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Lasgue in 1873 and Gull in 1874 designated the term anorexia nervosa (AN) in separate cases in which they reported young females who were starving themselves. Descriptions of this illness became more frequent in the late 19th century. Changes with the DSM-5 for anorexia include three diagnostic elements that focus on persistent food or energy intake restriction; an intense fear of weight gain, becoming fat and exhibiting behavior which demonstrates a fear of weight gain; and a disturbance in perceptions of one's body that results in a lack of recognition and denial of being underweight. Anorexia nervosa is subtyped as being either restricting type, in which individuals will experience weight loss through dietary restraint, abstention from food, or excessive exercise, but have not engaged in bingeing or purging behaviors within the past 3 months. Binge-eating/purging subtype is characterized by those anorexics who have engaged in recurrent binge-eating or purging behaviors within a 3-month period. Severity is categorized as being mild, moderate, severe, or extreme, based on an individual's current body mass index (BMI). The primary age of onset is during adolescence or young adulthood, and the onset is often related to a stressful life experience.
Bulimia nervosa (BN), as noted in the current DSM-5 diagnostic criteria, was relatively obscure until the latter part of the 20th century. More prevalent than anorexia nervosa, individuals with BN strive to prevent weight gain or lose weight through recurrent episodes of binge/purge behaviors. Other hallmark characteristics include poor compensatory measures to avoid weight gain such as laxative use, vomiting, medication misuse, excessive exercise, abstention from food in addition to a sense of self based on body perception of shape and weight. The triggers to incidents of binge/purge episodes can vary, but stress and an inability to feel a sense of control may preclude an event. Most often carried out in secrecy, a bulimic will consume large amounts of high calorie foods in a relatively short period of about 2 hours. Afterwards the person feels extremely and frequently painfully full. The incidence of bingeing and purging can wax and wane, with the frequency occurring one or two times a week up to several times a day over a period of 3 months. Severity is categorized as being mild, moderate, severe, or extreme based on the number of inappropriate purging episodes/behaviors per week. Adolescence and young adulthood is the age most frequently affected by bulimia nervosa, often triggered by several life stressors.
Serious medical complications can arise with both disorders, and the incidence of death with AN appears to be higher when compared to individuals diagnosed with bulimia nervosa. A recent review of mortality rates with this population suggested the risk factors of AN patients may need to be staged, similar to cancer, in an effort to more effectively measure the incidence and death risks of this disease. Cardiac abnormalities, changes in brain function, osteoporosis, anemia, gastrointestinal problems, and altered blood chemistry may be seen in both anorexics and bulimics. Both disorders may exhibit symptoms of fatigue, sleep difficulties, and depression. In addition, individuals who binge and purge by vomiting often suffer from dental problems related to the loss of teeth enamel and gum disease because of hydrochloric acid in the vomitus.
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