eating disorders: def: “psychiatric sickness where food is used to help cope with unsettling...

Eating disordersEating disorders

AnorexiaAnorexia

Eating Disorders:Eating Disorders: Def:Def:

““Psychiatric sickness where food is used to help cope Psychiatric sickness where food is used to help cope with unsettling emotions and personal life issues”with unsettling emotions and personal life issues”

Persistent disturbance of eating behavior or a behavior Persistent disturbance of eating behavior or a behavior intended to control wtintended to control wt

Significantly impairs physical health or psychosocial fxSignificantly impairs physical health or psychosocial fxNot secondary to a general medical condition or another Not secondary to a general medical condition or another

psychiatric disorderpsychiatric disorder

Michel and Willard (2003)Michel and Willard (2003)

Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Klein, D.A., Walsh, T.B. (2004). “Eating Disorders:

Clinical Features and Pathophysiology.” Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2), 359-374.Physiology and Behavior, 81(2), 359-374.

Anorexia:Anorexia:

First described in medical literature First described in medical literature in __________.in __________.

Main feature: relentless pursuit of Main feature: relentless pursuit of thinness & refusal to maintain thinness & refusal to maintain minimum bodyweight for age and minimum bodyweight for age and height.height.

Klein and Walsh (2003)Klein and Walsh (2003)

Personality Characteristics:Personality Characteristics: ________________________________________________ Greater harm avoidanceGreater harm avoidance ConscientiousnessConscientiousness PerfectionismPerfectionism ObsessionObsession


Developmental factors:Developmental factors:Onset: during adolescence or young Onset: during adolescence or young

adulthood & rarely begins before adulthood & rarely begins before _____________._____________.

Cause: psychological reactions to Cause: psychological reactions to maturing body, changing peer maturing body, changing peer relationships, and new life roles.relationships, and new life roles.

Cause: StressCause: Stress


Clinical Features:Clinical Features:Weight loss usually from reduction in Weight loss usually from reduction in

food intake, in stagesfood intake, in stages• _______________ _______________

• Meat Meat

• Foods that could potentially contain fatFoods that could potentially contain fat

As the wt loss carries on, thinness As the wt loss carries on, thinness becomes more of an obsession.becomes more of an obsession.


Social avoidance can aid progressive Social avoidance can aid progressive weight lossweight loss• e.g, pts avoid situations where ______________. e.g, pts avoid situations where ______________.

Psych components of starvation include:Psych components of starvation include:• IrritabilityIrritability• Poor concentration Poor concentration • FatigueFatigue


Over-Activity:Over-Activity:Forms of excessive physical activity:Forms of excessive physical activity:

• Planned sportsPlanned sports• WalkingWalking• StandingStanding• Maintenance of __________________ (to Maintenance of __________________ (to

burn more calories) burn more calories)


Assessment and Diagnosis:Assessment and Diagnosis:

Assessment: developmental, past Assessment: developmental, past psychiatric & medical history, current psychiatric & medical history, current psychosocial fxing & supports.psychosocial fxing & supports.

Diagnosis: based on behavioral, Diagnosis: based on behavioral, psychological, & physicalpsychological, & physical


Warning Signs of Anorexia:Warning Signs of Anorexia:____________________________________________________Frequent weighingFrequent weighingSleep difficulties Sleep difficulties Frequent exercising before and after Frequent exercising before and after

eatingeatingUse of laxativesUse of laxatives


Loss of menstrual cycle (female)Loss of menstrual cycle (female)Preparing __________________, Preparing __________________,

but not for yourselfbut not for yourselfAttempts to obtain diet Attempts to obtain diet

instructions/pills from doctorsinstructions/pills from doctorsIsolation from peers and familiesIsolation from peers and families


DEFINITION OF BULIMIA DEFINITION OF BULIMIA NERVOSANERVOSA• Recurrent episodes of binge eating followed Recurrent episodes of binge eating followed

by inappropriate behaviors to by inappropriate behaviors to __________________ (e.g., self-induced __________________ (e.g., self-induced

vomitingvomiting))

Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Pathophysiology.” Physiology and BehaviorPhysiology and Behavior, 81(2), 359-374., 81(2), 359-374.

RISK FACTORSRISK FACTORS• History of Anorexia Nervosa (AN)History of Anorexia Nervosa (AN)• Familial correlationFamilial correlation• Females age 10-25Females age 10-25• ________________________________________________• Athletes, models, gymnastsAthletes, models, gymnasts

Bulimia Nervosa.Bulimia Nervosa. (2005 September 13). Retrieved September 19, 2005 (2005 September 13). Retrieved September 19, 2005 from http://en.wikipedia.org/wiki/Bulimiafrom http://en.wikipedia.org/wiki/Bulimia

• Students under stressful workloadStudents under stressful workload• Suffered traumatic events (sexual abuse, child Suffered traumatic events (sexual abuse, child

abuse)abuse)• ________________________________• Personality (higher reactivity)Personality (higher reactivity)

– Perfectionists/overachieversPerfectionists/overachievers

Bulimia Nervosa.Bulimia Nervosa. (2005 September 13). Retrieved September 19, 2005 (2005 September 13). Retrieved September 19, 2005 from http://en.wikipedia.org/wiki/Bulimiafrom http://en.wikipedia.org/wiki/Bulimia

SIGNS AND SYMTOMSSIGNS AND SYMTOMS• Distorted body image (focus on shape)Distorted body image (focus on shape)• Disturbed eating patternsDisturbed eating patterns

– Consuming large amounts of food, then Consuming large amounts of food, then “purging”“purging”

• Poor _____________________Poor _____________________• Dental erosionDental erosion

Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Pathophysiology.” Physiology and BehaviorPhysiology and Behavior, 81(2), 359-374., 81(2), 359-374.

DIAGNOSISDIAGNOSIS• DSM-IV criteriaDSM-IV criteria

– Binge eating Binge eating (more than usual w/ lack of control)(more than usual w/ lack of control)

– Compensatory behaviorsCompensatory behaviors•Purging (vomiting)Purging (vomiting)•Misusing medicationMisusing medication

– Laxatives, diet pills, diureticsLaxatives, diet pills, diuretics

•Weight controlWeight control– Fasting, excessive exerciseFasting, excessive exercise

– At least 2x’s/wk for _________At least 2x’s/wk for _________

SUBTYPESSUBTYPES

• PURGING TYPEPURGING TYPE– VomitingVomiting

• NON-PURGING NON-PURGING TYPETYPE– No vomitingNo vomiting– Excessive exercise, Excessive exercise,

fastingfasting

Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” and Pathophysiology.” Physiology and BehaviorPhysiology and Behavior, 81(2), 359-374., 81(2), 359-374.

COMORBIDITYCOMORBIDITY• Anxiety disorders Anxiety disorders (onset before BN/AN)(onset before BN/AN)

– ________ most common________ most common– Social phobiaSocial phobia– Specific phobiaSpecific phobia– Generalized anxiety disorderGeneralized anxiety disorder

• Mood disordersMood disorders– DepressionDepression

Kaye, W.H., Bulik, C.M., & et al. (2004). Comorbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa. Kaye, W.H., Bulik, C.M., & et al. (2004). Comorbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa. The American Journal of Psychiatry, 161, The American Journal of Psychiatry, 161, 2215-2221.2215-2221.

TREATMENTTREATMENT• Respond ________________ to Respond ________________ to

treatment than ANtreatment than AN

2 treatment approaches:2 treatment approaches:1.1. Short-term (4-6 months) Short-term (4-6 months)

• Psychological treatmentPsychological treatment

• Cognitive behavioral therapyCognitive behavioral therapy

2.2. Long-termLong-term• Anti-depressant therapyAnti-depressant therapy

Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Features and Pathophysiology.” Physiology Physiology and and BehaviorBehavior, 81(2), 359-374., 81(2), 359-374.

OUTCOMEOUTCOME• Study showed 5-10 years later….Study showed 5-10 years later….

– 50% patients fully recover50% patients fully recover– 20% continued to meet diagnosis20% continued to meet diagnosis– 30% _________________30% _________________

• Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Pathophysiology.” Physiology and BehaviorPhysiology and Behavior, 81(2), 359-374., 81(2), 359-374.

FYIFYI• Can consume up to ____________ calories in a Can consume up to ____________ calories in a

single binge episode!single binge episode!

• Eating disorders have one of the highest death Eating disorders have one of the highest death rates of mental illnessrates of mental illness

• 1-3% women in US have ED1-3% women in US have ED

• Those with BN usually have a normal weightThose with BN usually have a normal weight

• More cases of BN than ANMore cases of BN than AN

Obesity

What is obesity?• Physicians consider obese if weighs

more than 20% above the expected weight

for age, height, & body build. • _________________ or morbidly obese: If

100 pounds above expected wt

Brownell, K.D., Foster, G.D., Wadden, T.A. (2002). Obesity: Responding to the Global Epidemic. Journal of Consulting and Clinical Psychology, 70 (3), 510-525.

Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Web: http://www.anred.com/obese.html

http://www.anred.com/obese.html


What are the causes of obesity?• Consumption of more calories than are

burned through work, exercise, and other activities

• Attempts to _______________ emotional pain & distress

• Diets & prolonged caloric restriction. (ex: yo-yo dieting)

• Specific biological problems (ex: malfunctioning thyroid or pituitary glands; physical problems or disabilities that limit/prohibit exercise, strenuous work, or physical activity)





• Certain genetic processes• __________________________• New research shows that there is a

biological link between stress & the drive to eat. Comfort foods seem to calm the body’s response to chronic stress.

• Researchers believe that in most cases obesity represents a complex relationship between genetic, physiological, metabolic, socioeconomic, lifestyle, & cultural factors.





Health Risks Associated With Obesity:

• Hypertension• _______________• Cardiovascular disease• Cancer





• Endocrine problems• Gall bladder disease• Lung and breathing

problems• __________________• Premature death





What can be done about obesity??• The simplistic answer : eat less &

exercise more!!• The realistic answer:

– Work with a physician to identify & correct any underlying problems that contribute to excess wt gain.

– Talk with a counselor to see if you are using food for purposes that it cannot fulfill: love, comfort, escape, boredom, etc.


Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Wide Web: http://www.anred.com/obese.html



– Never diet or restrict calories when you are _____________________! If you do, binge eating might be a result.

– Eat normal, reasonable, moderate amounts of a wide range of foods. Portion control is one of the most important factors in a successful weight management program.





– Eat _________________!!– Get plenty of sleep each night!!– Exercise!!– Find a support system. Friends, family,

& support groups are key components of a healthy life.

– Be realistic with yourself. Losing wt takes time & commitment – don’t give up!!





Pica

The compulsive, recurrent consumption of nonnutritive

items

(Steigler, Spring 2005)

• From the Latin word for “magpie”

• Most commonly observed ED with ________ & other developmental disorders (DD)

• Nonfood items consumed repeatedly over a month or longer, despite efforts to restrain

• Frequently under identified, underreported, & under treated


(a) Nonfood items consumed

repeatedly over month or longer, despite efforts to restrain behavior

(b) Behavior considered inappropriate for developmental age (beyond _____________)

•Only suspected when:


(c) Not found in _________________

(d) Behavior is a sx of other mental disorder & is of sufficient concern to warrant medical attention


Etiologies• Nutritional Factors- Iron and/or zinc ___________• Environmental Factors-

Stressful events

Impoverished environment

Lack of active participation in activities

Insufficient levels of human interaction


• Mental Health Factors- Observed in individuals with normal intellect & those diagnosed with mental illnesses (OCD, schizophrenia, emotional disturbance, depression, pathological anxiety)

• Sensory/ Physiologic Factors- Taking pleasure in the _________, smell, and/or taste of the objects


Health Risks______________- Lead poisoning

Parasitic Infections- pinworms (geophagia~ dirt, clay & coprophagia~ feces)

Malnutrition- could eat substances that cause excessive calorie intake (cornstarch)


Oral & Dental- dental trauma, oral lacerations, gum disease, erosion of tooth enamel

Obstructions & Perforations- gastrointestinal or respiratory tracts- ______________ could be necessary

Other- may be extremely aggressive in their search for these items

- Pushing away peers & caregivers


TreatmentsNutritional Interventions- Iron or

Zinc ________________

Psychological Interventions- Counseling, psychotherapy

Pharmacological Interventions- Selective serotonin reuptake inhibitors (antidepressant drugs)

(All information was obtained from the article Understanding Pica Behavior: A Review for Clinical and Education Professionals by Lillian N. Stiegler; published in the journal Focus on Autism and Other Developmental Disabilities, Vol. 20, Number 1, Spring 2005: p. 27-38)

Behavioral Interventions-

– _________________

– Facial Screening/ Physical Restraint Procedures

– Aversive Substances

– Edible/ Nonedible Discrimination Training

Sensory Approaches- replace bad objects with safe objects of same texture/appearance

(All information was obtained from the article Understanding Pica Behavior: A Review for Clinical and Education Professionals by Lillian N. Stiegler; published in the journal Focus on Autism and Other Developmental Disabilities, Vol. 20, Number 1, Spring 2005: p. 27-38)

eating disorders: def: “psychiatric sickness where food is used to help cope with unsettling...

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