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Eating Disorders

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Melissa Hancocks

on 7 March 2014

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Transcript of Eating Disorders

Anorexia is a complex eating disorder with these three key factors:
refusal to maintain a healthy body weight
an intense fear of gaining weight
and a distorted body image
Types of Anorexia
There are two types of anorexia:
1. Restricted anorexia
weight loss is achieved by restricting calories [16]
What is body image?
Body image involves perceptions, thoughts, and behaviours related to one's appearance. [10]
Altered Body Image
Eating Disorders
When is body image established?

Typically, body image is established before the age of


. By this age, children are aware of their own appearance and of the societal bias against people with certain body types (eg. obesity), and children who are overweight tend to internalize this message. [11]
During early adolescence
, body image continues to develop, especially among girls (when they
gain an average of

, 20%-30% of which is comprised of fat deposited in the hips, thighs, buttocks, and waist). [11]
Causes of Anorexia
There are no simple or exact causes of this disorder. However, experts have many theories. Including:
a combination of social, psychological, emotional and biological factors - such as the family environment, low self-esteem, genetics, and traumatic experiences like death, divorce, break-ups etc.
tends to run in families; those with a parents or sibling with an eating disorder are more likely to develop one themselves
No matter how skinny one may become, it's never enough to the person with the disorder. Anorexia is a serious and fatal matter and becomes extremely serious when those affected deny the issue. [16]
Defining Characteristics:
Distorted views of one's body weight and shape for age.
Negative feelings about self and body.
Self-loathing (impulsive or obsessive).
Intense fear of gaining or not being able to lose weight.
In addition to biologic developmental processes, external factors affect body image.
Cultural Influences
Exposure to the Media
Life Experiences
How do you see yourself???
Mental Health Issues
Physical Abuse
Sexual Abuse
Mental abuse

Substance Abuse

Too protective
Best friends
Body image is:
A Persons
of his or her
Perceptions of the appearance of one's body
Emotional responses to those perceptions
Two Components of Body Image
PSW 205
Melissa Hancocks
Kelsie Neville
Courtney Caverly

For someone with the disorder the thought of eating, food, mealtimes and dieting may be very stressful. [16]
2. Purging anorexia
weight loss is achieved by vommiting., laxatives or diuretics [16]
Causes of Anorexia
Our cultures and society's idealization of thinness [16]
Families whom put pressure on children by putting over emphasis on looks, diet themselves or criticize their children's appearance. [16]
Causes of Anorexia-Con't
Last but not least, it's believed that brain chemistry plays an significant role in the onset of anorexia. People with anorexia tend to have a high level of cortisol - the brain hormone most related to stress. [16]
Physical Signs and Symptoms of Anorexia
Low body weight [16]
Constipation and slow emptying of the stomach [17]
Thinning hair, dry and yellow skin and brittle nails [16]
No monthly menstrual period [17]
Low body temperature and blood pressure [17]
Severe mood swings and depression [16]
Weak and lack of energy [16]
Slowed thinking [16]
Tooth decay/gum damage [16]
Dramatic weight loss [16]
Fatigue [17]
Dehydration [17]
Behavioral Patterns
Brain and nervous system is affected - making it hard to think right. sadness, moody and depression [16]
Feeling fat despite being underweight [16]
Fixation on body image - obsessed with weight, body shape, frequent weigh ins [16]
Denial of being too thin [16]
Use of diet pills and laxatives [16]
Throwing up after eating [16]
Compulsive exercising [16]
Fear of gaining weight [18]
Treatment/Intervention for Anorexia
The goals for treating somebody with anorexia are mainly to restore a healthy weight and healthy eating habits. Three main steps that one must take include:
taking control of healthy eating habits
learn emotional self care
build trust in those helping [20]
Treatment and Intervention for Anorexia
For serious cases in which malnutrition and starvation has started to break down the body hospital stays are necessary. [20]
However, in all cases, serious or small, medical treatment, nutritional counseling and emotional therapy are needed. [16]
Treatment for anorexia requires a team approach of medical doctors, psychologists, counselors, dietitians and the family also plays an important factor. [20]
Lifespan Health Effects and Limitations
Lifespan Health Effects and Limitations - Con't
Low White Blood Cell Count
Cathartic Colon
Cardiovascular Risk
Digestion Health
Salivary Problems
Electrolyte Imbalance
Tooth Enamel Erosion
Heart Attack
Impulse Control Disorder
Irritable Bowel Syndrome
Musculorsketal Problems
Parotid Gland Enlargement
Low Potassium
Renal Problems
Pituitary Gland Problems
Life Expectancy
Vision Impairment
Vitamin Deficiencies
Effects on the Family and Loved Ones
Eating Disorder Awareness Video
Bulimia Nervosa (BN)
Defined as binge eating and purging; Consuming a large amount of food in a short amount of time (binge eating), followed immediately by ridding your body of the food consumed (purging)-typically by vomiting, taking a laxative, diuretic, or stimulant, or even exercising excessively, because of an overwhelming obsession with body weight.
When continued for long periods of time, BN leads to a lower life expectancy. [1] Bulimia, like every eating disorder, effects not only the individual but everyone around them.
Causes of Bulimia
Genetic predisposition
. Similar to any addiction, the addiction to purging can be accredited to heredity. [2]
Social Media
. Societal pressure to look a certain way has played a significant role in the way people view themselves, and has influenced behavioural patterns, as people have found alternative means to fit into the mold that modern media has cast.
Hormonal Imbalance
. Research suggests that bulimia nervosa is linked to dopamine and serotonin abnormalities. Increased serotonin levels in the brain can lead a person to starve themselves, while decreased levels can cause an individual to overindulge. [2]
Signs and Symptoms
Obsessing over the number of calories consumed
Obsession over, or extreme awareness of weight
Low self-esteem
Low blood pressure
Irregular periods
Frequent trips to the bathroom (usually to "purge")
Rapid weight loss
Damage to teeth (perimolysis)
Acid Reflux/Persistent heartburn
Body dysmorphia
Severe physical symptoms including seizures, cardiac arrhythmia's, muscle deterioration, peptic ulcers, infertility and tetany.
Behavioural Patterns...
Social Isolation-individuals (especially women) suffering from bulimia spend more time alone than those who do not [3]
Food Obsession-affected individuals are reported as spending as much as 38% of the day thinking about food. [3]
Mood Swings/erratic behaviour

Treatment & Intervention
Initial care is provided in outpatient settings.
Outpatient treatment includes pharmaceutical
treatment as well as psychiatric intervention
(counselling and rehabilitation) & reintroduction of proper dietary habits.

Significant Metabolic Abnormalities
Medical complications.
Risk of Suicide
Failed Outpatient Treatment
Inability to care for self
Inpatient care is necessary when there are/is:
Personal Support Worker's Role
Work with the psychiatrist, psychotherapist, and nutritionist/dietitian.
Reduce & eliminate binge eating and purging.
Treat physical complications and restore nutritional health.
Motivate patient/client.
Enlist family support and provide family counselling and therapy where appropriate.
Help prevent relapse.
Follow guidelines regarding patient level of care; refer to the table from the APA Practice Guidelines for Eating Disorders.
Therapeutic Treatment Options...
Used to help the individual to understand how their thinking and negative self-talk and self-image directly impacts their eating and negative behaviours.
Focuses on identifying and altering dysfunctional thought patterns, attitudes and beliefs, which may trigger and increase the person's pattern of harmful eating behaviours.
CBT can be conducted in either an outpatient or inpatient setting. I done in an inpatient setting, eating disorders are often treated at residential treatment facilities.
Cognitive Behavioural Therapy (CBT)
Family Therapy
Helps an individual with bulimia understand the dysfunctional role they play within the family
Usually conducted with the person who has bulimia and their family.
May involve therapy without the person who has bulimia, to help the family understand the roles they are playing in supporting the disorder and suggest ways the family can help the person with bulimia acknowledge the problem and seek out treatment. [4]
Interpersonal Psychotherapy [5]
Goal is to engage the patient in treatment, identify current interpersonal problems and establish a treatment contract.
Treatment has three stages:
1) Evaluation of the interpersonal context in which the eating problem developed and has been maintained.
2) Assessment of the quality of the patient's current interpersonal functioning.
3) Examination of the interpersonal context of individual bulimic episodes. This stage ends with the therapist and patient deciding which of the identified problems will be the focus of the remainder of treatments.
Antidepressants-Prozac/Zoloft/Bupropion [6]
These are used for patients with substantial concurrent symptoms of depression, anxiety, obsessions, or certain impulse disorder symptoms.
Used to control/limit binge/purge behaviours [7]
Methylphenidate [8]
Useful for patients who do not respond to antidepressants. Acts as a mood stabilizer and helps the individual to control his/her emotions which leads to a greater control over the need to binge/purge.

[1] http://www.medicalnewstoday.com/articles/231022.php
References continued...
[14] http://en.wikipedia.org/wiki/Body_dysmorphic_disorder
[16] http://www.helpguide.org/mental/anorexia_signs_symptoms_causes_treatment.htm

Other factors that may determine how a person perceives their body image include....
Medical conditions such as [11]:
Endocrine disorders
Hypothyroidism (lower activity of thyroid gland)
Cushings syndrome (metabolic disorder)
Medications can also physically change a persons body image [13]...
Steroid treatment
Mood stabilizers
Some anti psychotic medication(increase appetite & are sedating)
Anti-seizure medication
Migraine medication
Type 2 diabetes drugs
Prescription antihistamines
High blood pressure medication
Birth control
Oral corticosteroids for asthma, inflammatory bowel disease, rheumatoid arthritis.
Heart burn & stomach ulcer medications.
There are several types of disorders
that cause people to have an altered body image
of themselves:

Anorexia Nervosa (1)
Bulimia Nervosa (2)
Compulsive Overeating
Body Dysmorphic Disorder (3)

We will focus more on #1, 2, and 3.
Body Dysmorphic Disorder
Is a chronic mental illness, a somatoform disorder, wherein the afflicted individual is concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of their physical appearance. [13]
An individual with BDD has perpetual negative thoughts about their appearance; in the majority of cases, an individual suffering from BDD is obsessed with a minor or imagined flaw. [13]
Afflicted individuals think they have a defect in either one or several features of their body, which causes psychological and clinically significant distress or impairs occupational or social functioning.

BD often co-occurs with depression, anxiety, social withdrawal, and social isolation.
The causes vary for each person, but are usually a combination of
, and
Approximately one percent of adults meet the diagnostic criteria for BDD. [13]
BDD continued...
Signs and Symptoms
People with BDD say that they wish that they could change or improve some aspect of their physical appearance even though they may generally be of normal or even highly attractive appearance. [13]

One of the greatest known celebrities who has been said to suffer with BDD is Michael Jackson. [14]

Over the years he had several Plastic surgeries to "correct" what he perceived as "flawed features". He was embarrassed by this disorder and refused to admit publicly that he had even had the surgeries.
In combination with BDD, in 1984 Jackson lost 20lbs bringing his 5'9" frame to just 105lbs, doctors speculated that he likely suffered from Anorexia Nervosa. His waist was generally only
28", on average. [14]
Causes of BDD

Can occur with obsessive-compulsive disorder (OCD)
Brain differences may contribute to its onset.
Research indicates that there is a weal connection between the amygdala, the brain's emotion centrem and the orbitofrontal cortex, the rational part of the brain that helps regulate and calm down emotional arousal.
Cognitive-behavioural Model (theory), represents an interaction between psychological and environmental factors. According to this theory, a combination of personality factors, such as introversion and self-consciousness together with early childhood experiences and social learning cause BDD.
EXAMPLE: individuals with BDD report a significantly greater incidence of emotional abuse and bullying during childhood (not all bullied individuals develop BDD).

Diagnosis & Treatment

BDD is under-diagnosed due to the disorder only recently being included in DSM IV. BDD is often associated with shame and secrecy so individuals may not reveal their appearance concerns for fear of appearing vain or superficial.
BDD is also often misdiagnosed because its symptoms can mimic that of major depressive disorder or sochobia.

CBT-cognitive behaviour therapy is thought to be effective treatment for BDD.

History of BDD
The disorder was first documented in 1891 by Enrique Morselli, who dubbed the condition "dysmorphophobia". BDD was recodgnicsed by the American Psychiatric Association as a disorder in 1987 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. It has since been changed from "dysmorphophobia" to "body dysmorphic disorder" because the original implies a phobia of people, not a reluctance to interact socially because of poor body image. [13]
Anorexia is not limited to only the individual with the disorder, but has also been shown to leave it's mark on the family, friends and loved ones. [21]
The family and loved ones effected may feel feelings of helplessness because they are not able to help, unless they are willing to help themselves. [21]
Feelings of confusion, anger, guilt and fear are very common amongst family members and loved ones. [21]
Medications for Anorexia
There is not known to be any medications specifically for anorexia it's self. However, medications that treat depression and anxiety have been used to help those with anorexia. [23] Such medications include:
Cymbalta (duloxetine) - Improves mood, sleep, appetite, energy levels and nervousness [24]
Lexapro (escitalopram) - Improves feelings of well being, energy levels and nervousness. [25]
Celexa (citalopram) - Increases energy level and feelings of well being. [26]
Role of the Personal Support Worker
As a personal support worker, there is not a whole lot we can do. We cannot force an individual with the disorder to seek professional help, they have to want it themselves. However, we can offer support and encouragement, gently express our concern and attentively listen. [22]
References Continued
[17] http://www.timberlineknolls.com/eatingdisorder/anorexia/signs-effects
[18] http://www.webmd.com/mental-health/anorexia-nervosa/anorexia-nervosa-symptoms
[19] http://www.eatingdisordersonline.com/medical/complications.php
[20] http://www.webmd.com/mental-health/anorexia-nervosa/anorexia-nervosa-treatment-overview
[21] http://www.mirror-mirror.org/families.htm
[22] http://www.something-fishy.org/helping/whatyoucando.php
[23] http://www.mayoclinic.org/diseases-conditions/anorexia/basics/treatment/con-20033002
[24] http://www.medicinenet.com/duloxetine-oral/page2.htm#Uses
[25] http://www.medicinenet.com.escitalopram-oral/page2.htm#Uses
[26] http://www.medicinenet.com/citalopram-oral/article.htm
Many medications prescribed for other conditions can have side effects including weight loss/gain. The following have been known to cause an increase in body weight:
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