Up to 4% of adolescents and young adults suffer from eating disorders like anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by refusal to maintain a healthy body weight and an intense fear of gaining weight. Bulimia nervosa involves recurrent binge eating and compensatory behaviors like purging. Both disorders involve biological factors like changes in neurotransmitters and hormones as well as psychological and social factors like perfectionism, low self-esteem, and troubled family relationships. They have varying mortality rates, symptoms, comorbidities, and treatments depending on the specific type and characteristics of each case.

1. EATING DISORDERSBULIMIAANOREXIA NERVOSA

2. EPIDEMIOLOGYUp to 4% of adolescent & young adultsMost common age of onset bet. 14 & 18 yrs0.5% to 1 % of adolescent girls20X more common in femalesProfessions requiring thinnessCOMORBIDITYDepression 65%;social phobia 34% OCD 26%ANOREXIA NERVOSA

3. BIOLOGICALopiods- deny hungerhypercortisolemiaNon suppression on DSTThyroid fxn-supressedAmenorrhea- low LH, FSH, GRHEnlarged ventriclesHigher caudate metabolismDysfunction in DA, S, NEDelayed release of insulinSOCIALClose but troubled relationship with parentsHigh levels of chaos, hostility, isolationLow levels of nurturance and empathy ANOREXIA NERVOSA ETIOLOGY

4. A. REFUSAL TO MAINTAIN BODY WEIGHT AT OR ABOVE A MINIMALLY NORMAL WEIGHT FOR AGE & HEIGHT(e.g. weight loss leading to maintenance of body weight less than 85% of that expected; failure to make expected weight gain during period of growth, leading to body weight less than 85% that expected).DSM CRITERIA FOR ANOREXIA NERVOSA

5. B. INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT EVEN THOUGH UNDERWEIGHTC. DISTURBANCE IN THE WAY WHICH ONE’S BODY WEIGHT OR SHAPE IS EXPERIENCED, UNDUE INFLUENCE OF BODY WEIGHT OR SHAPE ON SELF- EVALUATION,OR DENIAL OF THE SERIOUSNESS OF THE CURRENT LOW BODY WEIGHTDSM CRITERIA FOR ANOREXIA NERVOSA

6. D. IN POSTMENARCHEAL FEMALES, AMENORRHEA,(ABSENCE OF AT LEAST 3 CONSECUTIVE MENSTRUAL CYCLES)TYPES1. RESTRICTING- DURING THE CURRENT EPISODE OF ANOREXIA NERVOSA, THE PERSON HAS NOT REGULARLY ENGAGED IN BINGE EATING OR PURGING BEHAVIOR2. BINGE EATING/PURGING TYPE- SELF- INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR ENEMAS)DSM CRITERIA FOR ANOREXIA NERVOSA

7. Onset between 10 and 30 yearsBehavior and psychopathology present for at least 3 months; HALF WILL HAVE BULIMIA WITHIN ONE YEARPeculiar behavior about foodComorbidity with obsessive compulsive behavior, depression and anxietyDelayed psychosocial sexual developmentPE- hypothermia, dependent edema, hypotension, lanugo hairLaboratory- hypokalemia, ECG changesCLINICAL FEATURES

8. CLINICAL FEATURESMORTALITY 5 TO 18%RESTRICTING TYPEBINGE EATING/PURGING TYPEOBSESSIVE COMPULSIVE TRAITSLOWER SUICIDELOWER RECOVERYSUBSTANCE ABUSE,IMPULSE CONTROL &PERSONALITY DISORDERHIGHER SUICIDEHIGHER RECOVERY

9. VERSUS DEPRESSIONNORMAL APPETITEHYPERACTIVITY PLANNED & RITUALISTICFEAR OF OBESITYVERSUS SCHIZOPHRENIA INVOLVE CALORIC INTAKEHYPERACTIVEDIFFERENTIAL DIAGNOSIS

10. MORE PREVALENTLATER ONSETMAINTAIN NORMAL WEIGHTFEMALES>MALES 10:1 BULIMIA NERVOSA

11. BIOLOGICAL FACTORSNE & SEROTONINRAISED ENDORPHINSSOCIAL FACTORSDEPRESSED AND MORE CONFLICTUAL FAMILIESDescribe parents as NEGLECTFUL & REJECTINGPSYCHOLOGICAL FACTORSMORE ANGRY, OUTGOING AND IMPULSIVEEGO DYSTONIC LACK OF TRANSITIONALOBJECT , struggle with separation Ambivalent attitude BULIMIA-ETIOLOGY

12. A. RECURRENT EPISODES OF BINGE EATING. AN EPISODE OF BINGE EATING IS CHARACTERIZED BY both of the following:(1) EATING, IN A DISCRETE PERIOD OF TIME(WITHIN ANY 2 HOUR PERIOD) , AN AMOUNT OF FOOD THAT IS DEFINITELY LARGER THAN MOST PEOPLE WOULD EAT DURING A SIMILAR PERIOD OF TIME AND CIRCUMSTANCES(2) A SENSE OF LACK OF CONTROL OVER EATING DURING THE EPISODEDSM CRITERIA FOR BINGE EATING DISORDER AND BULIMIA

13. B. RECURRENT INAPPROPRIATE COMPENSATORY BEHAVIOR IN ORDER TO PREVENT WEIGHT GAINC. THE BINGE EATING AND INAPPROPRIATE COMPENSATORY BEHAVIOR BOTH OCCUR ON AVERAGE,AT LEAST TWICE A WEEK FOR 3 MONTHSD. SELF EVALUATION IS UNDULY INFLUENCED BY BODY SHAPE AND WEIGHTDSM CRITERIA FOR BULIMIA

14. E. THE DISTURBANCE DOES NOT OCCUR EXCLUSIVELY DURING EPISODES OF ANOREXIA NERVOSATYPE:1. PURGING TYPE: ENGAGED IN SELF INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR ENEMAS2. NON PURGING TYPE- EXCESSIVE EXERCISE OR FASTING DSM CRITERIA FOR BULIMIA

15. MOST HAVE NORMAL WEIGHTSEXUALLY ACTIVEHIGH RATES OF MOOD AND IMPULSE CONTROL DISORDER (15%)HIGHER RECOVERY THAN ANOREXIA NERVOSACLINICAL FEATURES

16. B. THE BINGE EATING EPISODES ARE ASSOCIATED WITH 3 OR MORE OF THE FOLLOWING:1. EATING MUCH MORE RAPIDLY THAN NORMAL2. EATING UNTIL UNCOMFORTABLY FULL3. EATING LARGE AMOUNTS OF FOOD WHEN NOT PHYSICALLY HUNGRY4. EATING ALONE BECAUSE OF BEING EMBARRASSED BY HOW MUCH ONE IS EATING5. FEELING DISGUSTED WITH ONESELF, DEPRESSED, OR VERY GUILTY AFTER OVEREATINGDSM CRITERIA FOR BINGE EATING DISORDER

17. C. MARKED DISTRESS REGARDING BINGE EATING IS PRESENTD. THE BINGE EATING OCCURS, ON AVERAGE, AT LEAST 2 DAYS A WEEK FOR 6 MONTHSE. THE BINGE EATING IS NOT ASSOCIATED WITH THE REGULAR USE OF INAPPROPRIATE COMPENSATORY BEHAVIORS, AND DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF ANOREXIA NERVOSA OR BULIMIA NERVOSACRITERIA FOR BINGE EATING DISORDER