Is anorexia (nervosa) bulimia? Understand what it is and the treatment

It is natural to want to take care of the body and be in good shape. But it becomes a nuisance when that concern becomes obsessive.

Anorexia nervosa has the highest mortality rate among eating disorders. In addition, the condition can result in several health complications.

So, if you know someone who is in this situation, talk and refer a doctor to do an evaluation.

What is anorexia nervosa?

Anorexia nervosa (AN) is an eating disorder characterized by excessive weight loss. The patient usually eliminates the foods that he believes to be more caloric and progressively excludes several others. Food issues become fundamental in the life of the patient, who becomes obsessed with weight gain.

The mind cannot get rid of excessive thoughts about the body, food and calories, as if food were its main concern, to the point of losing the instinct of hunger and survival.

Patients often deny the problem and refuse to maintain a minimum weight, being indifferent regarding their nutritional status.

The bodily systems are damaged, showing mainly by 3 signs:

  • Alteration of satiety : People are very satisfied even though they have eaten little;
  • Appetite reduction : It is reduced and the person restricts the food groups he eats (usually cut carbohydrates);
  • Distortion of body image: In which the person, even though thin, perceives himself as large or fat.

In addition to the symptoms mentioned above, we need to be aware of people who have some recurring habits in their daily lives, for example:

  • Make diets very recurrent or very radical;
  • Excessive concern for body and weight;
  • Dissatisfaction with the body and food;
  • Has strict beliefs about food;
  • Habit of eating alone or not eating;

With regard to the main risk group and age group, 80% of cases of anorexia nervosa begin between 12 and 20 years of age and occur with women.

Anorexia can incapacitate an individual from performing their daily activities, causing great emotional suffering.

This condition can be found in ICD-10 in the following classifications:

  • F50.0: anorexia nervosa;
  • F50.1: atypical anorexia nervosa;
  • R63.0: anorexia.

What are eating disorders?

Among the main types of eating disorders are anorexia and bulimia . Both are characterized by a recurrent preoccupation with weight and an abundant fear of gaining weight. In addition, body image disorder and self-criticism are present daily in this condition.

Types

Anorexia nervosa is characterized by extreme weight loss, an excessive fear of gaining weight, distortion of body image and inappropriate compensatory behaviors.

The main difference between the subtypes of anorexia nervosa are related to the strategy to lose weight.

Some doctors and researchers believe that people who have anorexia will not necessarily develop one type. They are usually phases of the disease, in which the patient can alternate the types of deprivation.

Restrictive

It is characterized by the obsessive refusal of food in order to limit caloric intake as much as possible to maintain or decrease weight.

In this type of condition, although the person keeps the weight below ideal, however, the chances of comorbidities are lower and the tendency to recover is greater because there are no purgative compensatory methods.

Purgative

This subtype is linked to the frequency and intensity of bulimic behaviors related to restrictive eating behavior.

Induction of vomiting, consumption of laxatives and diuretics can occur in 40% of cases, always aiming to lose weight.

The purgative subtype is usually associated with impulsive behaviors, such as self-mutilation, substance abuse and suicidal behavior.

Read more: What is Binge eating, symptoms, remedies, how to treat?

In addition, when compared with the restrictive subtype, it presents a higher frequency of conditions related to anxiety and depression , making its evolution more complex.

Anorexia in men

Contrary to popular belief, both anorexia and bulimia are conditions that also affect men.

Recent studies reveal an average of 8% of cases occur in males. However, several factors make diagnoses difficult, for example, the way men express their conflicts and discomfort regarding body shape.

Anorexia in men is usually associated with low levels of testosterone, LH and FSH, in addition to a decrease in testicular volume and libido.

Anorexia in children

The cause of anorexia in children is still unknown, however, it is believed to be related to genetic and external factors, such as the environment in which it lives.

Over time, this condition can cause consequences that include: stunted growth, bone loss and damage to major organs, such as the heart.

It is necessary to pay attention to the child’s behavior even before the physical changes. Some symptoms that can be presented are: obsession with food, distorted body image, excessive physical activity, among others.

Treatment, as with cases in adults, is done with a multidisciplinary team of specialists, which must include nutritional support and therapy.

What is the difference between anorexia and bulimia?

Both conditions are considered eating disorders, which are associated with distortion of body image, fear of gaining weight and the search for the ideal body.

The main difference between them is the method used to lose weight.

Anorexia is related to strict diets and long periods of food restriction, in addition to the elimination of foods considered more caloric, such as the carbohydrate group .

Bulimia, on the other hand, can be described as episodes in which the person eats uncontrollably in excessive amounts and then uses purgative methods (abuse of laxatives, diuretics, induction of vomiting), and may also have strict and restrictive diet cycles.

What causes?

The specific cause of anorexia is not known, but it is believed to be derived from a combination of genetic factors, personality, emotions and thought patterns, as well as environmental and biological factors.

Eating disorders can have physical causes, such as changes in the hormones that regulate the body. In addition, psychological and emotional disorders have a major impact on the development of this condition.

Read more: Healthy Eating: what it is, benefits, how to have it, menu, tips

Groups of risk

Regarding the main risk group and age group, the majority of people who suffer from this condition are women still in their teens, between 12 and 20 years old.

The condition generates great emotional suffering, preventing an individual from carrying out their daily activities.

Some professions can also increase the risk of anorexia nervosa, among which we can mention: dancers, models and athletes, who are subject to greater pressure related to weight loss.

In addition, it is necessary to be attentive to teenagers. It can be said that contemporary society has fused an idea of ​​perfection linked to thinness, which ends up influencing body image and what will be considered aesthetically beautiful.

Internalized factors, such as the ideal of thinness, are exposed every day by the media, promoting food restriction behaviors and extreme dedication to physical exercises. In addition, these factors contribute to body dissatisfaction, since the ideal is never achieved by women.

Symptoms

Because it is considered a complex condition, it is necessary to pay attention to the most diverse patterns of manifestation of the disease, among which we can mention:

Dry or yellow skin (hypercarotenemia)

This is due to increased levels of carotene in the body. The yellowish skin is caused by an accumulation of this yellow substance in the blood, which is deposited on the skin, eyes and mucous membranes.

The lack of nutrients can also cause the tissue to dry out and weaken.

Cardiovascular changes

The hypotension blood can be diagnosed in up to 85% of patients with anorexia nervosa.

Malnutrition resulting from this condition can lead to atrophy of the heart muscle and ventricular mass, which can cause the left side of the heart to close.

Fast and prolonged weight loss

People who have this condition begin to gradually restrict their food, especially sugars and carbohydrates.

Due to an inadequate perception of body image, some people who have anorexia eat extremely restrictive diets and, in some cases, may present malnutrition.

Renal changes

The high intake of low-calorie fluids and the instability of ADH levels (hypothalamic alteration promoting partial diabetes insipidus), can cause lower than normal urinary concentrations.

As a consequence, 70% of people with anorexia develop azotemia, that is, large concentrations of urea, creatinine , uric acid in the kidney, which can lead to permanent damage.

Gastrointestinal changes

The use of laxative is recurrent in people with anorexia and bulimia. If used for a long period, they can cause irreversible damage to the intestinal colon. In addition, frequent vomiting can cause esophagitis and bleeding from the intestinal mucosa.

How is the diagnosis made?

 

Through the Statistical Manual and Diagnosis of Mental Disorders (DSM), some evaluation criteria were defined to define anorexia, among which we can mention:

  • Exaggerated fear (phobia) of getting fat;
  • Loss of 25% or more of weight, beyond the expected;
  • Amenorrhea (absence of menstruation in women);
  • Body image disorder.

The main factor to be analyzed by the doctor is the way in which the issue of self-perception is treated. Most people who suffer from this condition believe that they are out of shape, or that they can become even thinner.

The levels of physical activity and diet should also be discussed with the doctor, as well as other problems related to behaviors, such as bulimic tendencies or other eating disorders.

Another important medical criterion for diagnosing anorexia is the Body Mass Index ( BMI ), which in some more severe cases ends up below 15.

Is anorexia curable?

-Yeah . However, having multidisciplinary treatment can take a little longer. In some cases, hospitalization is necessary to reintroduce food and a balanced diet, so as not to overload the heart.

Some professionals consider that the treatment is for life, making the disorder just controlled.

What is the treatment?

Treatments for eating disorders are carried out with a multidisciplinary team and aim to address various areas related to anorexia.

Psychiatric follow-up

The first step in treating anorexia is to contact a psychiatrist and do a medical evaluation. During this evaluation, records related to the medical and psychiatric history of the reason for the search are made.

The psychiatric intermediate aims at normalizing weight, eating behavior, maintaining healthy habits and weight. The use of medication is the main psychiatric aspect of anorexia.

Nutritional monitoring

The second specialist to be consulted is the nutritionist. He is the professional trained to propose a balanced diet, suggesting changes in consumption and dietary attitudes.

Nutritional care aims to regain and maintain adequate weight, in addition to teaching concepts such as healthy eating, types and sources of nutrients.

In general, nutritional assistance is provided once a week, where food and behavioral goals are set, which must be accomplished during the week.

Family accompaniment

The inclusion and participation of the family in the treatment process is essential for therapeutic effectiveness. Service is provided through guidance, information, exchange of experiences and the participation of family members.

The intention of this therapeutic approach is to provide knowledge, reduce anxiety and concern of family members, solve and reinforce appropriate postures for the family with patients who face eating disorders.

Psychological support

From the perspective of treatment, it is very important that patients understand the interaction of thoughts, emotions and behaviors, as they will be able to recognize their own changes and reactions.

With that in mind, part of the treatment for eating disorders is cognitive-behavioral psychological monitoring, seeking to understand which emotions and behaviors are influenced by the patient’s perception of situations.

According to the Academy of Eating Disorders (DAE), psychotherapy assists in the healing process of eating disorders, addressing the topic, curing traumatic episodes and developing skills.

They can be indicated for punctual episodes in a short period, but can also extend for years, depending on each person and case.

The frequency of sessions depends on the professional’s assessment.

Medicines

The use of medications is restricted to an individual medical evaluation, aiming at the treatment of the eating disorder. In some cases, remedies may be used to treat anxiety, depression or compulsive attitudes.

According to the American Psychiatric Association (APA) the treatment of anorexia aims, above all, to make the patient manage to enter a healthy weight again.

Drug classes include:

Antidepressants

They act as a selective serotonin inhibitor , being recognized as effective in the treatment of symptoms of depression associated with anorexia and bulimia. However, SSRIs, as they are called, can cause several reactions. Among the most used options we have fluoxetine .

Already Amitriptyline is a drug of the class of tricyclic antidepressants (TCA’s), widely used in the treatment of mood disorders and depression.

Of the drugs, tricyclic antidepressants are the most used.

Antipsychotics

The use of antipsychotic drugs can be indicated mainly due to the body distortion that the patient has. Among the medication options we can mention pimozide and sulpiride .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

 

Getting help and support from family and friends helps in the recovery process. Strengthening emotional ties is also a good way to seek support.

Seek help

If you are suffering from problems related to eating, eating disorders or body image disorders, the most important thing is to seek professional help.

There are treatment centers and NGOs with people trained to assist in treatment and diagnosis.

One option is the Life Valuation Center , which provides all the emotional support for people who need to talk, in complete secrecy and anonymity. Contacts can be made by phone, in person, via chat or email.

Another aspect that can help in the process of acceptance and search for treatments is to talk to someone you trust.

Parents, friends, family, anyone you trust, and who will not judge you, can be extremely helpful in the process of treating anorexia.

Be in touch with nature

A study by the University of Virginia in partnership with the Stockholm Resilience Center looked at the relationship between contact with nature and the quality of mental health .

In response, the study showed that interactions with nature can bring health benefits and alleviate symptoms of psychiatric illnesses, such as depression and eating disorders.

Read more: The mental (and physical) benefits of deep breathing

Define what’s important to you

We know that some choices are more difficult to make, but that the most anticipated results only come with daily efforts.

Setting priorities is important so that we can create new bonds, habits and even find new distractions that avoid negative thoughts or even related to the distortion of body image.

Read more: 13 tips to improve self-esteem

Maintain a healthy eating routine

It is important to set specific times for food in order to restore a healthy weight.

In addition, it is important to outline dietary and / or behavioral goals to be accomplished during the week to be discussed in the next consultation with the nutritionist or psychologist.

The nutritional education is a major point for those facing some kind of binge eating. Thinking about it, we brought some tips from food groups more suitable for those who are facing this condition. Are they:

Foods rich in vitamin B6 and B9

These foods are responsible for the synthesis of serotonin (hormone that regulates mood) in the body. They can be found in red meats, chicken, whole grains, milk and beans .

Tryptophan-rich foods

This substance is considered an amino acid that is not produced by the human body, but that can be acquired through food. Tryptophan acts by synthesizing serotonin, a hormone linked to mood and well-being.

This amino acid can be found in eggs, milk and meat.

Foods rich in vitamin C

This vitamin is directly related to the decrease in cortisol levels, which is the hormone responsible for stress and anxiety.

By consuming this group of foods, we are improving the quality of life, in addition to strengthening the nervous system.

It can be found in fruits such as orange, acerola, pineapple, lemon and in some vegetables, such as tomatoes and peppers.

Treat yourself well

It is important to think of reward strategies for your body and mind, which can be done through simple activities, such as a relaxing bath, a different walk or a special treat.

Wear what makes you feel good

An interesting thought to have is to think “what do I want to use today?” and don’t be afraid to use it.

Anorexia is a condition that has image distortion as its main characteristics. So, a good tip is to start the acceptance process with clothes that you like and that make you feel good.

It is a complicated process that requires determination and support from family or friends. Self-acceptance in some cases can also be treated during therapy, as it is necessary to identify which points are bothersome and how to improve them.

Let your mind rest

It takes a lot of care and attention not to repeat old habits, like checking the weight and measurements all the time. So whenever you find yourself thinking about it, distract your head. It can be with a movie, a series or a good night’s sleep.

Tips for family members

Eating disorders are conditions that affect the family structure.

However, what most parents do not know is that, after the patient himself, they are precisely the people who can collaborate most in the treatment.

However, we know that it is normal to feel a little lost and not knowing what to do to help. Thinking about it, we brought some suggestions and information to facilitate this process.

First, it is important for the family to understand that the condition is not a freshness but a disease, in which family collaboration is essential in the treatment process.

In addition, it is important for the family to demonstrate that they believe in the suffering that this condition causes, offering to talk or even to seek treatment.

It is important to emphasize that parents and family members should unite around the cause, following medical recommendations, in order to assist the multidisciplinary team during treatment. This makes the chances of recovery much greater.

Prognosis

The great challenge of eating disorders is linked to the mortality rate, reaching 20% ​​in cases of anorexia, according to a study published by Arch Gen Psychiatry.

Patients can have very serious clinical and surgical complications resulting from malnutrition and purgative methods, in addition to suicide attempts.

About 50% of people suffering from anorexia heal completely, restoring weight and eating behavior.

Another 30% have a partial recovery, where there is some type of waste related to the disorder. The remaining 20% ​​are those who assume the disease in a chronic way, that is, they continue to try to combat anorexia.

What are the consequences of anorexia?

This condition can cause innumerable damage to the body. As the condition worsens, more areas of the body end up being harmed. Among the possible complications we can mention:

Acute malnutrition

Some cases of anorexia accompany endocrine and metabolic changes, due to the low rate of daily caloric intake. As a consequence, the person may have varying degrees of malnutrition, in addition to disorders of the body’s physiological functions.

Anemia

Due to the lack of nutrients, the body starts to get weak and thereby save energy.

In addition to nutritional deficiency ( anemia ), other manifestations may occur as a result, such as: reduced metabolism, low body temperature.

Decreased bone density

A study by Hospital Clínico Universitário de Barcelona found that victims of anorexia may have weakened bones due to eating disorder.

By resuming regular nutritional and eating habits, it is possible to reverse the situation and recover bone strength.

Gastrointestinal changes

Among the most common manifestations is constipation (stuck intestine), resulting from the excessive use of laxatives and purgative methods, which can cause irreversible damage to the intestinal colon.

Cardiovascular problems

Chronic malnutrition and lack of hydration can cause cardiovascular risks for people who face anorexia.

Due to intense dehydration, the heart is atrophied favoring the appearance of malignant arrhythmias.

In addition, people who have this condition can suffer from bradycardia (heart rate less than 60 beats per minute), which can lead to dizziness and fainting.

How to prevent anorexia?

Although not all cases of anorexia can be prevented, it is important that friends and family encourage healthy eating habits.

Another tip is to look for activities that promote self-knowledge, self-confidence and respect for your own body. It can be a physical activity, an alternative therapy or help groups.

A very important point to be reinforced is to maintain a healthy diet. It is essential to maintain a pleasure related to food and eating behaviors.


Anorexia is a silent condition, so you need to pay extra attention to symptoms, which may be hidden. If you know someone who is in this situation, don’t hesitate to offer help.

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