1. Eating Disorders Anorexia and Bulimia: Symptoms, Sequelae, Causes and Strategies Presented by Christopher Haymaker, Ph.D. Northeast Iowa Family Medicine Residency Program October 15, 2014

2. Eating Disorder Facts  Begins in adolescence  Approximately 1% of female adolescents;  Lifetime prevalence approaches 5%  More common on college campuses  More women than men  Mortality rate greater than 10%

3. Anorexia Criteria (DSM-V)  Restriction of energy intake relative to requirements  Intense fear of gaining weight or becoming fat  Disturbance in body image or self- evaluation based on body image  Restricting versus Binge/Purge  Severity Specifiers tied to BMI

4. Bulimia Criteria (DSM-V)  Recurrent episodes of binge eating  Inappropriate compensatory behavior  Binge/compensatory behavior occurs frequently  Self evaluation unduly shaped by bod image and weight  Severity specifier based on frequency

5. Anorexia Symptoms/Sequelae  Depression  Anxiety  Irritability  Obsession with food  Low Energy  Slower thinking

6. Anorexia Sequelae (2)  Low Hormone Levels  Amenorrhea  Protein Loss  Dehydration  Decrease in Liver Function  Heart Problems

7. Anorexia Sequelae (3)  Electrolyte Imbalance  Damaged Hair  Thick Body Hair  Hematology: Leukopenia, Anemia, thrombocytopenia

8. Anorexia Sequelae (4)  Heart Damage  Failure to Accumulate Bone Mass  Osteoporosis  Death

9. Bulimia Symptoms/Sequelae  Electrolyte Abnormalities (Which may have cognitive and physical affects)  Scarring of the hand  Menstrual Irregularity/Amenorrhea  Metabolic Alkalosis  Cardiac and Skeletal Myopathy (Ipecac)

10. Bulimia Sequelae  Metabolic Acidosis (Laxatives)  Erosion of Upper GI  Laxative Dependence  Osteoporosis  Potentially Fatal Complications

11. The Cycle of Escape Fear of Fat Dieting behavior Result: Escape from Fear (Momentarily) Escape increases fear

12. The Cycle of Addictive Brain Chemistry Guilty Feelings about Purging Bad Feelings Eating Activation of Parasympathetic Improved Mood Guilty Feelings about Eating Purging Release of Endorphins

13. Inpatient hospitalization from Society for Adolescent Medicine One or more of the following:  Sever malnutrition (<75% average body weight for age, sex, height)  Dehydration  Electrolyte disturbance  Cardiac Dysrythmia  Physiologic Instability (Brydycardia, Hypotention, Orthostatic Changes)

14.  Arrested growth/development  Failure of outpatient treatment  Acute food refusal  Uncontrollable binging and purging  Acute medical complications of malnutrition  Acute psychiatric emergency  Comorbid diagnosis

15. Treatment modalities  During acute phase, stabilize medically and make use of behavioral therapy  Once medically stable, intensity of treatment depends on severity  When possible, involve the family  When possible, CBT  Medical monitoring is important for long term outcomes

16. Treatment  Must regain weight  Reduce disordered behavior  Change cognitions  Deconstruction of unrealistic body image  New coping techniques

17. Risk Factors  Individual  Familial  Group  Societal

18. Individual Risk Factors  Stress (Life Transition)  Distorted Cognition  Low Interoceptive Awareness  Greater Dissatisfaction with Body Shape  Positive Attributes

19. Familial Risk Factors  No one specific factor  Transmission of body image from mother to daughter  Higher incidence of weight problems, alcoholism, and physical illness in families of children with eating disorder

20. Group Risk Factors  Competition  Social reinforcement  Shared Features  Sports

21. Societal Risk Factors  Increased concern about body image  Concern with weight loss  Increased concern at younger age  Why?

22. Body Image and Beauty  Focus on physical beauty  Ascription to slender body image  The choice between healthy and beautiful

23. Media  Media link body shape to happiness, love and success for women  Effect of repeated exposure  Unattainable ideal  Disproportionate focus on weight loss  Focus on superficial beauty  Morality messages

24. 90% of Girls own a Barbie

25. Miss Diet? Insert photo of Miss Diet

26. What’s the message from Calvin Klein? Photo to go here

27. What’s the message from Guess? Photo goes here

28. What’s the message from Gucci? Photo goes here

29. What’s the message from Lycra? 7 women photo shot