Eating Disorders. The term ‘eating disorders’ refers to a group of psychiatric disorders characterized by abnormal eating behaviour that is not caused by obvious organic disease. Thus, it does not include hyperphagia in conditions such as prader-willi syndrome, or anorexia secondary to malignant disease.
Anorexia nervosa- the primary feature is weight loss.
- In the restricting type, patients achieve weight loss by eating restraint alone
- In the binge-eating/purging type, patients may combine calorie restrictions with other means of weight control such as self-induced vomiting and abuse of laxatives or diuretics.
Bulimia nervosa is characterized by binge-eating-consumption of excessive of food associated with sense of loss control. Bingeing often follows a period of dietary restraint, and this can lead to the establishment of a vicious circle in which bingeing is followed by further attempts at restraint. Bulimia nervosa is sometimes associated with other impulsive behaviours such as alcohol or drugs misuse, repeated self-harm and stealing . Such patients are likely to have secondary diagnosis of borderline (emotion unstable) personality disorder.
Major physical complications of bulimia nervosa
- Hypokalaemia
- Metabolic alkalosis
- Dental erosion
- Parotid enlargement
- Hyperamylasaemia
- Mallory-weiss tears of the oesophagus
Treatment of physical complications should generally be along conventional lines and involves close cooperation between psychiatrist, general practitioner and if appropriate, physician.
Treatment of bulimia nervosa is usually on an out-patient basis. The most well established treatment is cognitive behaviour therapy, which usually requires 16-20 sessions of treatment. Some patients benefit form self help books. Admission to hospital is occasionally required in patients with complicated types of disorders
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