This document discusses eating disorders such as anorexia nervosa and bulimia nervosa. It covers the clinical picture, medical complications, risk factors, comorbidities, prognosis and treatment options. Anorexia is characterized by weight loss and fear of gaining weight while bulimia involves binge eating and compensatory behaviors. Both have higher prevalence in females and can lead to long term medical issues if not properly treated through psychotherapy and medication.

1. Psychiatry department
Beni Suef University

2.  They
are a group of disorders where there is
excessive preoccupation with weight, food,
and body shape.
Two main types are recognized:
 1. Anorexia Nervosa
 2. Bulimia Nervosa

4. Clinical Picture
 • Weight loss leading to maintenance of body weight
to less
than 85 % of expected weight
 • Intense fear of gaining weight
 • Intense disturbance of body image (the patient
perceives
herself as overweight despite the clear evidence of her
thinness)

•Amenorrhea in females

•Anorexia is not an essential feature.
 The patient may maintain low body weight by
consuming low-calorie diet and by other means such
as vigorous exercise


5. •
Amenorrhea, sometimes early
 • Change in the quality of hair, nails and skin
 • Constipation or diarrhea
 • Dizziness or fainting
 • Decreased blood pressure, temperature or
pulse rate

7. •
Depressed mood, social withdrawal
 • Loss of interest in usual activities
 • Anxiety
 • Fatigue

8.  They
are due to chronic severe malnutrition and
marked reduction in caloric intake.
They include the following:
 •Cardiological: loss of cardiac muscle,
arrhythmias,
 prolonged QT interval, bradycardia, sudden
death
 • Hepatic: fatty degeneration

10. •
Skeletal: osteoporosis
 • Hematological: anemia, leucopenia
 • Endocrine: low T3, LH and FSH
 • Electrolytes: hypokalemia, hypomagnesaemia
 • Nervous: neuropathies, cognitive impairment,
seizures
 Mortality

12. •
Females are 10-20 times more
frequently affected than males
• 0.5-1 % of female adolescents, 5 %
have subclinical forms
• Age at onset is in the early
adolescence, it may be delayed till
the early 20's

13.  1.
Biological Factors
 2. Social Factors
 3. Psychodynamic Factors
 Fears concerning acquisition of feminine shape
of body
 •Self-discipline over eating is an attempt to
gain autonomy due to inability to get separated
from the mother
 • An attempt to draw attention

15. •
•
•
•
•
Obsessive Compulsive Disorder
Major Depression
Generalized Anxiety Disorder
Phobic Disorders
Psychotic Disorders

16.  Ten-year
outcome study in the United States:
 • 25 % complete recovery
 • 50 % improve, functioning well with
residual symptoms
 " 25 % functioning poorly, including 7 %
mortality rate

17.  It
is generally difficult.
 Hospitalization (marked weight loss
and with medical complications).
 Full medical assessment is essential.
 cognitive behavioral psychotherapy
 pharmacotherapy (antidepressants,
anxiolytics and antipsychotics)

18. Clinical Picture
 • Recurrent episodes of binge-eating + lack of
control over eating
 • At least twice a week for 3 months
 • Recurrent, inappropriate compensatory
behavior to prevent weight gain, such as the use
of purgatives, laxatives or self-induced
vomiting
 • Body shape and weight unduly influence selfevaluation and self-esteem
 • The patient is within normal weight


19.  Clinical
picture
 Behavioral changes
 Medical complications
 Social problems

20.  Behavioral
Changes
 • Secretive behavior (hiding food, spending
long periods in the bathroom)
 • Restrictive meal patterns or over-concern
with dieting and nutrition but with little
change in weight

21.  Physical
Changes
 • Loss of dental enamel as a result of
recurrent vomiting
 • Dehydration, fatigue, swollen salivary
glands
 • Esophageal or gastric tears
 • Side effects of emetics, diuretics or
purgatives

22.  Medical
Complications
 • Gastro-esophageal bleeding
 • Cardiac complications (e.g. arrhythmia)
 • Muscle cramping due to electrolyte
imbalance
 • Renal failure
 Social
Problems
 Social isolation
 Impairment in family relationships as a result
of concealment and lying

23. •
Much higher prevalence in females
 • The prevalence of bulimia nervosa is
between 3-5% of young women, four
times more common than anorexia
nervosa
 • 40 % of college-aged women have
bulimic symptoms
 • Usually starts in late adolescence or
early adulthood (later than anorexia
nervosa)

24.  1.
Biological Factors
 2. Social Factors
 3. Psychodynamic Factors

25. 1. Biological Factors
 The beneficial effect of antidepressants points
the
 potential role of serotonin and norepinephrine
 2. Social Factors
 •Patients are high achievers and respond to
societal pressures to be slim
 • Families are less close, but more conflictual
than those of
 anorexia nervosa
 • Parents are neglectful and rejecting


26.  3.
Psychodynamic Factors
 • patients exert self-discipline over eating in an
attempt to gain autonomy from the mother, but
they are more out-going, angry and impulsive.
 This leads to bouts of binge-eating.
 • They have other behaviors characteristic of
weakened impulse control, such as substance
abuse, self-destructive sexual relationships, and
shoplifting.
 • Binge-eating is experienced as ego-dystonic

27. •
Depression (30-70% lifetime rate)
• Generalized Anxiety (30-70%
lifetime rate)
• High rates of other anxiety
disorders and panic disorder
• Deliberate self harm, e.g.,
reckless driving, self-injury, suicide,
etc...
• Alcohol and substance misuse

28. •
The long-term outcome of bulimia
nervosa is still under study.
 • Without treatment, the disorder
usually persists for at least several
years, with a waxing and waning
course.
 • Up to 70% benefit from ttt
 full recovery is achieved in 50 % of
cases.
 • Mortality is approximately 1% due to
medical complications and suicide.

29. •
Cognitive-Behavioral Therapy
 • Group Therapy
 • Family Therapy
 • Pharmacotherapy: antidepressants, in
particular SSRIs, are very useful