Eating Disorders
Eating disorders refers to a heterogeneous group of conditions characterized by sever disturbance in eating behavior.
A-Anorexia Nervosa:
Is a clinical syndrome of self-induced starvation characterized by a voluntary refusal to eat due to an intense fear of fatness & disturbed perception of body size. It occurs 15-20 times more frequently in females than males.
Atypical patient with this disorder is a white-female from middle to upper middle class family. In more than half of cases the syndrome begins before age 20 & in about 3/4 it occurs before age 25 years.
It is a potentially life-threaten disorder characterized by the patient s refusal to maintain body wt above 85% of what would be expected based on age & height.
@Causes: the specific cause(s) of the disease is still not known, but both biological & psychological factors may be involved. There is increase risk of anorexia nervosa among siblings (6%) with a 4-5 fold differences in concordance rates for monozygotic twin. This suggests a predisposing role for genetic factors.
@ Clinical features:
In addition to the skeletal-like appearance, sever complication (including any of the consequences of starvation) are possible in this disorder.
Amenorrhea (occur in about 30%), osteoporosis, decrease in BMR, lowered heart rate, hypotension, hypothermia, decrease WBC, hypoproteinemia, & anemia.
@Management:
Anorexia nervosa is a chronic illness requiring a multidisciplinary management approach using medical, psychiatric, nutritional therapy.
Sever malnutrition is not only life-threatening, but it also impairs thinking so the psychological treatment is not possible until nutritional status is improved.
Modest steady wt gain is an adequate goal in the early phase of the treatment.
Long-term psychotherapy is usually indicated.
With nutrition & psychotherapy 2/3 of cases recover to normal.
B- Bulimia Nervosa:
Is defined as recurrent episodes of rapid uncontrollable ingestion of large amounts of food in a short period of time usually followed by purging, either by forced vomiting &/or abuse of laxatives or diuretics.
This eating disorder is a significant problem for about 8% of adolescents & young adult females.
They generally look healthy & their behavior is unnoticed by friends & family
The patients who seek help do so because of feelings of guilty, anxiety or depression & more aware by her behavior & may be more willing to accept treatment.
@ Causes:
Unknown, but biologically & psychological role may present.
@ Clinical features:
There are no clinical signs of bulimia. Medical complications are the consequence of vomiting & laxative abuse which reveals:
Salivary gland hypertrophy due to vomiting, the induction of vomiting & dental erosion due to prolonged & repeated exposure to an acidic environment.
Irregular menses is frequent, metabolic alkalosis, hypochloremia & hypokalemia, cardiac arrhythmias.
@ Treatment:
Normalizing the patient s eating patterns & to change the patient s attitude towards food, eating & body size. Psychological therapy may be needed.
C- Binge Eating:
Here the binge are not followed by purges as in bulimia nervosa, those affected usually become obese.
D- Baryphobia:
This occurs when children themselves & parents put their children on the same low caloric diet that they follow. Children do not get adequate calories for growth.
E- Pica:
Ingestion of unsuitable substances having little or no nutritional value. Pica of pregnancy is most often reported as consumption of dirt, laundry starch, or clay.