous diet that expected; failure to make expected
o Rigorous diet but will lose control weight gain during period of growth,
and regularly engage in binge eating leading to body weight <85% of that
followed by purging behaviors expected)
o Routinely purge after eating small  Intense fear of gaining weight or
amounts of food becoming gat, even though
underweight
Epidemiology:  Disturbance in the way in which one’s
 Up to 4% of adolescent and young adult body weight or shape is experienced,
females (10x more common in females than undue influence of body weight or
in males) shape on self-evaluation, or denial of
 Most common onset are in midteens (14- the seriousness of the current low body
18 years old) weight.
 Most frequent in developed countries, with  In postmenarchal females, amenorrhea
the greatest frequency among young i.e., the absence of at least three
women in professions that require thinness consecutive menstrual cycles. (A
such as modeling and ballet woman is considered to have
amenorrhea if her periods occur only
Clinical Features: following hormone administration, e.g.,
 An intense fear of gaining weight and estrogen)
becoming obese is present in all patients
with the disorder and undoubtedly Specify type:
contributes to their lack of interest in, and
even resistance to, therapy. Restricting type: during current episode of
 Most aberrant behavior directed toward anorexia nervosa, the person has not regularly
losing weight occurs in secret. They usually engaged in binge-eating or purging behavior
refuse to eat with their families or in public (i.e, self-induced vomiting or the misuse of
places. laxatives, diuretics, or enemas
 Patient abuse laxatives and even diuretics
to lose weight, and ritualistic exercising, Binge-eating/Purging type: during the current
extensive cycling, walking, jogging and episode of anorexia nervosa, the person has
running are common activities. regularly engaged in binge-eating or purging
 Patient exhibit peculiar behavior about behavior (i.e., self-induced vomiting or the
food. They hide food all over the house and misuse of laxatives, diuretics, or enemas)
frequently carry large quantities of candies
 o Feelings and emotions
Course and Prognosis: o Bingeing and purging behaviors
 Varies greatly: o Problems in interpersonal
o Spontaneous recovery without relationships
treatment
o Recovery after a variety of BULIMIA NERVOSA
treatments
o Fluctuating course of weight gains  Bumilia means binge eating, which is
followed by relapses defined as eating more food than most
o Gradually deteriorating course persons in similar circumstances, and in
resulting to death caused by similar period of time, accompanied by a
complications of starvation strong sense of losing control
 Indicators of favorable outcome:  When binge eating occurs in normal weight
o Admission of hunger or overweight persons who are also
o Lessening of denial and immaturity excessively concerned with their body
o Improved self-esteem shape and weight and who are regularly
 Indicators of poor outcome: engage in behaviors to counteract the
o Childhood neuroticism calorie gain in binges.
o Parental conflict  Recurrent episodes are more common than
o Bulimia nervosa anorexia nervosa
o Vomiting  Unlike patients of anorexia nervosa, those
o Laxative abuse with bulimia nervosa may maintain a
o Various behavioral manifestations normal body weight
(e.g., obsessive-compulsive,  More prevalent than anorexia nervosa
hysterical, depressive,  Onset is often later in adolescence than that
psychosomatic, neurotic, and denial of anorexia
symptoms)  Rate of occurrence in males is one-tenth of
that in females
Treatment:
Hospitalization Diagnosis and Clinical Features:
 Restore patients’ nutritional status;  Vomiting is common and usually induced by
dehydration, starvation, and electrolye sticking a finger down the throat, although
balances some patients are able to vomit at will.
 Those who are 20% below the expected  Depression, sometimes called postbinge
weight are recommended for inpatient anguish, often follows the episode
programs and those who are 30% below
their expected weight require psychiatric DSM-IV-TR Diagnostic Criteria for Bulimia
hospitalization for 2 to 6 months. Nervosa
 Compulsatory admission or commitment  Recurrent episodes of binge eating. An
should be obtained only when the risk of episode of binge eating is characterized by
death from the complications of both of the ff:
malnutrition is likely o Eating, in a discrete period of time
(eg. Within any 2-hour period), an
Psychotherapy amount of food that is definitely
 Effective for inducing weight gain larger than most people would ear
 Patients are taught to monitor: during as similar period of time and
o Food intake under similar circumstances
 o A sense of lack of control over eating  Cognitive Behavioral Therapy
during the episode (eg., feeling that one o Considered to be benchmark, first
cannot stop eating or control what or line of treatment
how much one is eating)
 Recurrent inappropriate compensatory EATING DISORDER NOT OTHERWISE SPECIFIED
behavior in order to prevent weight gain,
such as self-induced vomiting; misuse of  Residual category used for eating disorders
laxatives, diuretics, enemas, or other that do not meet the criteria for specific
medications; fasting’ or excessive exercise eating disorder
 The binge eating and inappropriate  Binge-eating disorder:
compensatory behaviors both occur, on o Recurrent episodes of binge eating
average at least 2x a week in the absence of the inappropriate
 Self-evaluation is unduly influenced by body compensatory behaviors
shape and weight characteristic of bulimia nervosa
 The disturbance does not occur exclusively o Such patients are not fixated on
during episodes of anorexia nervosa body shape and weight

Specify type: OBESITY

Purging type: during the current episode of  Refers to an excess of body fat
bulimia nervosa, the person has regularly  Prevalence of obesity is highest in minority
engaged in self-induced vomiting or the misuse populations, particularly among women
of laxatives, diuretics, or enemas  Weight gain is most pronounced in both
sexes between the ages 25 and 44.
Nonpurging type: during the current episode of  Pregnancy probably contributes to the
bulimia nervosa, the person has used other greater increase in women
inappropriate compensatory behaviors, such as  Persons accumulate fat by eating more
fasting or excessive exercise, but has not calories than are expended as energy; thus
regularly engaged in self-induced vomiting or intake of energy exceeds its dissipation.
the misuse of laxatives, diuretics or enema
Factors causing obesity:
Course and Prognosis:  Genetic
 Overall, bulimia nervosa seems to have a  Developmental
better prognosis than anorexia nervosa.  Physical activity
 Prognosis depends on the severity of the  Brain damage: rare
purging sequelae – that is whether the  Other clinical factors:
patient has electrolyte imbalances and to o Cushing’s syndrome
what degree the frequent vomiting results o Myxedema
in esophagitis, amylasemia, salivary gland o Frohlich’s syndrome
enlargement, and dental caries
 Psychotropic drugs
 Psychological
Treatment:
 Most patients with uncomplicated bulimia
Clinical Features:
nervosa do not require hospitalization
 Many obese persons report that they
 They are not as secretive as anorexic overeat when they are emotionally upset,
patients, therefore outpatient treatment is
often soon thereafter
usually not difficult.
 Obese persons seem inordinately
susceptible to food cues in their
environment, to the palatability of foods,
and to the inability to stop eating if food is
available

Course and Prognosis:

Treatment:
 Diet and exercise
 Pharmacotherapy
o Orlistat (Xenical)
o Sibutramine (Meridia)
 Surgery
o Gastric bypass
o Gastroplasty
o Lipectomy (surgical removal of fat):
no effect on weight loss in the long
run
 Behavior modification

Valenzuela, April Abigail