Major eating disorders: anorexia and bulimia

According to the most recently accepted definitions by the American Psychiatric Association (1994), anorexia nervosa (AN) and bulimia nervosa (BN) are defined as highly severe emotional disorders and interference in many of the vital areas of the individual who suffers from it.

The data suggest that the confluence of biological, psychological and social factors interact with the individual's personality, promoting the development of this type of eating pathology.

Among the first set of factors, the type of temperament of the individual as well as his level of emotional stability may be determining; Regarding the socio-cultural components, it is worth highlighting the idealization of society for maintaining a slim body associating it with success and superiority over others; Regarding psychological factors, this type of patient presents phenomena such as low self-esteem, feelings of ineffectiveness in problem solving and coping or a high desire for perfectionism that make it extremely difficult to function daily.

Symptoms in Eating Disorders

On the other hand, the presence of anxiety and depressive symptoms is frequent, characterized by continued sadness and dichotomous thinking (of "all or nothing").

A large proportion of people with anorexia have traits of obsession and compulsion when it comes to maintenance of a rigidity and strict regulation in the control of the feeding, practice of extreme physical exercise, image and weight bodily. Finally, the difficulty in expressing oneself emotionally externally is also characteristic. despite being very smart, so they tend to isolate themselves from the circles of close relationships.

Anorexy

In the case of anorexia nervosa, this is characterized by a predominance of body weight rejection, usually accompanied by a distortion of body image and an inordinate fear of getting fat. Two subtypes are distinguished in anorexia nervosa, depending on whether or not there are bingeing or compensatory behaviors (AN-Purgative vs. AN-Restrictive, respectively).

Bulimia

The second nosology, the bulimia nervosa, it is characterized by the maintenance of cyclical episodes of binge eating and compensatory behaviors of those through vomiting, the use or abuse of laxatives, excessive physical exercise or restriction of subsequent intakes. In this case, the BN-Purgative categories are also differentiated, if the individual uses vomiting as compensatory behavior and BN-Non-Purgative, if you resort to fasting or physical activity inordinate.

Many of the people who have an Eating Disorder do not meet all the criteria that allow one of the two previous diagnoses to be made, for which, a third category called Unspecified Eating Disorder is distinguished where all these subjects of difficult classification can be included.

Characterization of bulimia nervosa and anorexia nervosa

Anorexia nervosa usually stems from family histories of eating disorders, especially obesity. It is more easily detectable than bulimia nervosa, due to the high weight loss and the numerous medical complications that accompany the condition, metabolic, cardiovascular, renal, dermatological, etc. In extreme cases of malnutrition, anorexia nervosa can lead to death, with the percentage of mortality between 8 and 18%.

Unlike anorexia, bulimia is seen much less frequently. In this case, the weight loss is not so evident since the binge-compensation cycles keep it, more or less, at similar values.

Bulimic people are characterized by expressing an exaggeratedly intense concern for their body image, although they manifest it in a different way than in anorexia: in this case the ingestion becomes the method to cover their emotional needs not satisfied by the appropriate channels.

Analogously to anorexia, alterations are also observed on a psychological and social level. Normally these people show marked isolation, which is why family and social interactions are often poor and unsatisfactory. Self-esteem is usually deficient. Comorbidity has also been observed between bulimia, anxiety and depression; the latter is usually presented as a derivative of the former.

Regarding the anxiety level, a parallelism is usually shown between this and the frequency of binges carried out by the subject. Later, the feelings of guilt and impulsivity motivate the compensatory behavior of the binge. It is for this reason that a certain relationship between bulimia has also been indicated with other impulsive disorders such as substance abuse, pathological gambling, or personality disorders where behavioral impulsivity predominates.

The thoughts that characterize bulimia are often also defined as dichotomous and irrational. They spend a lot of time a day on the cognitions regarding not gaining weight and feeding the distortions of the body figure.

Finally, medical pathologies are also common, due to the maintenance of binge-compensation cycles over time. The alterations are observed at the metabolic, renal, pancreatic, dental, endocrine or dermatological levels, among others.

Causes of eating disorders

There are three factors that have been demonstrated in a majority by consensus by expert authors in this field of knowledge: predisposing, precipitating and perpetuating. Thus there seems to be agreement in granting the causality of eating disorders a multi-causal aspect where both physiological and evolutionary elements are combined, psychological and cultural as intervening in the appearance of the pathology.

Among the predisposing aspects, reference is made to individual factors (overweight, perfectionism, level of self-esteem, etc.), genetic (higher prevalence in the subject whose relatives present this psychopathology) and sociocultural (fashionable ideals, eating habits, prejudices derived from body image, overprotection parental, etc.).

As precipitating factors are the age of the subject (greater vulnerability in adolescence and early youth), assessment inadequate body, excessive physical exercise, stressful environment, interpersonal problems, presence of other psychopathologies, etc.

Perpetuating factors differ in terms of psychopathologies. Although it is true that negative beliefs about body image, social pressure and the experience of stressful experiences are common, in the case of anorexia the most Important ones are related to complications derived from malnutrition, social isolation and the development of fears and obsessive ideas about food or figure bodily.

In the case of bulimia, the central elements that maintain the problem are linked to the binge-compensation cycle, the level of anxiety experienced and the presence of other maladaptive behaviors such as substance abuse or self harm.

Main behavioral, emotional and cognitive manifestations

As has been commented in previous lines, Eating Disorders derive in a long list of manifestations both physical (endocrine, nutritional, gastrointestinal, cardiovascular, renal, bone and immunological level) as well as psychological, emotional and behavioral

In summary, on this second set of symptoms, there may be:

At the behavioral level

• Restrictive diets or binges.
• Ingestion compensation through vomiting, laxatives and diuretics.
• Alterations in the mode of intake and rejection of some specific foods
• Obsessive-compulsive behaviors.
• Self-harm and other signs of impulsivity.
• Social isolation.

On a psychological level

• Terrible fear of getting fat.
• Misconceptions about diet, weight, and body image.
• Alteration in the perception of body image.
• Impoverishment of creative ability.
• Confusion in the feeling of satiety.
• Difficulties in the ability to concentrate.
• Cognitive distortions: polarized and dichotomous thinking, selective abstractions, thought attribution, personalization, overgeneralization, catastrophizing, and magical thinking.

On an emotional level

• Emotional lability.
• Depressive symptoms and suicidal ideation.
• Anxious symptoms, development of specific phobias or generalized phobia.

Intervention in eating disorders: objectives of the first personalized attention

In a generic approach to the intervention in eating disorders, the following guide points can be be a useful guide to offer a first individualized attention depending on the case that is presents:

1. An approach to the problem. In this first contact, a questionnaire is completed to acquire the greatest volume of information regarding the history and course of the disorder.

2. Awareness. Allow the patient to make an adequate insight into the deviant behaviors related to the disorder so that she can become aware of the vital risk derived from them.

3. Motivation towards treatment. Raising awareness of the importance of using a specialized clinical psychology and psychiatry professional is a fundamental step to ensure greater probability of therapeutic success, as well as early detection of incipient symptoms can be a great predictor of positive evolution of the disease. disease.

4. Information on intervention resources. Offering addresses of interest can be useful to increase the perception of social support received, such as associations of ED patients attending group therapy groups.

5. Bibliographic recommendation. The reading of certain self-help manuals can be indicated, both for the patients themselves and for their closest relatives.

In conclusion

Given the complex nature of this type of psychopathology and the powerful maintenance factors that make a favorable evolution of these disorders extremely difficult, early detection of the first manifestations seems essential as well as to guarantee a multicomponent and multidisciplinary intervention that covers both all altered components (physical, cognitive, emotional and behavioral) such as the extensive set of vital areas affected.

Bibliographic references:

• Cervera, Montserrat. "Risk and prevention of anorexia and bulimia". Martínez Roca. Barcelona, ​​1996.
• Fernández, A. and Turon Gil. "Eating disorders". Masson. 2002.
• Raich, Rosa Maria. "Anorexia and bulimia: Eating disorders". Pyramid. Madrid, 2001.