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Essentials of Eating Disorders

BH--BHP 2012

Adrienne MacKenzie

on 27 September 2012

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Transcript of Essentials of Eating Disorders

Essentials of
Disorders Definition: Any of a range of psychological disorders characterized by abnormal or disturbed eating habits. Binge Eating Anorexia Bulimia Binge eating disorder is characterized by compulsive
overeating in which people consume
huge amounts of food while feeling out of control and powerless to stop. Anorexia Nervosa meaning "loss of appetite" is a deadly eating disorder with several key features:

Self induced weight loss (85% or less IBW)
Drive for thinness & refusal to maintain a healthy body weight
Physical manifestations of malnutrition
Intense fear of gaining weight
Body image distortion -Thinking about food constantly
-Eating long after you are full
-Eating large quantity, very quickly
-"Grazing" variant
-Gaining too much weight fast
-Subjective sense of loss of control
-Prefer to eat alone in secret Signs of Binge Eating Signs of Anorexia -weigh 15 percent less than normal body weight
-afraid of weight gain
-obsess over food (eg cut into little pieces, calories)
-unsatisified about your appearance
-avoid eating
-over exercising Stomach problems
Heart problems
Irregular periods or no periods
Fine hair all over the body, including the face
Dry, scaly skin
Possible infertility
Liver and Kidney Failure Eating disorders have the highest mortality rate of all mental illnesses, with 10% to 20% eventually dying from complications. An estimated 78% of adolescent
girls wish to weigh less. People with eating disorders appear to share a common personality type. They may suffer from very low self-esteems and a strong need for control in their lives. They are often perfectionists and over-achievers. Eating may be a way to cope with stress and anxiety for many. Unfortunately over or undereating is followed by extreme guilt and a fear of gaining weight. What is Anorexia? Effects What is
Eating? The relief individuals feel after a binge is only temporary. Afterward, they feel guilty they have eaten, blame themselves and realize that the reality they were trying to escape from still exists.. The percentage of young women who admit to
having been affected by binge
eating symptoms is about 1 in 5. A person who binge eats can take in 20,000 calories during a binge, while most normal people only eat 1,500 – 2,500 calories a day. About 4 million people have binge eating disorder according to the National Institute of Health 40% of people suffering from compulsive eating are males Effects of Binge Eating weight-related hypertension and/or fatigue
weight gain
increase in risk of diabetes, high blood pressure, and some forms of cancer (for obese individuals only) It is estimated that 1 to 2 out of every 100 women has struggle with anorexia at some time in their lives Young women with anorexia are 12 more times likely to die than women who don't have anorexia. This is the highest rate of any emotional problem. It is estimated that only 4 out of every 10 people with anorexia nervosa will make a full recovery. In society, anorexia is potrayed as more of a women's disease, thus many men instead of undereating, over excercise. This stereotype also keeps many men from accepting their condition, admitting to their weaknesses and seeking help. What is Bulimia? BULIMIA is an eating disorder in which a person binges on food or has regular episodes of significant overeating and feels a loss of control. The individual could resort to methods such as vomiting or laxative abuse to prevent weight gain. People with bulimia most often abuse medicines and drugs. They usually take appetite suppressants, diuretics, laxatives and drugs to induce vomiting. An average binge is said to happen around 11 times a week. It is thought that the number of woman suffering from bulimia tripled between 1988 and 1993. -Weight gain
-Trying to control food intake
-Vomiting after meals
-Swollen cheeks & salivary glands
-Weakness and dizziness
-Loss of menstrual periods
-Routine trips to bathroom after meals
-Complaints of dizziness, fainting Signs of Bulimia A recent study found that 70 percent of grade 6 girls surveyed
reported that they first became concerned about their weight between
the ages of 9 and 11. Dr. Michael Pertschuk Paths to Weight Loss Dietary restriction Compulsive Exercise Self-induced vomiting PHYSICAL SIGNS Emaciation
Lanugo hair
Low BP
Slowed pulse
Low body temperature
Amenorrhea Compensatory Behaviors
Dietary restriction
Self-induced vomiting
Laxative abuse
Compulsive exercise
Diet pill abuse
Diuretic abuse
Eating & spitting Eating Disorders
& Health Anorexia Nervosa
Cardiac function
Kidney function
Immune function
Chemical imbalance
Bone loss Anorexia Nervosa
Mortality rate 5% - 15%
Heart failure
Kidney failure
Suicide Bulimia Nervosa
Electrolyte disturbance
Laxative dependence
Stomach/esophageal rupture Bulimia Nervosa
Mortality rate < 1%
Potential lethal in combination with
insulin dependent diabetes--diabulimia Binge Eating Disorder
Complications of morbid obesity--
Cardiovascular disease
Skin breakdown Eating Disorders
& Mental Health Anorexia Nervosa
-Secondary to malnutrition
OCD Bulimia Nervosa
-Disorders of Impulse Control
Substance abuse
Shoplifting Binge Eating
Anxiety All-consuming preoccupation
with symptoms
Derails normal development
Major barricade in relationships
Often interferes with education & vocational achievements Treatment Stages for Treatment Recognize
for help Evaluation Match
to need Follow
through Assisting with
Recognition Families can deny as well as individuals
Frank discussion usually works best
Identify resources in advance
DHS back-up in extreme cases
Non-judgmental stance Evaluation
Process Medical Assessment with PCP
or Pediatrician Psychological Assessment with
Mental Health Professional Important that the assessing medical &
mental health provides are familiar
with eating disorders. Treatment Options... Outpatient
Counseling Intensive
Programs Partial
Programs Residential
Programs Inpatient
Programs Medical
Units Factors Determining
Option Choice
Severity of symptoms
Managed care
Availability of care Treatment Managed care: start less intense
and move up if necessary

Practitioners: start at level judged
most likely to work & move down
with progress Overall Course of Treatment
Begins at level that matches needs (sometimes)
Progresses to less intensive stages
Time frame in weeks for inpatient/residential
Time frame in months of IOP/PHP
Time frame in months to year + for outpatient Common Elements
of Nutritional rehabilitation
Individual psychotherapy
Family therapy
Group therapies Current in Treatment Family based approach
"We" fix the problem vs. you fix the problem
Limited role for medication
Collaborative approach Outcome...
Anorexia 1/3 full recovery
1/3 weight
5-15% expire
Balance with
recurrent symptoms Outcome Bulimia... 80% + recover on
6 year follow up Outcome... Uncertain Predictors of Outcome Duration Age # of Axis I
Diagnoses Presence of
Axis II
Diagnoses Symptom
Severity Points to Remember... Most people with eating disorders DO get better eventually
You don't have to stand by & watch someone die
Emergency options: 302, DHS or emergency guardianship Case #1 Kim R 16 years old
Two year history of weight concerns
Vegan past six months
66" tall, 118 lbs 1/11, 98 lbs 2/12 What else would we want to know?
Based on that information what level of care
would be recommended? Case #2 Lisa B. 14 years old
Parents found evidence of purging
Lisa says she just started vomiting
occasionally but has stopped
She is 6'2" & 115 lbs, without recent change Options A. Advise parents to "wait & see"

B. Advise parents to admit her to have
her admitted to Brandywine's EDU

C. Advise parents to have her evaluated
by PCP & Eating Disorders Specialist Recovery
Possible! Never good enough Thank you!
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