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Anorexia and Bulimia

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Title: Anorexia and Bulimia


1
Anorexia and Bulimia
  • Lawrence D. Beem, D.C., FICPA
  • Professor
  • Cleveland Chiropractic College
  • Kansas City

2
Anorexia
  • Definition   
  • Anorexia nervosa is an eating disorder in which a
    person refuses to stay at even the minimum body
    weight considered normal for their age and
    height. Persons with this disorder may have an
    intense fear of weight gain and a distorted body
    image. Inadequate eating or excessive exercising
    results in severe weight loss.

3
Anorexia
  • Causes   
  • The exact cause of anorexia nervosa is not known,
    but social attitudes towards body appearance, as
    well as family factors, are believed to play a
    role.
  • Anorexia nervosa usually occurs in adolescence or
    young adulthood. It is more common in females.
    The eating disorder is seen mainly in Caucasian
    women who are high academic achievers and have a
    goal-oriented family or personality.
  • Some experts have suggested that conflicts within
    a family may contribute to this eating disorder.
    It is thought that anorexia is a way for a child
    to draw attention away from marital problems, for
    example, and bring the family back together.
  • Other psychologists have suggested that anorexia
    may be an attempt by young women to gain control
    and separate from their mothers.

4
Anorexia
  • Symptoms  
  • Most individuals with anorexia nervosa refuse to
    recognize (deny) that they have an eating
    disorder.
  • Symptoms may include
  • Weight loss of 15 or greater below the expected
    weight
  • Inappropriate use of laxatives, enemas, or
    diuretics (water pills) in an effort to lose
    weight
  • Self-imposed food intake restrictions, often
    hidden
  • No menstruation
  • Skeletal muscle atrophy
  • Loss of fatty tissue
  • Low blood pressure
  • Dental cavities due to self-induced vomiting
  • Blotchy or yellow skin
  • Depression

5
Anorexia Other Physical Symptoms
  • Physical signs and symptoms of anorexia include
  • Extreme weight loss
  • Thin appearance
  • Abnormal blood counts
  • Fatigue
  • Dizziness or fainting
  • Brittle nails
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Constipation
  • Dry skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Osteoporosis

6
Emotional Symptoms of Anorexia
  • Emotional and behavioral characteristics
    associated with anorexia include
  • Refusal to eat
  • Denial of hunger
  • Excessive exercise
  • Flat mood, or lack of emotion
  • Difficulty concentrating
  • Preoccupation with food

7
RED FLAGS TO WATCH FOR
  • Possible red flags
  • Skipping meals
  • Making excuses for not eating
  • Eating only a few certain "safe" foods, usually
    those low in fat and calories
  • Adopting rigid meal or eating rituals, such as
    cutting food into tiny pieces or spitting food
    out after chewing
  • Weighing food
  • Cooking elaborate meals for others but refusing
    to eat
  • Repeated weighing of themselves
  • Frequent checking in the mirror for perceived
    flaws
  • Wearing baggy or layered clothing
  • Complaining about being

8
Anorexia
  • Exams and Tests   
  • A diagnosis of anorexia nervosa is not made until
    other causes of weight loss are ruled out. The
    health care provider will determine if endocrine,
    metabolic, digestive, and central nervous system
    abnormalities can explain the weight loss. (For
    example, extreme weight loss could be due to
    celiac disease, inflammatory bowel disease,
    Addison's disease, and many other possible
    conditions.)
  • Tests will be done to help determine the cause of
    weight loss or to determine what damage the
    weight loss has caused cause.

9
Anorexia
  • Anorexia nervosa is a serious and potentially
    deadly medical condition. By some estimates, it
    leads to death in 10 of cases. Experienced
    treatment programs have a good success rate in
    restoring normal weight, but relapse is common.
  • Women who develop this eating disorder at an
    early age have a better chance of complete
    recovery. However, most people with anorexia will
    continue to prefer a lower body weight and be
    preoccupied with food and calories to some
    extent. Weight management may be difficult, and
    long-term treatment may be necessary to help
    maintain a healthy body weight.

10
Anorexia
  • Possible Complications   
  • Complications can be severe. A hospital stay may
    be needed.
  • Complications may include
  • Electrolyte imbalance (such as potassium
    insufficiency)
  • Cardiac arrhythmias
  • Severe malnutrition
  • Thyroid gland deficiencies which can lead to cold
    intolerance and constipation
  • Appearance of fine baby-like body hair (lanugo)
  • Bloating or edema
  • Decrease in white blood cells which leads to
    increased susceptibility to infection
  • Osteoporosis
  • Tooth erosion and decay
  • Seizures related to fluid shifts due to excessive
    diarrhea or vomiting Severe dehydration, possibly
    leading to shock

11
Anorexia
  • If you see that the child is restricting his or
    her food intake, over-exercising, or is
    excessiverly preoccupied with weight, you should
    talk to the parents. Early intervention before
    abnormal patterns are established can reduce the
    severity of an eating disorder.
  • Send them to the emergency room or call the local
    emergency number (such as 911) if fainting,
    irregular pulse, seizures, or other severe
    symptoms develop in a person with anorexia
    nervosa.

12
Anorexia
  • Prevention  
  • In some cases, prevention may not be possible.
    Encouraging healthy, realistic attitudes toward
    weight and diet may be helpful. Sometimes,
    counseling can help

13
Anorexia
14
Bulimia
  • Definition   
  • Bulimia is an illness defined by food binges, or
    recurrent episodes of significant overeating,
    that are accompanied by a sense of loss of
    control. The affected person then uses various
    methods -- such as vomiting or laxative abuse --
    to prevent weight gain.
  • Many, but not all, people with bulimia may also
    suffer from anorexia, an eating disorder
    involving severe, chronic weight loss that
    proceeds to starvation.

15
Bulimia
  • Causes
  • In bulimia, eating binges may occur as often as
    several times daily for many months. These binges
    cause a sense of self-disgust, which leads to
    compensatory behaviors like self-induced vomiting
    or excessive exercise. A person with bulimia may
    also abuse laxatives, diuretics, or enemas in
    order to prevent weight gain.
  • Such behaviors can be quite dangerous and may
    lead to serious medical complications over time.
    For example, the stomach acid which is introduced
    into the esophagus (the tube from the mouth to
    the stomach) during frequent vomiting can
    permanently damage this area.
  • Many more women than men have bulimia, and the
    disorder is most common in adolescent girls. The
    affected person is usually aware that her eating
    pattern is abnormal and may experience fear or
    guilt associated with the binge-purge episodes.
    Although the behavior is usually secretive, clues
    to this disorder include overactivity, peculiar
    eating habits or rituals, and frequent weighing.
  • Body weight is usually normal, although the
    person may perceive themselves as overweight. If
    bulimia is accompanied by anorexia, body weight
    may be extremely low.
  • The exact cause of bulimia is unknown, but
    factors thought to contribute to its development
    are family problems, perfectionist personality,
    and an overemphasis on physical appearance.
    Bulimia may also be associated with depression.

16
Bulimia
  • Symptoms   
  • Binge eating
  • Self-induced vomiting
  • Overachieving behavior
  • Inappropriate use of diuretics or laxatives

17
Bulimia
  • Physical signs and symptoms of bulimia include
  • Abnormal bowel functioning
  • Damaged teeth and gums
  • Swollen salivary glands in the cheeks
  • Sores in the throat and mouth
  • Bloating
  • Dehydration
  • Fatigue
  • Dry skin
  • Irregular heartbeat
  • Sores, scars or calluses on the knuckles or hands
  • Menstrual irregularities or loss of menstruation
    (amenorrhea)

18
Bulimia
  • Emotional and behavioral characteristics
    associated with bulimia may include
  • Constant dieting
  • Recurrent episodes of binge eating
  • Feeling that you can't control your eating
    behavior
  • Eating until the point of discomfort or pain
  • Eating much more food in a binge episode than in
    a normal meal or snack
  • Following a binge with efforts to prevent weight
    gain, such as self-induced vomiting, using
    laxatives or other medications, fasting or
    excessive exercise
  • Unhealthy focus on your body shape and weight
  • Having a distorted, excessively negative body
    image
  • Going to the bathroom after eating or during
    meals
  • Hoarding food
  • Depression or anxiety

19
Bulimia
  • Risk factors
  • Certain situations and events are associated with
    an increased risk of developing bulimia.

20
Risk Factors
  • Dieting. People who lose weight are often
    reinforced by positive comments from others and
    from their changing appearance. Children who diet
    are more likely than those who don't to develop
    an eating disorder such as bulimia. In addition,
    people with bulimia may excessively restrict
    their eating. That dieting can trigger a binge
    episode, leading to purging and then more dieting
    and consequently a vicious cycle.
  • Puberty. Some adolescents have trouble coping
    with the changes their bodies go through during
    puberty. They also may face increased peer
    pressure and may have a heightened sensitivity to
    criticism or even casual comments about weight or
    body shape. All of these can set the stage for
    bulimia and other eating disorders.

21
Risk Factors
  • Transitions. Whether it's heading off for
    college, moving, landing a new job or a
    relationship breakup, change can bring emotional
    distress. One way to cope, especially in
    situations that may be out of someone's control,
    is to latch on to something that they can
    control, such as their eating.
  • Sports, work and artistic activities. Athletes,
    actors and television personalities, dancers, and
    models are at higher risk of eating disorders
    such as bulimia. Eating disorders are
    particularly common among ballerinas, gymnasts,
    runners and wrestlers. Coaches and parents may
    contribute to eating disorders by suggesting
    young athletes lose weight.

22
Risk Factors
  • Media and society. The media, such as television
    and fashion magazines, frequently feature a
    parade of skinny beauties. But whether the media
    merely reflect social values or actually drive
    them is debatable. In any case, exposure to these
    images may lead girls and young women and their
    male counterparts to believe that thinness
    equates to success and popularity.

23
Bulimia
  • Exams and Tests
  • A dental exam may show dental cavities or gum
    infections (such as gingivitis). The enamel of
    the teeth may be eroded or pitted because of
    excessive exposure to acid in vomitus.
  • A chem-20 may show an electrolyte imbalance (such
    as hypokalemia) or dehydration.
  • Treatment
  • Treatment focuses on breaking the binge-purge
    cycles. Outpatient treatment may include behavior
    modification techniques as well as individual,
    group, or family counseling.
  • Antidepressant drugs may also be used in cases
    that involve depression.

24
Bulimia
  • Prognosis
  • Bulimia is a chronic illness and many people
    continue to have some symptoms despite treatment.
    People with fewer medical complications of
    bulimia, and who are willing and able to engage
    in therapy, tend to have a better chance of
    recovery.

25
Bulimia
  • Possible Complications
  • Pancreatitis
  • Dental cavities
  • Inflammation of the throat
  • Electrolyte abnormalities
  • Dehydration
  • Constipation
  • Hemorrhoids
  • Esophageal tears

26
Bulimia
  • Prevention  
  • Less social and cultural emphasis on physical
    perfection may eventually help reduce the
    frequency of this disorder.
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