Eating Disorders

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natalie31
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113092
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Eating Disorders
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2011-10-31 00:07:52
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Eating Disorders
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Eating Disorders abnormal psych
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  1. Anoreixa Nervosa
    • 1. Refusal to maintain healthy body weght (<85% expected BMI)
    • 2. BMI <17.5kg/m2
    • 3. Fear of becoming fat/gaining weight (fear, avoidence anxiety about food/eating)
    • 4.Altered/disturbed perception of body shae or weight
    • 5 Amenrrhea (missing 3+ periods)

    • Need for control
    • Fear/anxiety is an essential feature
    • Refractory
  2. Anoreixa Nervosa DSM Specifiers (current episode)
    Restricting type: Weight restriction through low food intake &/or excessive exericise, no regular binging or purging.

    Bing-eating/purging type
  3. Bulimia Nervosa DSM
    • 1. Recurrent episodes of bing eating
    • -In descrete periods (2hrs) more than most people would eat in similar circumstances
    • -Sense of being out of control
    • 2. Comensatory behviour eg. viting, laxatives, exercise
    • 3. At least twice a week for 3 months
    • 4. Excessve emphasis on body shape and weight

    Dont preset with same intensity of fear about food or fat.
  4. Bulmia Nervosa DSM specifiers (current episode)
    Purging type: Vomiting (90%) or laxatives/diuretics/enemas

    Nonpurging type: compensatory behviours do not include above- extreme excessive exercise
  5. Binge Eating Disorder DSM
    • 1. Recurrent episodes of binge eating (episode characterised by..)
    • -Eating a large amount during a short time frame
    • -Lack of control over eating during the binge episode

    • 2. Bing eating episodes are associated with 3 or more of the following
    • -Eating until feeling uncomfortably full
    • -Eating large amounts when not physically hungury
    • -Eating much more rapidly than normal
    • -Eating alone because you are embarrassed by how much youre eating
    • -Feeling disgusted, depressed or guilty after overeating

    3. Marked distress regarding binge eating

    4. No regularly use of compensatory behviours and does not occur exclusively during the couse of Bulima or anorexia
  6. Prevelence of eating disorders
    • 5-10% in US across eating disorders
    • AN: 0.5-1% of females in late adol/early adulthood
    • BN: 1-3% of females in late adol/early adulthood
    • Binge Eating: 0.7-4% in community samples, 1/3 males w` onset in middle age (usually overweight)
    • Eating Disorder NOS: 4.5% ore prevelent that anorexia or bulima nervosa
    • -10:1 females to males (being female is strongest predictor)
    • -Reduced gender diff at younger ages and for binge eating
    • -Onset often associated w` stressor.
  7. Eidemiology of ED's
    • AN: Two peaks in onset 13-14yrs & 17-18yrs
    • BN: Mean age of onset 1-2yrs later tha for anorexia nervosa
    • Overlap between AN & BN: 8yr study =62% of restrictors met criteria for bingeing and purging and only 12% never did either.
  8. Clinical Presentation of Anorexia
    • Restricting Subtype
    • -Denial of illness or thinness
    • -Resistance to treatment (usually admitted by GP or family on ITO)
    • -Perfectionism (drive for success/strick rules of conduct)
    • -Obsessive-compulsive behaviour (only around food)
    • -Preoccupation with food
    • -Rituals
    • -Starvation syndrom (Minnesota experienment-cog impairment/ lethargy/ poor concentration/ apathy/ pale dry marked skin/ loss of physical strengths/ cold/tired/fainting/ poor comprehension).
  9. Treating Anorexia
    • Difficult to treat
    • -Often do not present with concerns about eating
    • -Denial of illness present in up to 80%
    • -Behaviour & impact are consistent with their goals
    • -Unusual behavioural changes
    • -Shop for and prepare food, record everything eaten
    • -Hoard food
    • -Avoid social activities
    • -Unrealistic goals

    • -Symptoms offer two types of advantages
    • 1. defensive-protect from issues of autonomy, maturity, sexualty
    • 2. Enhancing- sense of competence, self-control & moral purity/superiority/ mastery.

    -Symptoms of stavation syndrom make CBT difficult due to cog impairments
  10. Clinical Presentation of Bulima Nervosa
    • -Binge may be up to 30x the coloric value of a normal or recommended meal
    • -Phsysical and psychological discomfort following binge leading to purging
    • -Denial much less frequent than AN
    • -Prominent Depression, shame, and guilt
    • -Unremarkable weight (often overweight)
  11. Treatment considerations for Bulimia
    • Usually self-referred-92% (vs 19% in AN)
    • Bingeing is incongruent with key objective to restict and thinnes
    • B, V, L use seen as distressing and needing help
    • HOWEVER
    • -B&P fulfil +ve & -ve reinforcing functions
    • -Reward, relief from -ve emotions, punishment, purifying/cleansing
    • Most ashamed of symptoms
    • Reluctance to forgo dieting & unrealistic weight goals
    • Beleife that V, L and restiction will acheive goals
    • Poor introceptive awareness of emotional and physical states
  12. Clinical Presentation of Binge Eating Disorder
    • Similar to bulimia but no purging
    • More likely to to be overweight that those with bulimia
  13. Clinical Presentation of Eating Disorders NOS
    • Simular levels of psychopathology to AN and BN (which qs whether this is a less severe form of ED)
    • Women with BPD show increased prevalence of EDNOS-33%
    • Also show a form specific to BPD-purging without binging,
  14. Clinical presentation AN & BN
    • KEY diagnostic feature is presence of body image disturbance
    • AN
    • -Denial of concern of low weight
    • -Beleif of normal weight or fat even though underweight
    • -Fear of weight gain expressed as anger or resistence to idea of weight gain
    • -Resistence to change current eating or exercise patterns
    • BN
    • -Body dissatisfaction evident through strong desire to lose weight & associated strong beliefs that weight loss will lead to increased Self-esteem, happiness and attractivness.
  15. Mortality rates in Eating Disorders
    • ED's have highest mortality rates of any MI
    • 5-20% of anorexics die within 30yrs
    • 18-20% of AN die after 20yrs
    • Only 30%-40% fully recover

    • AN mortality rate is 12x high than death rate of ALL causes of death for females 15-24yrs
    • 20% of AN will prematurely die from complications realted to AN including suicide and heart problems
  16. Medical Complications in ED's
    • Body systems distrupted by ED's
    • -Cardio (arythmia, cardic failure)
    • -Gastrointestinal (motility problems)
    • -Endocrine (amenorrhea, hypothyroidism)
    • -Skeletal (decresed bone desity, osteo, fractures)
    • -Lanugo
    • -Infertility
    • -Dental
  17. Diagnostic issues in ED's
    • Binge frequency and definition is arbitrart (not as important as distress it causes)
    • Amenorrhea does not always accur even at low weights
    • Inconsistencies in body image disturbance criteria between ED's (less freq than BN).
  18. Comorbid conditions in AN
    • AN freq orrurs with
    • -Major depression
    • -Anxiety (esp OCD and social phobia)
    • -Personality Disorders (esp OC and Avoident)
  19. Comorbid conditions in BN
    • Major depression
    • Anxiety disorder
    • Personaltiy disorder (Esp BPD)
    • Substance use disorders

    *extremes =life and relationships are very erratic
  20. Comorbid conditions in Binge Eating Disorder
    • Major Depression
    • Personality disorder (esp histrionic, BPD, and avoident)
    • Substance use disroders
  21. Aetiology: Genetic factors in ED's
    • -58-76% of varience in AN is Genetic
    • - 54-83% varience in BN is genetic

    Mre than 200 genes that contribute to appetite, hunger, satiety and other aspects of energy balance
  22. Aetiology: Family factors in ED's
    • Family functioning/interpersonal
    • Communication within family
    • Parental modelling of eating patterns
    • Psychological functioning of parents (verbal info processess, obsession with perfectionism, and body image, overly controlling, emotional emeshment)
    • Specific feedback to child concerning appearence.
  23. Aetiology: Family Characteristc in AN & BN
    • Family characterists AN
    • -Present a facade of perfectionism
    • -Emeshed & overly involved

    • Family characterists BN
    • -belittling/blaming between parents and offspring
    • -chaotic/neg affect and interaction

    *causal direction or cosequece?
  24. Aetiology: Learning & Modelling
    • Parents, peers, media (observational learning)
    • Internatlisation of verbal messages children receive
    • Negative appearence-related comments
    • Cultural acceptability of dieting
    • Parents concerns about their own weight
  25. Aetiology: Psychosocial factors
    • Study: 1157 women ages 18-30yrs, for 2 yrs
    • -increased likelihood of developing an eating disorder associated with baseline characteristics of:
  26. Lower self-esteemLower perceived soical supportIncreased body concernIncreased use of escape-avoidence coping
  27. SCOFF questions
    • 1. So you make yourself Sick because you feel uncofortable full? (Sick)
    • 2. Do you worry you have lost Control over how much you eat? (Control)
    • 3. Have you recently lost most than One stone in a 3 month period? (One)
    • 4. Do you Beleive youself to be Fat when others say you are too thin? (Fat)
    • 5. Would you say that Food dominates your life? (Food)
    • *1 point for every yes, 2+ = increased risk of AN or BN
  28. Access to treatment for ED's
    • 1 in 10 receive treatment
    • 80% who have accessed care don't get intensity of treatment needed to stay in recovery
    • Treatment in US ranges from $500 t $2000 a day ($30 000a month)
    • ED require aprox 3-6 months inpatient care
    • Most health insurance companies don't cover ED's
    • Outpatient treatment cost upto $100 000
  29. Treatment for AN
    Difficult to engage in therapy

    • Pharmacology
    • -No effective drug treatment
    • -Antidpressents all tried
    • -Current interest in antipsychotics

    • Medical/Nutritional
    • -Half need hosp to regain weight-contingency managment (reward/punishment) often ITO.
    • -Often lose weight when discharged.

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