Eating Disorders: Anorexia nervosa and Bulimia nervosa

One of the most common eating disorders in the world today are Bulimia nervosa and Anorexia nervosa. The former is characterized by eating of large amounts of food within a short time (bingeing) followed by various compensatory mechanisms. Compensatory mechanisms are basically methods used in purging the excessive food in order to avoid addition of weight. They include compulsive exercising, vomiting and prolonged use of laxatives (Stice & Bohon, 2012). There are two types of the disorder namely the purging type where vomiting and other methods of removal of food from the body are used and the non-purging type where the affected uses methods like excessive exercise and fasting to control their weight (Favaro et al., 2009). The purging type is easier to detect as the victim can be noticed and provided with help unlike the non-purging type where their tribulations can proceed unnoticed. Anorexia nervosa on its part is characterized by restriction of energy intake and constant fears of weight gain and insecurity with a self-perception of weight or shape (Myers& Dewall, 2016). In both eating disorders, there is a higher chance (about 10 times) of women developing them over boys and men. In cases where the latter are affected, they tend to develop the disorder with respect to over-excising and being muscular. This paper discusses the definition, symptomatology, diagnosis, etiology, treatment options, long and short term prognosis of Bulimia nervosa and Anorexia nervosa.

Definition

Both Bulimia nervosa and Anorexia nervosa are termed as eating disorders due to their association with dietary habits but have slight differences. Bulimia nervosa is defined by three distinct elements: Binge eating, compensatory acts and a feeling of lack of control while eating (Favaro et al., 2009). Binge eating refers to eating large amounts of food within a short time while compensatory mechanisms are the ways in which the affected person attempts to prevent weight gain after eating excessively. The feeling of lack of control while eating in Bulimia nervosa means that one goes on and on, consuming excessive calories helplessly. Anorexia nervosa on its part is defined by a restriction on energy intake, fear of gaining weight and a disturbed body image. In restricting energy intake, Anorexia nervosa patients are unable to maintain a healthy weight level and may lose large amounts of it within a short time (Wade, Keski-Rahkonen & Hudson, 2011). They also live in constant fear of gaining weight even when they are underweight. In the end, they place lots of attention on their body image and can be defined solely by how they look. They end up with a distorted view of their body shape (they can consider themselves overweight while in reality they are underweight).

Symptomatology

            There are many signs and symptoms of the above conditions some of which are closely related. For Anorexia nervosa patients, you may notice sudden changes in weight and disturbing of the menstrual cycle in women/loss of libido in men, dizziness, increasing intolerance towards food including constipation and vomiting, lethargy and facial changes (Myers & Dewall, 2016). Psychological signs include extreme dissatisfaction with body image, low self esteem, depression and anxiety and heightened fears of gaining weight. There may also be preoccupation with meals, body shape, weight and eating as well as irritability during times of meals. Behaviorally, signs and symptoms include excessive exercise, binge eating, avoiding eating with others and self harm (Wade, Keski-Rahkonen & Hudson, 2011). For Bulimia nervosa, physical signs and symptoms include fainting and dizziness, lack of sleep, frequent changes in weight and various forms of intolerance towards food (e.g. vomiting and constipation). Psychological signs and symptoms include low self esteem and feeling of shame and sensitivity in relation to food, depression and anxiety, extreme dissatisfaction with one’s body and a distorted body image (Favaro et al., 2009). In the behavioral sense, they could be vomiting and other compensatory acts, bingeing, self harm and substance abuse, secretive behavior in relation to food and compulsive exercising. As it emerges, the signs and symptoms of the two disorders are closely related and require a close examination to differentiate between the disorders.

Diagnosis

            The DSM V has offered guidelines for diagnosing both Bulimia nervosa and Anorexia nervosa. The latter is diagnosed using the aforementioned elements of restrictive energy intake relative to normal body needs leading to low body weight. It is important to take note of the contextual elements of age, body size and physical health (Save, 2000). Another criterion is the heightened fear of gaining weight even when one is of low weight. Further, there is disturbance in perception of body weight and shape. In this case, one evaluates themselves using their body weight/shape and fails to realize how serious their low weight could be. The level of severity is determined using the BMI in adults and the BMI percentile in children (Save, 2000). Other specifications in the manual include determination of full and partial remission. For Bulimia nervosa, binge eating is one of the criteria and refers to eating an amount of food larger than what would be taken under normal circumstances. Others include the feeling of lack of control in the midst of an eating episode as well as a self evaluation based on body weight and shape (Save, 2000). There is also inappropriate compensatory behavior to arrest weight gain including induced vomiting and misuse of laxative among others. The frequency of binge eating and inappropriate compensatory behaviors is at least once a week for three months.

Etiology

            The exact causes of Bulimia nervosa are not entirely known but a number of hereditary, environmental and cultural influences are often cited. Examples include low self esteem, occupations that are mindful of body shape/size, history of trauma or abuse and stressful life situations (Wade, Keski-Rahkonen & Hudson, 2011). For Anorexia Nervosa, there is evidence pointing towards genetic influences, social pressures, low self esteem and emotional distress. Just like in the case of Bulimia nervosa, the exact causes are unknown and most of the etiology remains speculative.

Treatment Options

            For both disorders, cognitive behavioral and analytical therapy, behavioral therapy and focal psychodynamic therapy are explored as potent solutions. In all these forms of therapy, there is faith integration with the counselor involving the biblical elements about personality to stir positive change (Wade, Keski-Rahkonen & Hudson, 2011). In a majority of therapeutic issues such as low self-esteem and personal harm, the counselor uses the positive descriptions of the patient provided in the Bible to help them realize their self worth and their high standing before God. This can help reprise negative self evaluations based on things like boy weight and shape and find greater meanings to define oneself with. For Bulimia nervosa, guided imagery, stress management, crisis interventions and family based treatments may also work (Myers& Dewall, 2016).

Long and Short Term Prognosis

            Both eating disorders have more serious effects that normally appreciated. In the short term, Bulimia nervosa may lead to unhealthy weight gain/losses, painful, swollen cheeks, electrolyte imbalances, breaking of blood vessels in the eyes, trouble swallowing, low self esteem, dehydration and acid reflux in the stomach (Stice & Bohon, 2012). In the long term, there can be stomach ulcers, chronic fatigue, seizures, significant relationship problems, higher susceptibility to illnesses and infections, high blood pressure, increased suicide risk and loss of normal bowel function (to the extent of requiring surgical intervention) among other effects. On the short term, Anorexia nervosa is characterized by unhealthy weight losses, low self esteem, increased risk of suicide, poor self image and bowel problems among others (Neumark-Sztainer, 2016).  More serious effects are noticeable on the long term including poor physical development in children and delaying of puberty, tooth enamel erosion due to purging, infertility and bone density loss (Favaro et al., 2009). The restriction of caloric intake may also lead to chronic malnutrition which may have extended effects such as general organ failure.

Conclusion

            It is clear that eating disorders are more serious health problems than they appear. Both Bulimia nervosa and Anorexia nervosa entail a large number of signs and symptoms that may be confused for normal feeding patterns though in essence they present a psychological disorder. More fundamentally, the signs and symptoms of the two health problems are overlapping and may complicate distinguishing them from one another. However, the DSM V manual offers two distinct frameworks that can be correctly applied to differentiate the two conditions. It must also be appreciated that the long term and short term prognosis of the two conditions is also quite damning. Therefore, it is important that one seeks treatment on either condition early enough. As demonstrated, faith integration is necessary in the therapeutic solutions to both eating disorders.

References

Favaro A, Caregaro L, Tenconi E, Bosello R, and Santonastaso P. (2009). Time trends in age at onset of anorexia nervosa and bulimia nervosa. Journal of Clinical Psychiatry, 70(12):1715-21.

Myers, D. G. & Dewall, N. (2016). Exploring psychology. (10 th ed.) Macmillan.

Neumark-Sztainer, D. (2016). Eating disorders prevention: Looking backward, moving forward; looking inward, moving outward. Eating disorders, 24(1), 29-38.

Save, Y. (2000). Diagnostic and statistical manual of mental disorders. American Psychiatric Association, 4th ed, text rev, Washington, DC: Author; Burket, RC, Schramm, LL, Therapists’ attitudes about treating patients with eating disorders (1995) Southern Medical Journal, 88, 813-818.

Stice, E. & Bohon., C. (2012). Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition, Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.

Wade, T. D., Keski-Rahkonen A., & Hudson J. (2011).Epidemiology of eating disorders. In M. Tsuang and M. Tohen (Eds.), Textbook in Psychiatric Epidemiology (3rd ed.) (pp. 343-360). New York: Wiley.