28 February 2019 Many false beliefs surrounding eating disorders still remain. The idea they are only related to appearance and beauty is completely untrue. Eating disorders: anorexia and bulimia nervosa Eating disorders are serious diseases characterised by: Unknown pathogenesis; Early onset; Prolonged development; Great therapeutic complexity. They are multifactorial diseases , caused by a combination of different factors: Genetic; Neurochemical; Psycho-environmental; Sociocultural. Anorexia and bulimia nervosa are the most prevalent forms of this type of disorder. They are psychiatric conditions that manifest themselves in marked changes in the patient's attitude to food. There are also eating disorders without a particular specification. These are cases where they do not meet all the internationally defined criteria for anorexia or bulimia nervosa, and are generally less serious. What are the main characteristics of anorexia and bulimia nervosa? Anorexia nervosa is characterised by exaggerated food restriction and a refusal to maintain a minimum weight within the normal range. Characteristics of anorexia nervosa: Progressive food restriction; Malnutrition (in the most serious cases); Refusal to maintain a minimum normal weight. Bulimia nervosa is characterised by excessive food intake together with compensation manoeuvres, where weight is maintained. Characteristics of bulimia nervosa: Compulsive food intake; Self-induced vomiting or abuse of laxatives or diuretics; Excessive physical exercise; Maintaining normal weight for age and height. What are the consequences of anorexia and bulimia nervosa? These diseases have consequences of greater or lesser severity, depending on the stage of the disease the patient is at. Consequences of anorexia nervosa: Hypoglycaemia and hypotension; Changes in heart rhythm; Increased risk of infection; Hormonal dysfunction; Osteoporosis. Consequences of bulimia nervosa: Hydroelectrolytic disturbances; Cardiovascular complications; Frequent tooth decay; Gastrointestinal bleeding (rare). Which organs are affected by eating disorders? Eating disorders are associated with various medical and physical comorbidities (other concomitant diseases). This being the case, all organs and systems can be affected. In addition, they often coexist with other psychiatric conditions, such as mood disorders, anxiety disorders or substance abuse, which aggravate the prognosis. Anorexia: clinical symptoms Anorexia nervosa is characterised by progressive dietary restriction with associated weight loss , and can lead to malnutrition . Sufferers refuse to maintain a minimum normal weight, given the persistent notion they have to keep losing weight so as not to become fat. The main clinical manifestations of anorexia nervosa are the result of malnutrition; in particular, hypoglycaemia, hypotension, abnormal heart rhythm, dizziness and increased risk of infection, among others. Hormonal dysfunction is a central change caused by anorexia nervosa, leading most importantly to amenorrhoea (loss of menstruation), which is one of the diagnostic criteria for the disease. One of the most common medical complications in patients suffering from this condition is osteopenia or even osteoporosis (severe loss of bone mineral density), with associated increased risk of fractures. All these changes are reversible with treatment. Bulimia: clinical signs Bulimia nervosa is characterised by repeated episodes of compulsive eating followed by inappropriate compensatory actions . These compensatory actions may involve self-induced vomiting, laxative or diuretic abuse (purgative behaviour), fasting or excessive physical exercise (non-purgative behaviour). In bulimia nervosa, weight can fluctuate slightly , but generally it remains normal for age and height. The main adverse consequences of this disease are hydroelectrolytic disturbances: a breakdown in the balance (between water and other constituents such as sodium, potassium or magnesium) which is essential in order for the body to the function properly. These changes are caused by vomiting and the use of laxatives and diuretics, and have associated cardiovascular complications. Dental caries are very common. In more isolated cases, gastrointestinal bleeding may occur. Diagnosis vs the "sin" of omission Early diagnosis of the disease affects its prognosis - the sooner a specific treatment is introduced, the better the prognosis will be. However, there are several things that can that mask an eating disorder and lead to a delay in diagnosis. Patients usually hide eating disorders , or try to minimise them. They will say they have no appetite, or that they are bloated or intolerant to certain foods when they make food restrictions. They even play down compulsive eating where it exists. They often do extensive research on medical conditions in order to find something they can use to explain away their weight loss: for example, neoplasias or gastrointestinal disorders that will explain their bloating or vomiting. They often deny fatigue and hunger , as well as the seriousness of their physical situation. On the other hand, they show great interest in healthy eating and its importance for health, attributing the changes in their diet to this. They will say that they are not worried about gaining weight, despite the fact their behaviour is taking them in the precise opposite direction. Patients are unable to explain what leads them to their restricted or uncontrolled food intake, and usually react with irritation when questioned about it. Of all the various mental illnesses, eating disorders represent one of the greatest therapeutic challenges (especially anorexia nervosa). This challenge is explained by the impact of these diseases on various areas of the body. The complexity of the treatment The treatment of eating disorders is complex, time-consuming, specific and difficult. A multidisciplinary team with experience in treating such disorders is necessary. The effectiveness of the therapeutic protocol will depend on appropriate surroundings and a treatment team working together, trained in different fields. The team will have to be able to deal with the psychological, psychiatric, medical and social aspects of these disorders. The central member of the group should be the psychiatrist , who will coordinate the treatment process and guide the patient to the other group members (clinical psychologist, nutritionist and internist or endocrinologist). This guidance will meet the needs and specific characteristics of both the disease and the patient in equal measures. Overall assessment and therapy Eating disorders are defined as being a psychopathology that leads to an attitude towards food that causes somatic changes. Therefore, the initial assessment and therapeutic plan should be global, comprising: Mental status assessment; General medical assessment; The drawing up of a food plan; The establishment of a target weight; The implementation of drug treatment (where indicated). International guidelines determine the use of psychopharmaceuticals in the treatment of bulimia nervosa and binge eating disorder (BED), another eating disorder. In the treatment of anorexia nervosa there is no formal indication for the use of any medicinal products. Psychotherapy (individual or group) is an essential therapeutic approach to these conditions, as they involve a large amount of psychological suffering. Family involvement is essential, and family meetings or even family therapy are recommended. Does treatment work? About half of all cases will end in full recovery, 30% in partial recovery and 20% of cases will show no significant improvement in symptoms, at which point it becomes a chronic disease. Factors associated with the worst prognosis are: Coexistence with other psychiatric conditions; Compulsive eating; Purging behaviour; Longer duration of the disease; High number of previous failed treatments. Mortality, when it occurs, varies at between 6% and 8% of cases. Suicide is the main cause of death relating to these diseases. We must reinforce the idea that being multifactorial diseases they require an integrated and comprehensive approach. This approach should include physical, psychosocial, family and educational involvement and requires treatment by a specialised, multidisciplinary team. Anorexia and bulimia: are these “fashionable” diseases? Even in the 21st century there are still many myths and false beliefs surrounding these diseases. There is a great deal of ignorance about them and the best way to treat them. Eating disorders are not “fashionable diseases” that have only arisen in the last few decades, related to supposed ideals of beauty. Historical research reports they may have been around since Ancient Greece. These diseases are more prevalent in industrialised societies and may occur in all socio-economic classes. Another common myth is that eating disorders only affect women. They also occur in men in around 10% of all cases . However, there are some differences. Eating disorders in women Eating disorders are among the most common psychiatric illnesses in young women, with more than 4% of women between the ages of 18 and 30 being affected. It is worth remembering that around 10% of women may suffer from this condition at some point in their lives. Eating disorders in men In men, the starting age is generally later , with excessive physical exercise being more common. They are often associated with other psychiatric conditions. It is also more common for men to suffer with premorbid obesity . Sexual orientation has nothing to do with the development of eating disorders. General information The prevalence of anorexia nervosa varies from between 0.3% and 0.6% of the general population, with 12% of young adolescents suffering with partial anorexia syndromes. The prevalence of bulimia nervosa is 1% for the general population. It is important to demystify the general notion about the age at which these diseases begin. Although anorexia nervosa occurs more frequently in adolescence, and bulimia nervosa at the beginning of adulthood, both conditions can also arise in other age groups, making it difficult to make a correct and timely diagnosis. Mistaken ideas about these diseases There are many people who do not think of anorexia and bulimia nervosa as diseases, but more as a matter of personal choice. The main misconceptions that exist about these diseases are that they are: “Just a fad”; “A way of upsetting the family”; “An attention-seeking strategy”; “Nothing more serious to think about”. The reality is that they are complex diseases, in which people refuse to eat, or eat too much, in order to satisfy a psychological rather than a physical need. The disease represents a dysfunctional strategy for dealing with issues around development and growth, with certain interpersonal relationships and various intrapsychic conflicts. Concern about weight and body image becomes the main source of self-esteem, leading to progressively ritualised food behaviour. Therefore, the belief that these diseases are related only to appearance and beauty is totally wrong. Even when the original weight target is reached, the food pattern is maintained. This reflects the enormous mental suffering in which those affected by the condition find themselves, and which seriously compromises their health. Other eating disorders Among the eating disorders without other specifications, the binge eating disorder (BED) is also significant. This disease is characterised by repeated episodes of compulsive food consumption. These episodes are associated with feelings of intense malaise, without associated compensatory actions that lead patients to be overweight and, eventually, obese. The consequences of BED are: Heart disease; Depression; High blood pressure; Diabetes; Hypercholesterolaemia; Under par performance at school and at work. As this is a possible cause of obesity , its diagnosis is crucial . It will also require a specific approach , aimed at food pathology that is different from other situations of obesity. Meet the psychiatry team from Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
