EatingDisorders5

• 90% girls, 40% new anorexia ages 15-19
• physically active populations -- athletes and military

• 1. failure to maintain weight or reach expected weight during pd of growth....less than 85% expected
• 2. binge eating and purging distinguishes between restricted and bing/purging subtypes
• 3. males 1/10th prevalence
• 4. features: pride and sense of "specialness," competitiveness, moral certitude
• 5. co-morbid disorders: depression, obsessive compulsive disorders, substance abuse, anxiety

• 1. amenorrhea
• 2. constipation, GI distress
• 3. cold intolerance
• 4. lanugo - fine hairs
• 5. anemia
• 6. hypotension
• 7. impaired renal function
• 8. cardiac arrhythmia
• 9. osteoporosis
• 10. death - 12 times more likely than general population

• 1. recurrent episodes of binge eating - with sense of lack of control
• 2. recurrent inappropriate compensatory behavior in order to prevent weight gain
• 3. binge eating and compensatory behavior both occur, on average, at least twice a week for three months
• 4. self-evaluation is excessively influenced by body shape and weight
• 5. does not occur exlusively during anorexia nervosa
• 6. subtypes distinguished by purging or not purging

• 1. mood disorders
• 2. anxiety disorders - social anxiety, PTSD
• 3. Substance abuse
• 4. personality features

• 1. maternal pregnancy or birth related consequences
• 2. female sex
• 3. early childhood eating problems or GI problems
• 4. elevated weight and shape concerns
• 5. sexual abuse
• 6. negative self-evaluation

• 1. dieting
• 2. perfectionism
• 3. criticism from family
• 4. family member with eating disorder
• 5. increased levels of cortisol in brain, decreased levels of seratonin and norepinephrine

• 1. childhood overweight
• 2. social phobia
• 3. parental depression and substance abuse
• 4. adverse family experiences

• anorexia lasts on average 1.7 yrs
• bulemia lasts on average 8 years
• BED - 8 years

sores around mouth, calluses/scars on knuckles, dry/flaky skin, cold sensitivity, constipation, edema, stress fractures, puffy cheeks, discolored teeth, frequent fluctuations in weight

• -all criteria for anorexia nervosa, but has regular menses and in normal weight range
• -all criteria for bulemia, but binging and compensatory eating behavior less that twice a week
• -inappropriate compensatory behavior after eating small amount of food
• -repeatedly chewing and spitting out, but not swallowing, small amounts of food

prevalence: more than half of all adult and 3/4 of all communties cases being treated for eating disorders

• 1. recurrent episodes of binge eating
• 2. associate with eating a lot when not hungry, being disgusted, depressed or guilty after eating, eating alone due to embarassment, eating until uncomfortably full, eating a lot faster than normal
• 3. occurs more than twice a week for 6 months
• 4. marked distress

prevalence: 15-50% of adults in weight control programs, women 1.5x more likely

• 1. more calories, more chaotic eating habits
• 2. more psychopathology
• 3. more impact on work
• 4. more co-morbitities and health problems

• 1. adverse childhood experiences
• 2. parental depression
• 3. vulnerability to obesity
• 4. repeated exposure to negative comments about weight, shape and eating (anorexia just has criticism from family, bulemia has no assoc. criticism)
• 5. female

more emotional signs than bulemia

• 1. strict height/weight standards
• 2. stress over weigh-ins
• 3. stigma of being over weight
• 4. lifestyle
• 5. access to/surrounded by high calorie. high fat foods
• 6. limited time
• 7. societal pressure
• 8. overweight
• 9. previous psychiatric treatment
• 10. hx of verbal abuse
• 11. female

more recently, over half in marines, 21% of all female adolescent dependents met criteria for ED, including binge eating

• -22% w/in last 3 months
• -12% regular basis
• -40% of new recruit weight dissatisfaction (which is shown to predict development of ED)
• -In AD women, overall prevalences: 1.1% AN, 8.1% BN, 62.8% for EDNOS
• -in the marines, those numbers for women are 5, 16, and 77

• 1. combat exposure
• 2. born after 1980
• 3. white, non-hispanic
• 4. marine
• 5. active duty
• 6. enlisted

• organize and oversee multi-component treatment team OR refer responsibilty to health professional. treatment options include:
• 1. individual therapy
• 2. medical monitoring
• 3. nutritional counseling
• 4. group/family therapy
• 5. collaborate with psychologist or mental health provider
• 6. *do not refer solely for nutritional counseling
• 7. monitor health co-morbities
• 8. prescribe and monitor meds
• 9. be supportive