Eating disorders: Pathology review

23 year old Adeline is brought to the emergency department by her peers after fainting in the college cafeteria. Upon examination, her pulse is 47/min, and her blood pressure is 89 over 48 mmHg. In addition, her height is 162 cm or 5 ft 4 in, and she weighs 45.4 kg or 100 lbs. Adeline mentions that she considers herself fat, which is why she’s been trying to lose weight, and admits to purging or making herself vomit whenever she eats a large meal. On further questioning, she tells you that her last menstrual period was more than 3 months ago. You decide to run a urine pregnancy test, which comes back negative. The next day, you see 17 year old Emmanuel, who is brought to the clinic by his mother, who saw him forcibly vomit after lunch. Emmanuel states he has recently been very anxious about the college entrance exam and that he feels like vomiting is the only thing in life that he can control. His vitals show no abnormalities, his height is 185 cm or 6 feet 1 in, and he weighs 72 kg or 158 lbs. Physical examination shows decaying enamel on teeth, as well as thickened skin around the knuckles of his right hand.

Based on the initial presentation, both Adeline and Emmanuel have some form of eating disorder. Eating disorders are mental health disorders in which an individual exhibits abnormal eating behaviors that negatively impact their physical and mental health. They are quite common, especially among young females who struggle with low self-esteem and the social pressure to look a certain way. However, remember that they can affect anybody, regardless of their sex, age, and social background. For your exams, the most common eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and pica.

Okay, let’s start with anorexia nervosa. This is characterized by a constant fear of gaining even the slightest amount of weight, associated with a distorted body image, with individuals often believing that they are overweight, while actually being underweight. To be more specific, their Body Mass Index or BMI is lower than 18.5.

Now there are two main types of anorexia. One is the binge-eating and purging type, where individuals eat large amounts of food in one sitting and then purge that food through self-induced vomiting or by taking laxatives or diuretics, and this occurs recurrently for at least 3 months. The other is the restricting type, where people reduce the amount of food they eat or over-exercise in order to lose weight without any purging.