By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System
Illness irrespective of the label frequently involves a disorder of some key-links in the life network (biopsychosocial) of the patient which may be affected by factors from the environment. Eating disorders especially anorexia nervosa is no exception.
Anorexia nervosa vs bulemia nervosa
Eating disorders include anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by failure/refusal to maintain a minimum normal body weight, fear of weight gain and fatness, dysmorphic body image and amenorrhoea.
In contrast, bulimia nervosa manifests as recurrent binge eating followed by inappropriate compensating behavior, which may include self-inducing vomiting; abuse of laxatives, diuretics or other medications; fasting; and over-exercise.
Anorexia nervosa is multifactorial, complex, learned behaviors which evolves from the patient's own defense system. There is an over-perception of body size. Natural weight gain around menarche can cause them to lose self confidence and experience a decrease in self esteem. They suffer from feelings of inadequacy, lack self confidence, and poor coping mechanisms.
Pathophysiology of anorexia nervosa
Driving force in an eating disorder such as anorexia nervosa appears to be a distorted body image. The psychobiological dynamics of eating disorders suggest involvement of significant hypnotic phenomena such as forms of dissociation, hallucination, time distortion and catalepsy [Walsh 2008].
There is a complex interplay between between weight, shape, dietary concerns, hypnotizability, dissociative capacity, and fantasy proneness. The reflective function may be impaired.
Emotions are experienced as a corporeality. The human body functions as metaphor, and in anorexia nervosa there is a striking closeness between emotions and different bodily experiences [Skarderud 2007]
Factors underlying anorexia nervosa
Patients with eating disorders should be investigated as to the underlying dynamics behind the eating disorders symptoms. For example, eating disorders and posttraumatic stress disorder (PTSD) may occur concurrently in same individual. Thus, presentation of an eating disorder may not be an isolated phenomenon, and it may be prudent to enquire about a history of trauma and/or current trauma symptoms [Lating 2002].
Both anorexia nervosa and hyperphagia may have an underlying stress component. It appears that personality characteristics and the environment, as models for habits, modified the manner of coping with stress differently for anorexia and hyperphagia.
Individuals with anxiety neurosis are more likely to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders [Berkman 2007]. They also have higher mortality as well as suicide risk.
Neural correlations
Studies by Friederich and colleagues shows that patients with anorexia nervosa, as compared to the healthy controls show different patterns of the self-other body shape comparison induced activation of the right sensorimotor brain regions rostral anterior cingulate cortex. The investigators concluded that insula hyperactivation along with anterior cingulate cortex hypoactivation may be critical for altered interoceptive awareness to body self-comparison and/or for altered implicit motivation to thin-idealized body images.
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