(based on lectures by Dr. Thomas Cummins and also by Dr. Nadine Kaslow)
Eating disorders are very serious, potentially lethal illnesses. They have probably always existed, but are strongly associated with affluent, industrialized societies (although within those societies, there is NO socioeconomic bias in diagnosis - you are as likely to get it if you're poor or rich). Bulimia and anorexia can both occur together. Both involve "control issues" and maybe associated with a childhood history of gastrointestinal problems.
0.5-1.0% of population
90-95% of patients are female
Demographics: Affects all ethnic and socioeconomic groups, although most patients are upper SES white females.
History: Probably occurred in 1920s and perhaps in ancient times as well.
40-60% of female high school seniors report dieting within the last year
13% admit to inducing vomiting or using diet pills, diuretics, or laxatives to lose weight
1st degree relatives with eating disorders, depression, anxiety
anorexia is a risk factor for bulimia
avoidant once illness occurs
high achievers, perfectionism
Affluence, especially in an affluent Western culture
Low levels of social support
Enmeshed families (particularly with anorexia)
Chaotic and abusive families with bulimia
Public health messages (e.g., that fat is bad)
Gymnasts, wrestlers, runners, dancers, flight attendants (less so now after law suits against airlines).
Multifactorial and not well known; unlikely that any single cause is responsible.
? variant of a mood disorder;
? genetic etiology;
Cognitive distortion (distorted body image);
Cultural influences (pressure to be thin).
Family enmeshment, rigidity, abuse, high expressed emotion, or conflict avoidance are associated with the disorder.
Effects of starvation on normals: volunteers developed food hoarding and binging, depression, irritability, and obsessive-compulsive behaviors when forced to lose 25 percent of their body weight.
Symptoms improved 6 to 12 months after regaining prior body weight.
Note that the patients often do not see themselves as having a problem, but are brought in by family members or friends. Therefore the physician must get collateral information from others besides the patient.
Anorexia nervosa has two subtypes:
Binge eating/purging type
50 percent have Major depression
25 percent have Obsessive Compulsive Disorder
50 percent of anorexics also have Bulimia Nervosa
maybe associative with Avoidant Personality Disorder
- medication, such as selective serotonin re-uptake inhibitors, after weight is restored; note: no double blind placebo controlled studies demonstrate their efficacy (v. in bulimia, in which they are effective)
Bulimia involves a recurrent pattern of binging (eating gobs and gobs of food in a compulsive, frantic way) followed by purging (inducing vomiting a la the Romans). Bulimics are less likely to be thin and more likely to be a little overweight.
Bulimia does NOT always have to involve purging behaviors.
A psychodynamic observation regarding anorexics is that their families tend to be perfectionistic, cold, and have taboos against expressing strong emotion. Family secrets and high, unexpressed tension are common.
DSM-IV, pages 539-550.