Eating disorders

1
Eating disorders

• Anorexia

2
Eating Disorders

• Def
• Psychiatric sickness where food is used to help
  cope with unsettling emotions and personal life
  issues
• Persistent disturbance of eating behavior or a
  behavior intended to control wt
• Significantly impairs physical health or
  psychosocial fx
• Not secondary to a general medical condition or
  another psychiatric disorder
• Michel and Willard (2003)
• Klein, D.A., Walsh, T.B. (2004). Eating
  Disorders
• Clinical Features and Pathophysiology.
• Physiology and Behavior, 81(2), 359-374.

3
Anorexia

• First described in medical literature in
  __________.
• Main feature relentless pursuit of thinness
  refusal to maintain minimum bodyweight for age
  and height.
• Klein and Walsh (2003)

4
Personality Characteristics

• ________________________
• Greater harm avoidance
• Conscientiousness
• Perfectionism
• Obsession
• Klein and Walsh (2003)

5
Developmental factors

• Onset during adolescence or young adulthood
  rarely begins before _____________.
• Cause psychological reactions to maturing body,
  changing peer relationships, and new life roles.
• Cause Stress
• Klein and Walsh (2003)

6
Clinical Features

• Weight loss usually from reduction in food
  intake, in stages
• _______________
• Meat
• Foods that could potentially contain fat
• As the wt loss carries on, thinness becomes more
  of an obsession.
• Klein and Walsh (2003)

7

• Social avoidance can aid progressive weight loss
• e.g, pts avoid situations where ______________.
• Psych components of starvation include
• Irritability
• Poor concentration
• Fatigue
• Klein and Walsh (2003)

8
Over-Activity

• Forms of excessive physical activity
• Planned sports
• Walking
• Standing
• Maintenance of __________________ (to burn more
  calories)
• Klein and Walsh (2003)

9
Assessment and Diagnosis

• Assessment developmental, past psychiatric
  medical history, current psychosocial fxing
  supports.
• Diagnosis based on behavioral, psychological,
  physical
• Klein and Walsh (2003)

10
Warning Signs of Anorexia

• __________________________
• Frequent weighing
• Sleep difficulties
• Frequent exercising before and after eating
• Use of laxatives
• Michel and Willard (2003)

11

• Loss of menstrual cycle (female)
• Preparing __________________, but not for
  yourself
• Attempts to obtain diet instructions/pills from
  doctors
• Isolation from peers and families
• Michel and Willard (2003)

12
0
BULIMIA
13
DEFINITION OF BULIMIA NERVOSA

• Recurrent episodes of binge eating followed by
  inappropriate behaviors to __________________
  (e.g., self-induced vomiting)
• Klein, D.A., Walsh, T.B. (2004). Eating
  Disorders Clinical Features and
  Pathophysiology. Physiology and Behavior, 81(2),
  359-374.

14
RISK FACTORS

• History of Anorexia Nervosa (AN)
• Familial correlation
• Females age 10-25
• ________________________
• Athletes, models, gymnasts
• Bulimia Nervosa. (2005 September 13). Retrieved
  September 19, 2005 from http//en.wikipedia.org/wi
  ki/Bulimia

15

• Students under stressful workload
• Suffered traumatic events (sexual abuse, child
  abuse)
• ________________
• Personality (higher reactivity)
• Perfectionists/overachievers
• Bulimia Nervosa. (2005 September 13). Retrieved
  September 19, 2005 from http//en.wikipedia.org/wi
  ki/Bulimia

16
SIGNS AND SYMTOMS

• Distorted body image (focus on shape)
• Disturbed eating patterns
• Consuming large amounts of food, then purging
• Poor _____________________
• Dental erosion
• Klein, D.A., Walsh, T.B. (2004). Eating
  Disorders Clinical Features and
  Pathophysiology. Physiology and Behavior, 81(2),
  359-374.

17
DIAGNOSIS

• DSM-IV criteria
• Binge eating (more than usual w/ lack of control)
• Compensatory behaviors
• Purging (vomiting)
• Misusing medication
• Laxatives, diet pills, diuretics
• Weight control
• Fasting, excessive exercise
• At least 2xs/wk for _________

18
SUBTYPES

• PURGING TYPE
• Vomiting

• NON-PURGING TYPE
• No vomiting
• Excessive exercise, fasting

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

19
COMORBIDITY

• Anxiety disorders (onset before BN/AN)
• ________ most common
• Social phobia
• Specific phobia
• Generalized anxiety disorder
• Mood disorders
• Depression
• Kaye, W.H., Bulik, C.M., et al. (2004).
  Comorbidity of Anxiety Disorders with Anorexia
  and Bulimia Nervosa. The American Journal of
  Psychiatry, 161, 2215-2221.

20
TREATMENT

• Respond ________________ to treatment than AN
• 2 treatment approaches
• Short-term (4-6 months)
• Psychological treatment
• Cognitive behavioral therapy
• Long-term
• Anti-depressant therapy

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

21
OUTCOME

• Study showed 5-10 years later.
• 50 patients fully recover
• 20 continued to meet diagnosis
• 30 _________________
• Klein, D.A., Walsh, T.B. (2004). Eating
  Disorders Clinical Features and
  Pathophysiology. Physiology and Behavior, 81(2),
  359-374.

22
FYI

• Can consume up to ____________ calories in a
  single binge episode!
• Eating disorders have one of the highest death
  rates of mental illness
• 1-3 women in US have ED
• Those with BN usually have a normal weight
• More cases of BN than AN

23
Obesity
24
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
25
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)

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
26

• Certain genetic processes
• __________________________
• New research shows that there is a biological
  link between stress the drive to eat. Comfort
  foods seem to calm the bodys response to chronic
  stress.
• Researchers believe that in most cases obesity
  represents a complex relationship between
  genetic, physiological, metabolic, socioeconomic,
  lifestyle, cultural factors.

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
27
Health Risks Associated With Obesity

• Hypertension
• _______________
• Cardiovascular disease
• Cancer

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
28

• Endocrine problems
• Gall bladder disease
• Lung and breathing
• problems
• __________________
• Premature death

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
29
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.

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
Wide Web  http//www.anred.com/obese.html
30

• 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.

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
Wide Web  http//www.anred.com/obese.html
31

• 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 dont give up!!

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
Wide Web  http//www.anred.com/obese.html
32
Pica

• The compulsive, recurrent consumption of
  nonnutritive items

(Steigler, Spring 2005)
33

• 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

(Steigler, Spring 2005)
34

• Only suspected when

• (a) Nonfood items consumed
• repeatedly over month or longer, despite efforts
  to restrain behavior
• (b) Behavior considered inappropriate for
  developmental age (beyond _____________)

(Steigler, Spring 2005)
35

• (c) Not found in _________________
• (d) Behavior is a sx of other mental disorder
  is of sufficient concern to warrant medical
  attention

(Steigler, Spring 2005)
36
Etiologies

• Nutritional Factors- Iron and/or zinc ___________
• Environmental Factors-
• Stressful events
• Impoverished environment
• Lack of active participation in activities
• Insufficient levels of human interaction

(Steigler, Spring 2005)
37

• 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

(Steigler, Spring 2005)
38
Health Risks

• ______________- Lead poisoning
• Parasitic Infections- pinworms (geophagia dirt,
  clay coprophagia feces)
• Malnutrition- could eat substances that cause
  excessive calorie intake (cornstarch)

(Steigler, Spring 2005)
39

• 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

(Steigler, Spring 2005)
40
Treatments

• Nutritional 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)
41

• 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)