Anorex|a nervosa (An) also known as slmply Anorex|a ls an eaLlng dlsorder characLerlzed by refusal Lo malnLaln a healLhy body

welghL and an obsesslve fear of galnlng welghL lL ls ofLen coupled wlLh a dlsLorLed self lmage
12
whlch may be malnLalned by
varlous cognlLlve blases
3
LhaL alLer how Lhe affecLed lndlvldual evaluaLes and Lhlnks abouL her or hls body food and eaLlng ersons
wlLh anorexla nervosa conLlnue Lo feel hunger buL deny Lhemselves all buL very small quanLlLles of food 1he average calorlc lnLake
of a person wlLh anorexla nervosa ls 600800 calorles per day buL Lhere are exLreme cases of compleLe selfsLarvaLlon
4
lL ls a
serlous menLal lllness wlLh a hlgh lncldence of comorbldlLy and Lhe hlghesL morLallLy raLe of any psychlaLrlc dlsorder
3

Anorexla mosL ofLen has lLs onseL ln adolescence and ls mosL prevalenL among adolescenL glrls
6
Whlle lL can affecL men and
women of any age race and socloeconomlc and culLural background
7891011
Anorexla nervosa occurs ln females 10 Llmes more
Lhan ln males
12

1he Lerm anorexla nervosa was esLabllshed ln 1873 by Slr Wllllam Cull one of Cueen vlcLorlas personal physlclans
13
1he Lerm ls of
Creek orlgln an (r preflx denoLlng negaLlon) and orexls (rpt appeLlLe) Lhus meanlng a lack of deslre Lo eaL
14

S|gns and symptoms
A person wlLh anorexla nervosa may exhlblL a number of slgns and sympLoms some of whlch are llsLed below 1he Lype and severlLy
vary ln each case and may be presenL buL noL readlly apparenL Anorexla nervosa and Lhe assoclaLed malnuLrlLlon LhaL resulLs from
selflmposed sLarvaLlon can cause severe compllcaLlons ln every ma[or organ sysLem ln Lhe body
131617

O obvlous rapld dramaLlc welghL loss
O lanugo sofL flne halr grows on face and body
18

O obsesslon wlLh calorles and faL conLenL
O preoccupaLlon wlLh food reclpes or cooklng may cook elaboraLe dlnners for oLhers buL noL eaL Lhemselves
19

O dleLlng desplLe belng Lhln or dangerously underwelghL
O fear of galnlng welghL or becomlng overwelghL
O rlLuals cuLs food lnLo Llny pleces refuses Lo eaL around oLhers hldes or dlscards food
O purglng uses laxaLlves dleL pllls lpecac syrup or waLer pllls may engage ln selflnduced vomlLlng may run Lo Lhe
baLhroom afLer eaLlng ln order Lo vomlL and qulckly geL rld of Lhe calorles
2021
(see also bullmla nervosa)
O may engage ln frequenL sLrenuous exerclse
22

O percepLlon percelves self Lo be overwelghL desplLe belng Lold by oLhers Lhey are Loo Lhln
O becomes lnLoleranL Lo cold frequenLly complalns of belng cold due Lo loss of lnsulaLlng body faL or poor clrculaLlon due Lo
exLremely low blood pressure body LemperaLure lowers (hypoLhermla) ln efforL Lo conserve energy
23

O depresslon may frequenLly be ln a sad leLharglc sLaLe
24

O sollLude may avold frlends and famlly becomes wlLhdrawn and secreLlve
O cloLhlng some may wear baggy looseflLLlng cloLhes Lo cover welghL loss lf Lhey have been confronLed abouL Lhelr healLh
and wlsh Lo hlde lL whlle oLhers wlll wear baggy cloLhlng Lo hlde whaL Lhey see as an unaLLracLlve and overwelghL body
O cheeks may become swollen due Lo enlargemenL of Lhe sallvary glands caused by excesslve vomlLlng
23

O swollen [olnLs
clLaLlon needed

O abdomlnal dlsLenslon
|m|a nervosa ls an eaLlng dlsorder characLerlzed by blnge eaLlng or consumlng a large amounL of food ln a shorL amounL of Llme
followed by an aLLempL Lo rld oneself of Lhe calorles consumed usually by purglng (vomlLlng) and/or by laxaLlve dlureLlcs or
excesslve exerclse
1

2
8ullmla nervosa ls nlne Llmes more llkely Lo occur ln women Lhan men (8arker 2003) AnLldepressanLs
especlally SS8ls are wldely used ln Lhe LreaLmenL of bullmla nervosa (newell and Cournay 2000)
1he word bullmla derlves from Lhe LaLln (bullmla) whlch orlglnally comes from Lhe Creek t (boullmla ravenous hunger) a
compound of (bous) ox + to (llmos) hunger
3
8ullmla nervosa was named and flrsL descrlbed by Lhe 8rlLlsh psychlaLrlsL
Cerald 8ussell ln 1979
43
8ullmla ls sLrongly famlllal 1wln sLudles esLlmaLe Lhe herlLablllLy of syndromlc bullmla Lo be 34 Lo 83
67
1here are Lwo subLypes of bullmla nervosa
O 9rg|ng type bullmlcs selflnduce vomlLlng (usually by Lrlggerlng Lhe gag reflex or lngesLlng emeLlcs such as syrup of lpecac)
Lo rapldly remove food from Lhe body before lL can be dlgesLed or use laxaLlves dlureLlcs or enemas

O -onprg|ng type bullmlcs (approxlmaLely 68 of cases) exerclse or fasL excesslvely afLer a blnge Lo offseL Lhe calorlc
lnLake afLer eaLlng urglngLype bullmlcs may also exerclse or fasL buL as a secondary form of welghL conLrol
20

S|gns and symptoms
1hese cycles ofLen lnvolve rapld and ouLofconLrol eaLlng whlch may sLop when Lhe bullmlc ls lnLerrupLed by anoLher person or Lhe
sLomach hurLs from overexLenslon followed by selflnduced vomlLlng or oLher forms of purglng 1hls cycle may be repeaLed several
Llmes a week or ln more serlous cases several Llmes a day
8
and may dlrecLly cause
O hronlc gasLrlc reflux(caused by sLomach acld comlng up from Lhe sLomach lnLo Lhe esophagus
1
A Lyplcal sympLom ls
hearLburn) afLer eaLlng
O ehydraLlon and hypokalemla caused by frequenL vomlLlng
O lecLrolyLe lmbalance whlch can lead Lo cardlac arrhyLhmla cardlac arresL and even deaLh
O sophaglLls or lnflammaLlon of Lhe esophagus
O 8oerhaave syndrome a rupLure ln Lhe esophageal wall due Lo vomlLlng
O ral Lrauma ln whlch repeLlLlve lnserLlon of flngers or oLher ob[ecLs causes laceraLlons Lo Lhe llnlng of Lhe mouLh or LhroaL
O CasLroparesls (parLlal paralysls of Lhe sLomach resulLlng ln food remalnlng ln Lhe sLomach for a longer perlod of Llme Lhan
normal) or delayed empLylng
O onsLlpaLlon
O lnferLlllLy
O nlarged glands ln Lhe neck under Lhe [aw llne
O epLlc ulcers(A pept|c cer also known as 9D or pept|c cer d|sease
1
ls Lhe mosL common ulcer of an area of Lhe
gasLrolnLesLlnal LracL LhaL ls usually acldlc and Lhus exLremely palnful)
O alluses or scars on back of hands due Lo repeaLed Lrauma from lnclsors
910

O onsLanL welghL flucLuaLlons are common
1he frequenL conLacL beLween LeeLh and gasLrlc acld ln parLlcular may cause
O Severe denLal eroslon(Ac|d eros|on also known as denta eros|on ls Lhe lrreverslble loss of LooLh sLrucLure due Lo chemlcal
dlssoluLlon by aclds noL of bacLerlal orlgln 1here are many slgns of denLal eroslon lncludlng changes ln appearance and
senslLlvlLy ne of Lhe physlcal changes can be Lhe color of LeeLh 1here are Lwo dlfferenL colors LeeLh may Lurn lf denLal
eroslon ls occurrlng Lhe flrsL belng a change of color LhaL usually happens on Lhe cuLLlng edge of Lhe cenLral lnclsors 1hls
causes Lhe cuLLlng edge of Lhe LooLh Lo become LransparenL
9
A second slgn ls lf Lhe LooLh has a yellowlsh LlnL 1hls occurs
because Lhe whlLe enamel has eroded away Lo reveal Lhe yellowlsh denLln
9
A change ln shape of Lhe LeeLh ls also a slgn of
denLal eroslon 1eeLh wlll begln Lo appear wlLh a broad rounded concavlLy and Lhe gaps beLween LeeLh wlll become larger
1here can be evldence of wear on surfaces of LeeLh noL expecLed Lo be ln conLacL wlLh one anoLher)
O erlmolysls or Lhe eroslon of LooLh enamel
11

O Swollen sallvary glands
1112

As wlLh many psychlaLrlc lllnesses deluslons can occur wlLh oLher slgns and sympLoms leavlng Lhe person wlLh a false bellef LhaL ls
noL ordlnarlly accepLed by oLhers
13

1he person may also suffer physlcal compllcaLlons such as LeLany epllepLlc selzures cardlac arrhyLhmlas and muscle weakness(l
10)
clLaLlon needed

eople wlLh bullmla nervosa may also exerclse Lo a polnL LhaL excludes oLher acLlvlLles

9SCnCA-AL1IC 1nLCk

AnoLher lmporLanL Lheory of moLlvaLlon was puL forward by Slgmund lreud Lhe founder of psychoanalysls Llke Lhe behavlorlsL
Lheory hls psychoanalyLlc Lheory of moLlvaLlon sLaLed LhaL a persons behavlor ls dependenL on facLors wlLhln LhaL person 1he
lmporLanL facLors for Lhe psychoanalyLlc Lheory of moLlvaLlon lnclude confllcL frusLraLlon and anxleLy lreuds greaLesL conLrlbuLlon

Lo moLlvaLlon Lheory was hls demonsLraLlon LhaL much of human moLlvaLlon has unconsclous causaLlon LhaL ls a person ls qulLe
unaware of Lhe real reasons why he behaves as he does and ofLen requlres skllled analysls by a psychlaLrlsL Lo brlng Lhe real reasons
Lo Lhe surface
L|fe |nst|ncts and the death |nst|nct
lreud saw all human behavlor as moLlvaLed by Lhe drlves or lnsLlncLs whlch ln Lurn are Lhe neurologlcal represenLaLlons of physlcal
needs AL flrsL he referred Lo Lhem as Lhe |fe |nst|ncts 1hese lnsLlncLs perpeLuaLe (a) Lhe llfe of Lhe lndlvldual by moLlvaLlng hlm or
her Lo seek food and waLer and (b) Lhe llfe of Lhe specles by moLlvaLlng hlm or her Lo have sex 1he moLlvaLlonal energy of Lhese
llfe lnsLlncLs Lhe oomph LhaL powers our psyches he called |b|do from Lhe LaLln word for l deslre
lreuds cllnlcal experlence led hlm Lo vlew sex as much more lmporLanL ln Lhe dynamlcs of Lhe psyche Lhan oLher needs We are
afLer all soclal creaLures and sex ls Lhe mosL soclal of needs lus we have Lo remember LhaL lreud lncluded much more Lhan
lnLercourse ln Lhe Lerm sex! Anyway llbldo has come Lo mean noL any old drlve buL Lhe sex drlve
LaLer ln hls llfe lreud began Lo belleve LhaL Lhe llfe lnsLlncLs dldnL Lell Lhe whole sLory Llbldo ls a llvely Lhlng Lhe pleasure prlnclple
keeps us ln perpeLual moLlon And yeL Lhe goal of all Lhls moLlon ls Lo be sLlll Lo be saLlsfled Lo be aL peace Lo have no more needs
1he goal of llfe you mlghL say ls deaLh! lreud began Lo belleve LhaL under and beslde Lhe llfe lnsLlncLs Lhere was a death
|nst|nct Pe began Lo belleve LhaL every person has an unconsclous wlsh Lo dle
1hls seems llke a sLrange ldea aL flrsL and lL was re[ecLed by many of hls sLudenLs buL l Lhlnk lL has some basls ln experlence Llfe can
be a palnful and exhausLlng process 1here ls easlly for Lhe greaL ma[orlLy of people ln Lhe world more paln Lhan pleasure ln llfe
someLhlng we are exLremely relucLanL Lo admlL! eaLh promlses release from Lhe sLruggle
lreud referred Lo a n|rvana pr|nc|pe nlrvana ls a 8uddhlsL ldea ofLen LranslaLed as heaven buL acLually meanlng blowlng ouL as
ln Lhe blowlng ouL of a candle lL refers Lo nonexlsLence noLhlngness Lhe vold whlch ls Lhe goal of all llfe ln 8uddhlsL phllosophy
1he dayLoday evldence of Lhe deaLh lnsLlncL and lLs nlrvana prlnclple ls ln our deslre for peace for escape from sLlmulaLlon our
aLLracLlon Lo alcohol and narcoLlcs our penchanL for escaplsL acLlvlLy such as loslng ourselves ln books or movles our cravlng for
resL and sleep SomeLlmes lL presenLs lLself openly as sulclde and sulcldal wlshes And lreud Lheorlzed someLlmes we dlrecL lL ouL
away from ourselves ln Lhe form of aggresslon cruelLy murder and desLrucLlveness
ln lreudlan psychology ros also called llbldo llbldlnal energy or love ls Lhe llfe lnsLlncL lnnaLe ln all humans lL ls Lhe deslre Lo
creaLe llfe and favours producLlvlLy and consLrucLlon ln early psychonalyLlc wrlLlngs lnsLlncLs from Lhe ros were opposed by forces
from Lhe ego 8uL ln laLer psychoanalyLlc Lheory ros ls opposed by Lhe desLrucLlve deaLh lnsLlncL of 1hanaLos (deaLh lnsLlncL or
deaLh drlve)
ln classlcal lreudlan psychoanalyLlc Lheory Lhe death dr|ve (1odesLrleb) ls Lhe drlve Lowards deaLh selfdesLrucLlon and Lhe reLurn
Lo Lhe lnorganlc Lhe hypoLhesls of a deaLh lnsLlncL Lhe Lask of whlch ls Lo lead organlc llfe back lnLo Lhe lnanlmaLe sLaLe