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.Miller M.N., Pumariega A.J.(2001) Culture and eating disorders: a historical andcross-cultural review.Psychiatry, 64: 93 110.2.Mautner R.D., Owen S.V., Furnham A.F.(2000) Cross-cultural explanations ofbody image disturbance in western cultural samples.Int.J.Eat.Disord., 30: 165-172.3.Furnham A., Husain K.(1999) The role of conflict with parents in disorderedeating among British Asian females.Soc.Psychiatry Psychiatr.Epidemiol., 34: 498505. _________________________________________________________________________________________________ CHAPTER_________________________3Physical Complications andPhysiological Aberrations in EatingDisorders: A ReviewFrancesca Brambilla and Palmiero MonteleoneDepartment of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie,80138 Naples, ItalyINTRODUCTIONAnorexia nervosa and bulimia nervosa are perhaps the most intriguingcombinations of psychological and medical impairments, both beingpathognomonic and paradigmatic for the nosographic definition of thediseases.Even the eating alterations occurring in the two syndromes,although a definite expression of psychopathological impairments, seem topoint out the existence of a physical derangement in the capacity of thepatients to perceive and correctly define the internal stimuli of hunger,satiety, food selection and taste sensations [1 11].The medical complications observed in anorexia and bulimia nervosahave always been considered the consequence of nutritional derangements,on the basis of the similarities with the alterations observed in simplestarvation in both experimental animals and humans [12].In fact, inanorexia nervosa, most of these aberrations start after the beginning ofsevere food restriction and weight loss and disappear after recovery ofnormal eating habits and weight, with the possible exception of amenor-rhoea, which can start before significant weight loss takes place and doesnot always disappear with weight normalization [13 17].Bulimic patientsare not starving, but the loss of food obtained with vomiting or the use oflaxatives, the biased selection of macro micronutrients typical of bingeingepisodes and the alternation of gorging and severe dieting might lead tomalnutrition, resulting in some of the impairments of simple starvation.What are still not fully defined are the mechanisms by which starvationfor anorexia nervosa and malnutrition for bulimia nervosa induce andEating Disorders.Edited by Mario Maj, Katherine Halmi, Juan José López-Ibor and Norman Sartorius.&2003 John Wiley & Sons Ltd: ISBN 0-470-84865-0 140 ___________________________________________________________________________ EATING DISORDERSmaintain the medical complications of the two syndromes.In particular, itis not clear why some patients show the full spectrum of medicalcomplications and others with a very similar clinical picture do not.Moreover, it is not clear what the influence exerted by peripheral medicalcomplications is on the course, response to treatments and prognosis ofanorexia and bulimia nervosa.The same seems to occur for the brain biological alterations thatcharacterize anorexia and bulimia nervosa.The reduced function ofserotonin (5-HT) and noradrenaline systems and the increased activity ofdopamine systems, frequently observed in anorexia nervosa, have beenconsidered an expression of malnutrition, because they occur in starvedexperimental animals and sometimes in human simple malnutrition [1830].However, it is not clear why these alterations do not occur in all thestarving malnourished anorexics and bulimics and why they do notcorrelate with the indices of food deficiency.Moreover, it has been observedthat long after recovery from anorexia nervosa, when eating habits andweight have normalized, some patients show the persistence of dopaminehyperactivity and noradrenaline hypofunction and the appearance of 5-HThyperfunction [25,26,31].Therefore, the significance of peripheral medical alterations and brainbiological impairments for the development, course, response to treatmentand prognosis of anorexia and bulimia nervosa is still not clear and is worthfurther study
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