Eating Disorder : A Malaysian Context (Part 2)

Anorexia Nervosa (AN)

Anorexia” = “loss of appetite”
“Nervosa” = “hysteria”
existed for more than 300 years

Diagnostic Criteria (Based on DSM IV):

• Refusal to maintain body weight at or above 85% of expected weight.
• Intense fear of gaining weight or becoming fat, even though underweight.
• Disturbance in the perception of one’s body weight or shape, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low
• body weight.
• In postmenarcheal females, amenorrhea i.e. absence of at least 3 consecutive menstrual cycles.

Types:

1) Restricting: No regular binging or purging

2) Binge-Eating/ Purging Type: Regular purging and/or binging

Bulimia Nervosa (BN)
“bulimia” comes from the Greek words
“bous” (ox) and “limos” (hunger)
A more modern disease than AN

Diagnostic Criteria (Based on DSM IV):

• Recurrent episodes of binge eating.
• Eating a large amount in a discrete time
• Eating as if out of control
• Recurrent “purging”
• Vomiting, use of laxative, fasting, excessive exercise
• Binge eating and purging occur at least twice a week for 3 months
• Self-evaluation is unduly influenced by body weight and shape

Types:

1) Purging Type: Regularly engage in self-induced vomiting, misuse of laxative, diuretics and enemas

2) Non-purging Type: No regular self-induced vomiting, misuse of laxative, diuretics and enemas; Engage regularly in excessive exercise and fasting

Malaysian Context:
10.2% of young women in Kuala Lumpur are susceptible to developing eating disorders.

Data mimic the findings in western populations

Ethnicity is also important in the assessment of eating disorder symptoms.

**No professional treatment available (nearest comprehensive treatment center = Singapore)

How bad is the problem?
Mortality rate as high as 18-20% (many due to suicide)
ED has the highest mortality rate of any other psychiatric disorder

Major BioPsychoSocial Consequences

BIOLOGICAL: Decrease metabolic rate, Compromise immune system, Infertility, Osteopenia (decreased bone density), Dermatological problems, Constipation/diarrhoea, “Hamster cheeks”- swelling of parotid or submandibular glands, Dental decay, GI problems, Electrolyte imbalance

PSYCHOLOGICAL: Preoccupation with food, Irritable, angry, Aggressive (harm self /others), Decreased self-esteem, Decreased concentration, Poor judgment, Psychotic episodes, Depression/anxiety, Hyperactivity

*Thanks to Dr Lukman, for the very informative talk....

As promised...part 2 of eating disorders...