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Eating Disorders

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Hoarding food, loves to cook, saves recipes. Preoccupation with food, calories, nutrition ... Eating more rapidly than normal. Eating until uncomfortably full ... – PowerPoint PPT presentation

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Title: Eating Disorders


1
Eating Disorders
  • 7.5.2006

2
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,
    even though underweight
  • Disturbance in the way in which ones body weight
    or shape is experienced, undue influence of body
    weight or shape on self-evaluation, or denial of
    the seriousness of the current low body weight
  • In postmenarcheal females, amenorrhea is present
    (A woman is considered to have amenorrhea if her
    period occur only following hormone)

3
Subtypes of Anorexia Nervosa
  • Restricting Type During the current episode,
    the person has not regularly engaged in
    binge-eating or purging behavior (i.e.
    self-induced vomiting, laxatives, diuretics, or
    enemas)
  • Binge-Eating/Purging Type During the current
    episode, the person has regularly engaged in
    binge-eating or purging behavior (i.e.
    self-induced vomiting, laxatives, diuretics, or
    enemas)

4
Facts about Anorexia Nervosa
  • Prevalence Approximately 0.8 (females
    lifetime)
  • Gender 90 female, 10 male
  • Age of Onset Early adolescence, ages 13-18
  • Course With treatment
  • 1/3 complete remission
  • 1/3 symptoms turn to BN or EDNOS
  • 1/3 chronic symptoms
  • 30-50 transition from restricting
    subtype to binge-eating/purging type

5
Associated Features
  • Death
  • Due to suicide and physiological complications
  • Mortality rate for people with Anorexia Nervosa
    is about 10 - the highest of any mental illness
  • Mortality rate among female anorexics is 12 times
    higher than for females aged 15-24 in the general
    population
  • Comorbidity
  • Depression 68 of people with Anorexia Nervosa
    also suffer from Major Depressive Disorder
  • Obsessive-Compulsive Disorder
  • Substance Use Disorders (not with restricting
    anorexics)
  • Self-harm behaviors

6
Associated Features
  • Rigidity and Perfectionism
  • Hoarding food, loves to cook, saves recipes
  • Preoccupation with food, calories, nutrition
  • Ritualistic eating and exercising
  • Frequent checking of weight/shape, scrutinizing
    self
  • Deviousness in defeating efforts to help the
    patient gain weight
  • Low self-esteem, shame
  • Poor performance in school, withdrawal from
    relationships
  • Pride

7
Medical Complications
  • Amenorrhea
  • Lanugo
  • Thin, brittle hair and/or hair loss
  • Dry skin
  • Pale, yellowish complexion
  • Sensitivity to cold
  • Low blood pressure
  • Resulting in fatigue, dizziness, and feeling
    faint
  • High cholesterol
  • Serious bone loss, seems to be irreversible

8
Medical Complications
  • Anemia
  • Electrolyte and mineral imbalances
  • Low levels of Potassium
  • Results in heart arrhythmias
  • Reduced immune system functioning
  • Kidney damage
  • Slowed heart rate
  • Heart failure

9
Bulimia Nervosa
  • A. Recurrent episodes of binge eating. An episode
    of binge eating is characterized by both of the
    following
  • 1. Eating, in a discrete period of time, an
    amount of feed that is definitely larger than
    most people would eat during a similar period of
    time and under similar circumstances
  • 2. A sense of lack of control over eating during
    the episode (e.g. a feeling that one cannot stop
    eating or control what or how much one is eating)

10
Bulimia Nervosa
  • B. Recurrent, inappropriate compensatory behavior
    in order to prevent weight gain (e.g.
    self-induced vomiting, laxatives, diuretics,
    fasting, excessive exercise)
  • C. The binge eating and inappropriate
    compensatory behaviors both occur, on average, at
    least twice a week for 3 months
  • D. Self-evaluation is unduly influenced by body
    shape and weight
  • E. The disturbance does not occur exclusively
    during episodes of Anorexia Nervosa

11
Subtypes of Bulimia Nervosa
  • Purging Type During the current episode, the
    person has regularly engaged in self-induced
    vomiting or the misuse of laxatives, diuretics,
    or enemas
  • Nonpurging Type During the current episode, the
    person has used other inappropriate compensatory
    behaviors, such as fasting or excessive exercise,
    but has not regularly engaged in self-induced
    vomiting, or the misuse of laxatives, diuretics,
    or enemas

12
Facts about Bulimia Nervosa
  • Prevalence 1-3 (females lifetime)
  • Gender 90 female, 10 male
  • Age of Onset Late adolescence early adulthood
  • Course Chronic or episodic, symptoms may
    remit over time

13
Associated Features
  • Comorbidity
  • 63 of people with Bulimia Nervosa also suffer
    from Major Depressive Disorder
  • Substance Use Disorders
  • Self-harm behaviors
  • Impulsivity and risk taking
  • Hoarding food, may lead to stealing food
  • Shame, guilt, self-deprecation
  • Intense efforts to hide bingeing and purging

14
Medical Complications
  • Electrolyte Imbalances
  • Low levels of Potassium leads to heart
    arrhythmias
  • Low blood pressure (fainting, dizziness, fatigue)
  • Seizures
  • Loss of tooth enamel
  • Mouth ulcers, tears to the throat, and cavities
  • Calluses to hands
  • Small red dots around the eyes
  • Swollen salivary glands
  • Gastro-intestinal problems

15
Sociocultural Factors and Eating Disorders
  • Over the past 40 years, the number of full-body
    shots of women on the covers of popular fashion
    magazines has significantly increased
  • Over the past 20 years, there has been a
    significant decrease in the overall body size of
    models pictured
  • Between the years 1959 and 1988, the overall body
    size of Playboy models and Miss America
    contestants has significantly decreased,
    eventually leveling off at approximately 13-19
    below their expected/ideal body weights.

16
Sociocultural Factors andEating Disorders
  • Social Comparison
  • Comparing ones own body to that of others,
    especially others in positions of power
  • Internalization of the thin ideal
  • Taking on the belief that women need to be thin
    to be beautiful as your own
  • Self-objectification
  • Viewing ones body as an object, as if from a
    third persons perspective
  • Self-discrepancy
  • Discrepancy between actual and ideal selves?
  • Discrepancy between actual and ought selves?

17
Cultural Factors
  • Thought to be a White, Upper-middle class
    disorder
  • Increasing rates in other ethnic groups in the
    U.S.
  • Also prevalent in more countries that are more
    Industrialized or Western South Africa, Japan,
    Hong Kong, Taiwan, Singapore, India, Iran, China,
    Korea, Argentina
  • Beckers study of EDs in Fiji
  • Essentially there were no cases of eating
    disorders prior to the introduction of
    television, rates of eating disorders increased
    dramatically in about 5 years

18
Cultural Factors
  • Clinical Features seem to differ across countries
  • 58 of Anorectics in Hong Kong are not
    excessively concerned about fat, but stomach
    bloating
  • Young women in Ghana emphasized religious ideas
    of self-control and denial of hunger
  • Japanese women report lower levels of
    perfectionism and less of a drive for thinness
  • Cultural and historical evidence supports the
    theory that Anorexia is less culture-bound than
    Bulimia Nervosa

19
Risk Factors
  • Personal
  • Internalization of the thin ideal
  • Body Dissatisfaction
  • Dieting
  • Negative affect
  • Perfectionism
  • Childhood abuse
  • Low self-esteem
  • Genetics
  • Risk of Anorexia Nervosa is 11.4 times greater
    than for the relatives of normal controls
  • Risk of Bulimia Nervosa is 3.7 times greater than
    for the relatives of normal controls

20
Risk Factors
  • Family Influences
  • Family dysfunction
  • Preoccupation with desirability of thinness,
    dieting, and physical appearance
  • Anorexia Nervosa
  • Rigidity
  • Parental Overprotectiveness
  • Excessive control
  • Marital discord
  • Bulimia Nervosa
  • High parental expectations
  • Other family members dieting
  • Critical comments from family members about
    shape, weight, or eating

21
Eating Disorder Not Otherwise Specified (EDNOS)
  • Possibilities
  • For females, all of the criteria for Anorexia
    Nervosa are met except that the individual has
    regular menses
  • All of the criteria for Anorexia Nervosa are met
    except that, despite significant weight loss, the
    individuals current weight is in the normal
    range
  • All of the criteria for Bulimia Nervosa are met
    except that the binge eating and compensatory
    behavior occur at a frequency of less than twice
    a week or for a duration of less than 6 months

22
Eating Disorder Not Otherwise Specified (EDNOS)
  • Possibilities
  • 4. The regular use of inappropriate compensatory
    behavior by an individual of normal body weight
    after eating small amounts of food
  • 5. Repeatedly chewing and spitting out, but not
    swallowing, large amounts of food
  • 6. Binge-eating disorder

23
Binge Eating Disorder
  • Recurrent episodes of binge eating (large amounts
    of food and loss of control) characterized by
  • Eating large amounts of food when not physically
    hungry
  • Eating more rapidly than normal
  • Eating until uncomfortably full
  • Eating alone because embarrassed about the
    quantity of food being consumed
  • Feeling guilty, depressed, or disgusted with ones
    self afterwards
  • Absence of regular use of inappropriate
    compensatory behaviors characteristic of Bulimia
    Nervosa

24
Facts about Binge Eating Disorder
  • Prevalence
  • Gender
  • Age of Onset
  • Course
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