Eating disorders are psychological illnesses defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health.

1. Eating Disorders
M.S Sara Dawod

2. Introduction
• They include bulimia, Anorexia nervosa.
• Bulimia has chronic course while others have
one episode.

3. Anorexia Nervosa
• Anorexia: loss of appetite.
• Nervosa: loss due to emotional reasons.

4. Anorexia Nervosa
• Individual refuses to maintain normal weight or
above minimally normal weight for age and
height (weight less than 85% of that expected).
• Fear of gaining weight even underweight.
• Denial the seriousness of the problem and lack of
insight.
• In postmenarcheal females, amenorrhea
(absence of 3 menstrual cycles).

5. Anorexia Nervosa
• They may use self induced vomiting or laxatives or
diuretics) and also stealing, drug abuse and suicide
are common.
• Pt manifests: depression, social withdrawal,
insomnia, irritability, loss of interest in sex, OCD
related or unrelated to food, inflexible thinking,
concern about eating in public.
• occurs during mid to late adolescence (14-18) and
more in females: 90% (10 times than men).
• Hospitalization to restores weight may be required
and recover may takes (6-7 years). Death risk: 10
times than population.

6. Bulimia Nervosa
• It means “ox hunger”.
• Diagnosis:
A. Recurrent episodes of binge eating which is
characterized as the following:
1. Eating within any 2 hours period a large amount of
food than other most people during similar period of
time.
2. Sense lack of control over eating during the episodes.
B. Inappropriate behaviors to prevent weight gain:
laxatives, enemas, tasting, excessive exercises, vomiting.

7. Bulimia Nervosa
C. It occurs at least twice a week for 3 months.
D. Self evaluation is influenced by body shape and
weight.
E. It doesn’t occur exclusively during anorexia
nervosa.
• Other notes:
• They are within normal weight, or lightly less or
above normal weight.
• Select low calorie diet.
• Has depression and anxiety disturbances.

8. Bulimia Nervosa
• F more than M
• Starts late adolescence or early adult life (12-40
years old).
• It begins after dieting failure.
• The majority have depressive symptoms.
• Dental problems and electrolytes imbalance are
common.
• Bulimia may occur in anorexia.
• Severe weight loss and amenorrhea in anorexia are
the major symptoms that differentiate it from
bulimia.

9. Etiology of eating disorders
• Genetic factors: 10 times higher in first degree
relative for anorexia and 5 times for bulimia, MZ
more than DZ.
• Neurobiological factors: hypothalamus (regulate
hunger and eating) problems, serotonin deficit.
• Sociocultural factors: ideal female body, high class,
media effect, negative attitude toward obesity (not
smart, lazy, stupid, stigma).
• Gender influences: women viewed through their
bodies but men through accomplishment, self
objectification (women see their body through the
eyes of others).

10. Etiology of eating disorders
• Psychodynamic views: disturbances in parent
child relationship, personality trait (low self
esteem, perfectionism), to overcome their feeling
of helplessness, ineffectiveness and to gain
respect, and powerlessness), facing the demand
of adolescence for identity and control. Mother
daughter conflict relation (food is symbol of this
relation and binging represents hate and love of
mother).
• Personality: perfectionism, shy, low self esteem,
anxious.

11. Etiology of eating disorders
• Family characteristics: family problems,
conflict, illness (depression, personality
disorders), enmeshment (over involvement
and intimacy in which the parent may speak
for their children because they believe they
know exactly how they feel), over
protectiveness, rigidity, lack of conflict
resolution.
• Child abuse (physical and sexual).

12. Etiology of eating disorders
• Cognitive behavioral views:
• Anorexia nervosa: fear of fatness and body
image disturbance which lead to dieting and
we weight loss to reinforce self control,
thinness is the ideal by media, criticism from
parent and peers, phobic response to sexual
changes associated with puberty.

13. Etiology of eating disorders
• Bulimia nervosa: over concerned with weight
gain and body appearance to reduce anxiety.
They have low self esteem so they focus on
the controllable features of self (weight &
shape) to feel better.

14. Treatment
• Pt typically deny the problem.
• Medication:
• Bulimia: antidepressant: fluoxetine, Prozac.
• Anorexia: antipsychotic : zyprexa: reduce
anxiety and increase weight gain.

15. Treatment
• Psychological treatment:
• Anorexia: behavior therapy to gain weight, family
therapy (lunch session), response prevention
technique: require the patients to be in the
presence of other patients for 2 hours after meal.
• Bulimia: CBT to question society standard of
physical attractiveness to change beliefs, develop
normal pattern of eating (3 meals and shacks
between meals), challenge negative thoughts,
individual and group therapy, response
prevention technique.