Eating Disorders · 5:09pm Nov 2nd, 2013
If I'm feeling generous masochistic, tomorrow you guys will have organic mental disorders.
Psychotic Syndromes
Humour Disorders
Anxiety, Dissociative and Somatoform Disorders
Personality Disorders
Eating Disorders
The concept of normality: A psychopathological approach
Organic Mental Disorders
I - Anorexia Nervosa
Anorexia nervosa is characterized by an intense disturbance of the corporal image and the incessant search for leanness, frequently to the point of inanition. The disorder has been known for several decades, being described in individuals with an impressive uniformity. Such disorder is much more prevalent in women than in men, and has its first manifestations during adolescence. The hypothesis of a basic psychological perturbations in young women with the disorder include conflicts involving the transition from a girl to a woman. Psychological questions related to the feeling of impotence and the difficulty at establishing autonomy have also been suggested as contributing factors to the development of such disorder.
Epidemiology
Eating disorders of various kinds have been related in up to 4% of young female students. Anorexia nervosa has been reported as a increasing problem in the last decades, with crescent reports of the disorder in pre-puberal girls and in men. The most common age of manifestation is during the adolescence, but up to 5% of the patients with anorexia nervosa have developed the disorder shortly after reaching 20 years of age. It is postulated that anorexia nervosa has an incidence of 0.5-1% in pre-puberal girls. It happens 10-20 times more frequently in women than in men. The prevalence of young women with the diagnosis is stipulated to be around 5%, according to estimatives. Although this disorder has first been described in people of a higher social strata, recent epidemiological studies have not shown such distribution. The disorder seems to be more common in developed countries, being more frequent in young women with professions that demand a lower weight, such as ballerinas and models.
Etiology
Biological, psychological and environmental factors are implicit in the etiology of anorexia nervosa.
Biological factors
Endogenous opiates can contribute to the denial of hunger in patients with anorexia nervosa. Preliminary studies have shown dramatic weight gain in patients that receive opiate antagonists. The inanition results from many biochemical alterations, some of which are also present in depression (such as hypercholesterolemia and the absence of suppression with dexametasone). The lower thyroid functioning results in amenorrhea, due to the lower levels of Gonadotrophin Release Hormone (GnRH), Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). However, some patients with anorexia nervosa develop amenorrhea due to a significant loss in weight.
Social factors
There are some evidences that the patients with anorexia nervosa do have intimate relationships, although problematic, with their parents and, with the disease, they tend to distract themselves from the tense conjugal relationships in their homes. The patients with anorexia nervosa have a higher propensity to have a familiar history of depression, alcohol dependency and an eating disorder.
Anorexia nervosa seems to be a reaction to the demands over adolescents for a greater independence and a higher sexual and social functioning. The patients with the disease substitute their normal adolescent worries with a worry to gain weight. These worries are very similar to obsessions.
The patients with anorexia nervosa typically don't have a sense of autonomy and individuality. Many patients with the disorder see their own bodies as, up to some degree, under the control of their parents. The induced inanition could represent a method to try to obtain validation ad a special and unique person. Only through extraordinary acts of self-discipline the anorexic patient develops a sense of autonomy and individuality.
Diagnosis and Clinical Manifestations
The disease manifests itself in a wide age range, from 10 to 30 years of age. The bigger part of the aberrant behavior towards weight loss happens in secrecy. The anorexic patients usually refuse to eat with their families or in public places. They lose weight through a drastic reduction in food ingestion, with a disproportional lowering in foods high in carbohydrates and lipids.
Unfortunately, the term "anorexia" is inadequate, for the loss of appetite is usually rare. The evidence that patients are constantly thinking in food reveals itself in the form of a passion to collect recipes and cooking elaborate meals for others. Some patients aren't able to continuously control their voluntary feeding restriction and, thus, have voracity episodes. These episodes, in general, occur in secrecy and frequently during the night. The act of causing themselves to vomit frequently follows such episode. Some patients abuse laxatives and diuretics as means to lose more weight. Ritualistic exercises, extensive cyclism, walking or running are common activities.
Obsessive-compulsive behavior, depression and anxiety are other psychiatric symptoms more frequently notices in the literature when regarding anorexia nervosa. The patients tend to be rigid and adopt perfectionism. Somatic complaints, especially of epigastric discomfort, are common. Compulsive stealing, usually of candy and laxatives, but occasionally clothes and other items are common.
A deficient sexual adjustment is often described in patients with this disorder. Many adolescent patients have a late psychosocial sexual development and older patients show an accentuated lowering in the libido. A minority, uncommon goup of anorexic patients have a pre-morbid history of promiscuity, drug abuse or both and, during the disease, they show no lack of sexual interest.
The patients usually reach doctors when the weight loss becomes apparent. As the weight lowers, systemic symptoms may happen, such as hypothermia (below 35ºC), edema, bradycardia, hypotention and lanugo (neonatal-like hair), apart from serious metabolic disorders. Some patients reach medical attention through amenorrhea, which frequently, comes before the weight loss becomes perceptible. Some patients with anorexia nervosa induce vomits or abuse laxatives and/or diuretics, raising the medical staff's worries about an hypovolemic alkalosis.
All patients must fill the four criteria:
1) Refuses to keep the corporal weight at the same level (or levels above) the minimal value of normalcy that is adequate to their height and age.
2) Intense fear of gaining weight or becoming fat.
3) A perturbation in the way they "live" their own weight or their corporeal form, followed by the denial of the condition.
4) Only valid for women after menarche: amenorrhea (at least three menstrual cycles).
It is very important for the doctor to differentiate between the two types of anorexia nervosa:
1) Restrictive Type: During the current episode of anorexia nervosa, the individual did not allow him/herself to fall under a compulsive feeding habit or method of purgation.
2) Purgative Type: During the current episode of anorexia nervosa, the individual did fall under a compulsive feeding habit or methos of purgation.
II - Bulimia Nervosa
Bulimia nervosa, something that is more common than anorexia nervosa, consists in recurrent episodes of consuming great quantities of food, followed by a feeling of lack of control. The individual also have compensatory behaviors (such as purgation, fasting or excessive exercises) to avoid weight gain. The difference between this and those with anorexia nervosa lies in the fact that patients with bulimia nervosa are usually in an adequate weight or, less frequently, are overweight. According to the diagnostic criteria for bulimia nervosa, the periodic compulsion and the compensatory behaviors must happen, at least twice a week for a period longer than three months.
Epidemiology
Bulimia nervosa is more prevalent than anorexia nervosa. The estimatives about bulimia nervosa vary between 1-3% of young women. Like anorexia nervosa, bulimia nervosa is also significantly more common in women, but its development tends to happen in late-adolescence and young-adult years. Occasional symptoms of bulimia nervosa, such as isolated episodes of periodic compulsion, have been related in over 40% of women in universities.
Etilogy
Biological factors
Some researchers have been trying to associate the cycles of periodic compulsion and purgation to various neurotransmitters. As the antidepressants, sometimes, benefit patients with bulimia nervosa, serotonin and noradrenaline are implicit in its physiopathology.
The levels of plasmatic endorphins are higher in some patients with bulimia nervosa that vomit, leading to the possibility that the feelings of well-being experiences by some of them after the vomit could be mediated by the higher levels of endorphins.
Social factors
The patients with bulimia nervosa, like those with anorexia nervosa, tend to be more ambitious and tend to reply to the same "pressures" towards the "ideal body" stereotype. As with anorexic patients, many bulimic patients are depressed (with a higher chance of a family history of depression). The families of these patients, on the other hand, are different from those of the anorexic; being characterized by less intimacy and more conflicts amongst its members. The bulimic patients describe their parents as negligent and rejecting.
Psychological factors
The bulimic patients, like the anorexic, has difficulties with adolescence's demands, although they are more extrovert, impulsive, irascible than anorexic. Alcohol dependency, stealing and emotional instability (including suicidal ideations) are associated with bulimia nervosa.
Diagnosis and Clinical Manifestations
The essential characteristics of bulimia nervosa are: recurrent episodes of periodic compulsion; feeling a lack of control over his/her eating habits during meals; self-induced vomits and/or use of laxatives and/or use of diuretics; rigid diets or vigorous exercises in order to avoid gaining weight and a higher worrying with the form and weight of their body. The periodic compulsion usually precedes self-induced vomits in a year.
The majority of patients maintain a normal weight, but some can be higher or lower. The bulimics worry with their corporal image, with their appearance, with what others will think of them and with sexual attractiveness. The majority of them is sexually active when compared to the anorexic, who don't care much for sex. Pica and conflicts during meals are occasionally revealed in the patient's history.
The patients of the purgative type of bulimia nervosa can have a higher risk for certain medical complications, such as hypokalemia, alkalosis and hypochloremia. Those that vomit repetitively are in risk of gastric or esophagic fissures. Bulimia nervosa happens in individuals with higher propensity to develop humour disorders, losing their control and becoming impulsive.
III - Periodic Compulsion Eating Disorder (Binge)
This disorder is characterized by recurrent episodes of excessive feasting in the absence of inadequate compensatory behaviors that are characteristic of bulimia nervosa. These patients have no fixation for their corporal weight or image.
Criteria for investigation
First criteria
Recurrent episodes of periodic compulsion. An episode is characterized by one or both of the following:
1) Ingestion, in a short period of time (for instance, withing two hours), of a significantly large quantity of food when compared to what other people would consume, given the similar period and circumstances.
2) A feeling of lack of control over the feeding habit during the episode.
Second criteria
The episodes of periodic compulsion are associated with three or more of the following:
1) Eating much more quickly than normal.
2) Eating until one feels that he/she ate too much.
3) Eating large quantities of food when not feeling any hunger.
4) Eating alone, embarrassed by the quantity of food they ingest.
5) Feeling repulse for him/herself; depression; or accentuated guilt after eating excessively.
Third criteria
Accentuated anguish relative to the periodic compulsion.
Fourth criteria
The periodic compulsion happens, averagely, at least 2 days a week for 6 months.
Fifth criteria
The periodic compulsion isn't associated with the regular use of compensatory behaviors, nor does it happen exclusively during the course of anorexia nervosa.
We are reaching the end of our psychopathological studies, sadly. What we have left: organic mental disorders (delirium and dementia) and substance abuse.
Also: What is the difference between a neurologist and a neurosurgeon?
The neurologist says "Oh God, what can I do?!"; the neurosurgeon says "Oh God, what have I done?!"
