Understanding Anorexia Nervosa

Eating Disorders

• Feeding and Eating disorders are classified in the DSM-5-TR
• Types of disorders include Anorexia Nervosa, Bulimia Nervosa, Binge-eating Disorder, Pica, Avoidant/Restrictive Food Intake Disorder, and Rumination Disorder

Anorexia Nervosa (AN)

• Diagnostic criteria include restricting nourishment intake, resulting in very low body weight for their age and gender
• Intense fear of gaining weight and persistent actions to prevent weight gain, despite being underweight
• Distorted body perception leading to inappropriate emphasis on weight or shape in self-evaluation, and a failure to recognize starvation's implications
• Specifiers include:
• Restricting type: Weight loss is achieved through limiting food intake
• Binge-eating/purging type: Engaging in binge eating, vomiting, or misuse of laxatives or diuretics
• The life prevalence is 0.6%
• Onset typically occurs between ages 14 and 20
• 75% of anorexia nervosa cases occur in women and girls
• Prevalence is higher in the LGBTQ+ population, with similar rates in BIPOC and White populations
• Key features are the goal of becoming thin and fear of gaining weight
• Preoccupation with food is common
• Distorted thinking includes a negative body image, overestimating actual body size
• Can cause amenorrhea, malnutrition, metabolic and electrolyte imbalances, heart issues, hair/nail/skin issues
• Approximately 6% of individuals die due to medical complications or suicide
• The disorder can start with dieting after a stressful event
• About 20% of people with this disorder show symptoms for decades
• These individuals often fear losing control of their diet and becoming obese
• Psychological challenges such as depression, anxiety, low self-esteem, and insomnia may arise

Bulimia Nervosa (BN)

• Diagnostic criteria include repeated binge-eating episodes
• Frequent inappropriate compensatory behaviors like forced vomiting, to prevent weight gain.
• Symptoms occur at least weekly for 3 months
• Self-evaluation is unduly influenced by body shape and weight
• The life prevalence is 1%, with 83% of cases being women and girls
• Higher prevalence is seen in LGBTQ+ populations, with rates that are similar in BIPOC and White populations
• Onset typically occurs in adolescence or young adulthood
• Weight may fluctuate but is often in a healthy range
• Some individuals may become underweight and meet anorexia nervosa criteria
• Binges are characterized by uncontrollable eating of large quantities of food, typically 2,000-3,400 calories per episode, often sweet, high-calorie foods
• Binges are pleasurable at the moment, but they lead to guilt and shame
• Compensatory behaviors include vomiting, laxative or diuretic abuse, or excessive exercise
• Can potentially cause significant health issues regarding the teeth, gastrointestinal tract, and muscle/bone structure
• Vomiting does not prevent the absorption of all calories
• Vomiting can lead the individual to become hungry again initiating more episodes of binging
• Typically begins after a period of intense dieting that was successful or praised
• Individuals are more concerned with pleasing others, are more sexually active, have a history of mood swings, are easily frustrated/bored, have trouble controlling impulses and strong emotions
• One third of individuals display characteristics of a personality disorder
• Can lead to cardiovascular problems, dangerous potassium deficiencies and dental issues

Binge-Eating Disorder

• Diagnostic criteria include recurrent binge-eating episodes
• Episodes must include at least three of: unusually fast eating, eating regardless of hunger, overeating to the point of discomfort, eating in secret due to shame, and feeling self-disgust, depression, or severe guilt afterward
• Significant distress regarding binge eating
• Episodes occur at least weekly over 3 months
• Absence of regular compensatory behaviors like those in bulimia nervosa
• Lifetime prevalence is 2.8%, typically later in life
• Approximately 67% of cases are women and girls
• 50% are overweight or obese
• Binge eating disorder was not listed in the DSM until 2013
• Obesity doesn't automatically mean they have a binge eating disorder
• Those with past or present food insecurity have a higher risk
• Increases the risk of developing diabetes, high blood pressure, heart disease, high cholesterol, and strokes.
• Key difference: presence or absence of compensatory behavior (present in BN, absent in Binge-eating)

Other Eating Disorders

• Pica involves persistent eating of non-nutritive, nonfood substances for over 1 month, not socially or culturally supported
• Avoidant/Restrictive Food Intake Disorder includes avoidance or restriction of food intake that leads to negative consequences like weight loss, malnutrition, and psychosocial impairment, not tied to concerns about weight or shape
• Rumination Disorder causes repeated regurgitation of food over 1 month, re-chewing, re-swallowing, or spitting out

What Causes Eating Disorders?

• Factors include depression, body dissatisfaction, psychodynamic perspectives, biological factors, societal pressures, and family environment
• Depression sets the stage for eating disorders and may be treated with antidepressants
• Body dissatisfaction is a powerful contributor to dieting and development of eating disorders
• Disturbed parent-child interactions can lead to ego deficiencies and perceptual disturbances, affecting awareness of hunger
• Dysfunction in brain circuits is similar between depression and disordered eating
• Perfectionism, unrealistic expectations, social media, societal biases, and family dynamics contribute
• Genetic reasons, imbalanced serotonin, dopamine, and glutamate levels and dysregulation in the hypothalamus and related brain structures all contribute to biological factors
• Western standards for female attractiveness, prejudice against overweight and obesity, and media messaging all contribute to societal pressures
• Eating disorders can be triggered in order to model a sick role due to enmeshed family environment with overly involved parents
• 9% of transgender or nonbinary people experience eating disorders, compared to 2% of cisgender people
• Men make up only 25% of diagnosed anorexia and bulimia cases
• There is a double standard for attractiveness
• Methods of wieght loss differ between genders: exercise vs dieting
• Muscularity-oriented disordered eating behaviors can result in muscle dysmorphia or reverse anorexia nervosa
• Gay men are 7 times more likely to experince eating disorders than straight men
• They make up approximately 42% of all cases in men

Treatment for AN

• Restoring weight and promoting healthy eating is a key goal that can be acheived though nutritional rehabilitation, tube feedings, and behavioral weight-restoration
• Cognitive-behavioral therapy (CBT) assists to address attitudes about weight and eating, the need for independence and control mechanisms, alternative stress, and problem-solving strategies
• Treatments also benefit from monitoring the connections between feelings, hunger, and food intake

Treatment for BN

• Treatments include nutritional rehabilitation, cognitive behavioral therapy and antidepressant medications
• Nutritional rehabilitation eliminates binge-purge patterns and establishes good eating habits
• Cognitive-behavioral therapy (CBT) addresses attitudes to help with food diaresm hunger, fullness, and mood
• CBT also includes exposure and response prevention (ERP)
• The treatment for Binge-eating disorder is also similar to BN with additional weight management intervention