Problem 5 – Hooley and Butcher 17th ed. + Harvey 2nd ed.
Anorexia nervosa: the term literally means ‘lack of appetite by nervousness’. The pursuit of thinness is
relentless and involves behaviors that result in a significant low body weight.
Even though patients may look
painfully thin, many of them deny
having any problem. They might even
come to feel fulfilled by their weight
loss. Despite this satisfaction, they
may also feel ambivalent about their
weight.
There are 2 types of anorexia nervosa:
- the restricting type
- the binge-eating / purging type
The central differentiation concerns
the way in which patients maintain
their low weight.
In the restricting type, every effort is
made to limit the quantity of food
consumed. Caloric intake is tightly
controlled. Patients often try to avoid
eating in the presence of other, they
may eat very slowly, cut their food
into small pieces or dispose food
secretly.
The restriction is food intake is not possible or all patients. Patients with binge-eating type of anorexia
differ because they either binge, purge or binge and purge. A binge involves an out-of-control
consumption of food that is far greater than what most people would eat in the same amount of time and
under the same circumstances.
These binges may be followed by efforts to purge or remove the food they’ve eaten from their body.
Methods of purging include self-induced vomiting or misuse of laxatives, diuretics and enemas. Others
behaviors that don’t include purging are excessive exercising or fasting. Even purging strategies don’t
prevent absorption of all calories from food.
Patients have distorted values, those with restricting type are often greatly admired by others with eating
disorders. Some report they have not been successful in their anorexia because of failure to reach
extremely low weight.
They refuse to maintain a minimal body weight, they have a pathological fear of gaining weight, and they a
have distorted body image in which even when clearly anorexic, they continue to insist they are
overweight.
People with anorexia often deny the seriousness of their disorders and are shocked by the concern of
others. The objective level of judging the severity of the symptoms is based on BMI. The normal limit for
BMI is 18.5 and a level below that should be considered low enough to be at risk.
, Bulimia nervosa: characterized by uncontrollable binge eating and efforts to prevent resulting weight gain
by using inappropriate behaviors such as self-inducing vomiting and excessive exercise. Bulimia has been
recognized a s a psychiatric disorder recently.
The clinical picture of binge-eating type of anorexia has much in common with bulimia. The difference is
about weight. By definition, a person with anorexia is severely underweight. This is not true for bulimia. If
the person who binges and purges also meets the criteria for anorexia then the diagnosis is anorexia and
not bulimia. There are far greater mortality rates associated with anorexia than bulimia and DSM-5
requires that the more severe form of eating pathology take priority.
Unlike patients with anorexia, patients with bulimia are typically of normal weight or sometimes even
slightly underweight. Bulimia typically begins with restricted eating motivated by the desire to be slender.
During the early stages, the person diets and eats low-calorie foods. Over time, the early resolve to restrict
gradually wears down and the person starts to eat forbidden food (chocolate, pizza, cake etc.). Some
patients binge on whatever food is available. During an average binge, someone with bulimia may
consume up to 4800 calories. After the binge in an effort to manage the break-down of self-control, the
person begins to vomit, fast, exercise excessively or abuse laxatives. This pattern persists because even
though they are disgusted by their behavior, the purging lessens the fear of gaining weight that comes
from eating. People with bulimia feel shame, guilt and self-deprecation. They make efforts to conceal their
behavior.
Anorexia nervosa: the term literally means ‘lack of appetite by nervousness’. The pursuit of thinness is
relentless and involves behaviors that result in a significant low body weight.
Even though patients may look
painfully thin, many of them deny
having any problem. They might even
come to feel fulfilled by their weight
loss. Despite this satisfaction, they
may also feel ambivalent about their
weight.
There are 2 types of anorexia nervosa:
- the restricting type
- the binge-eating / purging type
The central differentiation concerns
the way in which patients maintain
their low weight.
In the restricting type, every effort is
made to limit the quantity of food
consumed. Caloric intake is tightly
controlled. Patients often try to avoid
eating in the presence of other, they
may eat very slowly, cut their food
into small pieces or dispose food
secretly.
The restriction is food intake is not possible or all patients. Patients with binge-eating type of anorexia
differ because they either binge, purge or binge and purge. A binge involves an out-of-control
consumption of food that is far greater than what most people would eat in the same amount of time and
under the same circumstances.
These binges may be followed by efforts to purge or remove the food they’ve eaten from their body.
Methods of purging include self-induced vomiting or misuse of laxatives, diuretics and enemas. Others
behaviors that don’t include purging are excessive exercising or fasting. Even purging strategies don’t
prevent absorption of all calories from food.
Patients have distorted values, those with restricting type are often greatly admired by others with eating
disorders. Some report they have not been successful in their anorexia because of failure to reach
extremely low weight.
They refuse to maintain a minimal body weight, they have a pathological fear of gaining weight, and they a
have distorted body image in which even when clearly anorexic, they continue to insist they are
overweight.
People with anorexia often deny the seriousness of their disorders and are shocked by the concern of
others. The objective level of judging the severity of the symptoms is based on BMI. The normal limit for
BMI is 18.5 and a level below that should be considered low enough to be at risk.
, Bulimia nervosa: characterized by uncontrollable binge eating and efforts to prevent resulting weight gain
by using inappropriate behaviors such as self-inducing vomiting and excessive exercise. Bulimia has been
recognized a s a psychiatric disorder recently.
The clinical picture of binge-eating type of anorexia has much in common with bulimia. The difference is
about weight. By definition, a person with anorexia is severely underweight. This is not true for bulimia. If
the person who binges and purges also meets the criteria for anorexia then the diagnosis is anorexia and
not bulimia. There are far greater mortality rates associated with anorexia than bulimia and DSM-5
requires that the more severe form of eating pathology take priority.
Unlike patients with anorexia, patients with bulimia are typically of normal weight or sometimes even
slightly underweight. Bulimia typically begins with restricted eating motivated by the desire to be slender.
During the early stages, the person diets and eats low-calorie foods. Over time, the early resolve to restrict
gradually wears down and the person starts to eat forbidden food (chocolate, pizza, cake etc.). Some
patients binge on whatever food is available. During an average binge, someone with bulimia may
consume up to 4800 calories. After the binge in an effort to manage the break-down of self-control, the
person begins to vomit, fast, exercise excessively or abuse laxatives. This pattern persists because even
though they are disgusted by their behavior, the purging lessens the fear of gaining weight that comes
from eating. People with bulimia feel shame, guilt and self-deprecation. They make efforts to conceal their
behavior.
