Eating Disorders

Under the umbrella term eating disorders, two important syndromes are described: Anorexia nervosa and Bulimia nervosa. Both frequently occur as comorbidities with Borderline Personality Disorder.

Overview According to ICD-10

Code	Disorder	Subgroup
F50.0	Anorexia nervosa	Active/passive form
F50.00	Anorexia without active measures	Ascetic, passive, restrictive form
F50.01	Anorexia with active measures	Active, bulimic form
F50.2	Bulimia nervosa	Hyperorexia nervosa
F50.3	Atypical bulimia nervosa	Bulimia with normal weight

Development of Eating Disorders

Eating disorders range from appetite disorders, where children eat poorly according to their parents’ judgment, through vomiting after usually forced food intake, to anorexia, where particularly girls lose so much weight that their lives are at risk.

Causes in Children

Lack of tenderness and love
Lack of acceptance of the child in the parental home
Excessive emphasis on eating
Overanxious and overprotective mothers
Oppositional attitude toward parents

Anorexia Nervosa

Anorexia nervosa is a life-threatening disorder whose frequency has increased massively in recent years. It primarily affects young women and girls in puberty.

The onset often occurs around age 12 - coinciding with the first onset of menstruation.

Features of Anorexia

Very strong fear of gaining weight
Weight is at least 15% below normal
Striving for further weight reduction through:
- Appetite suppressants
- Vomiting ingested food
- Avoiding calorie-rich foods
- Excessive physical activity
Disturbed body perception - always feeling too fat

The Difference from Bulimia

In anorexia, there are no binge eating episodes. There is continuous weight loss.

Anorexia nervosa (active): Weight loss is supported by vomiting
Anorexia nervosa (passive): Weight loss only through food refusal

The anorexic says: “I am too fat.” The bulimic says: “I will become too fat.”

Typical Behaviors

Constant preoccupation with the topic of food
Collecting recipes, cooking for others - without eating themselves
Telling someone affected that they have gained weight causes a massive disease flare-up
Most lack insight into their illness

Possible Causes

Psychoanalytic: Fear of excessive sexual impulses; conflict in attempting to separate from the mother
Learning theory: One-sided orientation toward the ideal image of an excessively slim woman
Neurological: Impairment of the hypothalamus (food intake, sexual activity, menstruation)
Disturbed and pathogenic family relationships
Triggering events (separation and loss experiences, onset of puberty)

Bulimia Nervosa

Bulimia primarily affects young women. They periodically consume very large amounts of food (binge eating episodes), but then induce vomiting each time.

Difference from Anorexia

Bulimics are hardly underweight
But like anorexics: very strong, inappropriate fear of becoming fat
Eating often takes place in complete secrecy
The cycle of eating and vomiting can repeat until complete exhaustion

Reactions After Vomiting

Often depressed
Shame about the behavior
Unlike anorexia: illness insight is present

Physical Consequences

Sore throat
Swollen salivary glands
Destroyed tooth enamel
Intestinal damage

Triggers

Conflictual situations in childhood
Strong restrictions in childhood
Acute stressful situations:
- Separations
- Death of a family member
- Relationship problems

Connection with Other Disorders

Both eating disorders are often accompanied by other personality disorders (comorbidity):

Borderline Personality Disorder Frequent comorbidity

ADHD Impulsivity and eating disorders

Depression Accompanying depressive symptoms

Detailed Information

Anorexia nervosa ICD-10 criteria, subgroups and development of anorexia

Bulimia nervosa ICD-10 criteria and atypical forms of bulimia