eating disorders

1996

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Unformatted text preview: OMITANT PERSONALITY DISORDERS CONCOMITANT PERSONALITY DISORDERS Piran, et al 1988 • CLUSTER 1 ( A ) • • 0 – 1% of Anorexics and Bulimics Paranoid, Schizoid, Schizotypal • CLUSTER 2 ( B ) • 2% of Anorexics • 56% of Bulimics • Borderline, Histrionic, Narcissistic, Antisocial • CLUSTER 3 ( C ) • • • 72% of Anorexics 29% of Bulimics Anxious * Dependent * Avoidant * Compulsive * Passive­Aggressive Sexuality, Confusion & Related Challenges Sexuality, Shame, Guilt, Collusion & Enjoyment Confusion about Bodily Pleasure Indulgence or Avoidance Self­Loathing and Narcissism Dichotomous Thinking & Living Family Dynamics Parent Food­Related Attitudes Questionnaire Parent Food­Related Attitudes Questionnaire Better Way of Health Consulting, Inc. 1996 • • • • • • • • • • • • • • • 1. I follow a low­fat diet and try to get the rest of my family to do the same. 2. I worry about what other family members eat. 3. I have been on many diets. 4. I frequently talk about food, calories, diets and weight. 5. I frequently talk about recipes and cooking. 6. I try to get other people to eat the way I do. 7. I eat differently when I am alone than I do when I eat with my family. 8. I monitor the weights of family members. 9. I have suggested to family members that they should weigh less or more. 10. Food is used as a reward in our home. 11. Dinnertime is often in front of the TV or on the run. 12. I keep my own secret stash of _____________. (Name the food) 13. I have offered gifts to family members as incentives to lose or gain weight. 14. We have family nicknames that focus on a person’s weight, like “Thunder Thighs” o We have family nicknames that focus on a person’s weight, like “Thunder Thighs” “Toothpick”. 15. I identify people according to their physical characteristics (the fat one, the skinny g the pretty girl, and the lady with the big hips). (continued on handout) Medications Medications • SSRIs – Prozac, , Paxil, Luvox, Celexa – • Tricylcic Antidepressants – Imipramine, Norpramine, Elavil, Desipramine • Atypical Antidepressants – Wellbutrin, Effexor, Serzone, Stattera • Anti­Anxiety Agents – Buspar, Klonopin, Ativan, Valium • Mood Stabilizers – Lithium, Tegretol, Depakote, Neurontin, Lamictal, Topomax • Psychostimulants – Concerta, Adderall,Ritalin, Dextroamphetamine • Anti­Psychotics – From Thorazine to Geodon Integrated Treatment Approach Multi­disciplinary team Multiple orientations & techniques Multiple modalities Treatment is usually long­term (1 – 5 years) May require repeat hospitalization Emergency Treatment Emergency Treatment • • • • • • • • • • • Seizure Organic brain syndrome – cognitive interference; disorientation – changes in consciousness Bradycardia (HR slower than 40 beats/minute) Tachycardia (other HR irregularities) Chest pain Painful muscles spasms Quickly tired & weak when exerting Low urine output (less than 40 cc / day) Faintness Severe electrolyte imbalance Rapid unhealthy weight loss (15 lbs in 1 month) Treatment Approaches Treatment • Interpersonal: Family & Individual Therapy – Reduce social anxiety & Improve social skills – Family interaction patterns – Relationship to identity & symptoms • Insight­Oriented – Address historical, developmental issues – Redefine sense of self from empowered vs victim role • Habit Control: Behavioral Methods – – – – – – Realistic goal­setting Self­monitoring Impulse control Stimulus cue identification Increase repertoire of self­soothing/relaxation Increase availability of alternative reinforcers • Cognitive & Dialectic Behavior Therapy Methods – – – – Enhance self­regulation skills Affect regulation Self­trust Decrease cognitive rigidity Mood Regulation Mood Regulation • Charting mood changes • • • Rate mood on 1­10 Scale Keep Mood Log Cognitive “split voices” lists & associated emotions • Medication • Medication responsibility • Sleep & Eating regulation • • • Keep log of hours slept, time to bed and awake Note moods associated with patterns Breakfast is a MUST Treatment Challenges Treatment Challenges • Sexual abuse history may not be revealed for months or years • Concomitant Compulsions/Addictions – Promiscuity, Drugs, Alcohol • Deception ­ manipulation • Dissociation – delusional distortions • Severe anorexia (20% weight loss) – limits cognitive capacity • Recurrent relapses & hospitalizations “ I am not the same having seen the moon from the other side of the world” ­ Author unknown http://www.youtube.com/watch?v=DGOuSG9q http://www.health.umd.edu/mentalhealth/eatin • http://www.health.umd.edu/mentalhealth/eating...
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