1. Eating Disorders1 1 Presented by: Nehazia shah 3 rd year Medical Student (SHSU) Psychiatry Rotation Dr. D. Martinez Topics Covered 1.Anorexia nervosa 2.Bulimia nervosa Common psychiatric disorders affecting eating habits of young adolescents world wide

2. Eating Disorders2 http:// drlindamintle.com/wp- content/uploads/2010/06/size0Model_228x 360.jpg http://www.smh.com.au/national/fathers-anger-at-anorexia-death-20090214-87n7.html http://briancuban.com/wp-content/uploads/2008/05/eatingdisorders.jpg http://treatingeatingdisorders.info/ http://www.selfhelptopics.net/buli mia-eating-disorder-2/ http:// www.health-res.com/EX/08-04- 20/1823049.c17b9a51.560.jpg

3. Eating Disorders3 What is anorexia nervosa?  Characterized by failure to maintain a normal or healthy weight.  These individuals have a very bad body image with extreme fear of gaining weight.  They restrict their food intake by either dieting, starving themselves or exercising heavily. [1] “Two Subtypes of Anorexia” [2] a)Restricting Type b)Binge Purging Type  Anorexics are very thin. Their body weight is <85% of that expected [3] and they refuse to maintain normal body weight

4. Eating Disorders4 What is Bulimia nervosa? Characterized by eating a greater amount of food at once and then getting rid of that food by self induced vomiting also known as “binging and purging type” [2] And there are other individuals who will fast or exercise heavily. When bulimics binge they feel they have no control over their food intake [4] Persons with Bulimia are known to abuse laxative or diuretics In bulimics their weight is within normal limits or are over weight. It is common to see fear of weight gain in both anorexic and bulimic patients. [4]

5. Eating Disorders5 http://www.targetwoman.com/articles/binge-eating- disorder.html http://eatingdisorder-clinics.yolasite.com/ Bulimia Nervosa (Examples)

6. Eating Disorders6 Who are at risk? Individuals at risk for eating disorders specifically anorexia are females, those with low self esteem and those of high socioeconomic status. [5] Bulimia is common in females especially those with low self esteem, in addition to that, mood disorders and Obsessive compulsive disorders are usually present. [6]

7. Eating Disorders7 Anorexia (Examples) http://1.bp.blogspot.com/_RaOrchOImw8/TTpAwh-bJzI/AAAAAAAAp- k/FSrG2JqT6s4/s1600/Anorexia+nervosa.jpg http://3.bp.blogspot.com/_RaOrchOImw8/TTpCgqjj1MI/AAAAAAAAp-s/- TLQPuegnlc/s1600/anorexia+nervosa2.jpg

8. Eating Disorders8 Effects/complications Anorexia or bulimia may cause dehydration and other medical complications like heart problems or kidney failure. In extreme cases, eating disorders can lead to severe malnutrition and even death. [7] Anorexia nervosa can cause [2] 1) low blood pressure 2) amenorrhea, 3) thinning of bones, 4) kidney stones, 5) thyroid problems, 6) hair loss 7) fingernail breakage, 8) lightheadedness, 9) inability to concentrate, 10) dry and yellowish skin, 11) growth of fine hair over body, 12) feeling weak and 13) intolerable to cold.

9. Eating Disorders9 Anorexics look at their selves in the mirror and see an image distant from reality http://eatingdisorder-clinics.yolasite.com/ http://www.weightlossexercisediet.com/images/eating-disorders.jpg

10. Eating Disorders10 Complications of Bulimia Constant vomiting and lack of nutrients can cause: [8] Tooth decay (from exposure to stomach acids) Enlarged parotid glands (swelling/redness of cheeks) Scars of the dorsal hand surfaces (from inducing vomiting) Amenorrhea (missing menses for about 3 cycles) Fatigue (feeling lethargic and tired) Electrolyte imbalance ( Imbalance in sodium and potassium levels ) Heart problems such as Arrhythmias

11. Eating Disorders11Eating Disorders11 Treatment For Anorexics - monitor caloric intake to restore nutritional status and to establish weight - then focus on gaining weight - hospitalize if necessary to restore nutritional status [2] - rehydrate and correct electrolyte imbalance - Behavioral therapy should be initiated [2] - Family Therapy is also helpful, “it is designed to reduce conflicts about control by parents” [2] - antidepressants may play a role, when depression is seen

12. Eating Disorders12Eating Disorders12 For both Bulimia and Anorexia - Nutritional counseling is needed Cognitive behavioral therapy (CBT) and Behavioral therapy - (individual or group psychotherapy) Antidepressants medications, especially SSRI [2] (Selective Serotonin Reuptake Inhibitor ex: Celexa, Zoloft, Prozac)

13. Eating Disorders13 Anorexia http:// blog.timesunion.com/highschool/files/2010/03/eating-disorder1.jpg http:// betyudidntknow.blogspot.com/2011/01/did-you-know-what-anorexia- nervosa.html

14. Eating Disorders14 Prevention Parents can help prevent kids from developing an eating disorder by nurturing their self-esteem, and encouraging healthy attitudes towards life, peer pressure, nutrition and appearance [9] If parents develop their own healthy attitudes about food and exercise they can set an excellent example for their kids [7]

15. Eating Disorders15 References: References: [1] http://www.womenshealthcaretopics.com/TeenEatingDisorders.html [2] USMLE Step 2 CK Kaplan lecture notes: psychiatry and epidemiology pg. 67-69 [3] http://en.wikipedia.org/wiki/Eating_disorder [4] http://kidshealth.org/teen/food_fitness/problems/eat_disorder.html [5] http://www.eatingdisorders.org.au/media/key-statistics.html [6] http://www.aafp.org/afp/2003/0115/p297.html [7] http://kidshealth.org/parent/emotions/feelings/eating_disorders.html [8] Nelson Textbook Of Pediatrics - Eighteenth Edition by Robert M & Behrman, Richard E & Jenson, Hal B & Stanton, Bonita F Kliegman (2008) [9] http://www.apa.org/pubs/info/brochures/girls.aspx