Main Eating Disorders: Anorexia And Bulimia

Two eating disorders whose effects are alarming.

According to the most recently accepted definitions by the American Psychiatric Association (1994), anorexia nervosa (AN) and bulimia nervosa (BN) are defined as emotional disorders of high severity and interference in many of the vital areas of the individual that affect it. suffers.

The data indicate that the confluence of biological, psychological and social factors interact with the personality of the individual, promoting the development of this type of eating pathology.

Among the first set of factors, the type of temperament of the individual as well as his level of emotional stability may be determining; Regarding the socio-cultural components, it is worth highlighting the idealization of society by maintaining a slim body associating it with success and superiority over others; Regarding psychological factors, this type of patient presents phenomena such as low self-esteem, feelings of ineffectiveness in solving problems and coping, or a high desire for perfectionism that greatly hinder their daily functioning.

Symptoms in eating disorders

On the other hand, the presence of anxiety and depressive symptoms is frequent, characterized by continuous sadness and dichotomous thinking (of “all or nothing”).

A large proportion of people with anorexia present traits of obsession and compulsion regarding the maintenance of rigidity and strict regulation in the control of eating, extreme physical exercise, body image and weight. Finally, the difficulty in expressing themselves emotionally externally is also characteristic  despite being very intelligent, so they tend to isolate themselves from the circles of close relationships.


In the case of anorexia nervosa, it is characterized by a predominance of rejection of body weight, usually accompanied by a distortion of body image and an inordinate fear of gaining weight. Two subtypes are distinguished in anorexia nervosa, depending on whether or not binge-eating or compensatory behaviors occur (AN-Purgative vs. AN-Restrictive, respectively).


The second nosology,  bulimia nervosa, is characterized by the maintenance of cyclical episodes of binge eating and compensatory behaviors of those through vomiting, the use or abuse of laxatives, excessive physical exercise or the restriction of subsequent intake. In this case, the categories BN-Purgative are also differentiated, if the individual uses vomiting as compensatory behavior, and BN-Non-Purgative, if they resort to fasting or excessive physical activity.

Many of the people who present an Eating Disorder do not meet all the criteria that allow one of the two previous diagnoses to be made, for which a third category is distinguished called Unspecified Eating Disorder where all these can be included subjects of difficult classification.

Characterization of bulimia nervosa and anorexia nervosa

Anorexia nervosa usually stems from family histories of eating disorders, especially obesity. It is more easily detectable than bulimia nervosa, due to the high weight loss and the numerous medical complications that accompany the picture, of a metabolic, cardiovascular, renal, dermatological type, etc. In extreme cases of malnutrition, anorexia nervosa can lead to death, with the percentage of mortality between 8 and 18%.

Unlike anorexia, bulimia is seen much less frequently. In this case, the weight loss is not so evident since the binge-compensation cycles keep it, more or less, at similar values.

Bulimic people are characterized by expressing an exaggeratedly intense concern for their body image, although they manifest it in a different way than in anorexia: in this case the ingestion becomes the method to cover their emotional needs not satisfied by the appropriate channels.

Analogously to anorexia, alterations are also observed at a psychological and social level. Usually these people show marked isolation, which is why family and social interactions are often poor and unsatisfactory. Self-esteem is usually deficient. Comorbidity has also been observed between bulimia, anxiety and  depression ; the latter usually appears derived from the former.

Regarding the  level of anxiety, a parallel is usually shown between this and the frequency of bingeing carried out by the subject. Later on, feelings of guilt and impulsivity motivate the compensatory behavior of the  binge. It is for this reason that a certain relationship between bulimia and other impulsive disorders such as substance abuse, pathological gambling, or  personality disorders where behavioral impulsivity predominates has also been indicated  .

The thoughts that characterize bulimia are also often defined as dichotomous and irrational. They spend a lot of time a day on the cognitions regarding not gaining weight and feeding the distortions of the body figure.

Finally, medical pathologies are also common, due to the maintenance of binge-compensation cycles over time. The alterations are observed at the metabolic, renal, pancreatic, dental, endocrine or dermatological levels, among others.

Causes of eating disorders

There are three factors that have been demonstrated in a majority by consensus by expert authors in this field of knowledge: predisposing, precipitating and perpetuating. Thus, there seems to be an agreement in granting the causality of EDs a multicausal aspect where both physiological and evolutionary, psychological and cultural elements are combined as intervening in the appearance of the pathology.

Among the predisposing aspects, reference is made to individual factors (overweight,  perfectionism ,  level of self-esteem, etc.), genetic (higher prevalence in the subject whose relatives present this psychopathology) and sociocultural (fashionable ideals, eating habits, prejudices derived from body image, parental overprotection, etc.).

Precipitating factors include the subject’s age (greater vulnerability in adolescence and early youth), inadequate assessment of the body, excessive physical exercise, stressful environment, interpersonal problems, presence of other psychopathologies, etc.

The perpetuating factors differ in terms of psychopathology. Although it is true that negative beliefs about body image, social pressure and the experience of stressful experiences are common, in the case of anorexia the most important factors are related to complications derived from malnutrition, social isolation and development of fears and obsessive ideas about food or body shape.

In the case of bulimia, the central elements that maintain the problem are linked to the binge-compensation cycle, the level of anxiety experienced and the presence of other maladaptive behaviors such as substance abuse or self-harm.

Main behavioral, emotional and cognitive manifestations

As mentioned in previous lines, Eating Disorders result in a long list of manifestations both physical (endocrine, nutritional, gastrointestinal, cardiovascular, kidney, bone and immunological) as well as psychological, emotional and behavioral.

As a summary, on this second set of symptoms, the following can occur :

At the behavioral level

  • Restrictive diets or binges.
  • Compensation of intake through vomiting, laxatives and diuretics.
  • Alterations in the way of ingestion and rejection of some specific foods
  • Obsessive-compulsive behaviors.
  • Self-harm and other signs of impulsivity.
  • Social isolation.

On a psychological level

  • Terrible fear of getting fat.
  • Wrong thoughts about diet, weight, and body image.
  • Alteration in the perception of body image.
  • Impoverishment of creative ability.
  • Confusion in the feeling of satiety.
  • Difficulties in the ability to concentrate.
  • Cognitive distortions: polarized and dichotomous thinking, selective abstractions, thought attribution, personalization, overgeneralization, catastrophizing and magical thinking.

On an emotional level

  • Emotional lability.
  • Depressive symptoms and suicidal ideation.
  • Anxious symptoms, development of specific phobias or generalized phobia.

Intervention in eating disorders: objectives of the first personalized attention

In a generic approach to the intervention in eating disorders, the following guidelines can be a useful guide to offer a first individualized attention depending on the case that is presented:

1. An approach to the problem. In this first contact, a questionnaire is completed to acquire the greatest volume of information regarding the history and course of the disorder.

2. Awareness. Allow the patient to make an adequate insight into the deviant behaviors related to the disorder so that they can become aware of the vital risk derived from them.

3. Motivation towards treatment. Awareness about the importance of turning to a specialized clinical psychology and psychiatry professional is a fundamental step to guarantee a greater probability of therapeutic success, as well as an early detection of incipient symptoms can be a great predictor of a positive evolution of the disease .

4. Information on intervention resources. Offering addresses of interest can be useful to increase the perception of social support received, such as associations of ED patients attending group therapy groups.

5. Bibliographic recommendation. The reading of certain self-help manuals may be indicated, both for the patients themselves and for their closest relatives.

In conclusion

Given the complex nature of this type of psychopathology and the powerful maintenance factors that make a favorable evolution of these disorders extremely difficult, an early detection of the first manifestations seems essential as well as to guarantee a multicomponent and multidisciplinary intervention that encompasses both all the components altered (physical, cognitive, emotional and behavioral) as the extensive set of vital areas affected.

Bibliographic references:

  • Cervera, Montserrat. “Risk and prevention of anorexia and bulimia”. Martínez Roca. Barcelona, ​​1996.
  • Fernández, A. and Turon Gil. “Eating disorders”. Masson. 2002.
  • Raich, Rosa Maria. “Anorexia and bulimia: Eating disorders”. Pyramid. Madrid, 2001.

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