Anorexia and bulimia

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Both anorexia nervosa and bulimia nervosa can be diagnosed on the basis of a player’s history and examination. The typical signs and symptoms of these conditions are outlined below.

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Anorexia nervosa
Anorexia nervosa is generally diagnosed when a player severely reduces the amount of food they eat. This makes them lose more weight than is healthy for their age and height. Players with anorexia nervosa have an obsessive fear of gaining weight. They may diet or train too much so they can lose weight.


Signs and symptoms

  • Extreme thinness (emaciation)
  • A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
  • Intense fear of gaining weight
  • Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
  • Lack of menstruation among girls and women
  • Extremely restricted eating.

Medical tests to check for signs of physical deterioration in anorexia nervosa may be performed. These may include laboratory tests, and ECGs (the player may have hyperkalaemia) and, rarely, imaging studies.

Bulimia nervosa
Patients with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge eating is followed by behaviour that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise or a combination of these behaviours.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight and are intensely unhappy with their body size and shape. Usually, bulimic behaviour is done secretly because it is often accompanied by feelings of disgust or shame. The binge eating and purging cycle happens anywhere from several times a week to many times a day. To make a diagnosis of bulimia, the episodes of compensatory behaviours and binge eating must happen a minimum of once a week for a period of three months.


Clinical signs

There are a variety of clinical signs that have been described in association with bulimia. While these are not always present, they do include:

  • enamel erosion;
  • calluses on the middle phalanges (from inducing vomiting);
  • parotid enlargement (sialadenosis);
  • signs of self-harm.

As with depression and anxiety, there are clinical tools that can be used to help a clinician make a diagnosis of anorexia or bulimia nervosa.

Prof Astrid Junge

Professor of Prevention and Sports