BLOG No. THIRTY SIX

Welcome back to my blog on anxiety depression. Today, as promised (wow, 2 in a row!) I want to talk a little bit about anorexia nervosa and bulimia.

Anorexia nervosa is a condition where patients (usually more women than men) look at themselves in the mirror and don’t see what everybody else is seeing. They see themselves as being overweight and even obese, even though a BMI chart (height to weight) would say otherwise. And arguing with them is like arguing with a New York Yankees fan on how their team essentially buys their World Series rings. And as a Reds fan, nope, nope, not bitter at all.

You can point to the scale or show photos to the anorexia patients to no avail. Regardless of what you point out, they see themselves as fat. Hummm, have we seen somewhere in my blogs, where someone sees themselves different than what others do? Depersonalization maybe? You bet.

Bulimia is similar to anorexia nervosa. Some experts think bulimia is just a more severe form of anorexia nervosa. And I would be inclined to agree. It’s important to understand, that these two diseases are the deadliest of all psychiatric illness! Read that sentence again.

In bulimia, the patient has the same warped view of their body shape, but gives into the hunger of anorexia nervosa and binge eats. A person can consume thousands of calories in one sitting. But then realizing these calories are going to go to their hips and gut, they will purge via vomiting or inducing diarrhea. The constant acid makes their esophagus raw and the diarrhea will make their rectal area inflamed. In addition, their index and middle finger become macerated, looking as if they have been in constant dishwater, from inducing vomiting. Wow…maybe it’s time for a joke break.

My wife was serving me some pasta last week, but it tasted funny. I asked her if it was our normal pasta. She said yes, but she averted her eyes. I knew it! It was an impasta!

So what is the neurochemistry of anorexia nervosa and bulimia? They are two shades of the same disease, so I feel they share the same neurochemistry. Both have an altered perception of their bodice (a fancy way of saying body). And both obsess and compulse regarding food. You and I sit down to a meal and eat because we are hungry. We may have different tastes and different hankerings, but it is not a big deal.

But anorexia nervosa and bulimia patients see it as a very big deal. I have worked with patients where I have actually bartered with them over how many green beans they’re going to consume. “Eat 20,” I suggest. 10. “15?” 12. “Ok, let’s split the difference, 13”. And on and on goes. And it is real, folks. And it is not weird or funny. It is about neurotransmitters. But because this blog has gotten so big, I’m going to let it flow into blog 37, where we will talk more about neurochemistry.

And my wife’s Chardonnay is now completely gone. Jeeesh, I’m going to get another lecture! Until next time when we complete our discussion on anorexia nervosa and bulimia, this is Dr. G saying keep the faith!