STUDY - Technical - New Dacian's Medicine
Anorexia
Nervosa and Bulimia Nervosa (1)
Translation Draft
Nervous anorexia and bulimia nervosa are disorders in dietary behavior, occurring in young, previously healthy women, who develop a paralyzing fear of fattening.
Nervous anorexia and bulimia nervosa are disorders in dietary behavior, occurring in young, previously healthy women, who develop a paralyzing fear of fattening.
The population at risk of
disease is generally made up of white women belonging to the
middle class. Such conditions occur only rarely in black or
oriental women, poor women or men. The driving force is the
silhouette, all other aspects of life being secondary.
In anorexia nervosa this goal is achieved mainly by drastically reducing food intake, the end result being emaciation. In the case of bulimia, copious meals are followed by vomiting and massive use of laxatives. Weight loss in subjects suffering from bulimia is not great, despite their obsession with food. Some authors consider the two conditions as distinct diseases, others do not classify bulimia as a variant of anorexia nervosa. Overexposure syndromes exist because emaciated patients with all signs of anorexia nervosa may have bulimia behaviour, and patients with bulimia often also go through a phase of anorexia. In this post it is assumed that the two conditions are different expressions of a psychological obsession related to body weight.
The true prevalence and incidence of anorexia nervosa is not known. In the high-risk population, such as girls aged 16-18 in private schools, the prevalence may be 1%, while in girls of the same age in public schools it is about 0.1%. Another study tells us that prevalence was 0.2% in women and 0.02% in men.
Probable prevalence is 0.02-1% in women and about one-tenth of this percentage in men (incidence rate, new cases, adjusted for age and sex, was 7.3 per 100,000 individuals per year). Information about bulimia nervosa is even less satisfactory. One study suggested a total prevalence of 1.1% in women and 0.1% in men. All incidence estimates are influenced by the cohort studied. For example, postprandial spills occur at a maximum of 18% of college students, a group where incidence rates are high. Bulimia may now be more common than anorexia.
Diagnosis of both bulimia and anorexia nervosa is based on clinical criteria. In general, standards are very permissive and the diagnosis is therefore established frequently. Thus, the diagnostic criteria for anorexia nervosa are represented by: 1. refusal to maintain body weight at or above the normal minimum weight for age and height (e.g. weight loss leading to a body weight less than 85% compared to what is expected or failure to achieve expected weight gain for the growing period , leading to a body weight less than 85% compared to what is expected), 2. Obsessive fear of weight gain or becoming obese, even underweight, 3. disorders in the way body weight or personal body shape is perceived, the negative influence of body weight or body shape on self-assessment, or denial of the severity of current body weight and 4. in postmenarchous women, amenorrhea and the absence of at least three consecutive menstrual cycles (a woman is considered to have amenorrhea if her menstruation occurs only after the administration of hormones, e.g. estrogen).
Here we have several specific types: 1. restrictive type (during the episode of anorexia nervosa the person does not adopt the behavior with voracious appetite or forced elimination - respectively, self-induction of vomiting or nontherapeutic use of laxatives, diuretics or emetics) and 2. exaggerated/forced elimination (during the episode of anorexia nervosa, the person usually adopts the behavior with exaggerated appetite or with forced elimination - i.e. induction of vomiting or non-therapeutic use of laxatives, diuretics or emetics).
In the case of nerve bulimia, the diagnostic criteria are represented by: 1. recurrent episodes with exaggerated appetite (an episode of exaggerated appetite is characterized, simultaneously, by the following: a. the consumption in a small period of time, e.g. every 2 hours, of a quantity of food that is defined as much greater than that which most people would consume in a similar period of time and under the same conditions, and b. the feeling of loss of food control during each episode, e.g. the feeling that the person concerned cannot stop by feeding or control what or how much he eats), 2. recurrence of inappropriate compensatory behaviour in preventing weight gain, such as self-induction of vomiting, non-therapeutic use of laxatives, diuretics, or other medicines, starvation and/ or excessive physical exertion, 3. both over-appetite and inadequate-compensation behaviour occur, on average, at least twice a week for 3 months, 4. self-assessment is greatly influenced by body shape or weight and 5. disorder does not occur exclusively during periods of anorexia nervosa.
From the point of view of the specific types of bulimia we have: 1. types with forced elimination (usually the person resortes to self-provocation of vomiting or misuse of laxatives or diuretics) and 2. types without forced elimination (the person uses inappropriate compensation behaviors, such as starvation or excessive physical exertion, but usually does not resort to self-induction of vomiting or non-therapeutic use of laxatives or diuretics).
The diagnostic criterion for weight is 85% or less of the ideal weight. Although DSM-IV does not use body mass index, a body mass index of less than 18 is considered a diagnosis. Amenorrhea is an invariable feature. Thus, anorexia nervosa is the only psychiatric condition with an endocrine component. An intense fear of gaining weight or becoming obese, even when there is substandard body weight, and altering the image about the body (how the body is perceived by the patient) completes the diagnostic tetrada. Two types of anorexia have been described: restriction and over-appetite/elimination. In the first type, bulimic behavior is absent, while the last, copious meals followed by the elimination of ingested foods are the main components.
Diagnostic criteria for bulimia nervosa require that a greater amount of food is ingested, compared to the amount consumed by the majority of the population in the same period of time. The episode of voracious appetite must be accompanied by the feeling that the appetite is out of control and must be repeated at least twice a week for 3 months. and there must be signs of compensating behaviour in keeping the weight within low limits. Bulimic symptoms should not occur exclusively in the presence of anorexia nervosa, respectively, the patient is diagnosed with anorexia nervosa faster than with bulimia nervosa if the weight loss is constant.
Finally, as in anorexia, distortion of body image is an essential feature. The two subtypes of nerve bulimia are postprandial and without elimination. Obsessive/ compulsive behaviour, self-mutilation and antisocial behaviour are not essential criteria, although they are more common in bulimia than in anorexia nervosa and the control population. The diagnostic value of the change in body shape perception in patients with nutrition disorders has been questioned, because many normal young women experience this distortion of perception.
In practice, a presumptive diagnosis of anorexia nervosa is justified only if the following elements are present: 1. the existence of a drastic loss of weight in the past, 2. the absence of an organic condition justifying weight loss, 3. the absence of a primary psychiatric condition that can justify the inability to eat, 4. extreme reduction in the amount of food consumed with or without inducing vomiting , 5. ritualized exercise and 6. denial of hunger, fatigue, emaciation. The late manifestation of the disease is also recognized today, although symptoms usually occur during adolescence or early adulthood. Although the focus is on the absence of an organic disease that causes weight loss, anorexia nervosa can coexist with other diseases that can cause weight loss, such as insulin-dependent diabetes.
From the point of view of etiology, the cause of eating disorders is unknown. Although a dysfunction of the hypothalamus was initially postulated, associated hypothalamic abnormalities return to normal with weight gain, thus becoming secondary rather than causal. Many researchers have spoken out in formulating a psychiatric etiology, but have not agreed on its nature. Some argue that these manifestations occur in response to inadequate or destructive relationships between family members, directed at a particular target and with high potential.
Despite an apparent normality, interpersonal communication within such a family tends to become inadequate, often following a model in which the father seeks success professionally, while the mother turns to the children in search of fulfillment, gradually becoming domineering. It has been established that families are often like a whole, the boundaries between generations almost disappear, the problems of the parents being also the children and vice versa. Some researchers have suggested that sexual abuse plays a role, but it is a controversial view. Psychoanalytic interpretation tends to regard anorexia as a mechanism by which the patient tries to restore control over his or her own life, independent of that of his or her parents.
It is not clear how this chaining can generate fear of fattening, which is the main feature of both bulimia and anorexia. The absence of a serious psychiatric condition was a common diagnostic criterion, but depression and obsessive/compulsive behaviour are commonly associated with these conditions, especially bulimia. These abnormalities may be secondary or pre-existing to the status that predisposes the development of food disorders. Some studies have suggested that a genetic component may be involved in pathogenesis (e.g. increased prevalence of food disorders in first-degree relatives of the evidence). Such a genetic component, if any, is minor.
Culture also plays an important role in anorexia nervosa. Health and silhouette are the two desires of the current Western world and they can accentuate the fear of fattening patients with diagnosed anorexia or turn the symptoms of subjects with "borderline" disease into manifest anorexia. Occupation can also play an important role (dancers, for example, suffer from anorexia nervosa 10 times greater than the rest of the population). Similarly, athletes, especially runners, want to lower their body fat levels greatly (up to 5-7% of body weight).
Defects that cause appetite disorders remain unclear. There is some data on dysfunction in serotonin-mediated neurotransmission, which is believed to be a component of the satiety signaling system. Leptin peptide (a product of the ob gene) is released into the blood from adipose tissue and inhibits the synthesis or release from the hypothalamus of neuropeptide Y, a powerful hunger beacon. Serotonin can function as a neurotransmitter related to the inhibition of leptin and neuropeptide Y. Serotonin-taking inhibitors may be helpful in anorexia nervosa and bulimia nervosa. Leptin levels were not evaluated in either anorexia or bulimia.
We continue in the next post with the clinical picture...
In anorexia nervosa this goal is achieved mainly by drastically reducing food intake, the end result being emaciation. In the case of bulimia, copious meals are followed by vomiting and massive use of laxatives. Weight loss in subjects suffering from bulimia is not great, despite their obsession with food. Some authors consider the two conditions as distinct diseases, others do not classify bulimia as a variant of anorexia nervosa. Overexposure syndromes exist because emaciated patients with all signs of anorexia nervosa may have bulimia behaviour, and patients with bulimia often also go through a phase of anorexia. In this post it is assumed that the two conditions are different expressions of a psychological obsession related to body weight.
The true prevalence and incidence of anorexia nervosa is not known. In the high-risk population, such as girls aged 16-18 in private schools, the prevalence may be 1%, while in girls of the same age in public schools it is about 0.1%. Another study tells us that prevalence was 0.2% in women and 0.02% in men.
Probable prevalence is 0.02-1% in women and about one-tenth of this percentage in men (incidence rate, new cases, adjusted for age and sex, was 7.3 per 100,000 individuals per year). Information about bulimia nervosa is even less satisfactory. One study suggested a total prevalence of 1.1% in women and 0.1% in men. All incidence estimates are influenced by the cohort studied. For example, postprandial spills occur at a maximum of 18% of college students, a group where incidence rates are high. Bulimia may now be more common than anorexia.
Diagnosis of both bulimia and anorexia nervosa is based on clinical criteria. In general, standards are very permissive and the diagnosis is therefore established frequently. Thus, the diagnostic criteria for anorexia nervosa are represented by: 1. refusal to maintain body weight at or above the normal minimum weight for age and height (e.g. weight loss leading to a body weight less than 85% compared to what is expected or failure to achieve expected weight gain for the growing period , leading to a body weight less than 85% compared to what is expected), 2. Obsessive fear of weight gain or becoming obese, even underweight, 3. disorders in the way body weight or personal body shape is perceived, the negative influence of body weight or body shape on self-assessment, or denial of the severity of current body weight and 4. in postmenarchous women, amenorrhea and the absence of at least three consecutive menstrual cycles (a woman is considered to have amenorrhea if her menstruation occurs only after the administration of hormones, e.g. estrogen).
Here we have several specific types: 1. restrictive type (during the episode of anorexia nervosa the person does not adopt the behavior with voracious appetite or forced elimination - respectively, self-induction of vomiting or nontherapeutic use of laxatives, diuretics or emetics) and 2. exaggerated/forced elimination (during the episode of anorexia nervosa, the person usually adopts the behavior with exaggerated appetite or with forced elimination - i.e. induction of vomiting or non-therapeutic use of laxatives, diuretics or emetics).
In the case of nerve bulimia, the diagnostic criteria are represented by: 1. recurrent episodes with exaggerated appetite (an episode of exaggerated appetite is characterized, simultaneously, by the following: a. the consumption in a small period of time, e.g. every 2 hours, of a quantity of food that is defined as much greater than that which most people would consume in a similar period of time and under the same conditions, and b. the feeling of loss of food control during each episode, e.g. the feeling that the person concerned cannot stop by feeding or control what or how much he eats), 2. recurrence of inappropriate compensatory behaviour in preventing weight gain, such as self-induction of vomiting, non-therapeutic use of laxatives, diuretics, or other medicines, starvation and/ or excessive physical exertion, 3. both over-appetite and inadequate-compensation behaviour occur, on average, at least twice a week for 3 months, 4. self-assessment is greatly influenced by body shape or weight and 5. disorder does not occur exclusively during periods of anorexia nervosa.
From the point of view of the specific types of bulimia we have: 1. types with forced elimination (usually the person resortes to self-provocation of vomiting or misuse of laxatives or diuretics) and 2. types without forced elimination (the person uses inappropriate compensation behaviors, such as starvation or excessive physical exertion, but usually does not resort to self-induction of vomiting or non-therapeutic use of laxatives or diuretics).
The diagnostic criterion for weight is 85% or less of the ideal weight. Although DSM-IV does not use body mass index, a body mass index of less than 18 is considered a diagnosis. Amenorrhea is an invariable feature. Thus, anorexia nervosa is the only psychiatric condition with an endocrine component. An intense fear of gaining weight or becoming obese, even when there is substandard body weight, and altering the image about the body (how the body is perceived by the patient) completes the diagnostic tetrada. Two types of anorexia have been described: restriction and over-appetite/elimination. In the first type, bulimic behavior is absent, while the last, copious meals followed by the elimination of ingested foods are the main components.
Diagnostic criteria for bulimia nervosa require that a greater amount of food is ingested, compared to the amount consumed by the majority of the population in the same period of time. The episode of voracious appetite must be accompanied by the feeling that the appetite is out of control and must be repeated at least twice a week for 3 months. and there must be signs of compensating behaviour in keeping the weight within low limits. Bulimic symptoms should not occur exclusively in the presence of anorexia nervosa, respectively, the patient is diagnosed with anorexia nervosa faster than with bulimia nervosa if the weight loss is constant.
Finally, as in anorexia, distortion of body image is an essential feature. The two subtypes of nerve bulimia are postprandial and without elimination. Obsessive/ compulsive behaviour, self-mutilation and antisocial behaviour are not essential criteria, although they are more common in bulimia than in anorexia nervosa and the control population. The diagnostic value of the change in body shape perception in patients with nutrition disorders has been questioned, because many normal young women experience this distortion of perception.
In practice, a presumptive diagnosis of anorexia nervosa is justified only if the following elements are present: 1. the existence of a drastic loss of weight in the past, 2. the absence of an organic condition justifying weight loss, 3. the absence of a primary psychiatric condition that can justify the inability to eat, 4. extreme reduction in the amount of food consumed with or without inducing vomiting , 5. ritualized exercise and 6. denial of hunger, fatigue, emaciation. The late manifestation of the disease is also recognized today, although symptoms usually occur during adolescence or early adulthood. Although the focus is on the absence of an organic disease that causes weight loss, anorexia nervosa can coexist with other diseases that can cause weight loss, such as insulin-dependent diabetes.
From the point of view of etiology, the cause of eating disorders is unknown. Although a dysfunction of the hypothalamus was initially postulated, associated hypothalamic abnormalities return to normal with weight gain, thus becoming secondary rather than causal. Many researchers have spoken out in formulating a psychiatric etiology, but have not agreed on its nature. Some argue that these manifestations occur in response to inadequate or destructive relationships between family members, directed at a particular target and with high potential.
Despite an apparent normality, interpersonal communication within such a family tends to become inadequate, often following a model in which the father seeks success professionally, while the mother turns to the children in search of fulfillment, gradually becoming domineering. It has been established that families are often like a whole, the boundaries between generations almost disappear, the problems of the parents being also the children and vice versa. Some researchers have suggested that sexual abuse plays a role, but it is a controversial view. Psychoanalytic interpretation tends to regard anorexia as a mechanism by which the patient tries to restore control over his or her own life, independent of that of his or her parents.
It is not clear how this chaining can generate fear of fattening, which is the main feature of both bulimia and anorexia. The absence of a serious psychiatric condition was a common diagnostic criterion, but depression and obsessive/compulsive behaviour are commonly associated with these conditions, especially bulimia. These abnormalities may be secondary or pre-existing to the status that predisposes the development of food disorders. Some studies have suggested that a genetic component may be involved in pathogenesis (e.g. increased prevalence of food disorders in first-degree relatives of the evidence). Such a genetic component, if any, is minor.
Culture also plays an important role in anorexia nervosa. Health and silhouette are the two desires of the current Western world and they can accentuate the fear of fattening patients with diagnosed anorexia or turn the symptoms of subjects with "borderline" disease into manifest anorexia. Occupation can also play an important role (dancers, for example, suffer from anorexia nervosa 10 times greater than the rest of the population). Similarly, athletes, especially runners, want to lower their body fat levels greatly (up to 5-7% of body weight).
Defects that cause appetite disorders remain unclear. There is some data on dysfunction in serotonin-mediated neurotransmission, which is believed to be a component of the satiety signaling system. Leptin peptide (a product of the ob gene) is released into the blood from adipose tissue and inhibits the synthesis or release from the hypothalamus of neuropeptide Y, a powerful hunger beacon. Serotonin can function as a neurotransmitter related to the inhibition of leptin and neuropeptide Y. Serotonin-taking inhibitors may be helpful in anorexia nervosa and bulimia nervosa. Leptin levels were not evaluated in either anorexia or bulimia.
We continue in the next post with the clinical picture...
Understanding, love and
gratitude!!!
Dorin, Merticaru