Eating disorders
These disorders are characterized by marked disruption of a person’s normal eating behavior, and the two major syndromes are anorexia nervosa and bulimia nervosa. According to ICD-10 (Classification of Mental and Behavioural Disorders), also included in this category are orthorexia, psychogenic overeating (which can lead to obesity) and psychogenic vomiting.
The risk of suicide in patients with eating disorders should not be neglected.
1. Anorexia nervosa
It is a severe, potentially life-threatening condition characterized by distorted body image, voluntary weight loss, induced and sustained by the patient…
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2. Bulimia nervosa
It is a severe mental disorder characterized by repetitive “bouts” of overeating (episodic and uncontrolled ingestion in a short period of time…
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3. Obesity
It is a medical condition characterized by excessive fat accumulation in the body….
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4. Orthorexia
It is a severe medical condition characterized by an obsession or addiction to healthy eating and dieting….
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5. Binge eating disorder
It is an eating disorder included since 2013 in the DSM V (Diagnostic and Statistical Manual of Mental Disorders) that is characterized by episodes of eating disorders…
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1. Anorexia nervosa
It is a severe, potentially life-threatening condition characterized by distorted body image, voluntary weight loss, induced and sustained by the patient, which can lead to severe malnutrition and death. It is associated with pathological changes in most internal organs, although some tests performed may have normal results.
Epidemiology: the lifetime prevalence in women is 0.5-3.7%, with onset between 10 and 30 years of age (mostly associated with a stressful life event). In women, the frequency is 10-20 times higher than in men. It often occurs in developed countries and in patients who have a career that requires a slender type of figure (models, ballet).
The mortality rate is 5-18%.
Several factors are involved in the aetiology of this condition:
Biological factors: a deficiency of norepinephrine (a chemical involved in the transmission of brain nerve impulses from one neuron to the next) is associated;
Genetic factors: A genetic predisposition to this disorder has been shown, with anorexia nervosa being more common in families whose members have depression, alcohol dependence or eating disorders;
Psychological factors: anorexia is a reaction to the demands of social functioning especially in adolescence, and the result of a disturbed relationship with parents;
Social factors:Media promotion of slim silhouettes and excessive exercise.
Signs and symptomsanorexia nervosa include:
Intense fear of gaining weight (even if the person is underweight) that persists as an obsession (they are always looking for ways to lose weight); in some patients this can be so strong that they wish they were dead rather than gaining weight;
Severe malnutrition also causes other mental disorders such as mood disorders, irritability, irritability, mood swings, tendency to social isolation, eating rituals (obsessive-compulsive rituals), attention and memory disorders. These symptoms may improve once body weight is corrected.
The diagnosis is made by the psychiatrist based on the diagnostic criteria listed in the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V).
Two are described subtypes of anorexia nervosa:
Restrictive type: patients do not present in the current episode manifestations such as vomit induction, abuse of diuretics, laxatives, enemas;
The type with episodes of overeating alternating with self-induced vomiting.
Somatic complications
The somatic complications of anorexia vary according to the degree of malnutrition, and can be classified as follows:
- Endocrine: amenorrhoea, increased cortisol, decreased thyroid hormone levels, hypoglycaemia;
- Hydro-electrolyte imbalances: depletion of calcium, magnesium and potassium in the blood;
- Cardiovascular: hypotension, bradycardia, palpitations
- Gastrointestinal: hypertrophy of the parotid glands, oesophagitis, oesophageal erosions, pain and abdominal meteorism;
- Locomotor: fractures of various locations, growth retardation;
- Dermatological: dry skin, abrasions and bruises on the hand, thin and brittle hair, brittle nails;
- ENT: tooth enamel damage, repeated laryngitis;
- Haematological: anaemia, leukopenia, thrombocytopenia.
Differential diagnosis
The differential diagnosis of anorexia nervosa is made with the following conditions:
- General medical conditions: cancer, gastrointestinal disorders, AIDS, Chron’s disease;
- Substance use disorders: drug abuse;
- Depressive disorder: lack of appetite is present, but in anorexia patients show normal appetite;
- Somatization disorder: in this condition weight loss is not as severe as in anorexia nervosa;
- Bulimia nervosa: weight loss is not so marked .
Treatment
Treatment of anorexia nervosa can be carried out on an outpatient basis (doctor’s offices) or in hospital. The therapeutic approach to this condition is multidisciplinary, requiring both medication and psychotherapy.
Pharmacologically, anorexia nervosa can be treated with antidepressant medication (when there is a depressive disorder), mood stabilisers (when there are major mood swings), as well as cyproheptadine (an antihistamine that has a side effect of weight gain).
The types of psychotherapy used in anorexia nervosa are cognitive-behavioural (which attempts to change the patient’s attitudes about eating habits and body image), interpersonal, group and family.
Evolution
The evolution of this condition in the absence of adequate treatment is chronic, patients become dependent on caregivers, leading to limitation of daily activities, social isolation and disability.
Of all patients, 40% recover, 30% improve and 30% become chronic.
In the early stages of the disease, weight loss is due to a reduction in the amount of lipids in the body. In advanced stages, disorders of lipid, protein and carbohydrate metabolism are present.
Prognosis
In anorexia nervosa, being a severe psychiatric disorder that causes disability and numerous somatic disorders, it is very important to diagnose it as early as possible and to institute appropriate treatment.
2. Bulimia nervosa
It is a severe mental disorder characterized by repetitive “binges” of overeating (episodic and uncontrolled ingestion of food in a short period of time), followed by self-induced vomiting, periods of cessation of eating and excessive preoccupation with body weight control.
Epidemiology: the lifetime prevalence in women is 1-4%, with onset between 16 and 18 years. In women, the frequency is 10 times higher than in men (90% of all bulimia nervosa patients are women).
Biological factors: associated with a deficiency of norepinephrine and serotonin (chemicals involved in the transmission of brain nerve impulses from one neuron to the next);
Genetic factors: Genetic predisposition to the disorder has been shown, with bulimia nervosa being more common in families whose members have depression and obesity;
Psychological factors: patients show impulsivity, irritability, irritability as character traits;
Social factors:Media promotion of slim silhouettes as well as excessive exercise, patients tend to be perfectionists.
Signs and symptomsbulimia nervosa include:
Episodes of overeating and compensatory behaviour occur at least twice a week for 3 months.
The diagnosis of bulimia nervosa is made by the psychiatrist based on the diagnostic criteria listed in the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V).
Two are described subtypes of bulimia nervosa:
With purgative compensatory mechanisms (vomiting, laxatives, diuretics, enemas); this type is most commonly associated with depression;
With other compensatory mechanisms (dietary restriction, excessive exercise).
Somatic complications
Somatic complications of bulimia nervosa vary and can be classified as follows:
- Hydro-electrolyte imbalances: depletion of calcium, magnesium and potassium in the blood;
- Cardiovascular: bradycardia, palpitations
- Gastrointestinal: parotid gland hypertrophy, oesophagitis, oesophageal erosions;
- Dermatological: abrasions and bruising of the hand;
- ENT: tooth enamel damage, repeated laryngitis.
Differential diagnosis
The differential diagnosis of bulimia nervosa is made with the following conditions:
- Anorexia nervosa with episodes of overeating;
- General medical conditions: Kleine-Levin syndrome;
- Major depressive disorder;
- Borderline personality disorder (emotionally unstable).
Treatment
Treatment of bulimia nervosa can be carried out on an outpatient basis (doctor’s offices) or in hospital. The therapeutic approach to this condition is multidisciplinary, requiring both medication and psychotherapy.
Pharmacologically, bulimia nervosa can be treated with antidepressant medication, and several classes of antidepressants may be used.
The types of psychotherapy used in bulimia nervosa are cognitive-behavioural (which attempts to change attitudes about eating habits and body image), individual, group and family. It addresses the normalisation of eating habits and attitudes towards food in general.
Evolution
The course of this condition in the absence of adequate treatment is chronic, but not disabling if not complicated by hydroelectrolytic imbalance and metabolic alkalosis.
With appropriate treatment, recovery has been shown in 60% of cases. In 5 years, the relapse rate is 50%. Establishing a diagnosis of bulimia nervosa can be difficult due to maintenance of normal body weight, denial of overeating episodes and compensatory behaviours.
In order to have the most appropriate therapeutic results, it is necessary to establish a diagnosis and start treatment as early as possible, mainly because of the somatic and psychological complications that can occur in the course of this condition.
3. Obesity
It is a medical condition that is characterized by excessive fat accumulation in the body.
Epidemiology: it is estimated that approximately 50% of the inhabitants of the United States suffer from obesity, while in Romania the frequency of this condition is 20%. In the US, 60% of patients with obesity are female and of lower socio-economic status, while in Romania it is more common in men.
Several factors are involved in the aetiology of this condition:
Biological factors: there is a disruption of the metabolic signal to receptors in the hypothalamus;
Genetic factors: Genetic predisposition to this disorder has been demonstrated, 80% of patients have a family history of obesity;
Psychological factors: in general, stress causes hyperphagia;
Social factors:Media promotion of the slim, slender silhouette.
Somatic complications
Somatic complications of obesity can be classified as follows:
- Endocrine: diabetes, gout, hyperlipidaemia;
- Cardiovascular: left ventricular hypertrophy, hypertension, risk of heart attack or cerebral haemorrhage, venous stasis, angina pectoris, sudden death, heart failure;
- Respiratory: sleep apnea, Pickwick’s syndrome;
- Hepato-biliary: biliary lithiasis, cholecystitis, hepatic steatosis;
- Renal: proteinuria, hydronephrosis;
- Locomotor: osteoarthrosis of the spine, calcaneal bone spurs; neoplasms with different locations (breast, prostate, ovary, colon, rectum, etc.).
Differential diagnosis
The differential diagnosis of obesity is made with Cushing’s disease, myxedema and adipo-genital syndrome.
Treatment
Obesity treatment can be carried out on an outpatient (doctor’s surgery) or inpatient basis. The therapeutic approach to this condition is multidisciplinary, requiring both drug treatment, psychotherapy, diet and regular exercise.
Diet is the most important part of a body weight loss regime. A balanced diet that can be maintained over a long period of time is recommended. Total fasting is not recommended.
Regular exercise is necessary to increase the body’s basal metabolic rate and is an effective component of any weight loss regime. It is recommended to exercise at least 3 times a week, for 30-60 minutes, at an intensity of 50-70% of individual exercise capacity.
Pharmacotherapy is carried out by administering weight-loss drugs.
Surgery is recommended when other treatments have not worked. Gastric bypass is a specific procedure to reduce the size of the stomach.
Psychotherapy is an indispensable intervention in obesity. Through congnitive-behavioral therapy, patients are taught to recognize what makes them overeat and how they can adopt a healthy lifestyle. Without psychotherapy, other therapeutic modalities will not give the expected results.
Evolution
The evolution of this condition in the absence of adequate treatment is chronic, with adverse effects on the body’s health. Obesity increases the risk of colorectal, prostate, gallbladder, breast, uterine and ovarian cancers.
Prognosis
Obesity is both a medical and a social problem and the main goal of treatment is to reduce weight and maintain it over a long period of time.
4. Orthorexia
It is a severe medical condition characterized by obsession or addiction to healthy eating and the establishment of drastic diets out of a desire to eat as healthily as possible. In a society where obesity is on the rise, people are increasingly concerned about healthy eating, sometimes to extremes (as in the case of orthorexia).
A person with this type of disorder avoids eating foods containing sugar, white flour, food additives with carcinogenic potential, glutamate, fish meat, soy milk with high isoflavone content, beef (due to the risk of acquiring mad cow disease), cucumbers (due to the risk of becoming infected with E. coli bacteria) and will reject any food that is not organic. The person is concerned about the quality of food rather than the quantity, and breaking the rules of healthy eating results in a strong sense of guilt and anxiety.
Epidemiology: according to studies, the prevalence of orthorexia in the general population is 6.9%, and it is more common in men, especially in those with a lower level of education. The onset of the condition is between the ages of 20 and 40.
Several factors are involved in the aetiology of this condition:
Genetic factors: Genetic predisposition to this disorder has been demonstrated;
Psychological factors: the need for healthy eating stems from an emotional ‘crisis’;
Social factors:social pressure (“that’s the fashion”), economic problems.
Signs and symptomsorthorexia include:
The diagnosis is made by the psychiatrist after a thorough assessment of the patient.
They can be associated with orthorexia:
- Obesive-compulsive disorder
- Depressive disorder
- Bipolar disorder
- Panic disorder
- Post-traumatic stress disorder
- Abuse of drugs, medication or nutritional supplements
Somatic complications
Somatic complications of orthorexia are caused by the calorie-restrictive diet, leading to marked weight loss, protein-calorie malnutrition, cardiac complications and even death.
Differential diagnosis
Treatment
Treatment of orthorexia can be carried out on an outpatient basis (doctor’s offices) by a multidisciplinary team consisting of a doctor, psychotherapist and nutritionist.
Psychotherapy sessions can be beneficial and are aimed at overcoming psychological factors that have caused the disorder. The therapist helps the patient to identify problems they are not aware of and helps to resolve them.
Nutritional counselling can help patients to gradually introduce other foods that they have been mistakenly rejecting into their diet.
In severe forms, drug treatment is used. Antipsychotics, antidepressants, mood stabilisers and benzodiazepines prescribed by the specialist may be used.
Evolution
The evolution of this condition in the absence of adequate treatment is chronic, leading over time to social isolation and limitation of social actions. In advanced stages, disorders of lipid, protein and carbohydrate metabolism are present.
Orthorexia is a danger because sufferers severely limit their intake of salt (can cause hypertension), sugar (can cause diabetes) and fat (risk of increased cholesterol).
Even though limiting salt, sugar and fat intake is promoted by doctors, the problem arises when the person becomes obsessed with all these things and social isolation occurs (not participating in social or family events). People with orthorexia lose many hours a day thinking about the diet they have to follow and lose the pleasure of eating.
5. Binge eating disorder
It is an eating disorder included since 2013 in the DSM V (Diagnostic and Statistical Manual of Mental Disorders) that is characterized by frequent episodes of eating a large amount of food in a short period of time. The affected person loses control over the amount of food ingested and tends to eat very quickly. After these episodes, the feeling of guilt arises, and affected patients end up eating in secret.
Epidemiology: It is the most common eating disorder in the US, occurring equally in both men and women. The lifetime prevalence of this condition is between 2 and 3.5%. The average age at onset is 25, but most episodes start in adolescence .
Several factors are involved in the aetiology of this condition:
Genetic factors: Genetic predisposition to this disorder has been demonstrated;
Psychological factors: can occur against a background of strong emotional trauma, depression, generalised anxiety and obsessive-compulsive disorder;
Social factors:Intra-family conflict, financial instability, job dissatisfaction, low physical activity, fast food eating.
Signs and symptomsof compulsive eating are characterized by repeated episodes at least once a week for a minimum of three months and are represented by:
The diagnosis is made by the psychiatrist based on the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V).
Somatic complications
The somatic complications of compulsive eating are obesity, cardiovascular disease, diabetes, neoplasia, nutritional imbalance, metabolic syndrome, stroke, gastrointestinal disorders (abdominal pain, bloating, constipation, gastro-oesophageal reflux), hypercholesterolaemia, renal and hepatic dysfunction.
Differential diagnosis
Psychiatric comorbidities of compulsive eating are major depressive disorder, bipolar affective disorder, personality disorders, substance abuse, kleptomania and anxiety disorders.
Treatment
Treatment of anorexia nervosa can be carried out on an outpatient (doctor’s office) or inpatient basis. The therapeutic approach to this condition is multidisciplinary, requiring both drug treatment and psychotherapy and nutritional counselling.
Psychotherapy is considered the first step in addressing compulsive eating, the most commonly used types are cognitive-behavioural, individual and group therapy.
Medication treatment consists of the psychiatrist prescribing antidepressants and mood stabilizers .
Nutritional counselling is particularly effective in the treatment of this condition .
Evolution
The evolution of this condition in the absence of adequate treatment is chronic, leading to limitation of daily activities, social isolation and implicitly to a decrease in the quality of life.
Due to the high prevalence of depression, anxiety, diabetes, social isolation and suicide risk, compulsive eating is a major public health problem with a huge cost to society.
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