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Eating Disorders:  Def:  “Psychiatric sickness where food is used to help cope with unsettling emotions and personal life issues”  Persistent disturbance.

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Presentation on theme: "Eating Disorders:  Def:  “Psychiatric sickness where food is used to help cope with unsettling emotions and personal life issues”  Persistent disturbance."— Presentation transcript:

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

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 ______________________________ MeatMeat Foods that could potentially contain fatFoods 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 ______________.e.g, pts avoid situations where ______________.  Psych components of starvation include: IrritabilityIrritability Poor concentrationPoor concentration FatigueFatigue Klein and Walsh (2003)

8 Over-Activity:  Forms of excessive physical activity: Planned sportsPlanned sports WalkingWalking StandingStanding Maintenance of __________________ (to burn more calories)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)

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13 DEFINITION OF BULIMIA NERVOSA Recurrent episodes of binge eating followed by inappropriate behaviors to __________________ (e.g., self-induced vomiting ) 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),

14 RISK FACTORS History of Anorexia Nervosa (AN) History of Anorexia Nervosa (AN) Familial correlation Familial correlation Females age Females age ________________________ ________________________ Athletes, models, gymnasts Athletes, models, gymnasts Bulimia Nervosa. (2005 September 13). Retrieved September 19, 2005 from

15 Students under stressful workload Students under stressful workload Suffered traumatic events (sexual abuse, child abuse) Suffered traumatic events (sexual abuse, child abuse) ________________ ________________ Personality (higher reactivity) Personality (higher reactivity) –Perfectionists/overachievers Bulimia Nervosa. (2005 September 13). Retrieved September 19, 2005 from

16 SIGNS AND SYMTOMS Distorted body image (focus on shape) Distorted body image (focus on shape) Disturbed eating patterns Disturbed eating patterns –Consuming large amounts of food, then “purging” Poor _____________________ Poor _____________________ Dental erosion Dental erosion Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2),

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

18 SUBTYPES PURGING TYPE PURGING TYPE –Vomiting NON-PURGING TYPE 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), and Pathophysiology.” Physiology and Behavior, 81(2),

19 COMORBIDITY Anxiety disorders (onset before BN/AN) Anxiety disorders (onset before BN/AN) –________ most common –Social phobia –Specific phobia –Generalized anxiety disorder Mood disorders 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,

20 TREATMENT Respond ________________ to treatment than AN Respond ________________ to treatment than AN 2 treatment approaches: 1.Short-term (4-6 months) Psychological treatment Psychological treatment Cognitive behavioral therapy Cognitive behavioral therapy 2.Long-term Anti-depressant therapy Anti-depressant therapy  Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2),

21 OUTCOME Study showed 5-10 years later…. 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), Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2),

22 FYI Can consume up to ____________ calories in a single binge episode! Can consume up to ____________ calories in a single binge episode! Eating disorders have one of the highest death rates of mental illness Eating disorders have one of the highest death rates of mental illness 1-3% women in US have ED 1-3% women in US have ED Those with BN usually have a normal weight Those with BN usually have a normal weight More cases of BN than AN 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), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Web:

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), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Web:

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 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. Brownell, K.D., Foster, G.D., Wadden, T.A. (2002). Obesity: Responding to the Global Epidemic. Journal of Consulting and Clinical Psychology, 70 (3), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Web:

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), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Web:

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), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Web:

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), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Wide Web:

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), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Wide Web:

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 – don’t 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), Anorexia Nervosa and Related Eating Disorders, Inc. (2002). Retrieved September 13, 2005 from the World Wide Wide Web:

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 (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: (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 )

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 )


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