Eating disorder is a psychological disorder which are of two types anorexia nervosa and bulimia nervosa.
eating disorders is characterised by three central features
- Extreme concern about body shape,weight and thinness.
- Active pursuit and maintenance of low body weight,which is achieved by avoidance of fat food,vomiting and pruging and excessive exercise.
- Amenorrhea for atleast 3 months directly related to low body weight and indicating significant disturbances of hormonal status.
- Anorexia nervosa was first described in 1868 by sir william gull and the name anorexia was given in the year 1874.
- Familial predisposition
- Premorbid personality-anxious,impulsive,depressive,low self esteem.
- Familial factors
Enmeshment(disturbed environment) like confusion,conflicts,less cohesion,less support,less disclosure,less expression of feelings,less trust.
- Social factors
Social,familial and peer pressures to remain thin
widespread habit of dieting to maintain good figure.
onset of age common in 15-35 years.
Common in females
- More commonly seen in higher social class people.
- Anorexia nervosa
Onset in adolescence,history of obesity
Onset of symptoms follows period of stress where self esteem is threatened,after being teased by relatives and friends.
- Due to prolonged suffering ,eating pattern becomes markedly abnormal leading to repeated anger over relatives and friends regarding diet,weight and life style.
- Main clinical symptoms are intense desire to be thin,weight loss is disguised by wearing loss clothins,loss of weight below 17 BMI(body mass index).
- No known medical illness that would lead for weight loss,active and energetic despite weight loss.
Refusal to maintain normal weight,patient thinks she is too fat when severely underweight,intense fear of becoming fat,preoccupied with food,prepares food for family members but refuses to eat for herself.
- Unusual eating behaviours-giving number of reasons to skip meals,develops complex set of rules regarding foods and their manner of consumption,keeps herself undated about calorific values of food items to avoid eating foods which helps gain weight.pursuit to be thin by eating less,avoiding high calorific value foods,self inducing vomiting and e3xcessive purging
Bulimia nervosa(inge eating)
- Episodic,uncontrollable eating with rapid ingestion of large quantities of food over short period of time.
- After over-eating symptoms like abdominal pain,self induced vomiting.
- Patient fears of not able to stop eating voluntarily.
- Food consumed contains lots of calories.
- Binges are followed by feeling of guilt,depression,self-disgust,intensified efforts to loss weight.
- Suicidal attempts,self mutation,stealing,alcoholism and drug addiction.
- General measures
Education of patient about dangers of starvation,need for weight gain.
Establish good rapport with the patient so that firm approach is possible.
Set target weight to be achieved.
Strict regimen of refeeding.
Carefully controlledcalorie intake
Correct electrolyte imbalance.
Encourage pateinet to stop weighing herself
Eliminate self inducing vomiting and purging.
Individual and family counselling.
- Supportive therapy
Increase sense of personal effectiveness
Explain the patient that self esteem can be built up by other factors other than weight and appearance.
- Cognitive therapy
Changing patient’s attitude towards eating.
Reinterpretation of distorted perception of body.
- Self monitoring of eating behaviour
By advising patient to maintain eating diary.