Lecture on Eating Disorders

Overview

• Eating disorders are patterns of abnormal food intake affecting nutrition, physical and psychological health.
• Primarily refers to Anorexia Nervosa and Bulimia Nervosa.
• Involve overvalued beliefs about weight and maladaptive behaviors like food restriction or purging.

Anorexia Nervosa

• Core Characteristics:
  • Perception of being overweight despite being underweight.
  • Diagnosis requires below-average weight (BMI < 17.5).
  • Intense preoccupation with weight gain.
  • Distorted self-perception and compulsive behaviors to lose weight.
• Behavioral Patterns:
  • Excessive exercise, vomiting, or laxative abuse.
  • Severe food restriction, leading to malnutrition.
• Medical Impacts:
  • Fatigue, amenorrhea, infertility, osteoporosis, electrolyte imbalance, cardiac issues.
  • High hospitalization rates and severe cases of starvation.
• Psychological Aspects:
  • Obsessive thoughts similar to OCD but egosyntonic.
  • Related to obsessive-compulsive personality disorder (OCPD).
• Prevalence and Demographics:
  • Affects <0.5% of the population, predominantly women, onset around puberty.
  • High mortality rate due to complications and suicide.
• Treatment:
  • Nutritional rehabilitation, psychotherapy, family-involved therapy.
  • Limited role of medication.

Bulimia Nervosa

• Core Characteristics:
  • Episodes of impulsive binge eating followed by purging.
  • Consumption of large quantities of unhealthy food in a short time.
  • Emotional cycle: pre-binge lack of control, numbness during, guilt post-binge.
• Purging Methods:
  • Vomiting (most common), laxative abuse.
  • Causes dental, esophageal, and systemic issues.
• Criteria for Diagnosis:
  • Binging and purging at least once a week for three months.
• Psychological Aspects:
  • Linked to self-esteem, rejection sensitivity, and fear of being alone.
  • Strong comorbidity with borderline personality disorder (BPD).
• Prevalence and Demographics:
  • Affects ~1% of the population, more common in women.
  • Normal or slightly overweight BMI.
• Treatment:
  • CBT and interpersonal therapy.
  • Medications including SSRIs, avoiding bupropion.

Other Eating Disorders

Binge Eating Disorder

• Similar to bulimia without purging.
• Often results in overweight status.
• Equally prevalent in men and women.
• Strong association with BPD.
• Better prognosis compared to bulimia.

Avoidant Restrictive Food Intake Disorder (ARFID)

• New diagnosis in DSM-5.
• Avoids food due to reasons other than weight (e.g., sensory reactions).
• Leads to significant weight loss and nutritional deficiencies.
• Begins in childhood, treatable with CBT.

Conclusion

• Eating disorders impact both quality and longevity of life.
• Essential to diagnose and treat effectively.
• Related to other psychiatric conditions; understanding these is crucial for differential diagnosis.

Additional Resources

• Consider reading "Memorable Psychiatry" for practice questions.
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