Anorexia nervosa, bulimia nervosa: causal theories and treatment

Anorexia nervosa and bulimia nervosa are eating disorders characterized by gross disturbances in eating behavior. Recently these disorders have reached near-epidemic proportions, affecting approximately 1.2 million adolescent and young adult females in the United States. The incidence in males is considerably less, and the prevalence rate has remained fixed at 5 percent during the last five years. The estimates of mortality range between 1 and 15 percent and are equally divided between medical complications (electrolyte disturbance, acute kidney failure, cardiac complications) and suicide. Successful treatment requires a combination of aggressive medical management, psychotherapy, behavioral management, food-intake management and nutritional counseling. This requires health care providers to understand 1) the psychological ramifications of these disorders, 2) the types of depression associated with them, 3) antidepressants used and therapeutic dosages, 4) correction of nutritional deficiencies, 5) outpatient management and 6) indications for hospitalization (inpatient management).     

Anorexia nervosa: aspects of care and treatment

The literature concerned with anorexia nervosa is reviewed. The picture of a distinct, psychogenic syndrome emerges with a phobia about weight gain and preoccupation with eating. The illness occurs in young people and may take an obsessional or hysterical form. Treatment, in the first instance, consists of restoring calorific deficiency and body weight and attempting to prevent relapses. In this the nurse has a major role to play in supportive psychotherapy.     

Anorexia nervosa and bulimia: an activity-oriented approach

In recent years, there has been a growing trend away from a dogmatic adherence to any one approach in the treatment of eating disorders. This paper adds the new element of practice in relation to cognitive change. The activity-oriented approach outlined here stresses that patients with anorexia nervosa or bulimia must maintain responsibility for their own food intake throughout treatment. The key role of the occupational therapist in the treatment team is outlined, and suggestions for assessment and management of this type of patient are given.     

Anorexia nervosa and bulimia: diagnosis and comprehensive treatment

The following principles are associated with successful treatment of anorexia nervosa and bulimia: (1) correct identification of these syndromes by history and mental examination, rather than by the elimination of all possible medical explanations; (2) a balanced approach between changing the abnormal weight or eating pattern and understanding and correcting the predisposing and underlying psychodynamics; (3) an empirical practical approach to treatment that avoids speculative concepts of origin; (4) an understanding of the natural history and underlying psychopathology of these disorders; (5) a non-blaming supportive approach, with variation in the specific kind of psychotherapy chosen according to the needs and abilities of the patient; (6) global treatment goals including psychologic, biologic, and social improvement; (7) avoidance of procedures with high morbidity such as tube feeding, hyperalimentation, and high-dose medication; and (8) an attitude of realistic optimism. Virtually all aspects of these disorders have the potential for complete improvement.     

Anorexia nervosa: review of current treatment practices

The etiology of anorexia nervosa has defied elucidation for over 100 years and no systematic treatment has yet been developed for the illness. We have reviewed some current findings that relate to both neuroendocrinologic and psychologic defects. Review of current treatment practices reveals that a variety of approaches are used, alone or in combination. Special attention is directed to the rationale for the use of certain neuropharmacologic agents that influence eating behavior. We advocate a flexible, multimodal approach to treatment of this illness, the understanding of which is still in its early stage.     

Anorexia nervosa and culture

Anorexia nervosa is currently considered a disorder confined to Western culture. Its recent identification in non-Western societies and different subcultures within the Western world has provoked a theory that Western cultural ideals of slimness and beauty have infiltrated these societies. The biomedical definition of anorexia nervosa emphasizes fat-phobia in the presentation of anorexia nervosa. However, evidence exists that suggests anorexia nevosa can exist without the Western fear of fatness and that this culturally biased view of anorexia nervosa may obscure health care professionals' understanding of a patient's own cultural reasons for self-starvation, and even hinder their recovery.     

Anorexia nervosa and bulimia nervosa: chronic conditions affecting pregnancy

Anorexia nervosa and bulimia nervosa primarily affect women who are in the childbearing years. While many anorectic patients are unable to ovulate second to the disruptions of normal body function associated with anorexia, there are still women who will ovulate and become pregnant. Bulimia nervosa may also disrupt the normal menstrual cycle if the disease is very severe. However, many bulimic patients will become pregnant. Both of these disease states cause a decrease in circulating plasma volume, fluid and electrolyte shifts, and other alterations that may increase the risk to a pregnancy and developing fetus. Severe disease states are associated with intrauterine fetal growth retardation (IUGR). The nursing care of the anorectic or bulimic patient who becomes pregnant is specialized and requires coordination between nursing, perinatology, and the psychiatric team, as well as support services including nutritionists. The nursing care of anorectic patients is difficult and requires an understanding of the complex psychological and physical pathophysiology of the disease. Bulimia nervosa also requires a complete understanding of the psychological and pathophysiology of the disease process. This article provides a review of the syndromes, risk factors, definitions of the disease states, and the nursing management of those patients experiencing a pregnancy complicated by the predisposing factors of anorexia nervosa, and/or bulimia nervosa.     

Anorexia nervosa: an immunohistochemical study of the pituitary gland

The morphologic features of the anterior pituitary gland were studied by immunohistologic methods in 12 patients who had died of complications of anorexia nervosa, 4 patients who had died while on a "crash diet", 13 patients who had died of organic disease associated with inanition, and 5 age- and sex-matched control subjects who had been involved in sudden fatal accidents. All known pituitary hormones were found to be present. Abnormalities noted in both the patients with anorexia and those with organic inanition included relative hypogranulation of adrenocorticotropic and, to a lesser extent, growth hormone cells. These changes are of unknown importance but are likely the result of starvation in that they were not observed in patients on a "crash diet" or in control patients. We conclude that no specific or etiologic abnormalities are present in the pituitary glands of subjects with anorexia nervosa and that the altered secretion of adenohypophyseal hormones often noted in patients with this disorder cannot be attributed to a primary pituitary disorder.     

Anorexia nervosa as a compulsive behaviour disease.

A number of anorexic young women develop bulimia, a condition in which binge eating is driven so intensely they cannot resist it. Although this drive has the character of a compulsion the patients do not as a rule suffer from obsessional-compulsive neurosis. A questionnaire was developed and used to determine whether similar compulsive drives manifest themselves in restricting anorexics and whether there are compulsive features resembling patients with compulsive personality disorder (as described in DSM-III) in eating disorders. A total of 162 patients were studied, comprising 42 controls, 30 depressed patients, 34 non-bingeing anorexics, 28 bingeing anorexics and 28 compulsive patients. The questionnaire was shown to be a stable instrument and, on the compulsion scale, the anorexics, bulimics and compulsive patients all scored very highly (mean +/- S.E.; 32.1 +/- 1.9, 35.8 +/- 1.9, 28.0 +/- 2.2, respectively) compared to the controls (13.1 +/- 1.1, p < 0.005). The compulsive patients did not have anorexia-type eating disorders. It was concluded that many of the factors which underlie compulsive personality disorder are present in primary eating disorders and the compulsive nature of anorexia could not be ignored when treatment was considered. The difference between compulsive behaviour and addiction is discussed in the light of the failure of long-term naloxone infusion to cure severe anorexia, even though some patients had dramatic weight gains associated with the antilipolytic action of naloxone.     

Anorexia nervosa: a multidisciplinary approach

The childhood-adolescent psychiatrics field has, for various years, been confronted by a very significant increase in cases of nervous anorexia, a serious eating disorder characterized by a noticeable loss of weight. At the bottom of this situation lie complex biological, psychological and social-cultural problems, which demand an interdisciplinary approach to solve them. This article presents the predisposing factors, the initial factors, the factors which maintain this disorder...; what behaviors are considered to be normal; what the physical and psychological manifestations are; as well as what the medical evaluation carried out is ... to finalize with an explanation of the different functions to be performed by each member of a multidisciplinary team.     

Anorexia nervosa: a cognitive-behavioural approach

People with anorexia nervosa can be resistant to treatment because they do not feel the therapist is on their side. This article focuses on the need to establish a therapeutic relationship before interventions can begin. The author also outlines important factors in the onset and maintenance of anorexia nervosa.     

Anorexia nervosa and the efficacy of an eating disorder service

Anorexia nervosa is often a chronic and severe disorder in which morbidity and mortality are high. This article describes the treatments used at The Priory Hospital's eating disorder service. The findings of an audit and follow-up study found that 85 per cent of the anorexic patients were successfully helped to gain weight (up to their normal weight) at a rate of about 1 kg per week. In a follow-up study four years later 80 per cent were doing reasonably well.     

Anorexia nervosa in children and adolescents

Anorexia nervosa is one of the most important public health problems during puberty and adolescence. The authors describe the most important differenciating characteristics, both clinical and preventative, of this health problem at these ages. The authors list a series of recommendations which may be applied in daily life circumstances as well as the requirements needed to obtain the best results by therapeutic intervention.     

Anorexia nervosa and zinc: Letter to the Editor

During the last few years there has been a growing interest in the role of zinc metabolism in the symptomatology of anorexia nervosa (AN) [1-3]. The hypothesis is that in most cases of AN there are serious disturbances in zinc absorption, distribution and secretion, resulting in some of the classical secondary symptoms of AN. The same symptoms are found in zinc deficiency [4]. Reports have been made on investigations of zinc status in patients with AN, in terms of zinc absorption [5], plasma zinc level [6], plasma and neutrophil zinc in relation to plasma albumin [7J and taste for zinc [8]. Lately, there have been reports on zinc treatment in AN [9].