Wednesday, March 07, 2007

Teenage Eating Disorders: Anorexia and Bulimia

There are three main types of eating disorders that affect mainly teenaged and younger females. They are Anorexia Nervosa, Bulimia Nervosa and Binge eating. We will focus on the first 2 conditions in this blog.

Since most patients with these conditions will fail to recognize that they have a problem, I hope that this article will help you recognize the condition in the people you know so that you can help them seek medical attention. Conditions such as Anorexia Nervosa can potentially be fatal. Remember Karen Carpenter who sang "Yesterday once more"? Her death in 1983 from Anorexia Nervosa was one of the key events that brought this disorder into the limelight.

So how do you tell if a person is suffering from these disorders?

Anorexia Nervosa

People suffering from Anorexia Nervosa have an obsessive desire to lose weight through dieting and fasting leading to extreme weight loss. The condition is easy to spot. They are usually teenaged girls who refuse to eat and lose a lot of weight over a short period of time. They look haggard and they skin becomes dry and scaly. They may also be obsessively excercising and counting their calories.

It is important to note that when these people look at themselves in the mirror, they DO NOT see a thin person. ie they have a distorted view of themselves.

Bulimia Nervosa

These people are harder to spot because though they want to lose weight they are less successful than those with Anorexia Nervosa. Rather then not eat, they will secretly binge eat lots of stuff, frequently desserts, and then try to lose all the extra calories by inducing a vomit, fasting or resorting to the use of laxatives or diuretics to effect weight loss.

Bulimia usually begins later than Anorexia and affects women from 17 to 25. (Remember Princess Diana?) You may be able to spot them because they may frequently excuse themselves to go to the bathroom after eating or they might eat lots of food but fail to gain weight. They may also be always trying to lose weight and excercising. Sometimes you may be able to see erosion of the skin at the base of their fingers because they would frequently stick their fingers into their mouths to induce vomiting.

Severe and repeated vomiting may lead to loss of electrolytes which can become a medical emergency.

How to manage these eating problems.

This is a primarily a behavioural and psychological problem and there are often problems in the family relationships like crisis, sexual and physical abuse, drug and alcohol abuse that may need to be addressed. Problems with self esteem in this age group often stem from lack of acceptance from friends. It may be that they are not accepted because of their being overweight.

The disorder thus needs to be managed by a multidiciplinary team comprising the doctor, behavioural expert and dietician. Severe anorexia is an emergency and the patient may need to be warded.

In Singapore, children below 19 with eating disorders may be referred to IMH while those above 19 can be referred to SGH which has a specialised clinic dealing specifically with the disorders discussed above.

More information on Anorexia and Bulimia can be found here

Reference: John Murtagh, Patient Education, Fourth Edition, McGraw-Hill Australia


Anonymous said...

Doc, loved your foodblog and medicalblog too. My girlfriend and I always refer to these blogs when we're running out of ideas.

My question. My girlfriend enjoy eating. Especially tidbits and dessert and occassionally rice. Never gain weight instead losing at all times. What do you reckon that?

PS: Ladies envy her with forever energetic, slim and sexy (Me? forever worry!)

Dr Leslie said...

Just need to make sure she is not over producing thyroid hormones. A condition called hyperthyroidism. A simple blood test can be done to confirm this.

Anonymous said...

Thanks Doc but she's perfectly OK! Gone for her health screening with flying colors result. Hmmm, still wonder why?

Anonymous said...

What about Orthorexia Nervosa? Lol!!
-Rexic (:

Anonymous said...


I suspect that my friend is suffering from Anorexia Nervosa.

What & how can she start to eat normal again without having distorted view of themselves and worry about their weight?

Is a 3-meal or small 6-meal diet more recommendable to her?

Dr Leslie said...

If you suspect that your friend has Anorexia Nervosa, you should bring her to see a Doctor to get her properly assessed.