Eating Behavior Disorders (TCA)

What is it about ?

An eating disorder is a serious and complex mental disorder. Eating disorders are seen mainly in adolescent girls. They also affect boys, mainly in the form of bulimia and atypical eating disorders. An eating disorder is characterized by eating habits that become a way of controlling their appearance. Eating and gaining weight is often associated with anxiety.

Types of eating disorders

The most common eating disorders areanorexia nervosa and the bulimia. In addition, atypical forms of eating disorders and binge eating (compulsion pushed to the extreme where all food is swallowed in a very short time) are observed more and more often in younger and younger children.

Causes of eating disorders

Many factors are involved in the development of eating disorders:

• neurobiological factors;
• genetic factors;
• socio-cultural factors;
• family factors;
• factors related to individual development.

Generally, an eating disorder begins in adolescence and can compromise the physical and mental development of the young patient.

What is their frequency?

• Anorexia nervosa (anorexia) occurs mainly between the ages of 14 and 24.
• Bulimia, on the other hand, usually appears between the ages of 16 and 20.

Eating disorders affect girls 10 to 15 times more often than boys. Bulimia is more common than anorexia.

How to recognize them?

Anorexia (anorexia nervosa)

In case of anorexia, the weight is at least 15% less than the expected weight for age and height. A person with anorexia considers himself to be too fat, even though he is underweight, and is very afraid of gaining weight.

Anorexia usually sets in gradually. Weight loss can be slow, but it can also be fast. Most adolescents with eating disorders are still in school, pursuing their hobbies and feeling good about themselves. This is why families often react with surprise when they find out that their child is undernourished.

Here are some physical symptoms of anorexia:

• absence of menstruation ;
• constipation ;
• slow heart rate ;
• low blood pressure (hypotension);
• cold and bluish limbs;
• reduction of subcutaneous fat.

Bulimia

People with bulimia are also overweight and afraid to gain weight. They are constantly preoccupied with food and feel an overwhelming urge to eat. They experience repeated episodes of binge eating (at least twice a week), during which they lose all control over their eating behavior, then try to eliminate the food ingested by To vomit and / or taking laxatives and diuretics.

Young adults with bulimia are aware that their eating habits are not normal. They feel guilty and ashamed. They therefore often mask their symptoms for a long time and find it difficult to accept treatment.

Bulimia is also manifested by physical symptoms:

• menstrual disturbances ;
• disturbances in the metabolism of salt in the blood due to vomiting frequent;
• damage to tooth enamel.

Psychiatric symptoms associated with eating disorders

Eating disorders can go hand in hand with psychiatric symptoms:

• mood disorders ;
• anxiety disorders ;
• obsessive-compulsive disorder ;
• psychotic disorders.

Bulimia is often associated with disturbed impulse control and may predispose toalcoholism or drug addiction.

How is the diagnosis made?

• The doctor first examines the eating habits, the level ofphysical activity and the history of growth. He will also ask the girls about their menstruation.
• If he suspects an eating disorder, he can ask the patient 5 specific questions. These questions correspond to a screening questionnaire called SCOFF. Each positive answer gives 1 point, a score of 2 points or more suggests an eating disorder.
• Are you trying to To vomit when you have the unpleasant sensation of having a full stomach?
• Are you worried about losing control over the amount of food you eat?
• Have you lost more than 6 kg in the past 3 months?
• Do you find yourself too fat when others say you are too skinny?
• Do you spend your time eating or thinking about eating?
• The doctor will also do a blood test.
• In case of anorexia, the person often has a slight anemia, a decrease in the number of white blood cells and of platelets, and a too low blood sugar (glucose) (blood sugar).
• In bulimia, the person usually has a salt metabolism disorder and a high level of amylase, an enzyme that is involved in the digestion of starch.
• Moreover, the doctor systematically exclude other diseases such as diabetes or thyroid disorders, but also psychiatric disorders such as depression, a psychosis or drug addiction.

What can you do ?

An eating disorder is serious – you need help.

• Consult your general practitioner. He will assess with you who can help and support you. The earlier you are helped, the better the chances of recovery.
• Talk to someone you feel comfortable with and who you can talk to freely.

What can your doctor do?

Eating disorders are often difficult to treat. In the initial phase of anorexia, the prognosis is good, but it deteriorates in the long term. The prognosis for bulimia is better, but the risk of relapse is great.

If symptoms suggestive of anorexia are present, the doctor discuss with parents and caregivers first of the person before offering treatment. Sometimes it takes a long time to motivate someone to take the step to treatment.

Processing

• Treatment consists of restoration of nutritional status and an psychotherapy. The anorexia is often so severe that the general practitioner is unable to manage the treatment. In this case, he will refer the person to a center specializing in eating disorders.
• If the state of undernutrition threatens the vital prognosis, treatment is started in a non-psychiatric service. The person will only be followed in therapy afterwards. The individual therapy and family therapy give good results. In young people, treatment preferentially targets the whole family. Then a individual, supportive and long-term treatment is the best way to promote healing.
• A prolonged state of undernutrition and insufficient outpatient care justify the patient’s dismissal for a forced treatment.

Medications

It is a specialist who generally sets up the medical treatment. There is no specific treatment for anorexia, but the accompanying symptoms can be treated. Thus, the antipsychotics and antidepressants can help withanxiety, of obsessive-compulsive symptoms or from psychotic symptoms. Fluoxetine is believed to help prevent relapses in anorexia, when the person is at a normal weight, and reduce episodes of binge eating and binge eating. vomiting in bulimia.

Want to know more?

• Anorexia and bulimia – mongeneraliste.be – SSMG – Scientific Society of General Medicine
• Anorexia and bulimia, brochure for parents – Solidaris – Mutualité Socialiste
• Anorexia nervosa: when eating hurts – Solidaris – Mutualité Socialiste

• Fluoxetine – CBIP – Belgian Center for Pharmacotherapeutic Information

Are you looking for more specialized help?

• Mental Health Services – The Social Guide
• MIATA – Information and Reception Center for Eating Disorders
• Anorexia Bulimia Together – Listening, information, guidance

Source

Foreign clinical practice guide ‘Eating disorders in children and adolescents’ (2000), updated on 23.08.2017 and adapted to the Belgian context on 03.01.2018 – ebpracticenet