Eating Disorders: Anorexia Nervosa and Bulimia

Eating disorders, particularly anorexia nervosa and bulimia are significant problems among adolescent females and young women. Eating disorders are associated with serious medical and psychological issues. Eating disorders occur most often in adolescents and young adults and are ten times more common in females than in males. They occur in all ethnic groups but are most common among white's females.

Eating disorders can be hard to diagnose because some of the symptoms can be interpreted as normal adolescent behavior, such as secretiveness, moodiness and concern over appearance. However eating disorders are extreme versions of these behaviors. The person can be completely preoccupied with physical appearance; can be depressed, suicidal, anxious, and irritable. When diagnosing an eating disorder professionals look at symptoms such as dieting, refusal to eat, and rituals. The individual have very rigid rules around eating such as only eating certain foods or only on certain days. Baggy clothing, hoarding food and frequent trips to the bathroom can also be signs. The person may also avoid social situations that involve food. An accurate and prompt diagnosis is linked to better outcomes for individuals with eating disorders. A good medical history is the most powerful tool and the obvious first step. Young women with eating disorders frequently present with physical symptoms and do not generally come to the attention of medical professional voluntarily seeking mental health treatment.

One of the ways that anorexia is diagnosed is by the patient's refusal to maintain body weight at, at least 85 percent of their expected weigh. Patients with anorexia use calorie restriction or excessive exercise to control emotional need or pain, and they are terrified of becoming overweight. Bulimia is characterized by uncontrollable binging eating episodes, often followed by purging behaviors such as vomiting or the use of laxatives. Patients who have bulimia may be of normal weight which makes this disorder especially difficult to recognize and treat.

There are also eating disorders that do not quite meet the strict criteria for a diagnosis of an eating disorder, but involve frequent dieting and desire for weight loss. The Youth Risk Behavior Surveillance Survey in 1999 reported that between 40 -60% of students in the United States had exercised or dieted to lose weight. Some youth did so correctly and under supervision of doctors and their family. Others, may not meet the diagnostic criteria for a disorder, but may be at risk for developing the disorder. Proper identification and diagnose are important. Youth at risk also require treatment though it may be a more preventative focus. Generally, the distinction between normal dieting and disordered eating is based on whether the patient has a distorted body image.

Eating disorders are complex conditions caused by a combination of individual, family, interpersonal, biological, and social factors. Theories note a common set of issues including low self-esteem, social anxiety, depression, and feelings of lack of control .Family dynamics that can help to cause an eating disorder or interfere with recovery from an eating disorder include poor communication and a weak support system. The literature on effective interventions for adolescents with eating disorders often includes a review of traditional forms of treatment, which include outpatient therapy, partial hospitalization, inpatient treatment, medications, and intensive community-based interventions including case management, home-based treatment, and crisis services. A mix of these interventions can be successful and the individual may need to move back and forth on the continuum of care depending on their symptoms at any given time. It is extremely important that treatment include a variety of supports that can follow the patient from and inpatient setting back home to the community.

Because here is a need for both medical and mental health treatment, multidisciplinary team (MDT) approach is the best approach. The MDT should include the family doctor, psychiatrists, nutritionists, mental health professionals, and other professionals depending on the specific medical issues or symptoms. Multidisciplinary teams, as the name implies, are teams of people from different disciplines that come together for a common purpose. For a patient in a healthcare setting this means a holistic approach. Eating disorders are a particularly difficult disorder to treat so an approach that coordinates the treatment of various professional including medical, psychological, nutritional and social is best.