My Name is ED: Diagnosis, Research and Treatment of Eating Disorders - PowerPoint PPT Presentation

1 / 61
About This Presentation
Title:

My Name is ED: Diagnosis, Research and Treatment of Eating Disorders

Description:

My Name is ED: Diagnosis, Research and Treatment of Eating Disorders Sharon L.Ward, LPC, NCC 104 Maverick Street Aledo, Texas 76008 817-441-9973 lpc.ward_at_yahoo.com * – PowerPoint PPT presentation

Number of Views:218
Avg rating:3.0/5.0
Slides: 62
Provided by: Value730
Category:

less

Transcript and Presenter's Notes

Title: My Name is ED: Diagnosis, Research and Treatment of Eating Disorders


1
My Name is EDDiagnosis, Research and Treatment
of Eating Disorders
  • Sharon L.Ward, LPC, NCC
  • 104 Maverick Street
  • Aledo, Texas 76008
  • 817-441-9973
  • lpc.ward_at_yahoo.com

2
Todays Objectives
  • Review some of the more current statistics and
    literature about eating disorder prevalence,
    etiology and treatment.
  • Acquire a fundamental knowledge of signs
    symptoms.
  • Identify primary modes of treatment.
  • Identify ways you can personally help in the
    fight against Eating Disorders (ED).

3
Signs and Symptoms
  • Anorexia
  • Bulimia
  • Binge or Emotional Eating
  • Eating Disorder NOS

4
Anorexia
  • Intense Fear of becoming fat
  • Refusal or attempted refusal to maintain a normal
    range body weight.
  • Distorted body image
  • Menstrual period delayed or has ceased in
    females
  • (this may be masked by use of birth control
    pills)

5
Bulimia
  • Eating amounts of food that are definitely larger
    than what most people would eat in a similar
    period of time.
  • Inappropriate behaviour to compensate for food
    eaten
  • Self evaluation is unduly influenced by body
    shape/weight
  • Note Weight is usually within a normal range.

6
Binge or Emotional Eating(not recognized by
DSM-IV)
  • Eating amounts of food that are definitely larger
    than what most people would eat in a similar
    period of time often with a sense of being out
    of control.
  • Eating at times when true hunger is not present
    or being unaware when hungry
  • Eating past the point of fullness or not being
    aware of the sensation of fullness.

7
Eating Disorder NOS
  • Criteria for Anorexia met except individual has
    regular menses
  • Criteria met for Anorexia except despite
    significant weight loss, weight is in a normal
    range
  • Criteria for Bulimia met except compensatory
    behaviours are less than 2x week.
  • Normal weight individual regularly uses
    compensatory behaviours after eating small
    amounts of food.
  • Repeatedly chewing or spitting out (but not
    swallowing) food.
  • Note current research suggests that the vast
    majority of young adult women with diagnosable
    eating concerns were covered by the EDNOS
    umbrella. (Choate Schwitzer, 2009)

8
Research and Statistics
9
NIMH Statistics Self Report Published February
2007
  • NIMH funded study of 2,980 adults
  • 1 of women and .3 of men reported having
    anorexia at some time in their lives
  • 1.5 of women and .5 of men reported having
    bulimia at some time in their lives
  • 3.5 of women and 2 of men reported having
    binge-eating disorder at some time.
  • Less than 45 sought specific E.D. treatment. 50
    sought treatment for some kind of emotional
    problem.

10
Numbers in US Population Affected by ED
11
1990s Statistics
  • 5 - 10 million girls and women with anorexia or
    bulimia (still supported by NIMH data)
  • For every 4 females with anorexia, there is one
    male (NIMH shows slight increase)
  • 8-11 females with bulimia there is one male (2001
    data). NIMH now shows 3 to 1 ratio
  • 80 of women report dissatisfaction with their
    appearance 40 50 Billion dollars a year is
    spent on dieting and related products

12
More 1990s Statistics
  • 42 of 1st - 3rd grade girls say they want to be
    thinner
  • 46 of 9 - 11 year olds report dieting
  • 35 of "normal dieters" progress to pathological
    dieting. Of those, 20-25 progress to partial or
    full-syndrome eating disorders (Shisslak Crago,
    1995). Maines Data Suggests 38
  • 129.6 million (roughly 2/3 of adults) are
    overweight

13
From Margo Maines Article for Medscape 2006
  • 20 of women 70 and older are dieting
  • In 2003 1/3rd of women admitted to inpatient
    facilities for eating disorders were 30 and older
    (denial fueled by idea that ED is a teen disease)
  • 60 of women have engaged in pathogenic weight
    control
  • 25 of women reported body dissatisfaction in
    1972, 56 in 1997
  • 40 are restrained eaters

14
Margo Maine (cont.)
  • 40 are overeaters
  • 69 million women in US dieting
  • 50 say their eating is devoid of pleasure and
    causes them to feel guilty
  • 90 worry about their weight
  • ONLY 20 OF WOMEN ARE INSTINCTIVE EATERS

15
Margo Maine (cont.)
  • 1998 Survey of more than 80,000 9th and 12th
    graders in the US found
  • 56 of 9th grade females and 28 of males are
    engaged in unsafe dieting practices (skipping
    meals, diet pills, laxatives, vomiting, smoking
    for the purpose of weight control, binge eating)
  • 57 of females and 31 of males practice
    dangerous dieting with Hispanic and Native
    American students reporting the highest rates.

16
Co-Morbidity
  • 2006 study of 2,436 female inpatients showed
  • 94 mood disorders
  • 56 anxiety disorders
  • 22 substance abuse disorders 2x as likely with
    bulimics
  • OCD, PTSD 2x as likely with binge-purge anorexics
  • schizophrenia/psychosis 3x more likely with
    restricting anorexics
  • More research being done on co-morbidity of
    bi-polar and E.D.

17
Co-Morbidity
  • 2004 Study n600 findings
  • 2/3rds of individuals with ED had one or more
    lifetime anxiety disorder most often OCD.
  • Most participants reported the onset of the
    anxiety disorder prior to the onset of ED.
  • From Margo Maine
  • 5 times more likely to abuse alcohol or drugs
  • Alcohol drug abusing women 11 times more likely
    to have ED

18
Child Maltreatment and Eating Disorders
  • 2006 study of 107 outpatient females Norway
  • Patients who met criteria for bulimia reported
    far more bullying by peers, coldness and
    overprotection by fathers and more childhood
    physical, emotional and sexual abuse
  • 2006 study of 417 US undergrads showed that
    depression is a greater predictor of ED than
    dissociation as the result of childhood abuse.

19
Sexual Trauma ED
  • 2004 study of women participating in a study at
    the Harvard Study of Moods and Cycles showed that
    women who reported child physical and sexual
    abuse were 3x more likely to develop ED symptoms
    and nearly 4x more likely to meet DSM-IV criteria
    for ED.
  • 2005 study (using 1992 data) taken from a pool of
    14,069 women looked at pregnant women in 3
    districts in Avon, UK. Early sexual abuse was
    found to be a significant independent predictor
    of lifetime eating disorder, shape and weight.
    2005 Senior, Emberson Golding British Journal
    of Psychiatry 2005
  • Between 20-50 of women who present with ED have
    experienced previous trauma (includes sexual
    abuse, emotional, physical neglect, abuse,
    separations from caregivers witnessing domestic
    violence) from Margo Maine, 2006

20
Genetics
  • Study of 31,406 subjects in Sweden
  • monozygotic and dizygotic twins
  • Born between 1935 -1958
  • Screened for anorexia and other disorders between
    in 1972-1973 and 1999 2002
  • Findings
  • Genetic factors accounted for 56 of the risk
  • 1.2 women, .29 in men (echoes NIMH data)
  • Increased rate of anorexia during birth period
  • Presence of neuroticism at 1972 screening
    increased likelihood of later anorexia nervosa

21
GeneticsMargo Maine 2006
  • Recent review of genetic studies showed 6 risk
    for ED for those who have a first degree relative
    with ED vs. 1 for those who didnt.
  • Genetics loads the gun. Environment pulls the
    trigger.

22
Warning Signs and Risk Factors
  • Determining if someone has an eating disorder
    requires some detective work

23
Warning Signs Risk FactorsPsychological and
Historical
  • Alexithymia difficulty expressing emotions
  • Difficulty with self calming
  • History of dieting
  • History of abuse
  • Perfectionism
  • Family history of addictive behaviors
  • Intelligent, creative
  • Obsessive thinking
  • Negative body image (beyond weight issue)

24
Warning Signs Risk FactorsPsychological and
Historical (continued)
  • Black and White thinking
  • Low Self Esteem
  • Difficulties within family or other close
    relationships
  • Sense of over-responsibility
  • Need for conformity
  • External Locus of Control

25
Warning Signs Risk FactorsBehavioral
  • Complaining of food allergies
  • Cooking for others but not eating food prepared
  • Fasting
  • Frequent weighing
  • Excess intake of low-fat or healthy foods
  • Wearing oversized clothing
  • Avoiding food in social situations (or avoiding
    social situations where food may be present).

26
Warning Signs Risk FactorsBehavioral
(continued)
  • Criticism of self and others
  • Mood swings
  • Extracurricular activities which involve a focus
    on body size, weight or shape.
  • Repeatedly feeling face, arms, legs for evidence
    of fat.
  • Excessive exercising
  • Self Injury
  • Social Withdrawal
  • Counting calories and or fat grams

27
Warning Signs Physical
Chronic, unexplained medical complaints that may
not have responded to medical treatment
  • Chronic Sore throat
  • Hair loss
  • Dry skin / brittle nails
  • Recurrent stomach problems
  • Dizziness
  • Unexplained problems with the cornea/tear
    production and subsequent scarring 1990 Tufts
    Study
  • Edema (puffy face, ankles also a concern during
    refeeding)
  • Bruising
  • Irregular heart beat
  • Anemia
  • Headaches

28
Warning Signs Physical (continued)
  • Heartburn
  • Pericardial effusion
  • Failure to Heal Properly From Surgery or Injury
  • Body aches / pains
  • Chronic Constipation and or diarrhea
  • Fatigue

29
Warning Signs Physical (continued)
  • Endocrine abnormalities
  • Frequent Urination
  • Amenorrhea
  • Cold intolerance
  • Osteoporosis/osteopenia
  • Salivary gland hypertrophy
  • Timing of puberty
  • Mitral valve prolapse
  • Othostatic hypotension
  • Immune system deficiencies

30
Warning Signs Risk Factors for Men and Boys
  • Teased for being under or overweight
  • Runners, jockeys, wrestlers, body builders,
    gymnasts, divers, swimmers (weight)
  • Models, actors (appearance)
  • Focus onMirror Muscles 6 pack, biceps and
    upper body and not total strength or aerobic
    conditioning
  • Sexual orientation or identity issues
  • Distorted view of muscle size (see muscles as
    smaller than they really are)
  • Hostility (new study 2005)

31
Recognize Healthy Eating vs. Dieting
  • Healthy eating includes all food groups
  • Healthy eating emphasizes balance, variety and
    enjoyment
  • Diets tend to restrict certain food groups
  • Diets limit caloric intake too severely leaving
    the person feeling deprived (which can result in
    eating problems)

32
No, Really. Im a vegetarian
  • Becoming a vegetarian or vegan may at times mask
    an eating disorder. Consider the following
  • What is the motivation to become vegetarian?
  • Did the timing of becoming a vegetarian appear
    with other eating disordered behaviors?
  • What foods wont the person eat and why?
  • What feelings come with not following the
    vegetarian framework?
  • Does vegetarian eating interfere with social
    situations?

33
Treatment
  • A Multidisciplinary approach is imperative for
    the treatment of eating disorders.

34
PSYCHIATRIST
PSYCHOTHERAPIST
DIETITIAN
PHYSICIAN
CARDIOLOGIST
Client
SUPPORT SYSTEM
NURSE
DENTIST
HOSPITAL
FAMILY
SCHOOL
35
Triangulation
  • While a multidisciplinary approach is imperative,
    the dynamics that interfere with healthy
    communication within the clients primary
    relationships can sometimes interfere with
    communication within the treatment team.

36
Medical Screening Issues
  • Basic blood work often is close to or within
    normal range. This often helps someone maintain
    denial.
  • A Full cardiac assessment from someone with
    experience with eating disorders is recommended
    (echocardiogram and stress test in addition to
    EKG)
  • Pituitary tumor or dysfunction should be ruled
    out.
  • ED may appear to be thyroid dysfunction but be
    actually caused by hormone production issues
    caused by ED.
  • ED may also appear to be diabetes insipidus.
    Diabetes Insipidus is not the same as diabetes
    mellitus ("sugar" diabetes).   Diabetes Insipidus
    resembles diabetes mellitus because the symptoms
    of both diseases are increased urination and
    thirst. Diabetes Insipidus is divided into four
    types, each of which has a different cause and
    must be treated differently.  The most common
    type of DI is caused by a lack of vasopressin, a
    hormone that normally acts upon the kidney to
    reduce urine output by increasing the
    concentration of the urine. 

37
Trends in Treatment
  • No one treatment mode shows a remarkably high
    level of effectiveness in the research. This may
    be due to a lack of large, well designed studies.
    2006 Cochrane Collaboration Abstract
  • May also be related to small sample sizes and
    high dropout rates Agras Robinson 2008
  • Some studies show medication as effective, others
    do not. May have to do more with co-morbid
    diagnosis?
  • The best treatment for bulimia helps only 35
    40 of women with this diagnosis NIMH Council
    Minutes 2004
  • Case study on the use of imagery when used in
    conjunction with CBT interesting!

38
Treatment (cont.)
  • Treatment ideally addresses both the eating
    issue, body image and current relationships and
    other psychopathology. Treating one without
    treating the other does not seem to have a good
    outcome.
  • Body image distortion seems to typically be one
    of the last things to change. This means it is
    not the best place to start treatment, especially
    on an outpatient basis.

39
Conceptual Framework
  • 3 Stages of Eating Disorders
  • Preventable
  • susceptible - possible or probable
  • Intermediate
  • symptoms cause some difficulties but do not
    impair daily living
  • Entrenched
  • diagnosable
  • Drum and Lawler (1988) as discussed in the
    article Mental Health Counseling Responses to
    Eating Related Concerns in Young Adult Women A
    Prevention and Treatment Continuum by Laura
    Choate and Alan Schwitzer April 2009

40
Interventions based on Conceptual Framework
  • Prevention
  • Social/cognitive, media literacy and health
    promotion
  • Intermediate
  • Short term psychoeducational groups including
    cognitive behavioural and cognitive dissonance
    strategies. Seems to be more effective than
    prevention intervention.

41
Interventions based on Conceptual Framework
  • Psychotherapeutic Interventions
  • CBT (Cognitive Behavioural Therapy)
  • Focus on present and resolution of symptoms by
    enhancing motivation, incremental behavioural
    change and cognitive restructuring.
  • IT (Interpersonal Therapy)
  • Recommended as alternative to CBT when CBT is not
    effective. Focus on interpersonal issues such as
    conflict, social problem solving.
  • DBT (Dialectical Behaviour Therapy)
  • Developed for work with Borderline Personality
    disorder but has shown effectiveness with ED
    treatment.

42
Maudsley
  • Developed by a team of psychiatrists and
    psychologists at the Maudsley Hospital, London.
  • Developed and used primarily with Anorexic
    Adolescents.
  • Focus is on refeeding within an emotionally
    supportive environment at home.
  • Research outcomes encouraging.
  • www.maudsleyparents.org

43
How Does Disordered Eating Develop?
44
Shadow Development
IMAGINATION
PHYSICALLY ACTIVE
GUILT
JOYFUL
CURIOUS
LAUGHING
INTELLIGENT
FORGIVING
CRYING
TRUSTING
FEAR
CREATIVE
NEED FOR SAFETY
AMAZEMENT
VULNERABILITY
ANGER
SADNESS
SPONTANEOUS
HUNGRY
ABILITY TO SAY NO
45
Shadow Development
IMAGINATION
PHYSICALLY ACTIVE
GUILT
JOYFUL
CURIOUS
RULES CONFORM BE THIN DONT FEEL DO MORE
LAUGHING
INTELLIGENT
FORGIVING
CRYING
TRUSTING
FEAR
CREATIVE
NEED FOR SAFETY
AMAZEMENT
VULNERABILITY
ANGER
SADNESS
SPONTANEOUS
HUNGRY
ABILITY TO SAY NO
46
How Does This Disconnect Happen?
CULTURAL PRESSURE
PEERS
STUDENT
INDIVIDUAL VULNERABILTY
FAMILY DYNAMICS
FEELS BAD
MALADAPTIVE BEHAVIOR
GUILT, SHAME (cumulative)
TEMPORARY RELIEF
47
Remember That Disordered Eating is Not About Food
  • The disordered eating behavior is a specialized
    language.
  • An unlabeled discomfort or complex concern gets
    translated into the Language of Food and/or Fat.

48
How to Ask About ED
  • Avoid questions that would give tips about new
    ways to practice an eating disorder. Instead
    try
  • How much would you think you should weigh?
  • How do you feel about your present weight?
  • Are you concerned, or is anyone else concerned
    about your eating or exercise habits?
  • What have you used (or thought about using) to
    deal with your weight concerns?

49
More Questions You Can Ask
  • How has your weight changed over the years?
  • How do you manage your weight now?
  • What did you eat yesterday? (24 hour recall)
  • How much do you worry about weight, body size or
    parts and eating ( or scaling question)
  • To whom do you find yourself comparing yourself?

50
Help Clients Learn the Language of Feelings
  • Listen
  • Validating feelings or body perceptions doesnt
    mean you agree with them. Negating these
    observations contributes to Shadow Development.
  • Remind clients that managing feelings is
    different from not having them.

51
Handy Facts about ED to share with Clients
  • Weight alone is not a solid indicator of health
    (either physical or emotional)
  • ED slows metabolism (because the body is trying
    to conserve itself) and makes it more likely that
    the person will gain weight. It is EDs trick to
    keep you invested in him!
  • ED reduces the nutrients going to the brain which
    affects mood, interpersonal effectiveness and
    overall perception.

52
General Tips forFamilies Friends
  • Talk to the person in private
  • Never confront eating behavior at mealtime
  • Get parents or significant others involved.
    Al-Anon is a good, free support resource for
    them.
  • Do not bargain, bribe, plead, threaten, nag or
    argue with the sufferer to get them to eat.
  • Do not become the food police.
  • Discourage other kids from monitoring a child
    they are concerned about.

53
General Tips for Families Friends
  • If discussing consequences of Eating Disorders,
    focus on short term long term is often seen as
    irrelevant.
  • Reflect concern about specific behavioral changes
    before approaching the eating issue. If other
    students are worried about a friends eating,
    encourage them to focus on behavior/social
    changes, not food.

54
So Now That We Know What to Look For
  • What Can We Do To Help?

55
Provide Education about Real Growing and Changing
Bodies
  • 40 - 80 of body shape is genetic
  • Pre-pubertal girls will typically gain weight
    this is normal and necessary
  • Challenge peer norms about weight and dieting
  • Dieting (which is not the same as healthy eating)
    can stunt growth and can alter metabolism for life

56
Challenge How You Others Talk About Your Own
Bodies
  • Does this make my rear end look big?
  • I cant believe I ate that. Ill have to make
    up for it tomorrow!
  • I wish I looked like ____
  • I wish I could have an eating disorder for just
    a little while!
  • Eat that now, because when you get to be my
    age

57
Take the Challenge!
  • Try to go for a whole meal with your friends and
    not once talk about food, fat grams, calories,
    carbs, bodies or diets. Challenge each other to
    come up with more interesting topics!
  • Limit good food, bad food talk. Food isnt
    good or bad it depends on how we use it.

58
Be Media Literate!
  • A person who is Media Literate
  • Can describe the role the media plays in their
    life and use it wisely
  • Enjoys their use of media in a deliberately
    conscious way by understanding the impact of
    music and photographic special effects which
    prevent them from being unduly credulous or
    becoming unnecessarily frightened
  • The media literate person is in control of his or
    her media experiences

59
Help Kids See the Whole Picture
  • Not all good or all bad
  • Very young children can begin to critique
    advertising what is true, what is a trick etc.
  • Take kids on-line to age-appropriate media
    literacy sites.
  • Deficiency sells

60
Clients Say These Things Have Been Helpful.
  • Encouragement and validation
  • Education about the process that leads to eating
    disorders and the recovery process
  • Permission to express feelings
  • Not talking about food or stressful issues at
    mealtime
  • Not commenting on appearance (positive or
    negative)
  • Blind weighing reduces obsession with numbers
  • Peer support/support groups

61
And There is Hope...
  • Every person participating in this webinar will
    either be personally affected by or will be in a
    relationship with someone that has disordered
    eating during their lifetime.
  • The time and energy that you have given today is
    a significant step in helping these men, women
    and children. Thank you.
Write a Comment
User Comments (0)
About PowerShow.com