Anorexia and Bulimia: All you need to know and more-p1
by Emma Leigh
Introduction: So….. Way to throw a huge topic my way, Leigh! Anorexia AND bulimia? Sheesh….!! Hmmm…. So – Let’s get my thoughts in order so I can make sense of where I want to go…. I think I will first go over what will I cover (and therefore, what you should ‘take away’ from this rambling) and then I will get into the actual information….
The points I shall cover:
- What are Bulimia (BN) and Anorexia (AN) (the definitions)
- What causes them
-What are the Consequences – including:
- PHYSICAL and HEATH consequences of these things (the ugly issues)
- A brief look at PSYCHOLOGICAL and SOCIAL impacts (which many people ‘forget’ about)
- PHYSIQUE and ‘FITNESS’ consequences (body composition/ neurochemicals/ muscle mass/performance)….
But I am sure there will be random other stuff thrown in to boot… And with that – let’s get on with it so I can finish this before the turn of the century….
Eating disorders: The Definitions
My first take home message:
>Eating disorders are not just odd eating habits or diets… They are – deadly patterns of thinking and behavior that go beyond this…<
Ok, ok… so that is a no-brainer but many people do confuse these things. Regardless – Anorexia and Bulimia, in their ‘true meaning’, are actually forms of ‘mental illness’. They require certain ‘criteria’ to be met for a person to be classed as suffering from the disease. Are these criteria necessarily ‘correct’ (that is – is it right that someone must have ‘x, y and z’ before being classed as anorexic)? Many would argue no (psychiatrists/ medical professionals included) – but just as with other illnesses in mental health, something needs to be given as a guideline to ensure the *majority* with that illness are ‘defined’ and treated.
Adding from this – it means that a person’s eating patterns can be very ‘abnormal’ while not strictly being ‘a disorder’. And going a step further – a person can face a problem of ‘disordered eating’ but *technically* they do not have the diseases.
It must, however, be remembered that how one eats needs to be taken in light of the social context (just like anything).
For example – to someone who is NOT a bodybuilder – eating ‘chicken and rice’ for every meal would be considered slightly abnormal (and in some bb-ing circles it is considered such anyway). Does it mean this person has a ‘disease’? No. Does this person have ‘disordered eating’? No again. Because these two issues eventually come back to the THOUGHTS, COMPULSIONS or RITUALS behind the actions. Sadly, in saying that, there are MANY people in the fitness/ health/ athletic industry that have what would be termed ‘disordered eating’. Rituals/ thinking patterns and ‘food phobia’s’ that create unhealthy relationships with food and ‘eating’.
What is Anorexia Nervosa?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (as much as I hate its ‘slots’) -
- Resistance to maintaining body weight at or above the minimum of normal weight for age and height
- An intense and irrational fear of gaining weight or becoming fat
- Disturbance in perception of body weight or shape, or denial of the seriousness of their low body weight (on this note: some feel anorexia should be classed as a ‘psychosis’ of sorts – as these irrational thoughts/ perceptual disturbances could be seen as ‘delusions’)
- Amenorrhoea of > 3 months (in females who have reached puberty) Anorexia is then subclasses into two categories (which blur)
a. Binge Type [which is, as it states, involves periods of binging/ purging associated with the restriction]
b. Restrictive Type [pure starvation]
Anorexia occurs in about 1:100-150 females (mostly in late adolescence and early adulthood) but there are many more sufferers that are sub-threshold (they don’t meet all the criteria) with rates being similar in most developed countries of higher socioeconomic status. Although rates are far higher in females, and 90% of cases are female, Anorexia should not be thought of as a female disease with 1:10 sufferers being male. Length of illness figures varies depending on the source quoted, but average duration of illness is between 5-8 years. Only about 10-20% are thought to recover fully, with 10-20% of the population lifelong sufferers (never fully returning to a healthy weight/ healthy body image). Death rates are 15-20%, and up to 35-40% are also at risk of developing Bulimia.
What about Bulimia?
Again according to DSM-IV this is defined as -
- Recurrent episodes of binge eating, characterized by:
- eating an excessive amount within a discrete period of time
- a sense of lack of control over eating during the episode
- Recurrent (inappropriate) compensatory behaviour to prevent weight gain ( self-induced vomiting, laxatives/ diuretics/ enemas, medications, fasting, or excessive exercise)
- These behaviours both need to occur, on average, at least twice a week for 3 months
- And there needs to be a process of self-evaluation that is unduly influenced by body shape and weight.
Just like Anorexia, Bulimia tends to be a long-term disorder which tends to ‘wax and wane’. Most cases start in adolescence, but the disease tends to last many years beyond this time – with sufferers relapsing at times of crisis. About 90-95% of those affected are females – but adolescent males are also at risk of the disease, especially those who participate in sport/ athletics (which I will discuss later), and also those who have identity issues (eg: bisexual/ homosexual tendencies). Just like anorexia – rates tend to be higher in western society, average length of illness is usually long (with many going up to 8-10 yrs before they are diagnosed), and mortality rates are estimated to be up to 18-20%.
Other Eating Disorders: What else is there?
Other types of eating disorders would be things like ‘eating disorder, not otherwise specified’ – which covers the ‘catchment’ that is not covered by the above. But we are just focusing on these disorders for now – so I can cover those things at a later date if need be….
The Causes of Eating Disorders?
My second take home message:
>Eating disorders are not just related to ‘being skinny’<
NOT just a result of ‘the media’ – eating disorders need to be discussed under the ‘Bio-Psycho-Social’ model of disease development… This means that there are a number of factors that play a role in their development – divided into (surprise, surprise):
1. Biological Factors – eg: neurochemicals and genetic influences. And in this there has been many advancements regarding the various neurobiological vulnerabilities that make substantial contributions to whether or not someone develops AN and BN. Most of this revolves around altered brain serotonin (otherwise known as 5-HT) and dysregulation of appetite, mood, and impulse control.
2. Psychological Factors – eg: personality style, coping mechanisms, robustness/ resilience and a person’s sense of self. In this – individuals with AN and BN are usually characterized by perfectionism, obsessive-compulsiveness, and are usually described as having ‘dysphoric mood’ (that is – an abnormal or incongruent mood). To divide traits further – those with AN tend to have higher constraint/constriction of affect and emotional expressiveness (that is – they control their emotions), ahendonia (they gain little enjoyment from activities) and asceticism (‘barren of emotion’). Individuals with BN tend to be more impulsive /sensation seeking (that is – they are ‘all over the place’ in their emotional experiences). What needs to be stated is that these traits are often seen BEFORE the onset of the eating disorder, and will also persist afterward (which is important in identifying CAUSE v’s EFFECT of disease).
3. Social Factors – eg: home life, education, stress, relationships, and trauma. Unlike many other mental illnesses – rates are not related to things such as ‘broken homes’ or ‘poor backgrounds’… AN is actually seen more in middle class, well educated, ‘high achievers’. With that said some figures suggest up to 40% having also suffered some sort of traumatic experience in the past. As mentioned above, western societies have higher rate of disease. Many people try to blame media influence on the disease and rates seemed to sky rocket after ‘Twiggy’ hit the scene in the 1960-1970’s… and although there is no debate that this probably DID have a role in altering the perception of what is considered ‘beautiful’ for a female – it cannot be seen as the cause/reason for the disease. It is when all these three things place a venerable person in a venerable position that you get ‘the sum’ of their impact…. And the above can also demonstrate this with a pretty diagram: If you then go more deeply into the disorders you can also describe Anorexia and Bulimia in terms of The ‘4 p’ principle of Mental Illness… In this – A gentleman Barker developed a ‘four p-model’ to psychiatric illness where he proposed four ‘categories’ for which people do (or do not) develop/ recover from an illness.
These are:
- Predisposing Factors
- Precipitating Factors
- Perpetuating Factors
- Protective Factors
Each of these have contributions from all of the three groups above. So – to *quickly* run through the issues:
Some of the predisposing factors you would consider would be venerable personalities (anxiety, obsessive, perfectionist), family history of disease (or family history of mental illness such as depression or anxiety), external locus of control, and poor self-esteem, western society…. That sort of thing…. Things that mean a person has an INCREASED RISK of the disease.
Precipitating factors would be the ‘trigger’ for the development of the disease (as I mentioned – a person can be ‘AT RISK’ of something without developing the problem and it is only when you ‘add water and mix’ – that you create the issue). So these could be things such as family stressors, a conflict or incident, or a relationship breakdown. Going through puberty also seems to be an ‘at risk’ time for many and there are a few different factors that may act to cause this. Going back to neurochemical pathways – gonadal steroids (eg: oestrogen/progesterone/testosterone) are thought to exacerbate 5-HT and dopamine dysregulation (one of the reasons females get PMS and why males going through their teenage years are more at risk of schizophrenia).Second, stress from peer groups/ cultural and societal pressures to ‘fit in’ and even interfamily ‘tension’ about the ‘growing up’ of the individual may contribute to stress – increasing anxiety and further pushing a person into feeling ‘out of control’. So it is thought that the restriction of food causes changes in cortisol and 5-HTP levels, which ‘quell’ this anxious mood, and puts the individual ‘back in control’.
Perpetuating factors are those things that prevent recovery/maintain the disease state – in the case of ED this is a complex area and involves not only things like a person’s personality and social surroundings (obsessionality in itself = resistance to change… and having dysfunctional family relationships such as overbearing parents or neglect will impact), but also the disease state itself. For example – starvation has an impact on the frontal lobe functioning of sufferers. The frontal lobes are the parts of the brain that are responsible for things such as reason, insight, judgment, logic, and planning. Thus people with anorexia lose the ability to ‘think’ properly about the consequences of what is happening, and the disease state is prolonged. The psychological state they are in also maintains ‘thinness’ (hyper-anxious/hyper-aroused state = alterations in energy expenditure). Additionally, there is also this odd mechanism seen in starvation states which causes a paradoxical INCREASE in energy expenditure (the so called ‘frenzy of starvation’). This is thought to be a survival mechanism that flicks on to make people ‘get up and search for food’…. Problem is that those with AN end up getting up and ‘exercising’ instead…..
As mentioned above – disturbances of 5-HT function are common and this, in association with the dysphoric temperament, is thought to lead to food-emotion reward pathways and disturbed appetite behaviours. In Anorexia, as touched on before, there is a cycle where calorie restriction leads to relief from mood abnormalities. The problem in this is that malnutrition eventually alters other neuropeptides/dopamine levels which will create worsening of the dysphoria and the cycle is worsened. In the case of BN there are alterations in satiety hormones. These decrease satiety and causes changes in ‘hunger’ pathways, as well as modifying the neurochemicals involved in mood and reward (serotonin and dopamine). The result is the reinforcement of addictive patterns similar to those seen in those with gambling or drug problems.
And finally – protective factors include things that PREVENT the disease from developing. And it would include a strong sense of self, internal locus of control, robustness/resilience, strong family/social supports and any other number of things…
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To read part 2 click here
To read part 3 click here
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Feature Product: If looking for a program to help aid recovery for AN or Bulimia check out the Metabolic Repair Manual as part of The Fat Loss Troubleshoot program.
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