According to the most recently accepted definitions by the American Psychiatric Association (1994), Anorexia nervosa (AN) and bulimia nervosa (BN) are defined as highly serious emotional disorders. and interference in many of the vital areas of the individual who suffers from it.
The data suggest that the confluence of biological, psychological and social factors interact with the personality of the individual, promoting the development of this type of dietary pathologies.
Among the first set of factors, the type of temperament of the individual as well as their level of emotional stability may be determining factors; Regarding the socio-cultural components, it is worth highlighting society’s idealization of maintaining a thin body, associating it with success and superiority over others; Regarding psychological factors, this type of patient presents phenomena such as low self-esteem, feelings of inefficiency in problem solving and coping, or a high desire for perfectionism that greatly hinders their daily functioning.
On the other hand, The presence of anxious and depressive symptoms is usually common. characterized by continuous sadness and dichotomous thinking (“all or nothing”).
A large proportion of people with anorexia present traits of obsession and compulsion in relation to maintaining rigidity and strict regulation in the control of eating, practicing extreme physical exercise, image and body weight. Finally, the difficulty in expressing themselves emotionally externally despite being very intelligent is also characteristic, which is why they tend to isolate themselves from close circles of relationships.
Anorexia
In the case of anorexia nervosa, This is characterized by a predominance of rejection of body weight usually accompanied by a distortion of body image and an excessive fear of gaining weight. In anorexia nervosa, two subtypes are distinguished, depending on whether or not binge-eating or compensatory behaviors occur (AN-Purgative vs. AN-Restrictive, respectively).
The second nosology, bulimia nervosa, It is characterized by the maintenance of cyclical episodes of binge eating and compensatory behaviors through vomiting. the use or abuse of laxatives, excessive physical exercise or restriction of subsequent intakes. In this case, the BN-Purgative categories are also differentiated, if the individual uses vomiting as a compensatory behavior, and BN-Non-Purgative, if the individual resorts to fasting or excessive physical activity.
Many of the people who have an Eating Disorder do not meet all the criteria that allow one of the two previous diagnoses to be made, which is why a third category is distinguished called Unspecified Eating Disorder where all of these can be included. subjects that are difficult to classify.
Characterization of bulimia nervosa and anorexia nervosa
Anorexia nervosa usually stems from family histories of dietary disorders, especially obesity. It is more easily detectable than bulimia nervosa, due to the high weight loss and the numerous medical complications that accompany the condition, metabolic, cardiovascular, renal, dermatological, etc. In extreme cases of malnutrition, anorexia nervosa can lead to death, with the mortality rate between 8 and 18%.
Unlike anorexia, bulimia is consulted much less frequently. In this case, the weight loss is not so evident since the binge-compensation cycles cause it to remain, more or less, at similar values.
Bulimic people are characterized by expressing an exaggeratedly intense concern about their body image. although they manifest it in a different way than in anorexia: in this case, eating becomes the method to cover their emotional needs not satisfied through appropriate means.
Analogous to anorexia, alterations are also observed on a psychological and social level. Normally these people show marked isolation, which is why family and social interactions tend to be poor and unsatisfactory. Self-esteem is usually deficient. Comorbidity has also been observed between bulimia, anxiety and depression; The latter is usually presented as a derivative of the former.
Regarding the level of anxiety, a parallel is usually shown between this and the frequency of binge eating carried out by the subject. Subsequently, feelings of guilt and impulsivity motivate binge eating compensation behavior. It is for this reason that a certain relationship between bulimia and other impulsive disorders such as substance abuse, pathological gambling, or personality disorders where behavioral impulsivity predominates has also been indicated.
The thoughts that characterize bulimia are also usually defined as dichotomous and irrational. They dedicate a lot of time each day to cognitions related to not gaining weight and feeding distortions in their body shape.
Finally, medical pathologies are also common, due to the maintenance of binge-compensation cycles over time. The alterations are observed at the metabolic, renal, pancreatic, dental, endocrine or dermatological level, among others.
Causes of eating disorders
There are three factors that have been demonstrated in a majority consensus by expert authors in this area of knowledge: predisposing factors, precipitating factors and perpetuating factors. Thus there seems to be agreement in granting the causality of EDs have a multi-causal aspect where both physiological and evolutionary elements are combined. psychological and cultural as interveners in the appearance of the pathology.
Among the predisposing aspects, reference is made to individual factors (overweight, perfectionism, level of self-esteem, etc.), genetic (greater prevalence in the subject whose family members present said psychopathology) and sociocultural (fashion ideals, eating habits, prejudices derived from body image, parental overprotection, etc.).
Precipitating factors include the subject’s age (greater vulnerability in adolescence and early youth), inadequate assessment of the body, excessive physical exercise, stressful environment, interpersonal problems, presence of other psychopathologies, etc.
The perpetuating factors differ in terms of their respective psychopathologies. Although it is true that negative beliefs about body image, social pressure and stressful experiences are common, in the case of anorexia the most important factors are related to complications derived from malnutrition, social isolation and development. of fears and obsessive ideas regarding food or body shape.
In the case of bulimia, the central elements that maintain the problem are linked to the binge-compensation cycle, the level of anxiety experienced and the presence of other maladaptive behaviors such as substance abuse or self-harm.
Main behavioral, emotional and cognitive manifestations
As mentioned in previous lines, Eating Disorders lead to a long list of manifestations, both physical (endocrine, nutritional, gastrointestinal, cardiovascular, kidney, bone and immunological) as well as psychological, emotional and behavioral.
As a summary, Regarding this second set of symptoms, there may be :
At a behavioral level
On a psychological level
On an emotional level
Intervention in eating disorders: objectives of the first personalized attention
In a generic approach to intervention in ED, the following guidelines can be a useful guide to offer a first individualized attention depending on the case that is presented:
1. An approach to the problem. In this first contact, a questionnaire is completed to acquire the greatest volume of information regarding the history and course of the disorder.
2. Awareness. Allow the patient to gain adequate insight into the deviant behaviors related to the disorder so that she can become aware of the vital risk derived from them.
3. Motivation towards treatment. Raising awareness about the importance of turning to a specialized clinical psychology and psychiatry professional is a fundamental step to guarantee a greater probability of therapeutic success, as well as early detection of incipient symptoms can be a great predictor of positive evolution of the disease. .
4. Information on intervention resources. Offering addresses of interest may be useful to increase the perception of social support received, such as associations of ED patients attending group therapy groups.
5. Bibliographic recommendation. Reading certain self-help manuals may be indicated, both for the patients themselves and for their closest relatives.
By way of conclusion
Given the complex nature of this type of psychopathology and the powerful maintaining factors that make a favorable evolution of these disorders extremely difficult, early detection of the first manifestations seems essential as well as guaranteeing a multicomponent and multidisciplinary intervention that covers both all the altered components (physical, cognitive, emotional and behavioral) as well as the extensive set of vital areas affected.
