1. Eating Disorders 1

2. There are basically two psychological or behavioral eating disorders: Anorexia Nervosa, and Bulimia Nervosa. Obesity is not classified as a psychiatric problem in DSM-IV. Society and culture have a major influence on eating behaviors. 2

3. Anorexia Nervosa Ch.Ch. By (criteria): 1. extreme weight loss (at least 15 percent) deliberately (on purpose) achieved by dieting (denial of the seriousness of the current low body weight). 2. a morbid fear of obesity and refusal to maintain body weight at or above normal weight for age and height, or failure to make expected weight gain during a period of growth leading to a body weight less than 85% of that expected. 3. Distortion in body-image (they perceive self as fat when obviously underweight). They use self-induced vomiting, laxatives and diuretics 4. Preoccupation (abnormal attitudes) with food: there may be obsessive with food, refusal to eat… 5. Feeling of depression and/or anxiety usually combine this disorder 6. Amenorrhea in females; loss of libido in males. 3

4. Anorexia Nervosa Age of onset is early to late adolescents.  It occurs 0.5-1% of adolescent girls  It is 10-20 times more common in girls (95% female).  The prognosis is not good and the mortality (death) rate 5-18% (due to cardiac arrest secondary to severe food restriction or suicide) There are two types: 1. Restricting type (dramatic decrease in food intake) 2. Binge (excessive)-eating/Purging type. Behavioral ch.ch.: Individuals usually exhibit obsessive compulsive behavior, depression, anxiety, rigidity, perfectionism, and poor sexual adjustment 4

5. Physical Complications Reduction of sex and thyroid hormone secretion, secondary to hypothalamic and pituitary dysfunction Increase of growth hormone and cortisol secretion Increased insulin response to glucose loading low basal (general, main body) temperature and impaired temperature regulation (hypothermia: a lower than normal body temperature) Bradycardia (abnormal slow heart rate) and risk of cardiac failure Edema and skin problems low basal metabolic rate and GI problems High serum cholesterol Abnormal liver function tests low serum zinc (leads to brittle nails and hair loss) Osteoporosis (and other skeletal problems) Loss of muscle tone and muscle mass (general weakness) Brain ventricles enlargement 5

6. Bulimia Nervosa (criteria) Bulimia is an episodic, uncontrolled, compulsive, rapid ingestion (taking) of large amount of food followed by inappropriate compensation to get rid the body from the excess calories (powerful and intractable urges نهم بإلحاح to overeat) efforts to avoid the fattening effects of food by inappropriate compensatory behaviors (inducing vomiting, abusing purgatives (laxatives and diuretics misuse: in purging type.. Other behaviors: fasting, or intense exercise: in non purging type) morbid fear of fatness 25–50 percent of bulimic patients have a past history of anorexia People have this binge and purge syndrome are within a normal weight range. There are two specific types: 1. Purging type: inducing vomiting, laxatives misuse 2. Non purging type: fasting, or intense exercise 6

7. Epidemiology Patients tend to be older, more sexually experienced, and more confident and outgoing than those with AN. Sex: most cases are female. Age: late teens or early 20s. Marital status: about 25 percent are married. 7

8. Etiological implications for Anorexia & Bulimia 1. Genetics 2. Neuroendocrine abnormalities 3. Serotonin neurotransmitter activity/dysregulation 4. Psychodynamic influences (individual (body dissatisfaction, frustration, anger..), social, and cultural influences: e.g., media, pressures, environmental demands, failures, abuse, eating disturbances and restrictions…) 5. Family influences/interactions (conflict avoidance)* 6. Elements of power and control 8

9. Review of Bulimia Nervosa Criteria Diagnostic criteria:  Recurrent episode of binge eating defined as lack of control over a discrete periods of excessive eating  Recurrent, inappropriate compensatory behavior in order to prevent weight gain  Induce vomiting  Fasting  Use of laxative  Excessive exercise  Binge eating and inappropriate compensatory behaviors both occur, on an average, at least twice a week for three months. 9

10. Bulimia Nervosa (cont'd)  Self evaluation is unduly influenced by body shape and weight  The disturbance does not occur exclusively during episode of anorexia nervosa Onset, prevalence and prognosis  The usual age of onset is usually later than anorexia  It is present in 1-3 % of women  More common in women  The prognosis is better than for anorexia nervosa 10

11. Bulimia Nervosa (cont'd) Behavioral changes:  Individuals are often obsessed with their appearance and attractiveness to the opposite sex  They are likely to be sexually active and maintain a normal weight 11