![](https://images.ecency.com/DQmZo4GohJJRnkv36mD5tKczBeJYkyvFJ9fyLrLR63kxwoh/eating_disorders_in_twitter5.png)



<blockquote class="twitter-tweet"><p lang="en" dir="ltr">It makes me sad when people don’t know the difference between bulimia and anorexia. I believe mental health should be a thing that is taught in schools, but instead it’s just an option.</p>— Rose (@rosehiptea25) <a href="https://twitter.com/rosehiptea25/status/1276346543302467584?ref_src=twsrc%5Etfw">June 26, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>




In the last post, we saw how:
- BN is characterised with binging and feelings of guilt and derpession.
- There is an element of control seen in patients with AN such that the patient can deal with other chaos through abnormal eating habits.
- CBT is the main stay of treatment for BN.

![Eating Disorders in twitter4.png](https://files.peakd.com/file/peakd-hive/ebingo/23yd3vyBAJwPRYJqUAJPm8sfsaqmxpP5KWY78kKMCXoWpvBruynKY5B8xQ5CN6kNXrfE3.png)
[Inkscape.org](Inkscape.org)


<a href='https://www.freepik.com/vectors/depression'>Depression vector created by pch.vector - www.freepik.com</a>
to splittingblockquote class="twitter-tweet"><p lang="en" dir="ltr">the comfort anorexia brings me is unmatched. nothing else in this world has ever been able to provide me w this much comfort & control, it’s addicting & that’s what makes it so sweet & destructive at the same time, but i love it</p>— mousse





Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.

In this post, we are looking at **Twitter posts**. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.

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![Vibes dimacations.png](https://files.peakd.com/file/peakd-hive/ebingo/23vsqueDeqMiXPMUbFQM6ReJsiU63MBTLZGStCb3FobcSrsf3qrdMZecHReN7Kv6GVC5L.png)

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**<center>Etiology</center>**
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**<center>Biological Factors </center>**
Some studies have tried to have neurotransmitters explain the cause of the purging and binging. When antidepressants such as SSRIs are used on these patients there was a noticeable increase in satisfaction after feeding. There is also a noticeable increase in the amount of endorphins in those who vomit. This is probably why those who vomit tend to feel as if they are in a better state of being afterwards.

There is also a possible genetic component to the disorder. Those who have this condition have a higher tendency of having first-degree relatives with this condition.

News studies done with magnetic resonance imaging are showing that when a patient with BN overeats, there is an increased perception of what hunger means to them. This is expressed in the right insula area and is linked with the sweet taste of the food.


**<center>Social Factors </center>**
Those who have AN are people who aim high and attain them and are acting out of a need imposed on them by society. In a similar light to BN, those who have AN tend to be depressed and those who have BN show the same poor parental harmony. Those who have BN tend to see their parents as non-attentive to them.


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![Vibes dimacations.png](https://files.peakd.com/file/peakd-hive/ebingo/23vsqueDeqMiXPMUbFQM6ReJsiU63MBTLZGStCb3FobcSrsf3qrdMZecHReN7Kv6GVC5L.png)

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# <center>AN VS BN (Reaction post)</center> 
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![image.png](https://files.peakd.com/file/peakd-hive/ebingo/23u67Q9YbyipG5xCyTBEh2YiQ5drzUQHk7cLcALmntyAVD7aipJCt5JMPPjm8LD3ZQs9t.png)



[Source](https://www.freepik.com/free-vector/healthy-life-design-concept-with-fat-woman-holding-peace-cake-thin-woman-trying-healthy-foods-flat-vector-illustration_26764853.htm#query=anorexia%20and%20bulemia&position=3&from_view=search&track=ais)

Both of these conditions are eating disorders in which the patients have an abnormality in the way they view themselves. But their food habits are different.

Those who have AN tend to either restrict food consumption or use purging as a means to affect their food consumption but in BN their main way to affect food consumption is with the use of punishment pathways so that they tend to feel bad when they consume food in excess.


Women tend to be more affected by both disorders. Statistics show that about 1% of women are affected by ED in America. Bout 1.5% of women will have BN in their lifetime. The National Association of Anorexia Nervosa and Associated Disorders estimates that nearly 30 million Americans have some form of eating Disorder or the other.


Eating disorders usually have thoughts of food in common. Those who suffer from this condition tend to spend a good amount of time thinking about food. They also do not like the way they look.

In AN, the patient in addition to not being aware of how they look may have other psychological problems like anxiety and depression. They may also suffer from past trauma. In our last post about control, we saw how these patients may see their poor eating habits as means to take control over their lives. The physical state of a person with AN is what has the capability of killing them.



They typically look wasted, they may suffer from sleep problems, they will be dehydrated suffer from constipation and be very tired. They may have occasional fainting spells and have thin hair that breaks.



They may show some behavioural features seen in people who have AN such as not following the normal meal plan, hiding their eating habits, eating poor that is low calories, hiding small amounts of food and they may express bad thoughts about their body. They also have the extreme habit of exercising too. 

They have a bad way of seeing themselves, they are irritable and agitated and tend to isolate themselves.


Those who have BN have poor eating habits that start as time goes by. These patients eat plants of food and feel guilty afterwards. They may take up habits such as purging to deal with their weight gain.

In BN they may use different means to deal with their weight gains such as purging or the use of laxatives. This is seen as a way to deal with the excessive consumption of food.

In the non-purging type of BN, there is a fast that attempts to lose weight after a period of binging. They may also participate in an extreme exercise to prevent weight gain.



The consequences of these behaviours can be that the patient will experience complications of dehydration such as reduced pulse rate, dried lips and injuries in the oesophagus due to vomiting.

No one is very sure of the cause of eating disorders like this but most psychiatric problems are a combination of biopsychosocial problems.

Biologically genetics may play a role in the development of eating disorders because it has been found that those who have a close relative with ED tend to develop it. The specific gene segments have not been localized but more studies are being done to find these specific gene segments.


Psychologically the patients tend to suffer from depression and anxiety. There are usually feeling of psychological stress and the patients often lack confidence.

Socially the patients tend to have a feeling of being drawn to the pressures of society and how they see themselves. These patients are affected by peer group influence.



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![Vibes dimacations.png](https://files.peakd.com/file/peakd-hive/ebingo/23vsqueDeqMiXPMUbFQM6ReJsiU63MBTLZGStCb3FobcSrsf3qrdMZecHReN7Kv6GVC5L.png)
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# <center>Treatment</center>
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**<center>Pharmacotherapy</center>**
Antidepressants have been noted to be useful in dealing with bulimia. These are particularly the SSRIs like fluoxetine. This is related to 5-hydroxytryptamine concentration.

When SSRI on used on patients with binge and purge, there is a noticeable reduction in the incidence of binging and purging with or without mood disorders.

In the case of binge and purge disorders that are non-responsive to psychotherapy, SSRIs have been very helpful. Drugs like Imipramine, desipramine, trazodone and monoamine oxidase inhibitors have been very useful.
The doses used in binge and purge disorders are the same as those used in depression. For fluoxetine, however, the doses may be slightly increased to achieve the required effect.

Medication is very helpful when the patient has depression in addition to BN.

Carbamazepine and lithium were also seen to be very helpful in those that have been useful in BN but it was not helpful for those who have comorbid bipolar type I. Some studies show that antidepressants alone were more effective in binge and purging disorders but other studies have shown them to be effective in combination with CBT.



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# <center>Questions</center>
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- What did you learn about Eating Diorders?


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# <center>Conclusion</center>
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- There are biopsychosocial factors that can lead to BN
- These two disorders are very similar but tend to differ in the way the patient present. Those who have AN tend to be lower than the weight for height in BMI while BN may have normal or increased weight for height.
- SSRIs are very effective for the binge and purging types of ED.


![Medic Vibes Logo.png](https://files.peakd.com/file/peakd-hive/ebingo/AJhdrsjLeDph84bWdX9cMCvySBVnFziVCkTM3LkNaZ4Wza7QAVeRTn61CH1DKJq.png)
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# <center>References</center>
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- [Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry](https://www.amazon.com/Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry/dp/1451100477)
- Page demarcations made with [Inkscape.org](Inkscape.org)
- [Spine-Health](https://www.spine-health.com/conditions/spine-anatomy/anatomy-coccyx-tailbone
)
- [Eating Disorder Hope](https://www.eatingdisorderhope.com/blog/illusion-control-development-eating-disorders)