Dr. Ravi Bhatt Clinic

Anorexia Nervosa and Bulimia Nervosa -Eating disorders

Anorexia nervosa (AN) and bulimia nervosa (BN) are both come under the common term “eating disorder”, in both of these there occurs severe disturbance in the behavior of eating.

In anorexia nervosa, there is a refusal to maintain minimally normal body weight, while in bulimia nervosa there are recurrent episodes of binge eating which is followed by abnormal behaviors like self-induced vomiting. Anorexia nervosa and bulimia nervosa these both eating disorders commonly found in previously healthy young women who become over-concerned with her body weight and body shape.

In many cases, of bulimia nervosa, it was seen that they have a past history of anorexia nervosa too and many patients suffering from anorexia nervosa are also involved in purging behavior and excessive eating.

How to distinguish that a person is suffering from Anorexia nervosa or Bulimia nervosa?

A person suffering from anorexia nervosa is underweight, whereas a person suffering from bulimia nervosa have normal body weight or above the normal range of body weight.

Anorexia nervosa:

It is less common in males, it is more prevalent in those cultures where food is plentiful and where “thin person” is associated with attractiveness. The person who is in a carrier where there is more focus on how thin you are, like in ballet and modeling, are at more risk of suffering from anorexia nervosa.

Causes of Anorexia nervosa:

  1. Is unknown.
  2. Maybe a combination of cultural, biological and psychological factors.
  3. The genetic factor is a risk factor.

Symptoms of Anorexia nervosa:

  1. It begins in mid to late adolescence, sometimes it is found that anorexia nervosa is associated with a stressful event in life, like leaving home for school.
  2. This eating disorder develops in early puberty, before the start of the menstrual period, very rarely found after the age of 40 years of age.
  3. The patient is afraid of gaining weight, even he or she is underweight, they have an overconcern of gaining weight.
  4. The patient of anorexia nervosa exhibits a distortion of body image for example, despite being emaciated, the patient of this eating disorder believes that their body as a whole or some part of their body is too fat.
  5. Patients of this eating disorder view his or her weight loss as a fulfilling accomplishment and gaining weight as a personal failure.
  6. The patient rarely complains of hunger or fatigue and they are found to doing exercise extensively.
  7. The patient is in denial mode that they are not hungry but many are engaged in binge eating.
  8. The patient tends to become socially withdrawn and increasingly committed to work or study, dieting and exercise.
  9. The patient of anorexia nervosa collects books related to cooking and recipes.

The physical feature of patient of anorexia nervosa:

  1. Cold intolerance.
  2. Diminished gastrointestinal motility, which leads to reduced gastric emptying and constipation.
  3. In some females in which anorexia nervosa occurs after the onset of the menstrual period, it is noticed that their menstrual cycle stops before the occurrence of weight loss.
  4. There may be the presence of slow heart rate, low blood pressure, hypothermia.
  5. Hair symptoms are also seen like soft, downy hair growth i.e lanugo, alopecia may occur.
  6. There is an enlargement of the salivary gland, which is connected with binge eating and vomiting and starvation.

Bulimia nervosa:

Less common in males as compared to females.

The cause of bulimia nervosa is also multifactorial as in anorexia nervosa. Abnormalities of CNS serotonergic function, this is involved in the regulation of eating behavior and bring disruption of satiety mechanism.

Symptoms of bulimia nervosa:

  1. Mostly the patient is a woman of normal body weight of age between her mid-twenties, who do binge eating and purging 5 to 10 times per week for at least 5 to 10 years. Recurrent episodes of binge eating which is characterized by consumption of a large amount of food in a short period of time and a feeling that eating is out of control.
  2. Bulimia nervosa begins in late adolescence during or following a diet, which some time associated with depressed mood. The patient applies self-restriction of calories which leads to an increase in hunger and compels the patient to overeat.
  3. The patient tries to do induced vomiting, takes laxatives (laxative abuse ) or diuretics to avoid weight gain. Some who are suffering from diabetes mellitus type 1, they avoid taking insulin injections.
  4. In the initial stage, the patient experiences a sense of satisfaction that appealing food can be eaten without weight gain, but as the condition progresses, the patient perceives diminished control over the eating.
  5. During binges, the patient with bulimia nervosa tends to consume a large amount of sweet food with fat-rich content.
  6. The frequency of binges increases and size of binges too, which is provoked by anxiety, depression which is of the transient in nature, there may be the sense that too much food has been consumed in a normal meal.
  7. The patient attempts to restrict calories between the meal, which in turn increases the hunger and sets the stage for the next binge.
  8. The patient of bulimia nervosa is ashamed of his eating behavior and tries to hide this from family and friends.
  9. Like the patient of anorexia nervosa, the patient of bulimia nervosa place an unusual emphasis on weight and shape of the body as a basis of self-esteem.
  10. Mild depression, suicide attempts drugs and alcohol abuse also found in patients of bulimia nervosa.

Physical abnormalities in bulimia nervosa:

  1. Hypertrophy salivary glands of both sides because of purging behavior.
  2. There is the presence of scar or callus in the dorsum of the hand due to repeated trauma from teeth among patients who do gag reflex manually.
  3. Loss of dental enamel and chipping and erosion of front teeth, due to recurrent vomiting.

The prognosis of bulimia nervosa is more favorable than anorexia nervosa, there is full recovery of half of the patient of bulimia nervosa within 10 years, few patients of bulimia nervosa go towards anorexia nervosa.

Binge eating disorder:

It is characterized by repeated episodes of binge eating, like as found in bulimia nervosa, but there is the absence of induced vomiting, this syndrome occurs in both middle-aged male and female, with significant obesity. These patients have episodes of anxiety and depression as compared to other obese persons who are not suffering from binge eating disorder.

Natural ways to treat eating disorder:

  1. Yoga,as it helps to reduce stress.
  2. Acupuncture.
  3. Relaxation therapy like massage and aromatherapy.