Anorexia & Bulimia

By Joe Yang

and Narattapat Watcharapariyapat

Bulimia and Anorexia: The Similarity

• Both types are classified as eating disorders.

• The actual or specific causes (etiology) and pathogenesis of both types are currently unclear.

• Both are considered progressive diseases; that is they get worse and worse as time progresses.

• Both types affect women more than men worldwide.

• Both types are considered incurable diseases; only treatments and remission (temporary end) are possible.

Bulimia and Anorexia: The Difference

• Different signs and symptoms

• Different criteria of diagnosis

• Different threats to health problems

• Different courses of treatments

• Different prevalence rates

Intro of anorexia

• It is a disorder where victims mentally believes that they are overweigh, regardless of their true weight.

• People who are anorexic, their minds are not their own, they felt unattractive and ugly but still want to be thin (Toby D. Goldsmith, 2013)

Etiology of anorexia

• One main factor; through cultural & peer pressure in pursuit of perfect or attractive body shape (The Canadian Journal of Psychiatry, 1981)

• Sudden change in diet, causing stress onto the body, thus develop anorexia. Though may be caused by genetic heritage, abnormal neurotransmissions, along with combinations of personality traits.

• Thought to be a skill applied when coping with stress ( WebMD, 2013)

Pathogenesis of anorexia

• Anorexia develops as the victims ingest less foods, eventually lack of nutrients, leading to the full developments of anorexia.

• Patients suffer from constipation, muscle weakness due to lack of nutrients and waking up unusually early, caused by the hormone disturbance (Newbridge, N/A)

Pathogenesis of anorexia

• Most crucially, anorexia causes atrophy of many organs within the body, such as the heart, leads to problems such as hypovolemia, victim have lack of oxygen.

• Victims would also have arrhythmia, for the victim have lack of energy to maintain regular heartbeat (Cardiol Rev, 2006)

Diagnosis of anorexia

• When diagnosing anorexia, be aware of how people answer questions concerning weight.

• Check for weight and BMI

• Check for irregular heartbeat, blood tests

Treatment for anorexia nervosa• From Douglas Rhein , the most common treatment for

anorexia is cognitive behavioral therapy, although the treatment is not as effective as those when compared with the effects having when treating anxiety and mild depression.

• Strictly speaking, there are no effective treatment for anorexia.

Bulimia Nervosa

© 2011 - 2012 Doctor Tipster

Bulimia Nervosa: The Definition

Feeling ashamed

Strict Dieting

Binge eating

(Overeating)

Removal of Food

(purging, etc.)

Bulimia nervosa is characterized by “recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors” (NIMH, 2011).

*Purging = self-induced vomiting, uses of laxatives, diuretics and/or enema

DIY Enema Kit

Constipation Remedies by Dr. Stephen. The enema kit that can be found in most store, by PatBlockNY An enema washes out the rectum and

lower colon by PatBlockNY.

Etiology of Bulimia Nervosa

• The exact cause of bulimia is unknown (A.D.A.M, 2012).

• Physiologically, it may be caused by an abnormality of serotonergic(serotonin-related) neuron functioning (Micah Orliss, N/A)

• Some evidence supports that it may be a genetic disease (Micah Orliss, N/A).

• Stress caused by dieting may lead to binge eating, which then leads to purging (Micah Orliss, N/A).

• In sociocultural viewpoint, bulimia is cause by the “ideal thin” body vastly portrayed in the media (Micah Orliss, N/A).

Pathogenesis of Bulimia Nervosa

• The exact pathogenesis is unclear (Brambilla, 2001).

• Generally, “people may binge and purge when they have low self-esteem, when they are pressured to conform to eating or to adhere to a specific weight and shape, and when they are knowledgeable about bingeing and purging. Compensatory behaviors such as vomiting, use of laxatives, or exercise may result in large fluctuations in weight that reinforce the behavior” (British Medical Journal, 2012).

• One hypothesis suggests that if serotonergic neurons were inadequate or ineffective it could cause an enhanced craving for food rich in carbohydrates (Micah Orliss, N/A).

Purging Type

• Dental and enamel erosion

• Swollen salivary glands (sialosis/sialadenosis)

• Callused and/or discolored skin on the finger joints (Russell's sign)

• Tooth decalcification

• Irregularly-shaped biting edges of teeth

• Increase in number of cavities

• Swollen cheeks and jaw

• Bloodshot eyes

• Metabolic acidosis, metabolic alkalosis

• Hypochloremia, hypokalemia, hyperamylasemia, hyperchloesterolimia

(ECRI Institute, 2013)

Signs & Symptoms of Bulimia Nervosa

Dental and enamel erosion

Source: Figure 1. Pretreatment dentition. A, Frontal view. B, Right side. C, Left side. D, Maxillary view. E, Mandibular view byStefanie Schwarz, Alexander Kreuter, and Peter Rammelsberg; Efficient prosthodontic treatment in a young patient with long-standing bulimia nervosa: A clinical report

Sialosis/Sialadenosis

Source: British Journal of Oral and Maxillofacial Surgery, Sialosis: 35 cases of persistent parotid swelling from two countries by CrispianScully, Jose V. Bagán, et al.

External feature of sialosis

Microscopy showing acinar hypertrophy with granular cytoplasm and compression of the striated ducts

©2013 Eating Disorders Advice, Russell’s sign – callussedknuckles from repeatedly inducing vomiting

Russell's sign

Non-purging Type

• Excessive exercise

• Abusive uses of over-the-counter diet pills

• Engagement of extended period of fasting

• (No signs of vomiting , and no use of laxatives and enema)

(ECRI Institute, 2013)

Signs & Symptoms of Bulimia Nervosa

Diagnostic Criteria for Bulimia Nervosa

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

by American Psychiatric Association

• A. Recurrent episodes of binge eating.

• B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting or excessive exercise.

• C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.

• D. Self-evaluation is unduly influenced by body shape and weight.

• E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

(Beth McGilley, Tamara Pryor, 1998)

Treatments of Bulimia Nervosa

• Cognitive behavioral therapy (CBT) (Ken Duckworth, 2012)

• Prescription medication; SSRIs (e.g. Prozac) (Ken Duckworth, 2012)

• Nutritional counseling (Havard Health, 2009)

• Interpersonal therapy (Havard Health, 2009)

References• Cardiol Rev (2006). Cardiovascular complications of eating disorders. Retrieved

at:http://www.ncbi.nlm.nih.gov/ pubmed/16924163

• Newbridge (N/A). The physical effects of anorexia. Retrieved at:http://www.newbridge-health.org.uk/factsheets/the_physical_effects_of_anorexia.php

• Toby.D (2013). An introduction to anorexia nervosa. Retrieved at:http://psychcentral.com/lib/2006/an-introduction-to-anorexia-nervosa/

• WebMD (2013). Anorexia nervosa-cause. Retrieved at:http://www.webmd.com/mental-health/anorexia-nervosa/anorexia-nervosa-cause

• NIMH (2011). A detailed booklet that describes the symptoms, causes, and treatments of eating disorders. Retrieved at http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml

• A.D.A.M (2012). Bulimia. Retrieved at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001381/

• Micah Orliss (N/A). Bulimia Nervosa. Retrieved at http://www.education.ucsb.edu/jimerson/bulimia.html#bulimia etiology

• Brambilla (2001). Aetiopathogenesis and pathophysiology of bulimia nervosa: biological bases and implications for treatment. Retrieved at http://www.ncbi.nlm.nih.gov/pubmed/11460890

• British Medical Journal (2012). Bulimia nervosa. Retrieved at http://bestpractice.bmj.com/best-practice/monograph/441/basics/pathophysiology.html

• ECRI Institute (2013). What are the signs and symptoms of bulimia nervosa?. Retrieved at http://www.bulimiaguide.org/summary/detail.aspx?doc_id=9454

• Beth McGilley, Tamara Pryor (1998). Assessment and Treatment of Bulimia Nervosa. Retrieved at http://www.aafp.org/afp/1998/0601/p2743.html#afp19980601p2743-t1

• Ken Duckworth (2012). Bulimia Nervosa. Retrieved athttp://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=149448

• Havard Health (2009). Treating bulimia nervosa. Retrieved athttp://www.health.harvard.edu/fhg/updates/treating-bulimia-nervosa.shtml