Unformatted text preview: Eating Disorders
Lesley Allen, Ph.D. UMDNJ RWJ Medical School Princeton University Eating Disorders vs. Disordered Eating Eating Disorders = psychiatric condition involving severe body dissatisfaction and harmful eating habits Disordered Eating = various abnormal or atypical eating attitudes and behaviors aimed at reducing weight DSMIV and Beyond Anorexia Nervosa Bulimia Nervosa Eating Disorder Not Otherwise Specified Other disordered eating Binge Eating Disorder (Proposed for DSMV) Female Athlete Triad Muscle Dysmorphia (categorized as BDD) Chronic Dieting Chronic Overeating Anorexia Nervosa DSMIV Anorexia Nervosa Refusal to maintain normal weight (> 85% of normal body weight) Intense fear of gaining weight or becoming fat, even though underweight Disturbed body perception Amenorrhea Subtypes of Anorexia Restricting type No bingeeating or purging behaviors Definition of a binge Eating within a discrete period of time much more than most people would eat A sense of lack of control over eating Bingeeating/purging type Regular engagement in bingeeating or purging (selfinduced vomiting, misuse of laxatives or diuretics or enemas) Anorexia: Demographics 90%95% of cases occur in females Peak age of onset is 14 and 18 years Prevalence: More prevalent in cultures promoting thin ideal 0.5% 1.0% of female adolescents and young adults 0% 0.16% of male adolescents and young adults Industrialized/Western countries Dancers, models, gymnasts, etc. BUT, food refusal isn't culturebound Risk Factors for Anorexia Anorexia: Clinical Characteristics Preoccupied with weight and food High rates of depression and anxiety sxs Most common comorbid psychological High rates of perfectionism Often brought to treatment by family Depression, OCD, substance abuse Treatments for Anorexia None have been proven to be effective in randomized clinical trials Standard Treatment in U.S. CBT minimal evidence to support Familybased treatment some evidence Inpatient treatment to restore body weight SSRIs no evidence to support Psychotherapy Health Risks of Anorexia Electrolyte imbalances Cardiovascular problems Dermatological problems Arrythmias Bone problems Lanugo Blotchy or yellow skin Death highest mortality rate of DSM dx Diminished bone mineral density 620% eventually die of related causes Bulimia Nervosa DSMIV Bulimia Nervosa Recurrent episodes of binge eating Recurrent compensatory behavior Eating within a discrete period of time much more than most people would eat A sense of lack of control over eating E.g. Vomiting, misusing laxatives, etc. Binging and purging occur about 2x/week Selfevaluation unduly influenced by body shape and weight Subtypes of Bulimia Purging Type Regular engagement in selfinduced vomiting or misuse of laxatives or diuretics Nonpurging Type Use of fasting or excessive exercise, but no regular use of vomiting or misuse of laxatives or diuretics What is a binge? Often more than 1000 3000 calories are consumed per binge episode Typical foods = sweets Typically occurs in secret It is usually followed by feelings of extreme selfblame, guilt, depression, and fears of weight gain and "discovery" Bulimia: Demographics Prevalence in U.S.: Mean age of onset: 19 years Sparse evidence of its existence prior to 1950 No evidence of its existence in individuals not exposed to Western ideals 1% 3% of female adolescents and young adults 0% .3% of male adolescents and young adults Risk Factors for Bulimia The vicious cycle of restrictive dieting and binge eating Health Risks of Bulimia Electrolyte imbalances Cardiovascular problems Gastrointestinal problems arrhythmias Dental problems Especially in the esophagus and colon tooth decay, cavities Swelling of cheek or jaw Treatments shown to relieve symptoms of BN in RCTs Cognitivebehavioral treatment Interpersonal psychotherapy Demonstrated to have relatively few dropouts Mandated treatment for bulimia in UK Demonstrated to have relatively few dropouts Appears to result in more dropouts Primary effect may be on depression/anxiety? Antidepressant medication CBT for Bulimia Stage 1 Psychoeducation Restore normal eating (3 meals/day + snacks) Commence weekly weighings (no more or less) Monitor binges and purges Identify situational triggers Introduce stimulus control techniques Physical consequences of binge eating and purging Efficacy of purging as weight management CBT for Bulimia Stage 1 continued Identify function of binge eating and purging Plan alternative behaviors e.g., stress management, distraction e.g., call/visit friends, take bath Stage 2 Stage 3 Challenge dysfunctional thinking Examine core beliefs Relapse prevention Alternative Treatments for BN Interpersonal psychotherapy Antidepressant Medication Identify interpersonal context of eating disorder Identify interpersonal problem area of focus Alter problematic interpersonal behavior No attention on eating behavior or attitudes Prozac > placebo (FDA approved) Older antidepressants (TCAs) > placebo TCAs may produce more side effects than Prozac Binge eating Chronic overeating or chronic dieting Body dissatisfaction (80% college women) Purging Exercise dependence Disordered Eating and Disturbed Body Shape Attitudes and Management Behaviors Excessive exercise and Guilt and depression when don't exercise Diet pills Disordered Body Shape Management Behaviors: Gender Differences 0.1% 4.7% of boys 0.7% 17% of girls 0.3% 1.6% of boys 1.4% 2.0% of girls 0.4% 1.7% of boys 1.0% 8.3% of girls 5.4% of boys 5.5% of girls 3% 12% of boys 0.5% 9% of girls Laxatives for weight loss Selfinduced vomiting for weight loss Exercise dependence Anabolic steroid use DSMV: Binge Eating Disorder Recurrent episodes of binge eating The binge-eating episodes are associated with three (or more) of the following: eating much more rapidly than normal eating until feeling uncomfortably full eating large amounts of food when not feeling hungry eating alone due to embarrassment feeling disgusted with oneself, depressed, or guilty after overeating Marked distress regarding binge eating is present. The binge eating occurs, on average, at least once a week for three months. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (i.e., purging) Other Changes in DSM5 Anorexia Bulimia Refusal to eat>restriction in food intake Elimination of amenorrhea Binge/purge once/week for 3 months Elimination of subtype nonpurging type New suggstions in Eating Disorders NOS E.g., puring disorder, night eating syndrome Female Athlete Triad Components Low energy availability Menstrual dysfunction Energy intake vs. energy output Not necessarily, but possibly, disordered eating Low estrogen levels Prevalence Low bone density/Osteoporosis 78% female high school athletes have >1 component Athletes in aesthetic sports are especially at risk Muscle Dysmorphia Categorized as Body Dysmorphic Disorder Definition Preoccupation that body is not sufficiently lean and muscular Focus of preoccupation is on being too small or inadequately muscular Preoccupation causes significant distress/impairment ...
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- Fall '08
- Binge Eating Disorder