Eating Disorders

Introduction:

Anorexia nervosa is described by William Gull in 1868 and is characterized by deliberate weight loss and extreme characterized. In bulimia, binge eating episodes followed by vomiting. There is considerable overlap between these two eating disorders.

1 Anorexia Nervosa:

Concerns about weight and diet to lose weight are very common in the general population, particularly among young women. Anorexia nervosa is an extreme form of that conduct. The fear of fat leads to the assumption of a starvation diet. Weight is covered by at least 15% of normal, so that the Body Mass Index (BMI) of 17.5 or less. Despite these continue to believe anorexics that they are overweight even when they faced with their reflection thin. Distorted body image it continues to lose weight, and may have other methods, such as excessive exercise, even vomiting, abuse laxatives, diuretics or appetite suppressants such as amphetamine-induced adopted. You should not use food hoarding are employed or are very interested in the kitchen, making elaborate meals for their families while they refuse to eat. Amenorrhea occurs in the early stages of weight loss and is indicative of a generalized disorder of the endocrine system. Table 1 shows the signs and symptoms observed in anorexia nervosa.

2 Bulimia:

In bulimia, there is a fear of being fat, but the characteristic symptom of binge eating. Binge is the consumption of huge quantities of food in one sitting, especially carbohydrate-rich products such as biscuits, cakes and bread. They are often in secret and away from meals instead. Some bulimics usually eat at other times, though calorie-controlled diet are common. A few also have anorexia nervosa. In bulimia, binge produce feelings of guilt and disgust and the feeling of control. These feelings lead to a desire to get rid of the food, usually obtained by finger into the throat to vomit. Many bulimics are eventually able to vomit spontaneously. As with anorexia, laxative and diuretic abuse may be new threats to health. Despite the fear of gaining weight, many normal weight and may even be overweight. Menstruation is often normal.

Epidemiology

Bulimia is more common than anorexia. Anorexia nervosa usually begins later in adolescence and bulimia a few years. Surveys of young women found a prevalence of 13% for bulimia and 1 to 2% for anorexia nervosa. Both are much more common in women than in men. Occupations that have to maintain a low body weight, such as ballet dancing and modeling are instructed to be particularly at risk of anorexia.

etiology

The etiology of both anorexia and bulimia is similar. There are many factors considered important and most cases are caused by a combination of causes.

Predisposing

cultural factors. nervosa Anorexia and bulimia are diseases of life in the rich industrial countries.
Western society has developed a stereotypical view of physical attractiveness that “thin” with “beautiful” of the molecule and promotes a negative attitude toward obesity. The media bombard us with idealized images of underweight models in addition to the advertising of sweets. Young people are particularly susceptible to cultural pressure to conform and be attractive. genetic factors. twin studies have shown that genetic factors play a role, perhaps by creating a susceptibility to weight loss and in the presence of pollution from an eating disorder to develop. hypothalamic dysfunction. The area of the hypothalamus of the brain controls eating behavior, temperature regulation and water balance. There are significant changes in the functioning of the endocrine system in anorexia (Table 1) .. Overall, these changes are secondary to weight loss, but the early onset of amenorrhea in some women with anorexia nervosa, it can change some primary.

summarized in Table 1. (below) The signs and symptoms of anorexia nervosa.

endocrine

Growth hormone , cortisol, Gonadotropin, T3

heart

bradycardia, hypotension

Amenorrheo

downy hair on the

sensitivity / p> < muscle weakness / strong>

edema

psychological

/ fear of obesity, the study of Food disfigured body “image / strong

/ p> / p> > / p

/ p> / p>

failures and maintaining factors / p> family issues. Preparing and sharing food plays an important role in family relationships. The conflicts that are often played between young people ant their parents at mealtimes, with food refusal is an act of rebellion. There is often a discrepancy in family relationships, even if the problems are the result of an eating disorder, rather than the cause. It is common for the mother to have some concern about weight and diet, and in some cases, an eating disorder. psychological issues. Youth can be a time of conflict with parents or others. Feel they have little control over events, lack of confidence and low self-esteem are common. In some cases, anorexia can be a means to some of the psychological pressure address the illusion of control. Another theory is that amenorrhea and cessation of physical development of anorexia nervosa responding to the request, the problems of adolescence and adulthood to prevent escape. Parents who do not want their daughter, a wife and will leave the house in this illusion of extended childhood can be understood.

Patients with eating disorders are often very reluctant to, that they are sick, and the realistic fear that the main objective is the treatment gain weight. Therefore the first challenge engages in the management of eating disorders in the patient treatment. It may take several hours over several dates in order to gain the trust of the patient, make an assessment and developed a therapeutic relationship, the changes will happen early.

Assessment begins with a full psychiatric history and examination of mental status. A source in the family can often provide valuable information, but can not be in contact with the patient’s consent. The most important differential diagnosis to consider is the psychiatric disorder of depression. A detailed physical examination is important to find evidence of malnutrition and the effects of repeated vomiting. have physical illnesses that a weight loss must be excluded, particularly debilitating chronic disease, malabsorption, thyrotoxicosis. Investigations may include complete blood count, urea and electrolytes, creatinine, liver function tests, ECG and chest X-ray.

The aim of any treatment program should return to a healthy weight, and stop seizures and weight control measures that threaten health. It makes sense, towards a realistic target weight work is achieved through negotiation with the patient. Psychological, social and physical treatments are considered.

1 Psychological treatment

• I. cognitive therapy: It has been shown that successful in studies. It aims to examine and change the thought processes behind the abnormal behavior. The treatment can be a journal, such registration or vomiting frenzy and thoughts and feelings before, during and after the behavior. The protocol will work in therapy sessions for the patient and therapist to be finding a strategy for changing behavior.

• II behavior therapy. It is the patient learn new behaviors through a system or rewards and positive feedback. Goals that are realistic and fixed. A plan for achieving the target is discussed, and progress monitoring. Success is rewarded with praise and trust of the patient profits from their success. As each target a new set

is reached • III family therapy .. can That may be the treatment of choice if the abnormal family relationships are seen as having a role in eating disorders. There are many different models of family therapy. In most cases, two therapists work in collaboration with the family. The whole family will be the source of problems rather than the individual with the eating disorder and is known to all family members play in the therapy sessions, so the family is an opportunity to understand how to carry out the functions of the family and changes.

2 Physical therapy

There are only a limited role for drug treatment in the management of eating disorders. Fluoxetine, a reuptake inhibitor (SSRI), which is normally used to treat depression, bulimia is also used in order to suppress the appetite and limit bulimia. This is not an adequate treatment of bulimia in itself and should be used in addition to psychological therapists.

3 The Social

Some patients are social interventions, including help, need to gain confidence and independence. Social and support groups, advice on housing and finances and occupational therapy can be helpful.

4 Inpatient treatment

The majority of patients with anorexia and bulimia can be treated as outpatients. However, if the weight on a dangerous level, the approval may be required, ideally in the joint custody of both a psychiatrist and physician. Weight gain is a diet of regular meals, achieved complete with appropriate high-calorie drinks and snacks. The nurses have an important but difficult to manage. You have to find a balance between building a trusting relationship with the patient and the adoption of a supervisory role, monitoring, and meals, make sure there is no self-registration and vomiting weight gain.

evolution and prognosis

The course of development of eating disorders is variable and fluctuates. Normally about 65% good results and the maintenance of normal weight remain, 20% underweight moderate long-term and 15% have a poor record, with the low persistence of serious weight. poor performance is associated with early onset or late onset, chronic course, weight loss, anorexia and bulimia and coexistence are relationship difficulties. Men generally have a poorer prognosis.

References > p /

1 Stevens L, Rodin. Psychiatry: An illustrated text color, Churchill Livingstone, 2001

Bulimia Intervention