Introduction
Patients with this eating disorder will have a distorted body image, a fear of gaining weight, and an inability to understand the gravity of their illness. Anorexia, binge-eating disorders, and bulimia refer to eating disorders in which people either severely restrict themselves in food or overeat and then induce vomiting or exhaust themselves with excessive physical exertion.
History and Characteristics
The history of anorexia began in the Middle Ages. The so-called “anorexia mirabilis” (holy anorexia) existed first as a term (Pini et al., 2016). It was common among female nuns who limited themselves in food and observed complete asceticism (Pini et al., 2016).
Bulimia nervosa was first described in 1979 by the British psychiatrist Gerald Russell. People who have bulimia use their fingers to induce vomiting (Castillo & Weiselberg, 2017). The result is often traced on the back of the palms — the contact of the fingers with the teeth. This phenomenon is now known as “Russell’s sign” (Castillo & Weiselberg, 2017). Bulimia nervosa is much more common than anorexia, but is more difficult to recognize.
Both disorders have specific symptoms, which are in some way similar. Symptoms of anorexia include severe restriction of food intake or starvation; excessive sports activities; self-induced vomiting after eating; use of laxatives and/or enemas; frequent skipping of meals while a person can prepare food for others; and denying the feeling of hunger (Jain & Yilanli, 2020). Symptoms of bulimia include eating large amounts of food; destructive chewing, swallowing in pieces, and hasty eating; after eating, a person with bulimia can go to the toilet to induce vomiting; and a closed way of life, secretiveness, signs of psychological ill health (Jain & Yilanli, 2020). The reasons for developing the diseases are different – they can be both endogenous and exogenous.
Risks and Consequences
For both bulimia and anorexia, the risks are similar and unfavorable. With constant use of over-the-counter emetics, diuretics, and laxatives, problems in the work of the liver, pancreas, and kidneys begin with anorexia. Vomiting masses lead to inflammation of the esophagus and salivary glands and the destruction of teeth. The most deplorable consequences of bulimia are the stomach (Jain & Yilanli, 2020). With each uncontrolled absorption of food, the stomach undergoes mechanical stretching, thinning the walls.
Diagnostic Criteria and Treatment
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes numerous parameters as diagnostic criteria for anorexia. The first is a profound anxiety about gaining weight: people with anorexia generally fear gaining weight and becoming “fat.” People with anorexia take less food than their bodies require to operate correctly (McCallum Place, n.d.).
It may result in a considerably low body weight for the individual’s age and height; a skewed body image is another criterion. Anorexics frequently have inflated perceptions of their physique. The first physiological symptoms of anorexia are manifested in the form of a significant loss of weight (not due to disease) in a short period and worsening of well-being (dizziness) (Whitbourne, 2017).
The formal diagnostic criteria for bulimia nervosa, according to the DSM-5, include repeated episodes of binge eating, compensatory behavior to avoid weight gain, such as self-induced vomiting, and overuse of laxatives (McCallum Place, n.d.). The internal (physiological) causes of the development of anorexia nervosa include somatic diseases – diabetes, thyrotoxicosis, anemia; addictions – drug and alcohol addiction; immune disorders; hormonal changes; and diseases of the gastrointestinal tract. If those who have anorexia often lose weight to such an extent that they cannot hide their disease from others, then most of those who have bulimia have normal body volumes and normal weight.
Anorexia develops in stages that differ in the state of a person’s health, both physical and psychological. Treatment of anorexia nervosa, as well as bulimia, depends directly on the condition of the patient at the time of admission to the clinic, the features of the course of the disease, and the presence of concomitant diseases (Hay, 2020). To recover, it is necessary to undergo the entire complex of medical measures, as well as to receive the help of a psychotherapist and a psychologist.
Binge-eating disorder, in comparison to bulimia, is an episodic, uncontrolled eating of vast amounts of food. Episodes of overeating occur periodically and are associated with emotional distress and guilt for what a person has eaten (Iqbal & Rehman, 2020). Compulsive overeating differs from chronic overeating in the suddenness, amount of food eaten, and obsessive self-blame after the attack. An eating disorder occurs when the normal motivation to enjoy taste turns into a need to relieve tension. Bulimia nervosa is similar to binge-eating disorder because it is often accompanied by a pathologically increased feeling of hunger and a lack of satiety when eating.
Bulimia can develop as a result of increased insulin content in the blood. Patients with bulimia are often depressed: they are highly irritable, have mood swings, and are extremely self-critical (Whitbourne, 2017). Experts have noted that bulimia develops more often in people who belong to well-off families and have a tendency to pretentiousness and ambition in family attitudes (Jain & Yilanli, 2020).
Bulimia Treatment Center also suggests a comprehensive approach to solving the problem (Hay, 2020). The course of treatment includes the work of specialists of various profiles and the use of psychotherapeutic methods to eliminate the root cause of the appearance of the disease, which most often lies in the influence of external factors. Professionally prescribed drug treatment helps to achieve the result. In the case of organic bulimia (caused by internal factors, somatics), the root cause is first treated.
The diagnosis is based on collecting primary data from the anamnesis and studying characteristic clinical symptoms. It is essential to rule out primary diseases that could provoke the appearance of anorexia (Moore & Bokor, 2019). For this analysis, a complete diagnosis of the gastrointestinal tract is conducted. As a rule, the doctor carries out several basic diagnostic measures. They include studies of the stomach and intestines, which makes it possible to reveal the damage a person has already done to himself with the help of starvation. Ultrasound of the internal organs of the abdominal cavity, general biochemical blood analysis, and laboratory analysis of feces and urine are no less informative.
Conclusion
In conclusion, what distinguishes bulimia from anorexia is the presence of episodes of overeating and the emotional swings associated with this. A person who has bulimia finds himself in a cycle in which he periodically overeats and then gets rid of food with the help of vomiting, laxatives, diuretics, and enemas. A person with anorexia is not satisfied with their appearance, particularly with fullness, real or exaggerated.
References
Castillo, M., & Weiselberg, E. (2017). Bulimia nervosa/purging disorder. Current Problems in Pediatric and Adolescent Health Care, 47(4), 85–94. Web.
Hay, P. (2020). Current approach to eating disorders: a clinical update. Internal Medicine Journal, 50(1), 24–29. Web.
Iqbal, A., & Rehman, A. (2020). Binge eating disorder. PubMed; StatPearls Publishing. Web.
Jain, A., & Yilanli, M. (2020). Bulimia nervosa. PubMed; StatPearls Publishing. Web.
McCallum Place. (n.d.). DSM 5 diagnostic criteria for eating disorders. McCallum Place Eating Disorder Center. Web.
Moore, C. A., & Bokor, B. R. (2019). Anorexia nervosa. Nih.gov; StatPearls Publishing. Web.
Pini, S., Abelli, M., Carpita, B., Dell’Osso, L., Castellini, G., Carmassi, C., & Ricca, V. (2016). Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatric Disease and Treatment, Volume 12(12), 1651–1660. Web.
Whitbourne, S.K. (2017). Abnormal psychology: Clinical perspectives on psychological disorders (8th ed.). Dubuque, IA: McGraw-Hill.