Curriculum Vitae: dr W.M.

ROAN
Lahir: Cirebon, 10 September 1936
Menikah: 1 isteri. 3 anak, 1 (lk) dokter-psikiater, 1 (lk) dokter bidang
pharmaceuticals, 1 (pr) insinyur pertanian (hortikulturis), sudah punya 6
cucu
1963: Lulus dokter Univ. Airlangga, Surabaya.
1969-1971: Pendidikan spesialistik di Inggeris & mendapat Diploma in
Psychological Medicine, Institute of Psychiatry, Univ. of London, United
Kingdom.
1972-1992: Kasubdit Pencegahan, Dit Kes Jiwa, Dep Kes RI
1973-kini: Dosen FK UPH, FK UKI, FKUI: m.k. Terapi Perilaku, (pensiun
2005) FK Atmajaya (pensiun 2003)
1973-2001: Psikiater pada Bank Indonesia.
1977: ASEAN Ageing Project, Expert for Indonesia
1995: Psikiater RS St Carolus, Siloam West Jakarta & Gleneagles
Karawaci.

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EATING DISORDERS
W.M. ROAN,
Dr(UnAir), DPM(Lond.), SpKJ(K),
Psychiatrist
Jakarta January 13, 2016
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HISTORICAL PERPECTIVES

SIR WILLIAM WITHEY GULL (18161890)

IN 1873 described:
Apepsia hysterica
Anorexia hysterica
Anorexia nervosa

ERNEST CHARLES LASEQUE (18161883) in 1873 described independently

Anorexia nervosa

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ANOREXIA NERVOSA(1)

A form of disease occurring mostly in young

women ages 15-23, characterized by extreme
emaciation, in which the want of appetite was
due to a morbid mental state and the origin
was central not peripheral. Clinical
characteristics were those of starvation only,
without any sign of visceral disease. Though
completely wasted, pt complained of no pain,
nor any malaise, but often singularly restless
& wayward. There are associated
psychological disturbances & family
dysfunction

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ANOREXIA NERVOSA(2)
Management

was psychological
(moral) rather than only medical,
including changing family
relationships. Food should be given
at short intervals under supervision,
cannot be entrusted to patient

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KEPRIBADIAN MANUSIA

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WHO ICD-10
DESCRIPTION(1)
F 50.0 Anorexia Nervosa
A. There is weight loss or, in children, a lack
of weight gain, leading to a body weight
of at least 15% below the normal or
expected weight for age & height.
B. The weight loss is self-induced by
avoidance of fattening foods
C. There is self-perception of being too fat,
with an intrusive dread of fatness, which
leads to self-imposed low weight
threshold
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WHO ICD-10
DESCRIPTION(2)
D. A wide-spread endocrine disorder involving
the hypothalamic-pituitary-gonadal axis,
manifested in women as amenorrhea & in
men as a loss of sexual interest & potency
(an apparent excep-tion is the persistence
of vaginal bleeds in anorexic women who
are on hormonal replacement therapy. Most
commonly taken as a contraceptive pill)
E. The disorder does not meet criteria A & B
for Bulimia Nervosa (F50.2)
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PERSONA TESTS (BRUCH)

Photographs of patients faces were made
with different width, one photo is the actual
normal proportion and size, but 3 others
were narrower by 1, 2 or 3 mm, and 3
others are wider by 1,2, or 3 mm. Pt was
asked to judge which one is his real
proportional photo. The anorexic would
choose always the widest,
2. By the same token, he set 7 or 8 weighing
machines, and one is his real weight, but
other 3 were reduced by 2, 4 & 6 kg and
other 3 increased by 2, 4 & 6 kg. Pt would
choose the heaviest weight.
1.

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F50.2 Bulimia Nervosa (1)

A.

B.

There are recurrent episodes of

over-eating (at least twice a week
over a period of 3 months) in which
large amounts of food are consumed
in short periods of time.
There is persistent pre-occupation
with eating and a strong desire or a
sense of compulsion to eat (craving)

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Bulimia Nervosa (2)

C. The patient attempts to counteract the fattening
effects of food by one or more of the following:
1. self induced vomiting
2. self induced purging
3. Alternating periods of starvation
4. use of drugs such as appetite suppressants,
thyroid preparations, or diuretics, when bulimia
occurs in diabetic patients they may choose to
neglect their insulin treatment.
D. There is self perception of being too fat, with an
intrusive dread of fatness (usually leading to
underweight).
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Historical and current

analogues of Anorexia Nervosa
Religious

terms : Holy anorexia

(Catholic non-eaters)
Medical terms
: Chlorosis (morbus
virgineus)
Psychiatric terms: Anorexia nervosa
Political terms
: Hunger strike
Changing clinical manifestation with
time: Anorexia Multiforme
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Etiologies of Anorexia
Nervosa
Individual

1.
2.
3.
4.

Biomedical hypothesis
Mood disorder hypothesis
Developmental psychological hypothesis
Psychodynamic hypothesis

Family

5. Family system hypothesis

Socio-cultural

6, Feminist (social) hypothesis

7. Culture-bound syndrome
8. Culture-change syndrome (trans-cultural)
hypothesis

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Supporting data for sociocultural approach

Sex
Females predominate
Occupation Athletes, Dancers, Dietitian,
Models, Racing Jokeys
Social Class Middle & Upper Classes
Culture
Developmental gradient across
cultures Western
illness
Period
Increasing incidence
Prevalence Modern illness
Predisposing Developmental Family, Social &
cultural factors. No known biological cause
Precipitating Life Stress Events. Puberty
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BIOMEDICAL HYPOTHESIS

Obese-gene theory the finding of leptin

hormone
Disturbances of limbic system
hypothalamic & pituitary-gonadal axis
Low serum tryptophane, serotonin,
neopterin & kynurenin
Disturbances of pineal gland, including
subnormal serum level of melatonin
The importance of low cerebrospinal fluid
5-HIAA

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PSYCHO-SOCIO-CULTURAL
HYPOTHESIS (1)

Anorexic cultural dichotomies. The

disturbance being a attempt to reconcile
cultural conflicts surrounding social control &
power relations between the sexes, such as:

Mind/Body
Male/Female
Culture/Nature
Objective/Subjective
Rationality/Impulse or Emotional
Doctor/Patient

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PSYCHO-SOCIO-CULTURAL
HYPOTHESIS (2)

Effectiveness/Ineffectiveness
Powerful/powerless
Individualism/Interperssonal
connectedness
Dominant/Submissive
Strong/Weak
Big/Small
Muscular/Fatty
Superior intelligence/Inferior
Top/Bottom

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Incidence outside the West &

Industrialized countries

1872 Western Europe & North America

1894 Russia
1973 India
1974 Japan
1982 China
1982 Singapore
1983 Malaysia
1985 Taiwan
1985 Indonesia

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Differences between Asian &

European Anorexia Nervosa
Among

Asian

No fat phobia and body image

disturbance
Emaciation, food refusal, amenorrhoea
present

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Biomedical Treatment

Immediately restore nutritional state to normal,

prevent the complication of emaciation,
dehydration & electrolyte imbalance
Hospitalization with strict environmental
structure for weight restoration, duration 2-6
months
Relieve the insomnia & depression with antidepressives
Appetite stimulant such as,cyproheptadien,
(periactin), neuroleptics medication,
Sometimes electroconvulsive treatment is
needed
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Psycho-socio-cultural
treatment
Behaviour

therapy: positive
reinforcement, relaxations, rewards,
behaviour conditioning
Family therapy
Psychodinamic psychotherapy

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Incorporation of cultural
determinants in treatment
approach

Explore intra-psychic phenomena damaging

the self
Recognition of cultural and gender-based
determinants
Socially determined struggle for selfregulation and control
Resolution of cultural dichotomies of
polarities
Reconciliation of cultural conflict on social
control & power relations between the sexes
Disempowerment versus empowerment of
women

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Conclusion (1)

Anorexia Nervosa is a modern clinical entity

occurring among pubertal girls and young
women, living in stereotyped family
conditions; in the privileged classes of
Western or Westernized affluent societies &
among racial groups of European descent.
But both AN & its clinical analogues now
occur in pre-pubertal children and among
boys; has a broader social class distribution;
occurrence outside the Western world &
among many races. Its multifaceted
symptoms warrant for a term as Anorexia
Multiforme

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Conclusion (2)
Treatment

of AN should be a
combination of biomedical & psychosocio-cultural models approach where
the pathogenic dichotomies of
polarities male/mind/reason over
female/body/impulse & the conflicts
surrounding social control & power
relations between the sexes should
be resolved.

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