1. Eating Disorders

2. Anorexia Nervosa Restricting or Binge-Eating/Purging Type Restricting or Binge-Eating/Purging Type Body weight less than 85% of expected Body weight less than 85% of expected Intense fear of gaining weight Intense fear of gaining weight Disturbance of body image Disturbance of body image Three months without period (for females) Three months without period (for females) Look for hair falling out, wearing large size clothing Look for hair falling out, wearing large size clothing Control and body distortion Control and body distortion

3. Tx of Anorexia Specialized Field due to medical complications Specialized Field due to medical complications Often you will find separation/individuation issues and controlling/ emotionally punishing family system Often you will find separation/individuation issues and controlling/ emotionally punishing family system Help move away from all or nothing thinking Help move away from all or nothing thinking Help increase awareness of feelings and drives Help increase awareness of feelings and drives Antidepressants Antidepressants Louise Ousley (Psychologist) and Marjory Guise (psychiatrist) Louise Ousley (Psychologist) and Marjory Guise (psychiatrist) Work with physician and nutritionist. Cl must be under physicians care Work with physician and nutritionist. Cl must be under physicians care

4. Bulimia Nervosa Purging and Nonpurging Type Purging and Nonpurging Type Typically in the normal weight, but may be over or under weight Typically in the normal weight, but may be over or under weight Binge and Compensation at least twice a week for 3 months Binge and Compensation at least twice a week for 3 months Look at fingers and teeth Look at fingers and teeth Have cl obtain physical for internal organ damage and check potassium levels (cardiac problems can occur) Have cl obtain physical for internal organ damage and check potassium levels (cardiac problems can occur)

5. Cycles of Binge/Purge Usually you will be able to identify triggers as the cycles occur. Often related to family or other relationships. Usually you will be able to identify triggers as the cycles occur. Often related to family or other relationships. Anxiety increases and client seeks to reduce pain with binge Anxiety increases and client seeks to reduce pain with binge Binge reduces anxiety (like a drug), but is quickly followed by guilt and shame and anxiety. However, these emotions are more tolerable than the initial anxiety. Binge reduces anxiety (like a drug), but is quickly followed by guilt and shame and anxiety. However, these emotions are more tolerable than the initial anxiety.

6. Tx of Bulimia Helping Cl to recognize triggers and gain awareness of anxiety Helping Cl to recognize triggers and gain awareness of anxiety Help to “delay” binges Help to “delay” binges Identify other ways to reduce this anxiety Identify other ways to reduce this anxiety Reduce self-criticism Reduce self-criticism Work on Separation/Individuation issues with family Work on Separation/Individuation issues with family Work on self-image aside from body size Work on self-image aside from body size Help find supports and “breaking of secret” Help find supports and “breaking of secret”

7. Tx Bulimia Work with Nutritionist, physician, and at times psychiatrist Work with Nutritionist, physician, and at times psychiatrist Antidepressants Antidepressants

8. Eating Disorder NOS Anorexia Anorexia Normal weight Normal weight Females still have period Females still have periodBulimia -- Purge or compensatory less than frequency required -- Regular chewing and spitting out of food -- Regular binges w/out compensatory Behavior