Frances F. Conte
What is anorexia nervosa? The term implies a loss of appetite due to a nervous condition, but given the complexity of this disorder, the term appears to be a contradiction. Anorectics are obsessed with food, but stubbornly refuse to eat or retain it because of a fear of being fat and an obsession with thinness.
The diagnostic criteria for anorexia nervosa according to the American Psychiatric Association,
Diagnostic and Statistical Manual of Mental Disorders
(Third Edition) are:
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“A. Intense fear of becoming obese, which does not diminish as weight loss progresses.
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B. Disturbance of body image, e.g., claiming to ‘feel fat’ even when emaciated.
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C. Weight loss of at least 25 percent of original body weight or, if under 18 years of age, weight loss from original body weight plus projected weight gain expected from growth charts may be combined to make the 25 percent.
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D. Refusal to maintain body weight over a minimal normal weight for age and height.
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E. No known physical illness that would account for the weight loss.”
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Some individuals with this disorder cannot exert continuous control over their intended voluntary restriction of food intake and have bulimic episodes (eating binges), often followed by vomiting.
The anorectic consistently denies that she has a problem. She cannot be persuaded to eat, but instead is tyrannical over her body and food intake. Often control of food and dieting are the only things about which anorectics feel they have any power. As the self imposed starvation escalates, the anorectic becomes more and more obsessed with the preparation of food and often will plan and prepare elaborate meals for others but will avoid eating. In time the lack of nutrition may affect the anorectic’s judgment, which may account for her extreme negativism and stubbornness, although they may actually cover up her lack of independence and self confidence.
Anorectics involve themselves in strenuous exercise and physical activity for the purpose of burning calories. This exercise usually includes bicycling, jogging, running, aerobics, swimming or calisthenics, all pursued with speed and an inordinate sense of endurance. While they may feel more energetic initially and exhilarated in their newly acquired self discipline and control, in time the affects of this regimen begin to take their toll on the body.
The anorectic will become increasingly restless and often have difficulty sleeping. Starvation results in cessation of menstruation. Anorectics experience loss of scalp hair, while, at the same time, in response to the lowering of body temperature, a downy growth of hair called, Lanugo hair, appears on the face, back and extremities to help conserve heat. Blood pressure drops. The pulse slows. Eventually the body feeds off its own muscle tissue, including that of the heart and other vital organs.
Bulimia
. Although there is some controversy concerning the name and etiology of a syndrome consisting of episodes of binge eating and purging, most authors are able to agree on a basic conceptualization of the problem most commonly referred to as bulimia. Individuals with bulimia have a morbid fear of gaining weight and make repeated attempts to control it through dieting. Feeling deprived, bulimics find they can no longer restrict their food intake and experience intense hunger leading to episodes of overeating. These food binges are usually followed by self-induced vomiting, laxative or diuretic abuse in order to avoid the dreaded weight gain.
The diagnostic criteria for bulimia, according to the American Psychiatric Association,
Diagnostic and Statistical Manual of Mental Disorders
(Third Edition) are as follows:
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“A. Recurrent episodes of binge-eating (rapid consumption of a large amount of food in a discrete period of time, usually less than two hours).
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B. At least three of the following:
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1. consumption of high-caloric, easily ingested food during a binge
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2. inconspicuous eating during a binge
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3. termination of such eating episodes by abdominal pain, sleep, social interruption, or self-induced vomiting
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4. repeated attempts to lose weight by severely restrictive diets, self-induced vomiting, or use of cathartics or diuretics
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5. frequent weight fluctuations greater than ten pounds due to alternating binges and fasts
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C. Awareness that the eating pattern is abnormal and fear of not being able to stop eating voluntarily.
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D. Depressed mood and self-deprecating thoughts following eating binges.
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E. The bulimic episodes are not due to Anorexia Nervosa or any known physical disorder.”
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The amounts of food ingested by a bulimic patient are typically extreme. Subjects have reported consuming from 10,000 to 50,000 calories in a day. Actual episodes of binge eating occur most frequently late in the evening or during the night, throughout time of stress and periods of unstructured time.
The frequency of self-induced vomiting, laxative and diuretic abuse varies greatly. Reports indicate that some bulimic patients have vomited from as few as several times a month to as many as five times a day. Those who abuse laxatives may consume 100 tablets daily, while diuretic abusers may take up to 600 mg. daily.
There are a number of severe health problems associated with bulimia. (See Appendix A and B). The most threatening consequences are the results of self-induced vomiting, laxative and diuretic abuse. Such consequences as severe hypokalemic alkalosis, dry mouth, muscle spasms or tetany, parotid gland swelling, gastroesophageal symptoms, periorbital edema, dark circles under the eyes, lacerations on the back of the throat, constipation and dizziness may present themselves. Other medical consequences include the loss of tooth enamel, ear canal problems, electrolyte imbalance, anemia and loss of scalp hair. Scars on the dorsum of the hand have been observed—the result of frequent self-induced vomiting.
In contrast to those with anorexia nervosa, patients with bulimia do not have severely lowered weight which is why it has been referred to as the “secret addiction.” Patients are typically within five to ten percent of their normal body weight. Bulimic patients do not deny hunger as many classic anorectics do, nor do they display the pride and exhilaration characteristic of the anorectic’s self control. Patients with classic anorexia nervosa restrict their food intake to the point of emaciation, often in response to perceptual distortion of their body size. Bulimics are more aware of bodily discomfort, and experience dysphoric mood states from depression, anxiety and guilt. The most frequent psychological consequence of bulimia is a distressing sense of loss of control, with subsequent guilt, demoralization and feeling of helplessness in the presence of these bulimic urges and episodes.
