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Eating Disorders Anorexia Nervosa and Bulimia Nervosa

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REFUSAL to maintain body weight at or above a minimally normal weight for age ... Increased emphasis on weight/shape, body image distortion, OR denial of the ... – PowerPoint PPT presentation

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Title: Eating Disorders Anorexia Nervosa and Bulimia Nervosa


1
Eating Disorders???????? ?? ???? ?????(Anorexia
Nervosa and Bulimia Nervosa)( ????? ???? ??????
?????? ? ??? ?????? ??????)
  • ACHC. Dubai 2008
  • Dr. Alya Al Merri
  • Canadian Board in Psychiatry

2
Objectives??????? ????????
  • -Epidemiology
  • -Diagnosis and the clinical picture
  • -Pathogenesis and Risk Factors
  • -Treatment
  • -Summary
  • -??? ???? ????????
  • ? ???????
  • ????? ?????
  • ? ?????? ????????
  • -????(????) ?????? ?
  • ???????(??????) ???????? ?? ?????
  • -??????
  • -???????

3
Epidemiology??? ???? ???????? ? ???????
  • Anorexia Nervosa
  • (????? ???? ?????? ?????? )
  • -0.5 prevalence
  • 0?5 ???? ??????? ?? ???????
  • -Onset in mid to late adolescences (age 14-18)
  • ???? ????? ?? ????? ???????? ???????? ? ????????
    ??? ?? 14-18
  • -Mainly affects females (90)
  • 90 ??????? ??? ??????
  • -Debate whether the incidence is increasing
  • ???? ?? ??? ???????? ?????? ?? ???? ??????

4
Epidemiology??? ???? ???????? ? ???????
  • Bulimia Nervosa
  • -1-2 prevalence
  • 1-2 ???? ??????? ?? ???????
  • -Onset in late adolescence/early twenties
  • ???? ????? ?? ????? ???????? ???????? ? ?????
    ?????????
  • -Mainly affects females (90)
  • 90 ??????? ??? ??????
  • -Incidence has been growing
  • ??? ???????? ?? ??????

5
Diagnosis and the clinical picture(DSM-IV
Criteria)????? ????? ? ?????? ????????
????? ???? ?????? ?????? -??? ???? ???????? ???
????? ??? ???? ?????? ??????? ??? ?????? ?? ????
? ????? ???????. -????? ?????? ?? ????? ????? ??
??????. -??????? ?????? ??? ?????? ? ????? ? ?
????? ???? ???? (????) ????? ?? ????? ??? ?????
????? ????? ??????. -?????? ?????? ???????
?????? ????? ???????
  • Anorexia Nervosa
  • -REFUSAL to maintain body weight at or above a
    minimally normal weight for age and height.
  • INTENSE FEAR of gaining weight or becoming FAT.
  • Increased emphasis on weight/shape, body image
    distortion, OR denial of the seriousness of the
    current low body weight
  • Amenrrohea at least for three consecutive
    menstrual cycle

6
  • Subtypes
  • Restricting Type
  • Binge-Eating/Purging Type
  • ???????
  • -????? ??????? ?? ???????? ?????? ??????
  • -????? ?????? ?? ??????? ???????? ?? ?????? ?????
    ??????

7
The clinical picture of Anorexia Nervosa??????
?????? ???????? ?????? ???? ??????
  • Anorexia Nervosa
  • Food restriction
  • ?????? ?????? ??????
  • Excessive exercise
  • ??????? ?? ???????? ????????
  • Preoccupations with food, eating, and calories
  • ??????? ?????? ??????? ? ??????? ? ???????
    ????????
  • Social Isolation
  • ?????? ??????????
  • Mood irritability, Depression, Obsessive-compulsiv
    e behavior
  • ????? ?????? ? ???????? ? ?????? ??????? ??????

8
The clinical picture of Anorexia Nervosa??????
?????? ???????? ?????? ???? ??????
  • Cold intolerance
  • ??? ?????? ??? ???? ?????
  • Lanugo hair and hair loss
  • ????? ??? ????? ?? ????? ??? ?????
  • Poor sleep (early morning wakening)
  • ???????? ?????
  • Dizziness, fainting
  • ?????? ? ???????? ???????
  • Gastrointestinal symptoms, constipation, bloating
  • ?????? ?????? ?????? ?? ????? ? ?????? ???????
    ?????

9
Clinical picture of AN?????? ???????? ????????
  • ?Anorexia Nervosa
  • -5-18 die
  • 5-18 ????? ???????
  • -10-20 have an intractable
  • Course
  • 10-20 ????? ??????
  • -Risk of death increases 5
  • every decade
  • ????? ???? ?????? 5 ?? ?? ??? ?? ?????
  • -Many develop bulimic
  • symptoms (40-50)
  • ???? ??? ?????? ???? ????? ??????
  • -Death is due to suicide in
  • 24-50 of cases, and medical
  • complication in 50
  • ???? ?????? ????? ???????? ?? 24-50 ? ?????????
    ?????? ?? 50

10
Medical Complications????????? ??????
  • ?Anorexia Nervosa
  • -Heart rhythm abnormalities, Heart
  • failure, slow heart rate.
  • ???????? ?? ????? ????? ????? ?
  • ?????? ?? ??? ????? ? ??? ?? ????? ?????
  • -Osteoporosis
  • ???? ??????
  • -Dehydration
  • ??????
  • -Brain shrinkage
  • ??????/???? ??????
  • -Impaired fertility
  • ??? ???????
  • -Death from starvation and
  • Suicide
  • ?????? ????? ??????? ?? ??????? ?? ????????

11
Diagnosis and the clinical picture (DSM-IV
Criteria) ????? ????? ? ?????? ????????
??? ?????? ?????? -?????? ?? ????? ???? ????? ?
???? ?????? ?????? ?? ??????? ???????? -???
?????? ?????? ????? ????? ??????? ? ???? ?????
???? -???????? ?????? ?????? ? ????? ??????? -??
??????? ???????? ? ?????? -???? ??????? ????????
? ??????
  • Bulimia Nervosa
  • Binge eating (large amount of food in short
    period of time AND loss of control) AND
    compensatory behavior (eliminating calories)
  • Binge eating AND compensatory behaviors occur
    twice weekly or three months
  • Increased importance of weight and shape
  • Do not meet criteria for AN (weight is in normal
    range)
  • Subtypes
  • Purging Type
  • Nonpurging Type

12
Clinical picture of BN?????? ???????? ????????
??????
  • Bulimia Nervosa
  • Vomiting, laxatives, diet pills, excessive
    exercise
  • ?????? ?????? ? ??????? ???????? ? ??????
    ???????? ? ??????? ??????? ???????
  • Secretiveness, and shame
  • ?????? ?????? ? ?????? ??????
  • Social isolation
  • ?????? ??????????
  • Mood lability
  • ????? ?????? ???? ????? ?????
  • Preoccupations with food, eating, calories
  • ??????? ?????? ??????? ? ??????? ? ???????
    ????????
  • Russells sign- abrasion on hand from
    self-induced vomiting
  • ????? ???? ??? ? ?????? ?? ???? ????? ?????
    ?????? ?????
  • Enlarged salivary glands
  • ???? ????? ????????

13
Clinical picture of BN?????? ???????? ????????
??????
  • ?Bulimia Nervosa
  • -Patients go untreated
  • for many years
  • ??? ?????? ?????? ? ???????? ?????? ?????
  • -Mortality in BN (5-10 year studies)
  • 6-7 x more than normal population
  • ???? ?????? 6-7???? ???? ??????? ???????
    ?????????
  • -With treatment 50-70 improve,
  • 30 have a poor outcome
  • ?? ?????? 50-70 ??????? ? 30 ???? ??????? ?????
  • -30-50 relapse
  • ???? ????????? 30-50
  • -Generally better prognosis than AN
  • ???? ??? ???? ????? ? ??????? ?????? ???? ??
    ?????? ????? ???? ?????? ??????

14
Medical Complications????????? ??????
  • ?Bulimia Nervosa
  • -Electrolyte abnormalities
  • ??? ????? ??????? (??? ???????? ? ??????????)
  • -Heart rhythm abnormalities
  • ???????? ?? ????? ????? ?????
  • -Dental Damage
  • ???? ???????
  • -Tears to the esophagus
  • ???? ? ???? ?? ??????

15
Pathogenesis and Risk Factors ????(????) ??????
? ???????(??????) ????????
  • Vulnerability((??????? ??????? ??????? ??????
  • ?Female Gender
  • ??????
  • ?Family History (genetics)
  • ??????? ?????? ? ??????? ????????
  • ?Family Dynamics
  • ??????? ??????? ???? ???????
  • ?Childhood obesity and parental obesity
  • ?????? ??? ????? ??????? ? ???? ????????
  • ?Sexual and physical abuse
  • ?Adolescence
  • ?? ????????
  • ?Other Biological Factors
  • Serotonin abnormalities time precedence not
    determined
  • ??? ??????? ?????????? ????????? ?? ?????
    ???????? ???????
  • ???????? ?????? ? ??????

16
Pathogenesis and Risk Factors ????(????) ??????
? ???????(??????) ????????
  • Precipitating Factors (??????? ??????? ??? ????
    ?????)
  • ?Adolescence
  • ?? ????????
  • ?Western Culture/Media
  • ??????? ?????? ?????? ???????
  • ?Stresses
  • ?????? ???????
  • ?DIETING, DIETING, DIETING!!! (?????? ????????)
  • Dieting is often reported as preceding the onset
    of the eating disorder
  • ?????? ???? ?? ???? ???????? ?? ???? ?????
  • ?Profession Related weight control
  • ??? ????? ???? ????? ? ???? ??????? ? ???????

17
Pathogenesis and Risk Factors ????(????) ??????
? ???????(??????) ????????
  • Maintaining Factors ??????? ???? ? ???? ?????))
  • ?Long History
  • ????? ????? ????
  • ?Severe weight loss
  • ????? ????? ??????
  • ?Family Dynamics
  • ??????? ??????? ???? ???????
  • ?Psychological Problems (Depression, anxiety)
  • ?????????? ??????? ?????????? ? ?????
  • ?ThinnessSuccess, and Beauty
  • Personality disorder
  • ?????? ?? ???????
  • ?Substance abuse
  • ??????? ?????? ?????? ??????

18
Treatment??????
  • ?Inpatient/Outpatient
  • ?Multidisciplinary Approach
  • ???? ???? ???
  • ?Psychotherapy and Nutrition Rehabilitation
  • ?????? ?????? ?? ????? ??????? ???????
  • ?Psychotherapy
  • ?Family Therapy
  • ?????? ?????? ???????
  • ?CBT
  • ?????? ?????? ???????
  • ?Biological Treatment

19
Summary???????
  • ?Eating Disorder exists in our culture and is a
    disabling disease
  • ???????? ???? ????? ??? ???? ?? ??????? ?????? ?
    ???? ?????? ?? ?????? ???
  • Need of awareness
  • ?????? ??? ??????? ??????/ ???????

20
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