Eating Disorders are disorders characterized by alterations in eating patterns and disturbances in body image that interferes with relationships and occupational functioning. There are nine types described by the DSM-5:
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Other Specified Feeding and Eating Disorder (OSFED)
- Pica
- Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Unspecified Feeding or Eating Disorder (UFED)
- Others: - Muscle Dysmorphia - Orthorexia Nervosa (ON)
Factors Influencing Eating Disorders
- Biologic Factors: - Genetic vulnerability from personality types’ - Lateral hypothalamus dysfunction resulting in anorexia, and Ventromedial dysfunction resulting in unsatiety and excessive eating
- Neurochemical Changes: - Decreased norepinephrine results in anorexia (AN, AFRID) - Increased serotonin results in decreased satiety (bulimia, BEDs) - Decreased monoamine oxidase, resulting in bulimia and purging disorders
- Developmental Factors: lack of autonomy, lack of identity, lack of role models, and familial dysfunctions (disorder as a result of conflict response; childhood adversity e.g. abuse, rejection, overprotectiveness, authoritarianism, etc.)
- Sociocultural Factors: advertisements, magazines, and movies with unrealistic body standards, peer pressure, etc.
Anorexia Nervosa
A life-threatening disorder with weight reduction ranging from 15% to 85% less than normal body weight.
- Restricting Subtype: weight loss results from fasting, dieting, and excessive exercise.
- Binge-Purging Subtype: weight loss results from purging (vomiting, laxatives, diuretics, enema)
Symptoms
- Amenorrhea for at least three cycles
- No organic explanations for weight loss
- Overtly thin, but a feeling of being fat
- Refusal to maintain body weight
- Emotional expression is restrained
- Social Withdrawal and Depression may be present
- Intense fear of gaining weight
- Preoccupied with food, e.g. in grocery shopping, collecting recipes, counting calories, formulating fat-free meals, and other unusual ritualistic food behaviors (not eating around others, cutting food into small pieces, not allowing food to touch the lips)
| System | Symptoms |
|---|---|
| Cardiac | Hypotension, Bradycardia, Cardiac arrythmias |
| Dermatology | Dry cracking skin, Lanugo, Acrocyanosis |
| Hematology | Leukopenia, Anemia, Thrombocytopenia |
| Metabolic | Hypoglycemia, Hypothyroidism, Cold Intolerance, Weakness |
| Musculoskeletal | Fat loss, Osteoporosis, Pathologic Fractures |
| Gastrointestinal | Constipation, Abdominal pain, Diarrhea |
| Reproduction | Amenorrhea |
| Neuropsychiatry | Depression, Insomnia |
| Others | Electrolyte imbalances, Elevated BUN, Salivary gland hypertrophy |
Bulimia Nervosa
An eating disorder characterized by recurrent episodes of binge eating at least twice a week for three months.
Symptoms
- Binge-Eating
- Under strict diets or vigorous exercise
- Lack of eating control
- Induced Vomiting
- Moth-eaten appearance of teeth
- Increased and persistent bodily concerns
- Abuse of diuretics and laxatives
| System | Symptoms |
|---|---|
| Dental | Perimyolysis (erosion of dental enamel) |
| Gastrointestinal | Salivary gland inflammation, parotid gland enlargement, pancreatitis, esophagitis |
| Metabolic | Electrolyte abnormalities, hypokalemia, metabolic alkalosis, hypochloremic alkalosis, hypomagnesemia, elevated BUN |
| Neuropsychiatric | Seizures, fatigue, weakness |
| Anorexia | Bulimia |
|---|---|
| Egosyntonic | Egodystonic |
| Early Onset: 12 to 20 y.o. or less | Late Onset: >20 y.o. |
| Below normal body weight | Near normal or normal body weight |
| Does not recognize abnormal eating behavior | Recognizes altered eating pattern |
| Less worried about external opinions | Worried about external opinions |
| Starvation | Binge followed by purge |
| Amenorrhea | No amenorrhea |
- Egosyntonic: actions and thoughts in line with the ego i.e. perceived as natural to the individual.
- Egodystonic: actions and thoughts dissonant with the ego i.e. recognized as abnormal behavior.