Anorexia Nervosa

Bulimia Nervosa

Anorexia Nervosa

In the late nineteenth century two physicians, the British Sir William Gull and the French Ernest Charles Laseque, independently published observations of self-starving in adolescent girls. This condition was termed "anorexia nervosa." The term "anorexia" (derived from the Greek an meaning "without" and orexis meaning "desire for") was used to describe the starvation and "nervosa" was used to imply involvement of the brain rather than dysfunction of the gastrointestinal tract in the illness.

Anorexia nervosa is actually a misnomer. Anorexic patients do not lack a desire for food. Their starvation causes hunger, yet their illness will not allow them to eat. Anorexic patients will reduce food intake or increase physical activity that overrides their hunger and causes a serious decline in weight. Presently, there are four criteria used to diagnosis the condition. The first two are physical observations: bodyweight that is fifteen percent below normal and loss of menstruation. Starvation impairs the regularity of the menstrual cycle in women. Obviously, this criterion is not used for males. The second two criteria are assessments of patients' perceptions. Patients need to have an intense fear of gaining weight or becoming fat, even though underweight. Also, patients have a misperception of their physical appearance in that they may even perceive themselves as overweight even though they are emaciated. This misperception contributes to the denial that many anorexic patients have. Many patients really do not believe they are ill.

Social factors contribute to an individual's predisposition to developing anorexia nervosa. This is easily demonstrated by the above mentioned immigrant observation and the presence of the illness almost exclusively in Westernized cultures where dieting is common behavior. Recently, Westernized cultures have acclaimed thinness. The media and other societal influences use thinness to promote and advertise. It represents accomplishment, beauty, and desirability. This portrayal of the feminine ideal may instill a desire to reach such a state. This ideal is impractical and unhealthy in most and has nothing to do with accomplishment, beauty or desirability. It is a cultural convention that has become more and more prominent and is thought to be contributing to the increase of anorexia nervosa that has been observed in the past decades.

Bulimia Nervosa

Bulimia is derived from the Greek boulimos literally meaning "ox hunger" (bous meaning "ox" and limos meaning "hunger.") In the medical literature, dating all the way to the ancient Greeks, ravenous hunger has always been considered a symptom of other diseases. This observation has continued, as hunger and associated binge-eating behavior is noted in conditions, such as, diabetes, depression, and Kleine-Levin syndrome (A rare episodic illness that is characterized by periods of excessive binging and sleeping, which usually resolves by early adulthood and is thought to be caused by disruption of the hypothalamic system). However, not until the late twentieth century has medicine recognized binge eating as a core symptom of a disorder. The hallmark of bulimia nervosa is binge eating.

Bulimia nervosa consists of episodes of binge eating that are characterized by a sense of a lack of control of what or how much one is eating. This is followed by a maneuver to try to prevent weight gain after the episode. Self-induced vomiting, the misuse of laxatives, diuretics, and enemas, fasting, and excessive exercise are typical means to compensate for the binge eating physically and emotionally. Similar to anorexic patients, bulimic patients have misperceptions concerning their body weight and shape. However, unlike in anorexia nervosa, the weight of bulimic patients is usually normal; though patients may have marked fluctuations in weight. Making the diagnosis more difficult is that bulimic patients are often embarrassed about their eating habits and rarely binge or purge in the presence of others.

To note, the binge eating and/or compensating of bulimia nervosa may be seen in some anorexic patients. The difference between the two conditions is that anorexic patients will be underweight.