Anorexia Nervosa and Bulimia Nervosa

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What is an eating disorder? A simple definition of an eating disorder is abnormal patterns of behavior and thought. All eating disorders have shared characteristics. There is fear of becoming fat, drive to become thin, an obsession with food, weight, and calories. Families of sufferers also have an increased incidence of depression, obesity, substance abuse, and eating disorders.

Two main eating disorders are Anorexia Nervosa and Bulimia Nervosa. Anorexia is an eating disorder in which a person is obsessed by thoughts of an unattainable image of “perfect” thinness. This occurs by starvation and/or excessive exercise and can result in death. Bulimia is an eating disorder involving the alternation between the extremes of eating large amounts of food in a short time, and then compensating for the added calories either by vomiting or other extreme actions to avoid gaining weight.
There are other eating disorders other than Anorexia Nervosa and Bulimia Nervosa. Some include Food Avoidance Emotional Disorder (FAED), Food Refusal, Pervasive Refusal, Selective Eating, and Appetite Loss Secondary to Depression. Food Avoidance Emotional Disorder was first introduced by Higgs and colleagues in 1989. Sufferers of FAED have a history of food avoidance or difficulty. They also have a disorder of emotions. FAED patients have an absence of organic brain disease, psychosis, illicit drug abuse, or prescribed drug-related causes.

Food Refusal is common in young children. "I'm all done." "Mommy, I don't want anymore." "No! I won't eat." These are all common phrases that a child of this problem might utter. These children often need to be bribed with threats of no dessert, or bribing them with their favorite foods. It is hard to distinguish between fads and eating disorders. Food refusers will eat their favorite foods with complete ease and also in certain situations such as a friend's house. Surprisingly these types of children are not underweight and not calorie conscious. This eating behavior is generally viewed as a behavioral problem that usually resolves itself in time. It does not represent a serious threat to the child's health or well being.

Described by Lask, "Pervasive Refusal is a condition that is manifested by profound and pervasive refusal to eat, drink, walk, talk or engage in self-care. Children with this particular combination of symptoms do not fit any existing diagnostic category, and suggest that the condition may be understood as an extreme variation of the avoidance behavior seen in posttraumatic stress disorder.

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" (Lask et al, 20) Children with Pervasive Refusal are usually underweight, always refuse food and drink, and have features of a child with anorexia nervosa. Lask also says that "…a diagnosis of anorexia nervosa is inappropriate in such cases because not all the criteria for an eating disorder are known to be fulfilled, and the refusal exhibited extends across all areas of functioning."(Lask et al, 20)

Selective Eating is a term that Lask says "may be applied to children who appear to exist on typically only two or three different foods. These will often be carbohydrate-based, such as biscuits, crisps, or potatoes. Children with this form of extremely selective eating behavior are often of appropriate weight and height for their age, and tend not to present as an immediate cause for concern in physical terms." When children are in situations where they are obliged to eat food outside of their eating range, they are faced with a difficult contemplation. In most cases selective eaters are referred to a specialist for help regarding social, rather than physical concerns, and are clearly noticeable from children with anorexia nervosa.(Lask et al, 20)


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