Eating disorders

Eating Disorders (EDDs) are mental illnesses. That is, it is a set of behaviors, thoughts and feelings that we observe when the mental state of the person is particularly disturbed. Before proceeding to read this article on the diagnostic picture of the 2 main Eating Disorders, it is important to accept the following three basic assumptions:

 a. It is not a conscious choice, nor "stubbornness", nor an eating problem.

b. They have negative as well as positive consequences in human life.

c. They are mental illnesses and as such need treatment.

ANOREXIA PSYCHOGEN

It is important when referring to PSA to know that the disorder, at least initially, is not manifested by a loss of appetite but by a voluntary restriction of food intake. In the early stages of the condition, the person either gradually or abruptly restricts food intake. PSA does not always start as a mental illness. Sometimes, the person has more weight than desired and decides to go on a diet or begins to reduce food intake in order to lose a few pounds that he feels are unnecessary. Other times, he is "required" to restrict his diet due to his involvement in sports or artistic activities (eg dance). Finally, quite often the onset of PSA is observed after some physical or mental illness that has reduced the person's appetite (infections, surgeries, depression. The common feature is that at some point the measure is lost. The person continues to limit everything and more strictly the food intake, the body weight constantly decreases, the fear of losing control resulting in the weight increasing even with the slightest dietary "slip", keeps the diet to the minimum possible and the vicious circle is perpetuated.

The emotions one experiences at the onset of the disorder are usually positive. Satisfaction because the body weight has decreased, pleasure from the positive reactions of others, relief because it will reduce the reprimands for the extra pounds, peace because she can finally have control over something in her life that depends solely on personal effort. Negative emotions come a little later and reinforce the food restriction. Struggle to gain weight, fear of losing control despite constant effort, anger and confusion at negative reactions from others. The restriction of food intake is usually based on which food is considered dietary, therefore "healthy" and which non-dietary, therefore "forbidden". The individual formulates his own strict dietary rules which he tries to follow reverently. These rules concern both food categories that are allowed, as well as the time they are consumed, the cooking method and their allowed combinations. The person suffering from PTSD sometimes prefers to prepare the food themselves so that they can be sure that it was cooked the "right" way. He cuts food into small pieces and often takes a long time to eat it. Portions are usually small, meals sparse, and calorie-free drinks and/or chewing gum are consumed in large quantities in between. Many times we observe over-preoccupation with cooking, but without the person tasting the food they prepare. In addition to limiting food intake, other ways that can be used to achieve and maintain weight loss are long hours of exercise and, in general, increased physical activity, in a compulsive manner. In the purgative/binge eating type of PSA, the person succumbs to binge eating episodes, which are followed by induced vomiting. However, vomiting can be induced even if the sufferer feels that she "got away" and ate something more or different from the "allowed" limits . The distress caused by a small sweet treat or 1–2 forkfuls more is similar to the distress caused by a multi-thousand calorie binge.

PSYCHOGENIC BULIMIA

In contrast to PSA, which due to its thinness is easily and quickly noticed, PSE is a "hidden" mental illness. The shame of losing control and/or inducing vomiting causes the person to try to hide its existence. The fact that PsB is not accompanied by severe weight loss, nor the obvious medical complications of PsA, allows the disorder to remain hidden for a long time as the person remains fully functional. It is not uncommon for sufferers' parents or partners to never find out what is going on and learn about bulimia years after its onset, when the person feels the need to share with them or by accident. As the time passes that the person is trapped in PsB, their resistance to bulimic episodes decreases, with the result that the gradual acceptance of the situation leads to their giving up trying to avoid them. The result is that PSB regulates the person's daily life. A person's participation and capacity for work, personal and social life, and even for personal hygiene are determined according to the schedule of bulimic episodes. The bulimic episode is initially sudden, but over time it can also be scheduled at times of the day when the privacy of the moment can be ensured, as individuals seek to be alone, so they mainly choose the afternoon and evening hours. During the bulimic episode the person feels the overwhelming desire to eat a lot and consequently consumes, eating quickly, significant amounts of food. Foods that have a lot of calories are usually chosen and are strictly prohibited during the dieting phase. Episodes may be daily or sporadic during the week. Purgative behaviors and especially vomiting follow the end of bulimia or are even done in between episodes to empty the stomach contents. Although vomiting temporarily reassures the sufferer of the fear of weight gain, in the long term it increases his discomfort because he was unable to control himself, and renews his decision to start the diet again by promising himself that this time he will succeeds. It is yet another vicious cycle that perpetuates itself for years if there is no special psychiatric intervention.

Aigli G. Batzina

Child & Adolescent Psychiatrist – Psychotherapist

MSc of Psychosocial Problems A.P.Th.

Gr. Lambraki 201, Ano Toumpa 54352, Thessaloniki

Tel. 2313057106- Mobile 6974950936

aiglimpatz@hotmail.com