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Eating disorder prevalance
- 90% girls, 40% new anorexia ages 15-19
- physically active populations -- athletes and military
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Anorexia Nervosa
- 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
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Anorexia Symptoms/complications
- 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
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Bulimia Nervosa
- 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
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CO-morbidities of Bulemia
- 1. mood disorders
- 2. anxiety disorders - social anxiety, PTSD
- 3. Substance abuse
- 4. personality features
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Risk Factors for Anorexia and Bulemia
- 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
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Risk Factors for just Anorexia
- 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
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Risk factors for just Bulemia
- 1. childhood overweight
- 2. social phobia
- 3. parental depression and substance abuse
- 4. adverse family experiences
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Prognosis Anorexia vs. Bulemia vs BED
- anorexia lasts on average 1.7 yrs
- bulemia lasts on average 8 years
- BED - 8 years
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Bulemia physical features
sores around mouth, calluses/scars on knuckles, dry/flaky skin, cold sensitivity, constipation, edema, stress fractures, puffy cheeks, discolored teeth, frequent fluctuations in weight
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Eating Disorders Not Otherwise Specified
- -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
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Binge Eating Disorder
- 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
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Bing eating disorder vs obesity
- 1. more calories, more chaotic eating habits
- 2. more psychopathology
- 3. more impact on work
- 4. more co-morbitities and health problems
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risk factors for Binge eating disorder
- 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
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**contributing factors of eating disorders in the military
- 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
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ED in military
more recently, over half in marines, 21% of all female adolescent dependents met criteria for ED, including binge eating
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Female Solders and ED
- -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
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Subgroups with higher proportion new-onset ED
- 1. combat exposure
- 2. born after 1980
- 3. white, non-hispanic
- 4. marine
- 5. active duty
- 6. enlisted
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Role of physician**?
- 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
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