A brief analysis of the diagnosis and treatment process of eating disorders

Author: Wang Ying, Chief Physician of Tianjin Mental Health Center

Reviewer: Chen Jue, Chief Physician, Shanghai Mental Health Center

The history of eating disorders can be traced back to 1689, when Richard Morton recorded the first case of an eating disorder patient in his book. Morton's contemporaries called nuns who restricted food intake, fasted, or induced vomiting "Miraculous Maids"; laxatives and emetics were also used as a way to relieve overeating. It was not until 1703 that Hardenus believed that eating disorders were gastrointestinal nerve, mental, and sensory disorders. Other scholars such as Imbert and Chipley also described anorexia nervosa and bulimia nervosa in their works, which gradually approached the modern definition of eating disorders.

In 1873, William Gull pointed out several characteristics of anorexia nervosa, such as weight loss, amenorrhea and fatigue, as well as the patients' extraordinary energy. In the same year, another scholar, Ernest-Charles Lasegue, named the same condition "hysterical anorexia" and started treating the disease for the first time. In the late 18th century, industrialization led to more women going out to work, and for the upper class at that time, being thin became a capital to get ahead. Behaviors such as restricting food intake and fasting gradually lost their religious connotations and were more closely linked to self-body image. Anorexia patients restrict energy intake, pay too much attention to weight and figure, and have cognitive distortions about their body shape, fatness, thickness and size of certain parts of their limbs. We may usually think that anorexia patients do not like to eat and have no interest in food. In fact, on the contrary, some patients have a greater desire for food than ordinary people. They like to collect various books and magazines about food, like to go to food stores, and study cooking techniques. This increased interest in food is related to the hunger caused by the patient's self-restriction of eating. But they are more afraid of the calories brought by food, and may even experience adverse reactions such as nausea and stomach upset after forcing themselves to eat certain foods.

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In 1979, Gerald Russell first described the symptoms of bulimia nervosa. Bulimia patients mainly show uncontrolled eating, repeated compensatory behaviors and excessive self-evaluation. During eating, patients have difficulty controlling the speed and amount of eating. Even if the stomach sends a "full" signal, patients will continue to eat. Patients are deeply trapped in the vicious cycle of binge eating and dieting and cannot extricate themselves.

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Differences between Anorexia Nervosa and Bulimia Nervosa:

Different weight expectations: Most anorexia patients currently have weight expectations below the normal range, while most bulimia patients are able to maintain a normal or near-normal weight.

The manifestations of binge eating behavior in the two are different: the binge eating behavior of anorexia patients is secondary to hyperphagia after long-term dieting, and the eating strategy is still mainly dieting. After binge eating, they adopt behaviors such as vomiting to avoid weight gain. They are often proud of "binge eating but not getting fat". The binge eating behavior of bulimia patients is often difficult to control. Patients often make normal eating plans for themselves, but they often binge eat during the eating process because of the difficulty in self-control. They also adopt behaviors such as vomiting after binge eating, but they are not proud of it. They often blame themselves and regret their out-of-control behavior.

The purposes of abnormal eating behaviors are different: anorexia patients use eating behaviors to control their relationships with others or to attract the attention of others; while the binge eating of bulimia patients is often covert, and binge eating behaviors are often venting in nature.

Anorexia nervosa and bulimia nervosa have similar pathological psychological mechanisms and similar bad eating behaviors. Therefore, their treatments also have a lot in common. At present, comprehensive treatments such as nutritional therapy, drug therapy, and psychotherapy are mainly used for eating disorders. Regular eating and reasonable nutritional matching are the most basic and critical ways for patients to recover and treat diseases; drug therapy is symptomatic treatment and can help improve patients' physical discomfort, anxiety, depression, insomnia and other symptoms; psychotherapy is the main and commonly used treatment method, including cognitive behavioral therapy, interpersonal psychotherapy, dynamic therapy, trauma-related therapy, family therapy, group therapy, etc. Different therapies are suitable for different types of patients.

When we look back at the history of eating disorders, it is not difficult to find that eating disorders have accompanied the development of human civilization since ancient times. With the rapid development of the economy, eating disorders have become a severe challenge to the public's mental health. Therefore, early detection, early intervention, and early treatment are urgent tasks for patients with eating disorders.

References

Xu Yixiang, Chen Jue, Xiao Zeping. Body image disturbance in patients with eating disorders: concept and research progress[J]. Journal of Shanghai Jiao Tong University: Medical Edition, 2019, 39(2):6.