Anorexia and bulimia

Anorexia and bulimia are about more than just weight or not eating enough or too much. Find out how these mental health disorders threaten the health and lives of young girls as well as men and women of all ages.

What are anorexia and bulimia?

Anorexia and bulimia are mental health problems known as eating disorders. People with these disorders have distorted thoughts, attitudes and behaviours when it comes to their diet, weight and body image, and these have a major impact on their physical and mental health and can even put their lives at risk.

While no country is immune to these mental illnesses, they are more common in developed nations. These disorders usually appear in adolescence or early adulthood. Although boys and men can be affected, the majority of people with the disorder (90%) are women. An estimated 3% of the female population in Quebec has one of these disorders, and this rate triples if partial forms of the disorder are included. Between 10% and 20% of people with these disorders will die from complications.

Anorexia and bulimia are two separate health problems, but someone can suffer from one disorder after the other.

Anorexia

Also called anorexia nervosa, anorexia is characterized by an obsession with thinness and an extreme fear of weight gain, to the point of restricting your diet or even refusing to eat. People with this disease are obsessed with the fear of getting fat or being overweight, which can cause them to become excessively thin.

Anorexia causes terrible physical and psychological suffering: acrocyanosis (circulatory problems that cause the hands and feet to turn blue), hair loss and brittle hair, lanugo (fine hair on the body), anemia(lien fiche), concentration problems, insomnia, irritability, anxiety and depression. To protect itself, the body will slow its metabolism. In women, this can stop menstruation. Food deprivation can also lead to problems in vital organs, such as the heart or brain. Arrhythmia, a slowed heart rate (pulse), as well as impaired intellectual function are also possible.

Anorexia signs and symptoms

• Being underweight (at least 15% below a healthy weight) without a known medical reason.
• A constant fear of getting fat or being overweight, despite having a low weight.
• An unrealistic body image, and a disproportionate emphasis on body image.
• Food restrictions.
• Concerns and obsessions with the fat content or calories in food.
• Rituals or particular eating habits (e.g., refusing to eat in front of other people).
• Excessive exercise.
• Social and emotional withdrawal.
• Mood swings, irritability, insomnia, anxiety, depression, etc.
• Lack of recognition about the danger of the situation.

Bulimia

Bulimia or bulimia nervosa refers to episodes of excessive and impulsive eating of a large amount of food (hyperphagia, or what people may call “overeating” or “binge eating ”), followed by various harmful behaviours in response to the loss of food control and a fear of getting fat, e.g., vomiting, taking diuretics or laxatives, or exercising excessively. According to the diagnostic criteria of the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), these episodes must occur at least once a week for the condition to qualify as bulimia. In general, people with bulimia will maintain a normal weight, which can allow them to hide the problem for years.

Like with anorexia, bulimia also causes great physical and psychological suffering. Vomiting can cause inflammation of the esophagus and swelling of the salivary glands. In rare cases, hyperphagia  may cause the stomach to rupture. The abuse of laxatives or diuretics can cause electrolyte disorders and lead to heart or other problems. Like with anorexia, bulimia can cause irregular periods.

Bulimia signs and symptoms

• Compulsive eating (eating a large amount of food in a short period of time).
• Feeling that you’ve lost control over your food intake.
• Purging behaviour controlled by the fear of getting fat after episodes of compulsive eating: e.g., self-induced vomiting, use of laxatives or diuretics, or excessive exercise. Often going to the bathroom after meals may also be a sign of bulimia.
• An unrealistic body image, and a disproportionate emphasis on body image. 
• Fear of gaining weight.
• Dental problems (e.g., cavities, swelling of the salivary glands and bleeding gums).
• Heart problems (arrhythmia, decreased blood pressure).
• Social and emotional withdrawal.
• Mood swings, irritability, insomnia, anxiety or depression.

Risk factors

Anorexia and bulimia are caused by a combination of biological, psychological, social and environmental factors. Here are some possible risk factors:

• Genetics, a personal or family history of mental health problems (e.g., eating disorders, depression or anxiety disorders).
• Family or social factors (e.g., a dependency or unhealthy relationship).
• Personality traits such as low self-esteem, perfectionism, impulsivity, compulsion, self-criticism.
• Emotional stress (e.g., conflict, coping with a  death, history of being a victim  of sexual assault or violence). 
• Being pressured about your weight. This is why people who are obese as well as dancers, models and athletes are most at risk of developing an eating disorder. 
• The cult of thinness in our industrialized society very likely plays role in these disorders, especially bulimia.

Anorexia and bulimia treatment

Treatment requires a personalized, multidisciplinary approach. The duration and nature of the treatment will vary depending on each person's needs. To prevent a relapse, the person's family and social context must be taken into account, and health care professionals will need to work with all family members.

Individual psychotherapy is the starting point for all treatment. This may also include nutritional rehabilitation, family or couples therapy, support groups, and medication (e.g., antidepressants or anti-anxiety drugs).

The physiological complications of the eating disorder must also be treated.

If you think that you or someone you know may be suffering from an eating disorder, you must seek help from a health care professional (such as your doctor, a psychologist or your pharmacist) or from an information and support group. Don’t hesitate to discuss your concerns confidentially with your pharmacist, who takes your health and well-being to heart.