Anorexia & Bulimia Nervosa - Dark Side of Wafer Thin Look Part I

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It is reported that nearly half of the patients suffering adverse effects of Anorexia Nervosa or Bulimia Nervosa end in death and those who survive have a frail life to take ahead of them. Anorexia Nervosa is reported to be occurring in 0.3 to 1.3 % of females mostly of adolescent and pre adolescent age group and a tenth of that are males of the same age group. Bulimia Nervosa is reported to occur in 3 % to 7% of the female adolescent age group or young females in 20's. The underlying causes of both eating disorders are very complex as it involves psychological, nutritional and sociological complications to develop in the ghastly disorder that takes over the human into thinking she or in some cases he is not as thin as should be. Both disorders have their own characteristics but their subtype overlap and these are important for diagnosis, approach and patient care.

Anorexia Nervosa - There are two subtypes to this disorder A) Restricting B) Binging. In either cases anorexia nervosa has a common symptomatology of image distortion where the patient constantly feels she is fat or not overweight in some areas of her body, thereby adopting their to restrict food completely or binging and then compensating the binge by inducing purging. In the both subtypes the patient is grossly underweight (upto 85% underweight than accepted weight) and since the condition is usually in the adolescent age the ideal weight doesn't depend upon the height but as per the weight chart from 11 - 17 years of age. Restricting subtype is very calculative about energy intake in the diet and usually doesn't consume more than 1000 kcal per day. Most of the food consumed is very empty in calories and not nutrition dense. They eat very rarely and over a period of time survive a day without eating. They are under the impression that if they eat anymore than they do they won't get back to their desired shape. On the other hand the binging subtype does eat huge portion sizes of at least 1000 - 2000 kcal in just 2 hours mostly of high calorie diet or extremely large portions of low calorie food. After binging they compensate by inducing to purge the food out by their hand or laxatives or diuretics. The binge episodes however should occur at least 2 times a week for around 6 months to be identified. Anorexia Nervosa patients are known to have psychological symptoms of chronic depression, mild depression, obsessive compulsive disease, extremely focused at their goals, non social, stubborn, ambitious, restless, highly irritable by slightest of changes. Some may show all the above symptoms and some just a couple. Anorexia patients are not accommodative towards recognizing their disorder and therefore are against approaching for help or accept offered recommendation. They do not realize they suffer from a disorder as they are convinced about their weight issues and therefore justify their dietary needs. They are highly susceptible to any substance abuse that they perceive to help them reduce weight. Anorexic patients are characterized with amenorrhea (absence of menstrual cycle for months) or retarded sexual growth. They more often than not develop a cardiac complication along with bone frailty due to excessive muscle & mineral wasting. Their death is usually due to cardiac arrest or respiratory failure. They require intensive in patient care until recovery and rehabilitation to normal lifestyle post recovery. 

Bulimia Nervosa - Unlike Anorexia Nervosa bulimic patients are of normal weight or even slightly over weight. However they develop bulimia nervosa by recurring episodes of binging and purging or excessive exercise or alternate therapies. They binge around 2000 kcal of food within a span of 2 hours and purge it out or get alternatives to compensate for the episode. They are known to abuse laxatives and diuretics and also develop medical complications due to this like mineral loss, tissue loss of the gastric system, some hemetemesis (vomiting blood), esophagitis, esophageal ulcers and bleeding, dental carries and loss due to recurring gastric fluid acid being vomited.Laxatives cause loss of minerals like potassium, intestinal tissue erosion, nutrient loss due to sloughing off tissue and food. They suffer from extreme gastro-intestinal complications, bone density loss, dental health problems, kidney failure, sub conjunctive hemorrhage, sleep cycle loss. Bulimic patients also face mild depression or sometimes chronic depression. They are harassed by their binge episodes and themselves seek help. They are obsessed with their weight however they do not wish to continue their trials of binging and purging for too long due to sheer mental and physical exhaustion. Bulimia Nervosa like Anorexia Nervosa needs both psychological and nutritional counselling along with medical support but are comparatively easier to recover. Their treatment can be inpatient care depending on the severity of their complications or even outpatient / day care treatment. 

We will discuss their medical approach and treatment in the upcoming posts till then if you wish to seek nutritional and wellness coaching please contact me here with your specific concerns.

Wish you wellness. 

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