eating disorders

eating disorders - Eating Disorders Eating Disorders...

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Unformatted text preview: Eating Disorders Eating Disorders Anorexia Anorexia Nervosa Bulimia Bulimia Nervosa Binge Binge Eating Disorder Eating Eating Disorder NOS Eating Disorders Anorexia Anorexia Nervosa and Bulimia Nervosa are two of the most highly popular and publicized, yet most clandestine and covert diseases you will ever treat. They They are NOT new diseases, but have NOT high current social value. Culture, Age, Gender Associated Associated Disorders – Depression, Obsessions & Compulsions about food Prevalence Prevalence higher in industrialized societies with abundance of food and thinness associated with attractiveness Immigrants Immigrants acquire with assimilation 90% 90% females Single Single episode, episodic, chronically deteriorating Predisposing Factors 42% of 1st-3rd grade girls want to be thinner. 81% of 10 year olds are afraid of being fat. 51% of 9 and 10 year old girls feel better about themselves if they are on a diet. Cultural Cultural Pressure (+ correlation between prevalence and cultural pressure) Genetic- 30Genetic- 30-80% heritability FamilialFamilial- Bulimia 3.7 X, Anorexia 12 X as likely in family members of probands DietingDieting- 15 year-old girls (London) year– Dieters 8 X as likely to develop an ED in the next year 1 Etiology A traumatic event traumatic – Death of a loved one, divorce, leaving home, rape, abortion, rejection in a relationship, degrading comments Etiology Long Long term stressful period (2-5 years) (2– Too much, too fast – Depression Etiology Onset Onset of a mood disorder Extended Extended period of emotional pain – Growing up in an alcoholic family, physical, sexual, emotional abuse Having Having been a very sensitive child – “perfect” family, frequently very religious A controlling environment –parent or spouse controlling – Forces person to give up identity, constantly tries to ‘please’ other person Etiology Lack Lack of validation of feelings – difficulty identifying feelings, reason for eating disorder – Families did not have overt abuse of problems Subtle Subtle undermining of self-esteem selfDirect Direct expression not allowed Etilogy Common Common thread – Emotional pain at a level of intensity that she does not know how to manage in a healthy way Family Family contribution – Do not model or teach how to express feelings in a way that promotes closeness, support or resolution of conflict. – Wrong feelings, selfish feelings So So something must be wrong with me (bad, crazy?) 2 Fork in the Road Focus Focus on body or food –looking outside rather than inside for the source and solution to the emotional pain Eating Disorders These These are NOT just diseases of weight loss or vomiting, but rather are complex psychiatric diseases that have the manipulation of food intake as one of several symptoms. Anorexia Anorexia Nervosa Bulimia Bulimia Nervosa Binge Binge Eating Disorder Imagine Feelings Feelings are placed into a box Anorexia Anorexia Nervosa Anorexia Anorexia Nervosa is the third most common MOST disease of adolescence, and one of the MOST common chronic illness of adolescent females. Incidence Incidence at 30/100,000 two two peaks of onset at 13 and 18 years .5% .5% lifetime prevalence (women) With With an eating disorder serving as its lid Anorexia Nervosa Prognosis: Prognosis: – 42% recover after one course of treatment – 40-50% go in and out of treatment 40through life – 5-15% die (cardiac arrest, electrolyte imbalance, suicide 50%) Anorexia Nervosa Refusal Refusal to maintain normal body weight (<85% of that expected; ICD 9 BMI 17.5) – weight loss – failure to gain weight during growth period Intense Intense fear of gaining weight or becoming fat, even though underweight Disturbance Disturbance in way one’s body weight or shape is experienced, undue influence of weight/shape on self-evaluation, or denial of selfseriousness of current weight Amenorrhea Amenorrhea 3 Specify: Restricting Restricting Type: during the current episode of Anorexia, the person has not regularly engaged in binge-eating or purging bingeBingeBinge-Eating/Purging Type: regular bingebingeeating or purging behavior (vomiting, laxative, diuretics, enemas) Anorexia Nervosa SECONDARY SECONDARY PHYSICAL SYMPTOMS hypothermia hypothermia bradycardia bradycardia hypotension hypotension edema edema lanugo lanugo metabolic metabolic changes Anorexia Nervosa INDIVIDUAL INDIVIDUAL CHARACTERISTICS – perfectionistic – controlling – compulsive – depressed/withdrawn from peers – sexually immature – lack of independence from parents Anorexia Nervosa FAMILY FAMILY CHARACTERISTICS – enmeshment – overprotectiveness – unresolved parental conflicts – rigidity – lack of conflict resolution Food consumption patternspatternsAN Kcal Kcal intake – 300-1000 300Poor Poor high quality protein intake Very Very low CHO intake – 50 g M/V M/V deficiencies Fat Fat avoidance Fear Fear foods 4 Bulimia Nervosa Bulimia Bulimia Nervosa is more difficult to define. Think Think alcoholism This This may represent the most common symptom and/or illness of college age females. 13% use vomiting or purgatives peak peak onset at 17-18 years 173% 3% lifetime prevalence Bulimia Nervosa Recurrent Recurrent binge eating – eating a large amount of food with a sense of lack of control over eating Recurrent Recurrent inappropriate compensatory behavior to prevent weight gain – excessive exercise – fasting – misuse of laxatives, diuretics, enemas, other medications 2 X week for 3 months week SelfSelf-evaluation is unduly influenced by body shape and weight Bulimia Nervosa INDIVIDUAL INDIVIDUAL CHARACTERISTICS histrionic sexually mature – impulsive affectively labile depressed and guilty Bulimia Nervosa SECONDARY SECONDARY PHYSICAL SYMPTOMS tooth tooth decay esophageal esophageal or gastric tear calluses calluses on hands chronic chronic bowel dysfunction swollen swollen parotid glands metabolic metabolic changes FAMILY FAMILY CHARACTERISTICS – disengaged high degree of stress highly highly conflicted achievement oriented chaotic chaotic depressed family members Common Triggers Negative Negative Moods Stress Stress Hunger Hunger Thoughts Thoughts about shape, weight, food Food consumption patternspatternsBulimia Typically Typically begin bulimic behaviors ~1 yr following period of restriction Intense Intense hunger triggers binges Describe Describe it as “perfect solution” Most Most learn from friends, relatives, media PRO ANA websites Live Live in fear of losing control of food intake Most Most of normal weight 5 Overvalue Weight & Shape Cultural Pressure Unrealistic Dieting Bulimia Nervosa Prognosis: Prognosis: – 40% abstain after treatment – 60% return to disease despite treatment Vulnerability to Binge Eat Binge Eating Distress, Self-Esteem Compensatory Behavior Disruption of Learned Satiety Anxiety About Weight Gain Eating Disorder NOS Almost Almost Anorexia Almost Almost Bulimia Regular Regular use of inappropriate compensatory behavior by an individual of normal weight after eating small amounts of food Repeatedly Repeatedly chewing and spitting out, but not swallowing, large amounts of food BingeBinge-Eating Disorder Recurrent Recurrent binge eating – eating a large amount of food with a sense of lack of control over eating Associated Associated with 3 or more of the following: – – – – eating much more rapidly than normal eating until uncomfortably full eating large amounts of food when not hungry eating alone because of embarrassment about how much one is eating – feeling disgusted, depressed, or guilty Marked Marked distress regarding binge eating Binge Binge eating X 2 days/week for 6 months Ideal “A” team “A” Multidisciplinary Multidisciplinary team – Nutrition therapist, psychotherapist, psychiatrist, physician, dentist Standardized ED screening tools SCOFF SCOFF – Do you make yourself sick because you feel uncomfortably full? – Do you worry you have lost control over how much you eat? – Have you recently lost a (stone) 14 pounds in a 3-month period? 3– Do you believe yourself to be fat when others say you are too thin? – Would you say that food dominates you life? Each Each member should have a working knowledge of the contribution made by other team members – In reality, you likely need to educate them 6 Assessment Gather Gather history from multiple sources Weight Weight Physical Physical and Labs Eating Eating habits; bulimic behavior; self-image; selfdesired weight; history of weight fluctuations; menstrual pattern; laxative, diuretic, or diet pill usage; exercise; substance abuse; mood and anxiety problems; suicidal ideation School School and work performance, peer and family relationships, extracurricular activities Sample Questions Why Why do you want to lose weight? Are Are you scared to stop dieting? Are Are there foods that you used to eat that you won’t eat anymore? Why? Do Do you take a day off from exercise? – What would happen if you did? How How much of your day do you spend thinking about food? (more than 20%) Look for co-morbid coconditions Major Depression---65% Major Depression---65% ObsessiveObsessive-Compulsive or other anxiety symptoms--85% symptoms--85% Personality Disorders---21% (especially Personality Disorders---21% (especially Histrionic, Dependent, and Borderline) Drug Drug and alcohol abuse Treatment Time Time period – 6 months – years – Average is 2-3 years 2- Factors Factors that effect length of Tx – Depth of emotional pain – Ability to identify and express feelings – Length of time needed for a trusting relationship to be established Treatment Weight Weight management Minimum Minimum participation weight for athletes Involvement Involvement in social activities with peers Increased Increased independence from family Noncompetitive Noncompetitive activities Eating Eating Disorder support group Anorexia Treatment Restore Restore weight lost to dieting/restricting Treat Treat psychological disturbances: body image distortion, low self-esteem based on size, selfinterpersonal conflicts, find more appropriate expression of strong feelings especially in the family Achieve longAchieve long-term remission and rehabilitation 7 Bulimia Treatment: CognitiveCognitive-Behavioral Therapy Education Education (bulimia, treatment, core behavioral techniques, self-monitoring) selfReducing Reducing dietary restraint, developing cognitive and behavioral strategies for resisting binge eating Identify Identify and alter dysfunctional thoughts and attitudes regarding shape, weight, and eating. Relapse Relapse Prevention Goals of Treatment cease abnormalcease abnormal-eating and compensatory behaviors find find more appropriate expression of strong feelings especially in the family self self esteem becomes more appropriately based on something else other than shape and size Other Interventions Interpersonal Interpersonal Psychotherapy Group Group Therapy Family Family or Marital Therapy Psychopharmacological Interventions desipramine desipramine imipramine imipramine bupropion bupropion olanzapine olanzapine fluoxetine trazedone paroxetine risperidone Choosing a Path Eats Eats > Food is comfort > consistent > reliable consistent AND always there >something to look forward to > turn to when alone and scared > pain doesn’t hurt so much – Compulsive eating Treatment Rarely, Rarely, if ever, do ED clients automatically give up their food and weight behaviors as soon as treatment begins Reasons Reasons 1. Treatment provider is helpful, but still a stranger. Need to establish a trusting relationship 2. Must learn new, healthier coping skills before she can change destructive ones 3. Hard to let go of something that has “helped” 4. Fear of the unknown Restricts Restricts food or binge and purge to lose weight > receives receives positive feedback > feels good > positive attention > within her control > more dieting more > exercising > counting counting calories > purging > less less emotional pain Anorexia Anorexia nervosa Bulimia Bulimia nervosa nervosa 8 Pieces of the puzzle? Picture Picture a jigsaw puzzle – But you don’t get to see the picture on the cover – Dump it out on the table, some pieces are picture side up, some are facing down Conclusion Conclusion Causes Causes are multiple Prognosis Prognosis is not great – 42% recover Anorexia – 40-50% go in and out of Tx 40through life – 5-15% die – 40% abstain after treatment Bulimia – 60% return to disease despite treatment Distress Distress for the individual – Compassion, perseverance NOT judgment and NOT judgment criticism Some Some things are revealed pretty quickly Some Some things are hard to share One One piece at a time is revealed. Can Can take days, weeks, years? Purdue Resources for students PUSH PUSH - CAPS CAPS – counseling and psychological services – – 6 free sessions/semester Resources National National Eating Disorders Association Renfrew Renfrew Center Gurze Gurze catalog (reading material) SWO SWO – student wellness office – Free nutrition counseling Annie Annie Mahon, PhD, MS, RD 9 ...
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