What is Anorexia Nervosa? What is Bulimia Nervosa?

The two most common types of eating disorders are Anorexia Nervosa and Bulimia Nervosa. According to some estimates, about 5-7% of American females suffer from either disorder at some time during their lives.

If a person has a compulsion to eat, or not to eat - a compulsion that has a negative effect on their mental and physical health, they probably have an eating disorder.

What is Anorexia Nervosa?

Anorexia Nervosa is defined as a psychological disorder. The patient has a distorted body image and an irrational fear of becoming overweight - therefore, they deliberately try to lose weight. Even though the majority of patients are female, men can also suffer from Anorexia Nervosa .

*Anorexia is a generallossof appetite or no interest in food. Not lobe confused with Anorexia Nervosa. People with anorexia nervosa have not lost their appetite, they have deliberately restricted their food intake because of an irrational fear of gaining weight. However, you will often see the term "anorexia" with the meaning "anorexia nervosa".

According to DSM-IV ®TROLD Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, a person with Anorexia Nervosa:

  • weighs much less than he/she should -15% or more below their ideal weight
  • normally has a BMI of 17.5 or less
  • has missed three consecutive menstrual periods
  • has a preoccupation with body shape and weight
  • has a severe fear of putting on weight

Anorexia nervosa can be a devastating disease

Approximately 6% of all patients diagnosed with anorexia nervosa die" half of them from suicide. It is the mental illness with the highest suicide rate.

76% of reported Anorexia Nervosa onsets start between the ages 11-20.

The anorexia nervosa patient is often a perfectionist who sets herself targets beyond her reach. When those targets are not reached, she controls parts other life that she feels she can control, such as her food intake and weight.

There is a constant fear of losing control, which is mainly driven by low self-esteem and constant self-criticism. It is not uncommon to feel total loss of control after consuming a tiny amount of food.

Deep brain stimulation may help people with anorexia. Researchers reported in The Lancet that surgically implanting a pacemaker into the brains of patients with anorexia resulted in positive benefits for many of them.

What is Bulimia Nervosa?

Bulimia Nervosa is defined as a psychological disorder. The patient experiences regular bouts of serious overeating, which are always followed by a feeling of guilt, which can then lead to extreme reactions such as crash dieting, doing lots of exercise, and purging (deliberately vomiting).

According to DSM-IV-TR® Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, for patients to be diagnosed with bulimia nervosa (as opposed to anorexia nervosa), they must be showing the following 4 symptoms:

  • Binge -eating "repeatedly" - eating much more than most people normally do, together with a feeling that they can't stop or control their eating
  • Repeatedly and inappropriately compensating for the over -eating, such as over -medicating with laxatives, fasting, exercising to exhaustion, or making themselves vomit
  • Been doing these two things (binge -eating and inappropriately compensating) repeatedly at least twice a week for the last 3 months
  • Overly judging themselves in terms of the weight and shape of their bodies

Unlike anorexia nervosa, bulimia nervosa is difficult to identify. The sufferer is not usually underweight. Because of the shame and guilt associated with the illness, patients are skilled in masking the symptoms.

Long-term, the patient may experience malnutrition 'a symptom which often brings the patient to the attention of the doctor

Help and information on coping with eating disorders can be found by visiting one of the following national websites

  • National Eating Disorders Association (USA)
  • BEAT - beating eating disorders (UK)
  • National Eating Disorder Information Centre (Canada)
  • Eating Disorders Association (Australia)
  • Eating Disorders Association (Republic of Ireland)
  • Eating Disorders Services (New Zealand)

Written by - Christian Nordqvist
Copied with permission from Medical News Today

Frequently Asked Questions About Eating Disorders

The Johns Hopkins Eating Disorders Program

What is an eating disorder?

Eating disorders include anorexia nervosa, a form of self-starvation;bulimia nervosa, in which individuals engage in repetitive cycles of binge-eating alternating with self-induced vomiting or starvation; binge-eating disorder, which resembles bulimia but without compensatory behaviors (e.g. vomiting, excessive exercise, laxative abuse) to avoid weight gain; and atypical eating disorders, in which people may have fears and unusual behaviors (e.g. chewing and spitting or fear of choking) associated with eating. Although young women comprise the majority of people affected, eating disorders can occur in any age group. One in ten people with an eating disorder is male.

Anorexia nervosa and bulimia are psychiatric illnesses that center on food and its consumption and are usually characterized by:

Excessive preoccupation with food and dissatisfaction with one’s body shape or weight
A compulsion to engage in extreme eating habits and unhealthy methods of weight control such as:

  • Fasting or binge-eating
  • Excessive exercise
  • Self-induced vomiting
  • Chewing and spitting or regurgitating food
  • Laxative, diuretic, or diet pill abuse.

These unhealthy behaviors and preoccupations develop into a ruling passion interfering with physical, psychological and social well-being.

Eating disorders have many causes. They may be triggered by stressful life events, including a loss or trauma; relationship difficulties; physical illness; or a life change such as entering one’s teens, starting collage, marriage or pregnancy.An eating disorder may develop in association with another psychiatric illness such as a depressive disorder, obsessive-compulsive disorder, or substance abuse. Current research indicates some people are more genetically predisposed to developing an eating disorder than others.

How common are eating disorders?

The eating disorders anorexia nervosa and bulimia nervosa, respectively, affect 0.5 percent and 2-3 percent of women over their lifetime. The most common age of onset is between 12-25. Although much more common in females, 10 percent of cases detected are in males.

What is the difference between anorexia nervosa and bulimia?

Both anorexia nervosa and bulimia are characterized by an overvalued drive for thinness and a disturbance in eating behavior. The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are by definition at normal weight or above.

Bulimia is characterized by a cycle of dieting, binge-eating and compensatory purging behavior to prevent weight gain. Purging behavior includes vomiting, diuretic or laxative abuse. When underweight individuals with anorexia nervosa also engage in bingeing and purging behavior the diagnosis of anorexia nervosa supercedes that of bulimia.

Excessive exercise aimed at weight loss or at preventing weight gain is common in both anorexia nervosa and in bulimia.

What causes an eating disorder?
Eating disorders are believed to result from a combination of biological vulnerability, environmental, and social factors. Once an eating disorder develops, physiological changes play a role in sustaining the behaviors and irrational patterns of thinking involved. For example, starvation increases preoccupation with food and the risk of binge-eating. For underweight patients, achievement of a low normal weight is therefore a priority for successful treatment.

Are certain personality traits more common in individuals with eating disorders?
Women with eating disorders tend to be perfectionistic, eager to please others, sensitive to criticism, and self-doubting. They often have difficulty adapting to change and are future-oriented. A smaller group of patients with eating disorders have a more extroverted temperament and are often novelty-seeking and impulsive with difficulty maintaining stable relationships

What forms of treatment are effective for anorexia nervosa?

Treatment of anorexia nervosa involves behavioral monitoring and nutritional rehabilitation to normalize weight. Psychotherapy is aimed at correcting irrational preoccupations with weight and shape and preventing relapse. Interventions include monitoring weight gain, prescribing an adequate diet, and admitting patients who fail to gain weight to a specialty inpatient or partial hospitalization program. Specialty programs combining close behavioral monitoring with psychological therapy are generally very effective in achieving weight gain in patients unable to gain weight in outpatient settings. The fear of fatness and body dissatisfaction characteristic of the disorder tend to extinguish gradually over several months if target weight is maintained, and 50-75% of patients eventually recover. No medications have been shown to facilitate weight gain. In the case of patients under 18 years of age, family therapy has been found to be more effective than individual therapy alone.

What forms of treatment are effective for bulimia nervosa?

Most uncomplicated cases of bulimia nervosa can be treated on an outpatient basis although inpatient treatment is occasionally indicated. The best psychological treatment is cognitive-behavioral therapy, which involves self-monitoring of thoughts, feelings, and behaviors related to the eating disorder. Therapy is focused on normalizing eating behavior and identifying environmental triggers and irrational thoughts or feeling states that precipitate bingeing or purging. Patients are taught to challenge irrational beliefs about weight and self-esteem. Antidepressants have also been shown to be effective in decreasing bingeing and purging behaviors in bulimia.

Is there a biological basis to eating disorders?

Social pressure for thinness is known to influence dieting behavior.However, it does not sufficiently explain why less than five percent of women and girls develop a full-blown eating disorder because the majority of women in the United States diet at some time in their lives. Additional vulnerability factors must characterize the affected population. Family and twin studies suggest that genes predispose to an eating disorder and genetic studies are currently underway to attempt to isolate genes involved in the development of eating disorders. Abnormalities in the brain's serotonergic and dopaminergic systems are thought to play a role in the cause and or maintenance of eating disorders. Taken together these studies suggest that there may be an inborn genetic vulnerability to eating disorders in at-risk individuals, and that once dieting behavior starts it leads to biological changes that help sustain disordered eating behavior.

How do I know if I need inpatient treatment?

If you think you have an eating disorder, if your symptoms have persisted or worsened despite attempts at outpatient treatment, or if you feel constantly preoccupied by thoughts of food and weight, then a good place to start is with a comprehensive evaluation in our Consultation Clinic. You will be seen by a psychiatrist and undergo a thorough review of your history and symptoms, as well as medical tests when indicated. We ask that whenever possible you attend the consulation with a close family member or significant other, since we believe family support and involvement is very important when you are struggling with an eating disorder. The doctor will also be interested in any medical or psychiatric problems you may have besides the eating disorder.

Common co-occuring psychiatric conditions include depression, anxiety, substance abuse and obsessive compulsive disorder. Co-occuring medical conditions that may bring patients to treatment include gastrointestinal complaints, infertility problems or mentrual irregularities, osteoporosis, or chronic pain conditions. At the end of your evaluation, the consulting physician will review his or her impression and diagnosis of your condition and will make suggestions regarding the best next step for you in terms of treatment. These suggestions may include recommendations for medication, psychotherapy, further testing, or consultation with another medical specialist in The Johns Hopkins Health System.

What insurance does the hospital take?

If you are being admitted to the hospital programs, both inpatient and day hospital, our business office will verify you benefits beforehand, and the admissions coordinator will contact you with information about your coverage as it applies to our program. Admission to our program qualifies as a mental health admission through the johns Hopkins Hospital Department of Psychiatry and will be authorized under the mental health portion of your insurance, not the medical portion. Please see the Admissions page for more information.

PREVALENCE

  • It is estimated that 8 million Americans have asn eating disorder-seven millon women and one million men
  • One in 200 Amercian women suffers from anorexia.
  • Two to three in 100 Americans woemn suffers from bulimia.
  • Nearly half of all Amercicans personally know someone with an eating disorder( Note: One in five Americans suffer from mental illnesses.)
  • An estimated 10-15% of people with anorexia or bulimia are males.

Mortality Rates

  • Eating disorders have the highest mortality rate of any mental illness
  • A study by the National Association of Anorexia Nervosa and Associated Disorders reported that 5-10% of anorexics die within 10years after contacting the disease; 10-20% of anorexics will be dead after 20 years and only 30-40% ever fully recover
  • The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of all causes of death for females 15-24 year old.
  • 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems.

The revolutionary MAP program.

The road to recovery from eating disorders can be ridden with difficulties.Winning the battle takes focus, presistence and a fighting spirit. But even the courageour ones need the input and direction of those who’ve won before, as proper treatment must include a combination of monitoring, strategizing, and networking with all professionals involved.

That’s where the Magen Avrohom specialists excel.

Our MAP program is driven by years of research and a deep understanding of the mentalities of eating disorders. It helps struggling anorexics and bulimics discover a constructive path towards life and newfound happiness. Working outisde the confines of the ‘one size fits all ’ quick-fix approac, we guide each individual at a pace optimized for their recovery.

Meal coaching

Magen Avrohom has trained dedicated individuals to coach and support someone with an eating disorder during mealtime. They will follow a food plan provided by a nutritionist, under the care of a medical doctor. This hands-on approach helps ensure a commitment to healthy eating habits and has proven to be a very successful aid to recovery.

Mentoring

We provide a trained mentor to the struggler or coach a selected friend on how to mentor the struggler. It is well known that a healthy relationship can replace an eating disorder.

School Awareness

Education of school staff regarding prevention, early intervention, and detection of the early signs of an eating disorder.