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There are two types of Anorexia Nervosa: the Restricting type and the Binge Eating/Purging type. In a person with the Restricting type, his food intake is restricted on his own, and he doesn’t participate in binge eating or purging. Binge Eating/Purging type is when an individual self-induces vomiting or misuses laxatives, diuretics or enemas.

Below are overviews of both Anorexia Nervosa, Restricting type and Binge Eating/Purging type.

Anorexia Nervosa, Restricting Type

People with Anorexia Nervosa, Restricting type seriously cut their calories and eat very little. The most obvious sign of Anorexia Nervosa, Restricting type is a person’s underweight appearance. The goal of people with the disorder is to quickly lose weight or maintain a dangerously low weight. The consequences of Anorexia Nervosa can be death.

According to the Diagnostic Manual of Mental Disorders, 5th Edition (DSM-5), which is published by the American Psychiatric Association, the following defines Anorexia Nervosa.

  • Restriction of food intake leads to a significantly low body weight in the context of age, sex, development and physical health. The weight is less than minimally normal or, for children and adolescents, less than minimally expected.
  • Intense fear of gaining weight or of becoming fat; continuous behavior that disrupts weight gain even though the weight is significantly low.
  • A disturbance in body image (self-perceived weight or shape), undue influence of body weight or shape on self-evaluation, or continuous lack of realization of the seriousness of the low body weight.

The DSM-5 has removed amenorrhea—the abnormal absence of menstruation– from the criteria.

Causes of Anorexia Nervosa

There are many symptoms and effects of Anorexia Nervosa, and the causes are complex. It’s thought that the disorder develops as the result of biological and environmental factors.

Some of the environmental factors that can contribute to the disorder are:

  • Stress on thinness in the media with reinforcement that thin people are ideal.
  • Activities and careers that promote being thin, such as dancing and modeling.
  • Family and childhood trauma (sexual abuse, serious trauma)
  • Peer pressure from friends or coworkers to be thin.

Biological factors that can contribute to the disorder are:

  • Irregular hormone functions.
  • Genetics. The relation between anorexia and the genes is being researched; it is known that genetics is part of the factors.
  • Nutritionally deficient.

Signs of Anorexia Nervosa, Restricting Type

The signs of people with Anorexia Nervosa, Restricting type are physical, psychological and behavioral. Below are signs for each area.

Physical Signs

  • Rapid or sudden weight loss.
  • Dizziness, fainting and/or fatigue.
  • Sensitivity to the cold.
  • Lanugo (fine, soft hair) on the face and back.
  • Dry skin.
  • Hair loss.
  • Dry, brittle hair, skin, nails.
  • Gastrointestinal problems, such as constipation, cramps, pain, indigestion and bloating.
  • Reduced ability for concentration and memory.
  • Oedema (retaining body fluid; puffy appearance).
  • Reduction in metabolic rate.
  • Lower heart rate.
  • Lower blood pressure.
  • Reduced body temperature.
  • Dehydration.
  • Hypoglycemia—low blood glucose levels—causing confusion, illogical thinking, shakiness and irritability.
  • Easily bruised.

Psychological Signs

  • Preoccupation with body shape, weight and/or appearance.
  • Serious fear of gaining weight.
  • Preoccupation with food or food-related activities/events.
  • Negative body image.
  • Distorted body image.
  • Feeling or perception of being fat when at a healthy weight.
  • Low self-esteem (feelings of guilt, self-criticism and worthlessness).
  • Thinking is rigid—“good or bad” foods.
  • Feeling out of control when around food; in life.
  • Increased changes in mood; irritability.
  • Anxiety or depression.
  • Anxiety around meals is increased.
  • Increased sensitivity to comments or criticism about the body shape, weight, appearance, eating and exercise habits.
  • Suicidal thoughts or behaviors.
  • Obsessive behaviors.

Behavioral Sings

  • Constant dieting, restriction of food, rigid eating patterns.
  • Changes in style of clothing.
  • Extensive or compulsive exercise.
  • School or work performance is impaired.
  • Obsessive rituals when dealing with food.
  • Food preferences have changed.
  • Frequently avoid eating or make up excuses not to eat.
  • Withdrawal from social network and events, especially where there’s food included.
  • Repeatedly checking body.
  • Eating is done slowly.
  • Focus is around planning and preparing food.
  • Dishonest behavior in regard to food.

Binge Eating/Purging Type

Binge Eating/Purging is when a person eats large amounts of food–overeats well beyond the point of fullness—and feels out of control while doing so. The sense of being out of control is what separates binge eating from regular overeating. As a way to offset the binging, the person often follows the eating by self-induced vomiting, the misuse of laxatives, enemas, diuretics, or excessive exercise.

People who binge eat are severely preoccupied with their body shape and weight, especially because that’s where they base their feelings of self-worth. The criteria to diagnose a person with Binge Eating/Purging is that he engages in the inappropriate behavior at least twice a week for at least three months.

Some people don’t binge eat, but regularly purge after eating small amounts of food.

Signs of Binge Eating/Purging

People who struggle with Binge Eating may show the following signs:

  • Eating a large quantity of food in one episode than in a normal meal or snack.
  • Feeling that eating is not able to be controlled when the binge begins.
  • Hiding food.
  • Hoarding food.
  • Makes up excuses for food that goes missing or money that’s taken to pay for food.
  • Eating until the point of discomfort or pain.
  • Feelings of shame and self-disgust follow the binging.
  • After the binge, there’s a compulsion to purge in order to get rid of the extra calories (vomiting, abusing laxatives or diuretics, starvation periods or excessive dieting).

The signs of purging are:

  • The most prevalent sign of purging is vomiting.
  • Habit of using the bathroom after eating or during meals.
  • Swollen salivary glands in the cheeks.
  • Damaged teeth and gums.
  • Sores, scars or calluses on knuckles and hands because of self-induced vomiting.
  • Continuous sores in the throat and mouth.
  • Voice is scratchy.
  • It’s common to find empty boxes from laxatives, diuretics or enemas hidden in a person’s trash.
  • Exercise for hours on end.
  • Excuses cover up their behavior or periods when they’re absent from work, school or events.

Treatment for Anorexia Nervosa

The most powerful issue is the obsession with the person’s body image, and it’s the most difficult to change.

If the individual is severely emaciated, basic nutritional needs must first be dealt with, which is often done through an IV because he refuses to eat. While it isn’t the ideal way to begin therapy or form a trusting relationship with the person, it may be necessary because of medical complications. Getting the body back to a normal nutritional state may be slow, and the progress may be unclear. A person with Anorexia Nervosa may have relapses before he finally succeeds in therapy.

If the person isn’t in immediate danger or having issues from medical complications due to the disorder, Cognitive Behavioral Therapy is one of the most popular treatments. The therapy focuses on issues of self-image and self-evaluation. The issue of distorted self-body image is the most common among people with the disorder and is the focus of treatment in the beginning. Therapy will teach the individual how to recognize the appropriate weight and body fat proportions of a normal body and relate it to his own body.

The person may have problems with negative self-image because of traumatic events or memories that occurred during developmental stages of childhood. In addition, parents may inadvertently play a role in the individual’s negative self-image. Family therapy is ideal to identify the “reinforcers” that significant people in the person’s life are conveying. This means that there may be the message to stay thin that the family member/s are giving the person with the disorder. Family therapy can also be helpful in educating the family about the disorder and how they can help their loved one in the treatment process.

Prognosis for recovery from an eating disorder is increased if the individual doesn’t binge or purge and has had the disorder for less than six months.

Group therapy geared to eating disorders is ideal for the individual to have a support system. The people in the group can also confront the individual on issues easier than in individual therapy.
When children and adolescents suffer from Anorexia Nervosa, there’s the need for positive reinforcements for each weight gain (incremental). This should happen on a daily basis, and different rewards should be given for the different amounts of weight gained—the reward for a quarter-pound weight gain should be different than for a one-half-pound weight gain. The focus on weight gain instead of food intake may help to decrease needless arguments.

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