Eating disorders, known by the acronym TCA, have become an increasingly recognized and common reality in recent years.This type of psychopathological disorder is characterized by the appearance of symptoms related to eating disorders. This type of symptomatology varies depending on the person and the particular eating disorder they suffer from, with the two most common being anorexia and bulimia nervosa.
Although the most obvious characteristics of these problems are related to diet, they are actually the tip of a giant iceberg. The occurrence of eating disorders is rooted in emotional problems involving the person's emotional ties to their familySurroundings, herSelf-esteem, their early experiences come into play, among other things.
In general, the symptoms that characterize an eating disorder stem from an inappropriate relationship that the individual has with food and with their own body. In addition, there is a clearly distorted perception and a tendency to overestimate the importance of the silhouette in relation to the global value that one has as a person.The typical TCA tonic is a deep obsession with diet and the bodySo that in the end the whole life and existence of the patient is based on the disorder itself.
What exactly is anorexia?
In this article we will focus specifically on anorexia nervosa (AN). In addition to the common features that AN shares with the other eating disorders, this disorder has certain important defining characteristics.
Patients with anorexia initially have a highly distorted perception of their body image. This causes them to feel fat and even dirty or heavy despite being under the weight that is considered normal according to their age and constitution. There is also a very intense fear of possible weight gain. This terror endsconditioningthroughout his life as the fear of gaining weight dominates all decisions and actions that are undertaken.
For example, they might start taking the stairs instead of the elevator at home to burn more calories, or refuse to go out to dinner with friends to avoid eating foods that make them "fat." In this way, a dynamic is set in which countless everyday situations are avoided, which contributes to the fact that the patient ends up withdrawing into herself, lost in her obsession with not gaining a single gram.
On the other hand, it is common forPatients with anorexia deny that they have any problems. That is, they lack awareness of the disease, so it is particularly difficult for them in the first moments to go to a professional to get the necessary treatment. This denial of what is happening can provoke an aggressive response on your part that can strain and wear down your relationships with others, especially those closest to you. Refusal to accept that there is a real problem can, in the worst cases, mean denial of basic needs.
Not only is the feeling of hunger ignored, but other physiological signals such as thirst or sleep take a back seat. The AN eventually absorbs all the energies of the person who is unable to think or do anything other than what their TCA dictates. For this reason, other aspects such as social relationships or sexuality take a back seat. Sex arouses no interest and even generates rejection since sexual encounters consist in exposing the body, letting it be touched and seen, and all this is experienced as an unbearable experience when suffering from anorexia.
How is anorexia classified?
Now that we have described the main defining characteristics of anorexia, let's learn what types of anorexia there are. The truth is that the typologies established so far have been an attempt to divide reality into closed categories that do not really adapt to the complexity of clinical reality.
Talking about types of anorexia is a bit difficult, as usuallyPatients show mixed symptoms and even experience changes over timeas far as the presentation of the disorder is concerned. For this reason, the types of anorexia can serve as a kind of guide, although by no means accurately reflect clinical practice.
The types of anorexia and how they were distinguished differed between the fourth and fifth editions of the DSM (Diagnostic and Statistical Manual of Mental Disorders). The DSM is nothing more than a mental disorder classification system that collects the descriptions of the various diagnostic categories to enable physicians to diagnose, study, and treat these disorders.
This will be updated from time to time so changes will be added as deemed relevant.We will analyze the changes made between the last two editionsas for the classification of the types of anorexia.
The fourth edition of the DSM was published in Spain in 1994. At that time it was assumed that anorexia nervosa can be divided into two types:
1.1. Restrictive-type anorexia
This type of anorexia is one where the person does not binge or purge (induce vomiting, use laxatives, diuretics, or enemas...). This type of anorexia is really "difficult" to achieve sinceThere is a very strict food restriction, with tightened control resulting in the person keeping their caloric intake to a minimum. In this case, this trend is never broken with moments of "uncontrolled" in the form of binges and purges.
1.2. Compulsive/laxative anorexia
In this type of anorexia, the individual doesregularly resort to rinsing and bingeing, so that although the basis of the disorder is a search for control through severe food restriction, at certain times the person resorts to binge eating or purging. When we talk about binges in this case, they don't usually imply such uncontrolled and insatiable intake as in bulimia.
Although these behaviors occur in the type of anorexia that reminds us so much of bulimia, other emotional characteristics distinguish both disorders (bulimia and compulsive/purgative anorexia). Patients with anorexia tend to try to strictly control their lives through food, they tend to be emotionally shallow and are very disciplined, responsible and even academically brilliant, although they are very limited in the social sphere.
But still,emotional instability is commonly seen in bulimia, with great ups and downs, lots of explosiveness and sudden changes in behavior, ability to alternate periods of great openness and sociability with others, from solitude and depressive symptoms.
In the fifth edition of the DSM, published in 2013, some changes were made to the classification of the types of anorexia nervosa. As in the previous edition, the two types of anorexia are maintained: restrictive and purgative, the essential difference of which is that in the first there are no binges or purges and in the second there are.
However, this edition adds a novelty that was not present in the previous one, namely the distinction between anorexia in partial remission and complete remission.
2.1. Anorexia in partial remission
This type of anorexia is one in which, having previously met all the necessary criteria to receive an anorexia diagnosis,the patient is able to regain her normal weight, although she remains afraid of gaining weight, engaging in behaviors that in some way interfere with weight gain or distorted perceptions of one's own body.
2.2. Anorexia in total remission
This type no longer represents a disorder per se, but the overall state of recovery.The patient no longer shows any signs of anorexiaand he is physically and mentally healthy.
The distinction between anorexia in total and partial remission is of tremendous importance to professionals and shows how much progress has been made in understanding EDs. When this type of psychopathology emerged decades ago, healthcare professionals were unaware of the complexities of these issues and took actions that weren't always right.
The weight gain was usually associated with the end of the problem. However, nothing could be further from the truth. Restoring weight to normal is an essential first step in reaching the full end of TCA, but it is far from enough. Once a normal and healthy weight is reached,It is necessary to work on any underlying problems at a psychological levelThey represent the real root of the problem.
In eating disorders, eating symptoms are just a reflection of what is happening on an emotional level. Food becomes a tool to express needs and desires that would otherwise not be met. As long as these emotional issues have not been addressed and dealt with, one cannot speak of recovery. Otherwise, relapse and a return to being underweight are more than likely, and the problem can easily become chronic.