The two most common eating disorders are anorexia nervosa and bulimia nervosa; however, experts recently acknowledged the possibility of another eating disorder called binge eating disorder though official diagnosis criteria remain undeveloped.
Patients with eating disorders do not exhibit normal eating behavior, severely restricting their food intake or significantly overeating. However, another component of these disorders is a psychological one. With an eating disorder, patients experience harmful, upsetting thoughts and feelings about their body shape and/or weight.
Although anorexia and bulimia have similar and overlapping characteristics, they are two distinct disorders. The disorders occur mostly in healthy young women, typically in late teens to early to mid-20s. Both anorexics and bulimics engage in behaviors of both disorders. For example, numerous anorexics binge-eat and purge, and many bulimics are former anorexics.
Patients with anorexia are notably underweight and refuse to maintain a normal weight. Further, anorexics exhibit extreme fear of weight gain and are in denial about the fact that they are underweight. These patients view themselves as overweight while being abnormally underweight.
Anorexics demonstrate odd eating habits, often avoiding meals with the family and allowing themselves only certain foods to eat, consuming these foods in very small amounts. In addition, anorexic patients weigh themselves frequently. There are two types of anorexia nervosa. Patients with the restricting type do not typically binge-eat or purge. However, this behavior is typical in anorexics with the binge-eating/purging type.
Initial treatment of anorexia nervosa depends on the patient’s illness severity with the most important objective being the restoration of the patient’s normal weight range. Experts recommend hospitalization of patients with weights 75% less than normal. Physicians may use outpatient treatment for those with mild disease or partial hospitalization for those with moderate disease.
After establishing a weight range goal, patients undergo re-establishment of their nutritional status until the patient achieves a stable weight gain of Â˝ to 2 pounds per week. Clinicians carefully monitor a patient’s weight throughout treatment and in patients with moderate to severe disease, supervision of the patient’s eating habits and meals occur. Another aspect of treatment is psychiatric therapy, concentrated on two primary concerns.
The first of these is the provision of emotional support to the patient during weight gain. Anorexic patients are terrified of weight gain, making this an emotional time for them. The second issue is teaching anorexics how to increase their self-esteem and not tie this to an unhealthy low weight.
In contrast to anorexic patients, bulimics typically have a normal weight or an above-normal weight. Bulimic patients exhibit recurring moments of binge eating followed by purging behavior. During an episode of binge eating, bulimic patients eat a large amount of food during a relatively short period of time. However, in addition to the amount of food intake, these patients also feel out of control with their eating.
To compensate for this overeating, bulimics then engage in purging behavior in an attempt to prevent weight gain. Purging behavior includes a number of tactics such as the induction of vomiting, abuse of medications (laxatives, diuretics, and enemas), refusal to eat, and exercising too much.
Experts treat bulimia nervosa as a chronic illness, establishing treatment that may last for a significant time. Treatment is usually outpatient, with initial treatment geared towards stabilization of normal eating habits, ending purging behavior, as well as maintaining a normal weight.
Physicians may prescribe medication to help counteract unhealthy behaviors as well as psychotherapy or cognitive behavioral therapy to address self-esteem issues.
Typically, bulimics continue medication and/or psychological therapy for at least one year. The only medication that is FDA approved for bulimia nervosa is the antidepressant, fluoxetine (Prozac).