EATING DISORDERS

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1. Anorexia Nervosa
It is characterised by the following prominent
clinical features:
i. It occurs much more often in females as
compared to the males. The common age of
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ii. There is an intense fear of becoming obese. This
fear does not decrease even if body becomes very
thin and underweight.
iii. There is often a body-image disturbance. The
person is unable to perceive own body size
accurately.
iv. There is a refusal to maintain the body weight
above a minimum normal weight for that age, sex
and height.
v. Significant weight loss occurs, usually more than
25% of the original weight. The final weight is
usually 15% less than the minimum limit of
normal weight (for that age, sex and height) or a
 Quetelet's body-mass index (BMI) of 17.5 or less
(Quetelet's body-mass index = weight in kg
divided by square of height in meters).
vi. No known medical illness, which can account for
the weight loss, is present.
vii. Absence of any other primary psychiatric
disorder.
[Link], primary or secondary, is often
present in females.
► The patient imposes dietary restrictions on self;
can have peculiar patterns of handling food, such
as breaking food into small bits, hiding food; and
• • •
can engage 1n VIgorous exercises.
► ~orexia' is actually a misnomer as there is never
really a decrease in appetite, initially; in fact
patient is often preoccupied with food.
► A lot of time may be spent in collecting recipes
and cooking food for significant others.
► Depressive symptoms are common and so are
obsessive-compulsive personality traits.
► Psychomotor activity is usually increased.
► In severe cases, fine lanugo hair may develop all
over the body.
► Women with anorexia nervosa can present with
poor sexual adjustment, with conflicts about
being a woman and fear of pregnancy.
► Many patients are unconsciously unable to accept
a ' female role'.
► A large number (up to 50%) of patients with
anorexia nervosa also have bulimic episodes.
► These are characterised by rapid consumption of
large amounts of food in a relatively short period
of time, occurring usually when alone. This is
known as eating binges or binge-eating.
► These binges are followed by intense guilt and
attempts to remove eaten food, for example, by
self-induced vomiting, laxative abuse, and/ or
diuretic abuse.
► If untreated, the weight loss can become marked.
► Death may occur due to hypokalaernia (caused by
self-induced vomiting), dehydration,
malnutrition or congestive cardiac failure (caused
by anaemia).
► Anorexia nervosa should be differentiated from
other weight loss conditions such as
hypopituitarism, lateral hypo thalamic lesion and
debilitating systemic illnesses, e.g. disseminated
tuberculosis and psychiatric disorders such as
depressive disorder and schizophrenia.
Treatment
✓ Short-term treatment, to encourage weight gain
and correct nutritional deficiencies, if any.
✓ Long-term treatment, aimed at maintaining the
near normal weight achieved in short-term
treatment and preventing relapses.
✓ Behaviour therapy (BT) - providing positive
reinforcements (and at times, negative
reinforcements) based on weight gain by the
patient.
✓ Individual psychotherapy.
✓ Hospitalisation, with adequate nursing care for
food intake and weight gain. Watch for water and
electrolyte balance, need for supplementation
with vitamins and minerals, and prevent
osteoporosis.
✓ Ant-iR
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✓ Antidepressants.
✓ Group therapy and family therapy.
✓ Psycho-education.
Prognosis
✓ The prognosis is generally better if diagnosis is
made early, absence of previous hospitalisations
and absence of bulimic episodes.
✓ Weight gain and improvement in mental outlool<
often precedes return of menstrual function.
2. Bulimia Nervosa
It is characterised by the following clinical features:
i. Bulimia nervosa usually has an onset in early
teens or adolescence.
ii. There is an intense fear of becoming obese. There
may be an earlier history of anorexia nervosa.
iii. There is usually body-image disturbance and the
person is unable to perceive own body size
accurately.
iv. There is a persistent preoccupation with eating,
and an irresistible craving for food. There are
episodes of overeating in which large amounts of
food are consumed within short periods of time
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v. There are attempts to 'counteract' the effects of
overeating by one or more of the following: self
induced vomiting, purgative abuse, periods of
starvation, and/ or use of drugs such as appetite
suppressants.
vi. No known medical illness is present which can
account for the disorder.
vii. Absence of any other primary psychiatric
disorder.
Treatment
✓ Behaviour therapy: This is based on providing
positive reinforcements (and at times negative
reinforcements) based on the control of binge
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✓ Individual psychotherapy.
✓ Antidepressants.
✓ Group therapy and family therapy.
3. Obesity (Overeating Associated with Other
Psychological Disturbances)
► Obesity caused by a reaction to distressing events
is included here.
► Obesity caused by drugs or endocrinal factors, or
due to constitutional factors is not considered a
psychiatric disorder.
Treatment
✓ Depends on the underlying cause
psychotherapy (for present or past psychological
distress), antidepressants (for depression), advice
from dietician, drug treatment, or even bariatric
surgery.
4. Binge Eating Disorders
► In binge eating disorder, large amounts of food
are consumed in a relatively short period,
followed by severe discomfort and feelings of self-
denigration.
► There is a sense of lack of control over eating
during the episode.
► Additionally, there also may be eating of large
amounts of food throughout the day with no
planned meal times, eating alone because of
being embarrassed, and/or feeling guilty and
depressed after overeating.
► Treatment is similar to bulimia nervosa.
5. Psychogenic Vomiting
► The characteristic clinical features include:
i. Repeated vomiting, which typically occurs soon
after a meal has begun or just after it has been
completed.
ii. Vomiting often occurs in complete absence of
nausea or retching (Patients say that food just
seems to come back up).
iii. Vomiting is often self-induced and can be
suppressed, if necessary.
iv. Despite repeated vomiting, weight loss is not
usually significant.
v. The course of illness is usually chronic with
- -frequent remissions and relap~~:.
Treatment
✓ Correct diagnosis and exclusion of other physical
and/ or psychiatric causes.
✓ Identification of psychosocial stressor.
✓ Environmental manipulation and encouragement
of coping strategies to deal with stress.
✓ Psychotherapy - Cognitive behaviour therapy,
Psychodynamic therapy.