12 eating disorders

Anorexia nervosa
Bulimia nervosa
Binge-Eating disorder

 Patients with anorexia or bulimia have a disturbed body
image and use extensive methods to avoid gaining weight.
 Binge eating may occur in all of the eating disorders.

 It’s psychiatric illness that describes
an eating disorder characterized by
extremely low body weight and body
image distortion with an obsessive
fear of gaining weight.
 Patients are highly concerned with
their weight, body image, and being
thin.

 Patients are known to control body weight commonly through the
means of voluntary starvation, excessive exercise, or other
weight control measures such as diet pills or diuretics drugs.
 2 main subdivisions:
A-Restrictive type: eat very little amount and may vigorously
exercise. More often have obsessive-compulsive traits.
B-Binge eating/purging type: eat in binges followed by purging,
laxatives use and excessive exercise. Associated with increased
incidence of major depression and substance abuse.

 Family history.
 Psychiatric illness.
 Obesity.
 Chronic medical illness.
 History of sexual abuse.
 Homosexuals.

 10-20 times more common in women than men.
 In 4% of adolescents and young adults.
 Onset b/w ages 10 & 30.
 Increased incidence of comorbid mood disorders.

 More common in developed
countries and professions
requiring thin body.
 Etiology involved
environmental, social,
psychological and genetic
factors.

 Body weight at least 15% below normal
 Have intense fear of gaining weight or
becoming fat.
 Disturbed body image.
 Amenorrhea.

 Major Depression
 Obsessive compulsive disorder
 Alcohol or substance abuse

 Amenorrhea
 Electrolyte abnormalities
 Arrhythmias
 Hypotension
 Dry skin
 Hypercholesterolemia
 Lanugo
 Melanosis coli

 Leukopenia
 Hypothermia and cold intolerance
 Lethargy
 Osteoporosis
 Patients are often preoccupied with food rituals,
intensely fear becoming fat, and judge themselves
by their weight.

 Medical conditions
 Major depression
 Mental disorders
 Bulimia.

 Variable…
 Mortality rate…

 Early treatment centers on monitoring caloric intake to stabilize
weight and then focuses on weight gain.
 Treated as outpatients- unless; their weight is more than 20%
below ideal body weight, or in severe cases to restore nutritional
status and/or correct electrolyte imbalances.
 Later treatment includes individual, family, and group
psychotherapy.
 SSRIs may help treat comorbid depression such as Paroxetine.

 An eating disorder which is characterized by recurrent binge
eating, followed by compensatory behaviors. Patients are
usually ashamed of their eating behaviors, tend to keep them
secret, and often maintain normal body weight.
 Has a 3-5% prevalence rate among late adolescent girls.
 Can be classified into; purging & nonpurging types.

 Recurrent episodes of binge eating.
 Recurrent inappropriate attempts to compensate for
overeating and prevent weight gain.
 These behaviors occur at least twice a week for 3 months.
 Perception of self-worth is excessively influenced by body
weight and shape.

 Mood disorders
 Anxiety disorder
 Personality disorders
 Substance abuse

 Dental enamel erosion
 Salivary glands hypertrophy
 Calloused knuckles
 Menstrual irregularities
 Electrolyte imbalance (hypochloremic hypokalemic alkalosis)
 Laxative dependence
Patients’ self-esteem is overly dependant on body weight.

 Affects 1-3% of adolescents and
young females.
 More common in females than males.
 More common in developed
countries.
 High incidence of comorbid mood
disorders, impulse control disorders
and alcohol abuse/dependence

 Better prognosis than anorexia nervosa.
 Symptoms exacerbated by stressful conditions.
 One half fully recover with treatment.
 One half have chronic course with fluctuating symptoms.

 Individual psychotherapy, cognitive-behavior
therapy, group therapy.
 Pharmacotherapy: SSRIs as a first line
treatment then TCAs

 An eating disorder characterized by
periods of extreme over-eating, but here
they DO NOT try to control their weight by
purging or restricting calories as do
anorexics or bulimics.
 Patients with this disorder suffer emotional
distress over their binge eating.
 So they are obese.

 Recurrent episodes of binge eating ( excessive amounts of food in a
2 hour period associated with lack of control).
 Sever distress over binge eating.
 Bingeing occurs at least 2 days a week for 6 months and NOT
associated with compensatory behaviors.

 Three or more of the following:
1. Eating very rapidly.
2. Eating until uncomfortable full.
3. Eating large amounts when not hungry.
4. Eating alone.
5. Feeling disgusted, depressed, or guilty after overeating.

 Dysphoric mood
 Interpersonal stressors
 Intense hunger after dietary restrain

 People with binge eating disorder may become ill due to
a lack of proper nutrition.
 People with binge eating disorder are usually very upset
by their binge eating and may become very depressed.
 Obesity has many adverse effects on health
 Depression, sometimes called post binge anguish, often
follows the episode.

 Individual psychotherapy and behavioral therapy with strict diet
and exercise program.
 Comorbid mood disorders or anxiety disorders should be
treated.
 Pharmacotherapy: used adjunctively to promote weight loss.
Include:
-Stimulants: phentramine and amphetamine.
-Orlistat (Xenical).
-Sibutramine.

12 eating disorders

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