According to the definitions most recently accepted by the American Psychiatric Association (1994), anorexia nervosa (AN) and bulimia nervosa (BN) are defined as emotional disorders of high severity and interference in many vital areas of the individual suffering from it.
Data show that the confluence of biological, psychological and social factors interact with the personality of the individual, leading to the development of this type of eating pathology.
Among the first set of factors, the individual’s temperament type as well as his level of emotional stability may be determining; With regard to the socio-cultural components, it is necessary to underline the idealization of the company to maintain a slim body associating it with the success and with the superiority vis-a-vis the others; in terms of psychological factors, this type of patient exhibits such phenomena as low self-esteem, feelings of ineffectiveness in problem solving and coping or a strong desire for perfectionism that greatly hamper their daily functioning.
Symptoms of eating disorders
On another side, the presence of anxiety and depressive symptoms is usually common, Characterized by continuous sadness and dichotomous thinking (“all or nothing”).
A large proportion of people with anorexia suffer from obsessive-compulsive disorder in terms of maintaining strict rigidity and regulation of diet control, extreme physical exercise, body image and muscle tone. body weight. Finally, the difficulty in expressing themselves emotionally outward despite being very intelligent is also characteristic, so that they tend to isolate themselves from the circles of close relationships.
In the case of anorexia nervosa, this is characterized by a predominance of rejection of body weight, Usually accompanied by distortion of body image and excessive fear of gaining weight. In anorexia nervosa, two subtypes are distinguished, depending on whether or not binge or compensatory behaviors occur (AN-Purgative vs. AN-Restrictive, respectively).
The second nosology, bulimia nervosa, is characterized by the maintenance of cyclical episodes of binge eating and compensatory behaviors of those with vomiting, The use or abuse of laxatives, excessive exercise or restriction of subsequent intakes. In this case, the BN-Purgative categories are also differentiated, if the individual uses vomiting as compensatory behavior and BN-Non-Purgative, if he resorts to fasting or excessive physical activity.
Many people with an eating disorder do not meet all of the criteria for one of the two previous diagnoses, so there is a third category called an unspecified eating disorder where all of these can be included.
Characterization of bulimia nervosa and anorexia nervosa
Anorexia nervosa is usually derived from a family history of eating disorders, particularly obesity. It is more easily detectable than bulimia nervosa, due to the high weight loss and the many medical complications that accompany the disease, such as metabolic, cardiovascular, renal, dermatological, etc. In extreme cases of malnutrition, anorexia nervosa can lead to death, with the death rate ranging between 8 and 18%.
Unlike anorexia, bulimia is much less common. In this case, the weight loss is not so obvious that the overeating-compensating cycles keep it, more or less, at similar values.
Bulimics are characterized by an overly intense concern for their body image, Although they manifest it differently than in anorexia: in this case, ingestion becomes the method to cover their unmet emotional needs through the right channels.
Similar to anorexia, there are also psychological and social disorders. These people tend to show marked isolation, so family and social interactions are often poor and unsatisfactory. Self-esteem is generally low. A comorbidity between bulimia, anxiety and depression has also been observed; the latter is generally derived from the former.
Regarding the level of anxiety, a parallel is generally shown between it and the frequency of the binge eating attacks performed by the subject. Subsequently, feelings of guilt and impulsiveness motivate the compensatory behavior of binge eating. It is for this reason that a certain relationship of bulimia has also been indicated with other impulsive disorders such as drug addiction, pathological gambling or personality disorders where behavioral impulsivity predominates.
The thoughts that characterize bulimia are also often defined as dichotomous and irrational.. They devote a lot of time a day to the awareness not to gain weight and to feed the distortions of the figure.
Finally, medical pathologies are also frequent, due to the maintenance of excessive compensation cycles over time. The alterations are observed at the metabolic, renal, pancreatic, dental, endocrine or dermatological levels, among others.
Causes of eating disorders
There are three factors that have been demonstrated by consensus by experts in this area of knowledge: predisposers, precipitators and perpetuators. Thus, there seems to be agreement to grant the causality of TCA a multicausal aspect where physiological and evolutionary elements are combined, Psychological and cultural as intervening in the appearance of the pathology.
Among the predisposing aspects, reference is made to individual factors (overweight, perfectionism, level of self-esteem, etc.), genetic (greater prevalence in the subject whose relatives have this psychopathology) and sociocultural (fashion ideals). , eating habits, prejudices derived from body image, parental overprotection, etc.).
Precipitating factors include the subject’s age (increased vulnerability in adolescence and early youth), inadequate body assessment, excessive exercise, stressful environment, interpersonal problems, presence of other psychopathologies, etc. .
Perpetuation factors differ in terms of individual psychopathologies. While it is true that negative beliefs about body image, social pressure and stressful experiences are common, in the case of anorexia the most important factors are related to complications of malnutrition, isolation social and the development of fears and obsessive ideas about food. or body silhouette.
In the case of bulimia, the central elements that maintain the problem are related to the cycle of overcompensation, the level of anxiety experienced and the presence of other inappropriate behaviors such as drug addiction or self-harm.
Main behavioral, emotional and cognitive manifestations
As discussed in the previous lines, eating disorders result in a long list of manifestations that are both physical (endocrine, nutritional, gastrointestinal, cardiovascular, renal, bone and immune) and psychological, emotional and behavioral.
In summary, on this second set of symptoms, they can occur:
At the behavioral level
- Restrictive diets or frenzy.
- Compensation for ingestion by vomiting, laxatives and diuretics.
- Changes in the mode of ingestion and rejection of certain foods
- Obsessive-compulsive behaviors.
- Self-harm and other signs of impulsivity.
- Social isolation.
At the psychological level
- Terrible fear of getting fat.
- Misconceptions about diet, weight and body image.
- Altered perception of body image.
- Impoverishment of creative capacity.
- Confusion in the feeling of satiety.
- Difficulty concentrating.
- Distortions cognitive: polarized and dichotomous thinking, selective abstractions, thought attribution, personalization, overgeneralization, catastrophism and magical thinking.
On an emotional level
- Emotional lability.
- Suicide depressive symptoms and thoughts.
- Symptoms of anxiety, development of specific phobias or generalized phobia.
TCA intervention: objectives of the first personalized attention
In a generic approach to intervention in ADD, the following guidelines can be a useful guide in providing individualized first aid based on the case presented:
1. An approach to the problem. This first contact completes a questionnaire to acquire the largest volume of information on the history and evolution of the disease.
2. consciousness. Allow the patient to have an adequate overview of the deviant behaviors associated with the disorder so that he can become aware of the fatal risks that result from it.
3. Motivation for treatment. Realizing the importance of turning to a specialist in psychology and specialized clinical psychiatry is a key step in ensuring a greater likelihood of therapeutic success, and early detection of emerging symptomatology can be an excellent predictor of the positive course of the disease.
4. Information on intervention resources. Providing bookmarks could be useful in increasing the perception of social support received, such as associations of patients with APD participating in group therapy groups.
5. bibliographic recommendation. Reading some self-help manuals may be indicated, both for the patients themselves and for their next of kin.
Given the complex nature of this type of psychopathology and the powerful maintenance factors which greatly hinder a favorable course of these disorders, early detection of the first manifestations seems essential as well as to guarantee a multi-component and multidisciplinary intervention which covers both all the altered components (physical, cognitive, emotional and behavioral) and the vast set of affected vital areas.
- Cervera, Montserrat. “Risk and Prevention of Anorexia and Bulimia.” Martínez Roca. Barcelona, 1996.
- Fernández, A. and Turon Gil. “Eating disorders.” Masson. 2002.
- Raich, Rosa Maria. “Anorexia and Bulimia: Eating Disorders”. Pyramid. Madrid, 2001.