Name: Jennifer Mitchell
From: Durham, NC
The DSM-V regards anorexia and bulimia as disorders of feeding and eating (DSM-5, 2014). These disorders are dangerous and can lead to severe health problems or death if they are left untreated (Wormer, 2013). There is a debate as to what category these eating disorders belong in. Research has shown that anorexia and bulimia have similar symptoms of conditions related to addiction (Ekern & Karges, 2012). Other research states these two eating disorders are a form of Obsessive Compulsive Disorder (OCD) (Neziroglu & Sandler, 2015).
Early research has identified numerous core traits that appear to have a link to genes related to anorexia and bulimia. One early study found those people who have tendencies for perfectionism, an onset of early menstruation, and obsessions related to food have a greater chance of suffering from anorexia or bulimia. There were also indicators linking these two eating disorders to people suffering from anxiety and obsessiveness. Another study connected a person’s behavioral characteristics to their genetic information. The study found the bulimia group had more links to their recognized behavior characteristics and chromosomes than the anorexia group. One of the chromosomes identified in the second study was linked to obesity traits. Anorexia was strongly associated with the obsessiveness trait. Hormones have also been found to have a connection to eating disorders. In females, hormones begin to affect them after puberty. Personal experiences have also shown a relation to developing eating disorders. The tendency to be physically fit in today’s society causes some to participate in extreme dieting. This tendency can cause an addiction to undereating (Wormer, 2013).
Anorexia has many risks. There is a ten percent chance of death resulting from starvation, suicide, or an electrolyte imbalance. Those people with anorexia tend to also show signs of cold intolerance, being lethargic, constipation, and have an appearance of fine body hair called lanugo. Bulimia shares the same symptoms with an added risk of gastrointestinal and oral tooth related issues created from binge eating then purging. The purging also creates a risk of a chronically inflamed throat, swollen glands in the neck area, dehydration, and distress in the intestines caused by abusing laxatives. Those people who are suffering from anorexia and bulimia share personality traits. Some of these traits are a low self-esteem, clinical depression, and a lack of an ability to handle stress in a positive manner (Wormer, 2013).
There are many people who do not consider anorexia and bulimia to be a part of the OCD classification. The behaviors of each classification appear to be so similar it is sometimes difficult to diagnose what a patient has or what disorder has caused or created the other. Researchers have studied and made speculations on the parallels between eating disorders and OCD. There are some studies which found people who have eating disorders will have a higher chance of having OCD and people with OCD having a higher chance of eating disorders. The boundaries that bind OCD with anorexia and bulimia are blurred. It is difficult for clinicians to determine if the symptoms of bulimia and anorexia are a form of OCD or do they have obsessive and compulsive qualities. A person with anorexia tends to diet constantly and exercise frequently towards unhealthy levels. This person has a fear of gaining weight, therefore, refuses to eat. A person with bulimia will engage in a dangerous cycle of frequently binge eating large amounts of food followed by a sense of shame then purging. In each eating disorder, there are extremely unhealthy and life-threatening behaviors present which consists of either consuming too small or too large quantities of food because of an obsession to have a smaller body image. These eating disorders carry anxiety that can only be satiated by their ritualistic compulsions of not eating and/or exercise or overeating (The Relationship Between Eating Disorders and OCD Part of the Spectrum, 2015).
People dealing with anorexia often show signs of a hyper ideation and mental misrepresentations. This could mean they have all-or-none thinking, combined with them attempting to gain control of the environment around them. Those suffering from bulimia seem to have to relieve an obsessive guilt along with shame following their binge eating. This urges them to obsessively purge what they have eaten. These people will repeat the cycle again and again. Both disorders carry a sense of perfectionism because of a desire to feel approval from others and be accepted. In many cases, there are depression symptoms along with anxiety that fuels these symptoms (The Relationship Between Eating Disorders and OCD Part of the Spectrum, 2015).
The multimodal approach is a form of therapy developed by Dr. Arnold Lazarus. It is considered to be an eclectic form of therapy because of how it integrates fundamentals of several disciplines, psychological theories, or approaches to therapies (Multimodal therapy, n.d.). There are two forms of multimodal therapy that would benefit people diagnosed with eating disorders like anorexia and bulimia. The two combined modalities are pharmaceutical and Cognitive Behavior Therapy (CBT). In the pharmaceutical modality, there have been serotonin-enhancing antidepressants that have been found to help those people dealing with bulimia. CBT has been found to help people who are dealing with binge eating related issues. Research has shown CBT patients with bulimia have a greater chance of developing a remission from the purging behaviors than those who were treated with only antidepressants. Antidepressants have been found to have moderate success in treating those with anorexia. These antidepressants are used to treat the coexisting mood and anxiety symptoms that are linked to the anorexia symptoms (Wormer, 2013).
The preferred treatment for people with eating disorders like anorexia and bulimia is multimodal therapy. This type of therapy uses medication to help reduce the obsessive related behavior, education of proper nutrition, changing how they perceive themselves relating to social standards, alternatives to healthier thinking, and psychotherapy to deal with past issues that may be the cause of the unhealthy behaviors. It is important to not just focus on managing their obvious symptoms. A therapist treating an eating disorder patient must figure out what are the causal etiologies or biopsychosocial factors that created the problem (Wormer, 2013).
Group therapy tends to be more efficient in treating women. A large reason group therapy is such a benefit to women is because of the tremendous amount of sharing and support that comes with a collective experience. Women develop stronger personal relationships when there is a process of mutual decision making along with feedback. They can create a sense of self related to the others in the group setting. This helps the woman to see herself in a more positive physical manner rather than the negative aspects she previously saw (Wormer, 2013).
Eating disorders like anorexia and bulimia share some of the same characteristics as OCD. Those with eating disorders tend to be obsessed with their appearance, but research has not fully connected the eating disorders to OCD. The question remains as to whether the eating disorder themselves are a behavior addiction or are they part of the OCD spectrum. More research must be done to find a conclusion to better treat those dealing with eating disorders. This is truly a case of knowledge being power.
Diagnostic and statistical manual of mental disorders: DSM-5. (2014). Washington: American Psychiatric Publishing.
Ekern, J., & Karges, C. (2012, October 2). How addictions and eating disorders are related. Retrieved August 19, 2017, from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/alcohol-substance-abuse/eating-disorders-and-addiction-why-we-continue-to-engage-in-self-destructive-behaviors
Neziroglu, F., & Sandler, J. (2015, August 24). The Relationship Between Eating Disorders and OCD Part of the Spectrum. Retrieved August 19, 2017, from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
The Relationship Between Eating Disorders and OCD Part of the Spectrum. (2015, August 24). Retrieved August 21, 2017, from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
Wormer, K. V. (2013). Addiction Treatment, 3rd Edition. [Kaplan]. Retrieved from https://kaplan.vitalsource.com/#/books/9781285028194/