Eating Disorders (EDs)

Anorexia Nervosa (AN) The condition usually begins in adolescents, most often between the age of 16 and 17, with intense wish to be thin, fear of being fat, and the patient has distorted body image. Some try to achieve weight loss by induced vomiting, excessive exercise and misusing laxatives. Amenorrhea is one of the several physical features of the disorder, but depressive symptoms, liability of mood and social withdrawal are all common

Diagnoses: (DSM IV criteria) body weight is less than 85% of the expected(loss 15% of body weight) Intense fear of fatness. disturbance of body image amenorrhea, the absence of at least three consecutive menstrual cycles Two types can be specified: restrictive type: with reducing food intake and prolonged fasting binge eating type-purging type: with episodes of taking big amounts of food (binge eating ) then self induced vomiting (purging ).

Epidemiology Anorexia Nervosa is estimated about 1% of adolescent girls, it occurs times more often in females than in males. The disorder reported among the upper social classes, in developed countries and among young women in professions that require thinness, such as modeling and ballet.

Bulimia Nerovsa (BN) * Recurrent episodes of binge eating (eating a large amount of food given the context with an associated sense of loss of control) *Recurrent inappropriate compensatory behavior (purging, fasting, excessive, exercise) *Binge eating and compensatory behavior occur at least 2 times per week *Clients are usually normal body weight or overweight

Bulimia Bulimia is a psychological eating disorder defined by food binges, or recurrent episodes of significant overeating, that are accompanied by a sense of loss of control.

Bulimia Statistics Bulimia affects about 10% of college age women in the United States. About 10% of individuals diagnosed with bulimia are men. 10% of individuals suffering from bulimia will die from either starvation, cardiac arrest, other medical complications, or suicide.

Compensatory behaviors like: Self-induced vomiting Excessive exercise Abuse laxatives Diuretics Enemas in order to prevent weight gain

Causes The exact cause of bulimia is unknown Family problems Hypothalamic dysfunction: suggested a primary disorder of hypothalamus Social causes: most cases appear in school girls, female college students who have concern about their body shape and weight, especially in the middle and upper social class Perfectionist personality Overemphasis on physical appearance Associated with depression

Symptoms Binge eating Self-induced vomiting Inappropriate use of diuretics or laxatives Overachieving behavior Intense fear of gaining weight or becoming fat.

Subtypes of BN Purging type Person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas Non-purging type Person regularly engages in other inappropriate compensatory behavior— fasting or excessive exercise

Signs and Tests Dental Cavities Gum infections(such as Gingivitis( Teeth may be eroded or pitted because of excessive exposure to acid in vomitus Electrolyit imbalance(such as hypokalimia( Dehydration

Who’s at Risk for AN and BN? Adolescents Athletes Appearance focused professionals

Demographic Factors Females comprise 95% of those with EDs Onset of AN ranges from pre-puberty to the 30s, but generally occurs between Onset of BN typically begins during late adolescence or early adulthood

Statistical Data 10-18% mortality rate Highest mortality rate of any of the psychiatric disorders Death most frequently occurs by starvation, electrolyte disturbances, or suicide People who have had the disease greater than 20 years have a 20-25% increased mortality rate Long term data—no more than 50% recover completely

Risk Factors

Psychological Factors Low self-esteem Perfectionism and unrealistically high standards Difficulties in self-soothing and mood modulation

Biological Factors 8 times the risk if family member has ED 50% concordance in monozygotic twins, 15% for dizygotic A family history of mood or anxiety disorders or OCD increases the risk of EDs

Biological Factors Many neurochemical changes occur with EDs Low NE levels are seen in clients during periods of restricted intake High levels of 5-HT and its precursor tryptophan have been linked to satiety Low levels of 5-HT have been found in clients with BN and the binge-purge subtype of AN

Family Factors AN Family is rigid about values and rules Overprotective Unable to deal with conflict BN Family is chaotic with loose boundaries Perceived as less caring Unrealistic expectations for achievement Parental concerns with weight

Sociocultural Factors Cultural ideal of being thin Media focus on beauty, thinness, and fitness Chronic dieting, particularly among young women

Comorbid Illnesses

AN Depression Dysthymia OCD/OCPD Anxiety Disorders Avoidant PD

Comorbid Illnesses BN Depression Dysthymia Substance abuse Avoidant PD

Medical Complications of EDs Related to Weight Loss

Dermatologic Complications Dry skin Lanugo-like hair Alopecia Brittle nails Pale skin Cyanosis

Cardiac Complications Low heat rate—30-40s common Low BP Decrease in heart size CHF—biggest risk factor for death MI Arrhythmias Death

Hematologic Complications Leukopenia Anemia Thrombocytopenia Hypercholesterolemia

Neuropsychiatric Complications Abnormal taste sensation Apathetic depression Mild organic mental sx Sleep disturbances

Medical Complications of EDs Related to Purging

Metabolic Complications Electrolyte abnormalities Particularly hypokalemia and hypomagnesemia Elevated BUN

GI Complications Salivary gland enlargement Pancreatic inflammation with elevated serum amylase Esophageal irritation Gastric erosion

Dental Complications Erosion of dental enamel

Neuropsychiatric Complications Seizures Mild neuropathies Fatigue Weakness Mild organic mental sx

Treatment of EDs

First establish a good relationship with the patient in order to inverse the physical and psychological effects of starvation * Admission is needed if weight loss is more than 45% * Restoring weight at least three thousand calories daily *Behavior principles are used *Family therapy *Cognitive therapy *Self help groups *Antidepressant drugs

CBT Use strategies designed to change the client’s thinking (cognition) and actions (behaviors) about food Focus on: Interrupting the cycle of dieting, binging, and purging Altering dysfunctional thoughts and beliefs about food, weight, and body image

Recovery Long-term study of AN 50% fully recovered 25% had intermediate outcomes 10% still met criteria for AN 15% had died of causes r/t AN Best indicator for recovery is return of menses

Recovery 50 % recover fully 20% continue to meet criteria for BN 30% have episodic bouts Death rate with BN is estimated to be 0- 3%