There are a number of medically recognised eating disorders, the most common being anorexia nervosa and bulimia nervosa. However, there are likely many others that are simply not recognised by psychiatry, despite being debilitating to the individual. It has been suggested by some for example that some bodybuilders suffer from a body dysmorphia, and this has inherent eating disorders associated with it, which resemble anorexia nervosa in their manifestation. Bulimia nervosa is characterised by periods of binge eating, where large amounts of usually low quality highly palatable calorie dense foods are consumed in a short period of time. This is followed by purging whereby the individual attempts to remove the food prior to digestion through vomiting or taking laxative to induce defecation. Anorexia nervosa is characterised by a compulsive desire to lose weight, along with an unrealistic appraisal of the existing body size, such that the individual believes themselves to be overweight, when the opposite is often true.
Both bulimia nervosa and anorexia nervosa are complex medical conditions, and the truth is that they are not understood by science. The causes are not clear, and often individuals grow out of the negative behaviours with age. However, most sufferers of both conditions are female and young, suggesting that there may be some hormonal connection to their development. An underlying genetic susceptibility with an environmental trigger is the most likely cause of the disorders. One possible explanation is that the bingeing in bulimia indices an opiate release in the brain, and the individual who is susceptible to this becomes addicted to the elevated arousal and feeling of well being. Diagnosis with anorexia has increased in recent times, suggesting that exposure to modern life, perhaps peer pressure to conform to particular body shapes, is to blame. However, this may also be due to better diagnosis of the disorder. Bulimia often develops secondary to anorexia, making the two disorders intricately linked.
Many people suffer from the conviction that they are overweight when in reality there are of normal body size. Many people also feel elation or emotional satisfaction from eating certain foods, followed by a guilt for consuming them. It would seem therefore that characteristics of anorexia nervosa and bulimia nervosa are apparent in many who are never diagnosed with the condition. Are these normal human emotions that are taken to extremes with certain individuals who are susceptible genetically?
The current treatment is to provide antidepressant selective serotonin reuptake inhibitors in order to treat any underlying depression or anxiety and also to provide psychological support perhaps in the form of cognitive behavioural therapy. The success rate with medical intervention is poor at best, and management of the condition is often the best outcome. While diagnosis with bulimia and anorexia nervosa are either positive or negative, I suspect that in reality there is no black and white demarcation between ‘normality’ and ‘disease’ but instead exists a grey scale on which everyone lies. If this theory is correct then many people will have characteristics of both bulimia and anorexia nervosa, although not in a medically diagnosable way. Most people for example feel elation or emotionally high when they eat certain foods, showing that foods do act like drugs in people. Likewise the body dysmorphia associated with anorexia is felt by most individuals in some shape or form, and guilt is a normal response to overeating for most.
RdB
