Advanced Health Tune Up

ANOREXIA NERVOSA/BULLIMIA

Anorexia is a severe emotional disorder that is increasingly common, especially amongst young women in industrialised countries where cultural expectations encourage women to be thin. Fuelled by popular fixations with thin and lean bodies, anorexia is also affecting a growing number of men, particularly athletes and those in the military. People with anorexia are terrified of becoming obese and refuse to maintain a normal weight, putting themselves in danger of starvation. Anorexia rarely begins in people who are older than 40 years of age. It most commonly appears in the teenage years, affecting up to 3 in 100 adolescents. Although anorexia seldom emerges before puberty, associated mental conditions, such as depression and obsessive-compulsive behaviour, are usually more severe when it does. The onset of anorexia is often preceded by a traumatic or stressful event and it is usually accompanied by other emotional difficulties. Anorexia is a life-threatening condition that can result in death from starvation, heart failure, electrolyte imbalance, or suicide. There are two main types of anorexia nervosa:

Restricting Type—characterised by dieting, fasting, and/or excessive exercise

Binge-Eating/Purging Type (anorexic-bulimic)—characterised by self-induced vomiting and/or misuse of laxatives, enemas, and/or diuretics. Binge eating may or may not occur; purging is common even after small amounts of food have been eaten. This type carries greater medical risk.

Aetiology / Risk Factors

Severe trauma or emotional stress (such as the death of a loved one or sexual abuse) during puberty or prepuberty.

Abnormalities in brain chemistry: Changes in serotonin levels, a brain chemical that regulates appetite, may contribute to other symptoms of anorexia nervosa such as depression, impulsiveness, obsessive behaviours, or other mood disorders. In addition, the process of purging may deplete tryptophan, an amino acid necessary for the production of serotonin, leading to further imbalances.

Overbearing, controlling, and critical parents who do not show emotional warmth.

A tendency toward perfectionism, fear of being ridiculed or humiliated, a desire to always be perceived as being "good."

Family history of anorexia: About one-fifth of those with anorexia have a relative with an eating disorder.

Age and gender—anorexia is most common in teens and young adult women

Early onset of puberty

Obsessive-compulsive disorder (OCD) or other anxiety disorders—OCD is present in up to two-thirds of people with anorexia.

The primary sign of anorexia nervosa is severe weight loss, accompanied by any number of physical and psychological symptoms and unusual behaviours related to food, eating, or exercise.

Scanty or absent menstrual periods

Thinning hair, dry skin, cold or swollen hands and feet

Bloated or upset stomach

Distorted perception of self (that is, a great difference between how an individual believes he or she looks and his or her actual physical appearance)

Inability to remember things, poor judgement

Refusal to acknowledge the gravity of the illness

Obsessive-compulsive behaviour (excessive need to control personal environment)

Unusual behaviours related to food or eating (for example, hoarding or concealing food, refusing to eat in public, eating only one type of food, ritually cutting food into tiny pieces, intense study of diets and calories, planning and preparing elaborate meals for others)

Compulsive exercising

Preoccupation with body size or body image, weight control or dieting