Psychiatry department

Beni Suef University

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

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

• 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

• Depressed mood, social withdrawal

• Loss of interest in usual activities

• Anxiety

• Fatigue

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

• Skeletal: osteoporosis

• Hematological: anemia, leucopenia

• Endocrine: low T3, LH and FSH

• Electrolytes: hypokalemia, hypomagnesaemia

• Nervous: neuropathies, cognitive impairment,

seizures

Mortality

• 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

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

• Obsessive Compulsive Disorder

• Major Depression

• Generalized Anxiety Disorder

• Phobic Disorders

• Psychotic Disorders

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

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)

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 self-

evaluation and self-esteem

• The patient is within normal weight

Clinical picture

Behavioral changes

Medical complications

Social problems

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

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

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

• 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)

1. Biological Factors

2. Social Factors

3. Psychodynamic Factors

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

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

• 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

• 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.

• Cognitive-Behavioral Therapy

• Group Therapy

• Family Therapy

• Pharmacotherapy: antidepressants, in

particular SSRIs, are very useful