Understanding Anorexia and Bulimia Nervosa

• Eating disorders are serious mental health conditions
• These conditions involve preoccupation with food, body weight, and shape
• This preoccupation can lead to negative impacts on physical and mental health
• Eating disorders have been recognized in medical literature for centuries
• Early cases of eating disorders include descriptions of anorexia nervosa that appeared in the 19th century

Anorexia Nervosa (AN)

• Anorexia Nervosa is characterized by an intense fear of gaining weight
• Other characteristics include significant restriction of food intake and a markedly low body weight

Subtypes of Anorexia Nervosa

• Restricting Type
• Binge-eating/Purging Type

Physical Complications of Anorexia Nervosa

• Osteoporosis
• Amenorrhea
• Bradycardia
• Hypotension

Psychiatric Comorbidities Linked to Anorexia Nervosa

• Depression
• Anxiety
• Obsessive-compulsive traits

Bulimia Nervosa (BN)

• Bulimia Nervosa is characterized by recurrent episodes of binge eating
• This is followed by inappropriate compensatory behaviors, like vomiting, excessive exercise, or laxative use

Diagnostic Criteria for Bulimia Nervosa

• Binge and compensatory behaviors need to occur at least once a week for three months

Physical Complications of Bulimia Nervosa

• Electrolyte imbalances
• Esophageal tears
• Dental erosion

Psychiatric Comorbidities Linked to Bulimia Nervosa

• Mood disorders
• Substance abuse

Binge Eating Disorder (BED)

• Binge Eating Disorder is characterized by recurrent episodes of eating large quantities of food in a short period
• These episodes are accompanied by a sense of loss of control and guilt, but without compensatory behaviors
• Binge Eating Disorder is more common than Anorexia Nervosa and Bulimia Nervosa

Complications of Binge Eating Disorder

• Obesity
• Metabolic syndrome
• Cardiovascular risks

Psychiatric Comorbidities Linked to Binge Eating Disorder

• Depression
• Anxiety
• Impulsivity

Other Specified Feeding or Eating Disorder (OSFED)

• OSFED is a category that includes clinically significant eating disorders
• These eating disorders do not meet the full criteria for Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder

Avoidant/Restrictive Food Intake Disorder (ARFID)

• ARFID is characterized by the avoidance of certain foods due to sensory characteristics
• Other characteristics include concerns about choking, or a lack of interest in eating

Complications associated with eating disorders

• Nutritional deficiencies
• Stunted growth in children

Prevalence of Anorexia Nervosa (AN)

• Anorexia Nervosa has a lifetime prevalence of 0.5-1% in females
• The rate is significantly lower in males

Prevalence of Bulimia Nervosa (BN)

• Bulimia Nervosa affects 1-2% of women
• The rate is lower in men

Prevalence of Binge Eating Disorder (BED)

• Binge Eating Disorder affects about 2-3% of the general population

Gender Differences in Eating Disorders

• Eating disorders are more common in women, but the prevalence among men is rising

Typical Age of Onset for Eating Disorders

• Eating disorders typically begin in adolescence or early adulthood
• However, eating disorders can occur at any age

Cultural and Ethnic Considerations Related to Eating Disorders

• Westernized ideals of thinness contribute to a higher prevalence of eating disorders in certain cultures
• Eating disorders are seen worldwide

Biological Factors Contributing to Eating Disorders

• Genetics
• Neurobiological dysregulation in serotonin and dopamine pathways
• Hormonal changes

Genetic Influence on the Risk of Developing Eating Disorders

• Twin studies show heritability
• This is especially true for anorexia nervosa

Neurobiological Aspects Related to Eating Disorders

• Dysregulation in serotonin and dopamine pathways and abnormalities in the hypothalamus affect hunger and satiety

Psychological Factors Associated with Eating Disorders

• Cognitive distortions
• Trauma history
• Personality traits like impulsivity and perfectionism

The Impact of Trauma

• A history of childhood trauma, abuse, or neglect increases vulnerability to eating disorders

Sociocultural Factors Contributing to Eating Disorders

• Cultural pressures
• Family dynamics
• Peer influence related to body image concerns

Cultural Pressures

• Media influence and societal standards of beauty emphasizing thinness contribute to eating disorders

Family Dynamics

• Family conflict, enmeshment, overprotectiveness, or parental criticism can increase the risk of eating disorders

Peer Pressure

• Peer pressure and bullying related to body image concerns can contribute to the development of eating disorders

Brain Regions Involved in Eating Disorders

• The hypothalamus
• Insular cortex
• Reward system

Hypothalamus

• The hypothalamus is involved in appetite control
• Dysregulation can contribute to eating disorders

Insular Cortex

• The insular cortex is associated with altered interoceptive awareness in individuals with eating disorders

Reward System

• Altered dopamine functioning in the reward pathway is particularly noted in Bulimia Nervosa and Binge Eating Disorder

Serotonin

• Serotonin dysfunction is linked to satiety, mood regulation, and impulse control in Anorexia Nervosa (AN) and Bulimia Nervosa (BN)

Physical Signs of Anorexia Nervosa (AN)

• Severe weight loss
• Lanugo
• Cold intolerance
• Brittle nails
• Hair thinning

Behavioral Symptoms in Individuals with Eating Disorders

• Preoccupation with food, calories, or dieting
• Ritualistic eating habits
• Social withdrawal or avoidance of eating with others

Psychological Symptoms Experienced by Individuals with Bulimia Nervosa (BN)

• Shame
• Guilt
• Secrecy around eating behaviors
• A distorted body image

Comprehensive Evaluation for Diagnosing Eating Disorders

• A medical assessment of vital signs and laboratory tests
• A psychiatric assessment for comorbid disorders
• The use of eating disorder inventories

Eating Disorder Examination Questionnaire (EDE-Q)

• The Eating Disorder Examination Questionnaire is used as a tool for assessing the presence and severity of eating disorders

Cardiovascular Complications of Anorexia Nervosa

• Bradycardia
• Hypotension
• Arrhythmias
• An increased risk of sudden death

Gastrointestinal Complications of Bulimia Nervosa

• Gastroparesis
• Constipation
• Esophageal tears

Endocrine Complications of Anorexia Nervosa

• Amenorrhea
• Hypoglycemia
• Thyroid dysfunction
• Osteoporosis

Cognitive Behavioral Therapy (CBT)

• Considered the gold standard treatment for Bulimia Nervosa and Binge Eating Disorder
• Focuses on modifying distorted thoughts related to body image and food

Neurological Complications from Eating Disorders

• Seizures
• Cognitive impairment
• Peripheral neuropathy

Laboratory Tests

• Laboratory tests, such as blood tests for electrolytes and ECGs for arrhythmias, are crucial for assessing the medical consequences of eating disorders

Physical Signs of Binge Eating Disorder

• Individuals with Binge Eating Disorder are typically overweight or obese
• Do not exhibit physical signs of purging or compensatory behaviors

Family-Based Treatment (FBT)

• FBT is particularly effective for adolescents with Anorexia Nervosa (AN)
• FBT involves empowering families to take control of the patient's eating behaviors

Dialectical Behavioral Therapy (DBT)

• DBT addresses emotional regulation and impulsivity
• This is particularly important in individuals with Binge Eating Disorder (BED) and Bulimia Nervosa (BN)

Interpersonal Therapy (IPT)

• IPT focuses on improving interpersonal relationships
• This can help reduce disordered eating behaviors

Selective Serotonin Reuptake Inhibitors (SSRIs)

• SSRIs like fluoxetine help reduce binge-purge cycles in BN
• SSRIs may also assist in treating depression in Anorexia Nervosa (AN) and Binge Eating Disorder (BED)

Atypical Antipsychotics

• Atypical antipsychotics, such as olanzapine, are used off-label to promote weight gain in AN
• They can also reduce obsessive thinking about weight

Topiramate for Binge Eating Disorder

• Topiramate may help reduce binge eating and weight gain in individuals with BED

Lisdexamfetamine

• Known as Vyvanse
• FDA-approved for the treatment of moderate to severe Binge Eating Disorder (BED)

Nutritional Rehabilitation

• Nutritional rehabilitation involves supervised meal plans and gradual refeeding to avoid refeeding syndrome
• Refeeding syndrome involves dangerous shifts in fluids and electrolytes

Dietitian Involvement

• Dietitian involvement is crucial for meal planning and education
• Dietitians help patients understand their nutritional needs

Hospitalization Criteria

• Severe malnutrition (BMI < 15)
• Medical instability (electrolyte imbalances, bradycardia)
• Suicidality
• Failure of outpatient treatment

Recovery Rates for Anorexia Nervosa

• Recovery rates for Anorexia Nervosa range from 50-70%
• There are high rates of chronicity and relapse

Recovery Rates for Bulimia Nervosa

• Bulimia Nervosa has higher recovery rates than Anorexia Nervosa, with 70-80% showing significant improvement

Outcomes for Binge Eating Disorder

• Binge Eating Disorder typically has a more favorable outcome with appropriate treatment compared to other eating disorders

Relapse Rates in Anorexia Nervosa

• Anorexia Nervosa has high relapse rates
• This makes long-term follow-up critical for successful recovery

Mortality Rate for Anorexia Nervosa

• Anorexia Nervosa has the highest mortality rate of any psychiatric disorder
• Primarily due to medical complications or suicide