1. Psychiatry department
Beni Suef University

2.  They
are a group of disorders where there is
excessive preoccupation with weight, food,
and body shape.
Two main types are recognized:
 1. Anorexia Nervosa
 2. Bulimia Nervosa

4. Clinical Picture
 • Weight loss leading to maintenance of body weight
to less
than 85 % of expected weight
 • Intense fear of gaining weight
 • Intense disturbance of body image (the patient
perceives
herself as overweight despite the clear evidence of her
thinness)

•Amenorrhea in females

•Anorexia is not an essential feature.
 The patient may maintain low body weight by
consuming low-calorie diet and by other means such
as vigorous exercise


5. •
Amenorrhea, sometimes early
 • Change in the quality of hair, nails and skin
 • Constipation or diarrhea
 • Dizziness or fainting
 • Decreased blood pressure, temperature or
pulse rate

7. •
Depressed mood, social withdrawal
 • Loss of interest in usual activities
 • Anxiety
 • Fatigue

8.  They
are due to chronic severe malnutrition and
marked reduction in caloric intake.
They include the following:
 •Cardiological: loss of cardiac muscle,
arrhythmias,
 prolonged QT interval, bradycardia, sudden
death
 • Hepatic: fatty degeneration

10. •
Skeletal: osteoporosis
 • Hematological: anemia, leucopenia
 • Endocrine: low T3, LH and FSH
 • Electrolytes: hypokalemia, hypomagnesaemia
 • Nervous: neuropathies, cognitive impairment,
seizures
 Mortality

12. •
Females are 10-20 times more
frequently affected than males
• 0.5-1 % of female adolescents, 5 %
have subclinical forms
• Age at onset is in the early
adolescence, it may be delayed till
the early 20's

13.  1.
Biological Factors
 2. Social Factors
 3. Psychodynamic Factors
 Fears concerning acquisition of feminine shape
of body
 •Self-discipline over eating is an attempt to
gain autonomy due to inability to get separated
from the mother
 • An attempt to draw attention

15. •
•
•
•
•
Obsessive Compulsive Disorder
Major Depression
Generalized Anxiety Disorder
Phobic Disorders
Psychotic Disorders

16.  Ten-year
outcome study in the United States:
 • 25 % complete recovery
 • 50 % improve, functioning well with
residual symptoms
 " 25 % functioning poorly, including 7 %
mortality rate

17.  It
is generally difficult.
 Hospitalization (marked weight loss
and with medical complications).
 Full medical assessment is essential.
 cognitive behavioral psychotherapy
 pharmacotherapy (antidepressants,
anxiolytics and antipsychotics)

18. Clinical Picture
 • Recurrent episodes of binge-eating + lack of
control over eating
 • At least twice a week for 3 months
 • Recurrent, inappropriate compensatory
behavior to prevent weight gain, such as the use
of purgatives, laxatives or self-induced
vomiting
 • Body shape and weight unduly influence selfevaluation and self-esteem
 • The patient is within normal weight


19.  Clinical
picture
 Behavioral changes
 Medical complications
 Social problems

20.  Behavioral
Changes
 • Secretive behavior (hiding food, spending
long periods in the bathroom)
 • Restrictive meal patterns or over-concern
with dieting and nutrition but with little
change in weight

21.  Physical
Changes
 • Loss of dental enamel as a result of
recurrent vomiting
 • Dehydration, fatigue, swollen salivary
glands
 • Esophageal or gastric tears
 • Side effects of emetics, diuretics or
purgatives

22.  Medical
Complications
 • Gastro-esophageal bleeding
 • Cardiac complications (e.g. arrhythmia)
 • Muscle cramping due to electrolyte
imbalance
 • Renal failure
 Social
Problems
 Social isolation
 Impairment in family relationships as a result
of concealment and lying

23. •
Much higher prevalence in females
 • The prevalence of bulimia nervosa is
between 3-5% of young women, four
times more common than anorexia
nervosa
 • 40 % of college-aged women have
bulimic symptoms
 • Usually starts in late adolescence or
early adulthood (later than anorexia
nervosa)

24.  1.
Biological Factors
 2. Social Factors
 3. Psychodynamic Factors

25. 1. Biological Factors
 The beneficial effect of antidepressants points
the
 potential role of serotonin and norepinephrine
 2. Social Factors
 •Patients are high achievers and respond to
societal pressures to be slim
 • Families are less close, but more conflictual
than those of
 anorexia nervosa
 • Parents are neglectful and rejecting


26.  3.
Psychodynamic Factors
 • patients exert self-discipline over eating in an
attempt to gain autonomy from the mother, but
they are more out-going, angry and impulsive.
 This leads to bouts of binge-eating.
 • They have other behaviors characteristic of
weakened impulse control, such as substance
abuse, self-destructive sexual relationships, and
shoplifting.
 • Binge-eating is experienced as ego-dystonic

27. •
Depression (30-70% lifetime rate)
• Generalized Anxiety (30-70%
lifetime rate)
• High rates of other anxiety
disorders and panic disorder
• Deliberate self harm, e.g.,
reckless driving, self-injury, suicide,
etc...
• Alcohol and substance misuse

28. •
The long-term outcome of bulimia
nervosa is still under study.
 • Without treatment, the disorder
usually persists for at least several
years, with a waxing and waning
course.
 • Up to 70% benefit from ttt
 full recovery is achieved in 50 % of
cases.
 • Mortality is approximately 1% due to
medical complications and suicide.

29. •
Cognitive-Behavioral Therapy
 • Group Therapy
 • Family Therapy
 • Pharmacotherapy: antidepressants, in
particular SSRIs, are very useful