A POWERPOINT PRESENTATION FOR EATING DISORDERS

READ AND YOU WILL LEARN ABOUT EATING DISORDERS

1. EATING DISORDERS

2. TYPES OF EATING DISORDERS Anorexia Nervosa Bulimia Nervosa Eating Disorder Not Otherwise Specified

3. Anorexia Nervosa

4. Diagnostic Criteria Refusal to maintain body weight at or above a minimally normal weight for age and height Intense fear of gaining weight or becoming fat, even though underweight Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight In postmenarcheal females, amenorrhea, ie , the absence of at least 3 consecutive menstrual cycles

5. Types Restricting type Binge eating/purging type

6. Types of Anorexia Restricting Weight loss achieved by restricting calories Following diets, fasting, and exercising to excess Binge/Purging Weight loss achieved by vomiting, laxatives, or diuretics

7. O nset Late adolescence (14-18 years old)

8. I ncidence Women (95%) > Men 0.5%-1% of women 15-30 yo 85% develop anorexia <20 yo Women who usually are bright achievers

9. Defense Mechanisms Denial Displacement Projection Rationalization Regression Isolation Intellectualization

10. Warning Signs Drastic weight loss in the presence of unusual eating habits Obsession with neatness or personal appearance, including frequent mirror gazing Hostility and the desire to control others

11. Warning Signs Calorie counting, dieting, and excessive exercise or hyperactivity Weighing herself several times Amenorrhea or irregular menses Wearing loose-fitting clothing to hide her physical appearance Denial of hunger

12. Signs AND Symptoms Dry, flaky, or cracked skin Brittle hair and nails, hair beginning to fall out Amenorrhea or menstrual irregularity Constipation Hypothermia Decreased pulse, blood pressure, and BMR Skeletal appearance, BMI of 16 below

13. Signs AND Symptoms Presence of lanugo Intense fear of becoming obese Distorted body image Loss of appetite Callus formation on finger ( Russell’s sign ) Dental caries Total lack of concern about symptoms

14. Psychological and Behavioral Effects Distorted perception of self Preoccupation with food OCD Depression Forgetfulness Denial of issue

15. C omplications Cardiovascular: arrhythmias, hypotension, congestive heart failure, mitral valve prolapse, fluid and electrolyte imbalance, sudden cardiac death Dermatologic: hair loss, lanugo-like hair, dry skin, brittle hair and nails, petechiae , purpura Endocrine: delayed onset of puberty, amenorrhea, growth retardation, elevated growth hormone levels, abnormal serotonin metabolism

16. C omplications Gastrointestinal: delayed gastric emptying, gastric dilatation and rupture, refeeding pancreatitis, possible elevated liver enzymes Hematologic: anemia, leukopenia, thrombocytopenia, low erythrocyte sedimentation rate, folate and iron deficiency Metabolic: osteoporosis, osteopenia, increased plasma cholesterol and carotene Others: impaired thermoregulation, hypofibrinogenemia

17. BULIMIA NERVOSA

18. Diagnostic Criteria Recurrent episodes of binge eating 1. eating in a discrete period of time 2. lack of control over eating Recurrent inappropriate compensatory behavior in order to prevent weight gain

19. Diagnostic Criteria The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months Self-evaluation is unduly influenced by body shape and weight The disturbance does not occur exclusively during episodes of anorexia nervosa

20. Types Purging type Nonpurging type

21. O nset Late adolescence or early adulthood

22. Incidence Women > Men 1 %- 3 % of women

23. Signs AND Symptoms Binge eating episodes Preoccupation with body weight and dieting Lack of weight gain despite binge eating Strange eating rituals Eating in secret Using the bathroom frequently after meals Vomiting or purging

24. Signs AND Symptoms Binge eating episodes Preoccupation with body weight and dieting Lack of weight gain despite binge eating Strange eating rituals Eating in secret Using the bathroom frequently after meals Vomiting or purging Bad breath and teeth problems Chronic sore throat Swollen glands or cheeks Intestinal problems Irregular menstrual periods Depression or mood swings Abuse of drugs or alcohol Dry, flaky, or cracked skin Russell’s sign

25. Vicious Cycle of Bulimia

26. C omplications Dental: enamel erosion, dental caries, periodontal disease Dermatologic: Russell’s sign (finger calluses & abrasions) Endocrine: irregular menses, abnormal serotonin metabolism, hypoglycemia, nonsuppression of cortisol level on dexamethasone suppression test Fluid and electrolytes: dehydration, hypokalemia, hypochloremia , metabolic acidosis, metabolic alkalosis, hyponatremia , hypocalcemia , hypomagnesemia

27. C omplications Gastrointestinal: salivary and parotid gland hypertrophy, hyperamylasemia , pancreatitis, esophageal perforation, esophagitis, delayed gastric emptying, gastric dilatation and rupture, constipation, cathartic colon, hypokalemic ileus, steatorrhea and protein-losing gastroenteropathy , abnormal liver enzymes Pulmonary: aspiration pneumonitis, pulmonary edema Renal: reduced glomerular filtration rate, elevated blood urea nitrogen, pyuria , hematuria, proteinuria, polyuria Others : disordered thermoregulation, vitamin K deficient coagulopathy

28. Anorexia vs. Bulimia Denies abnormal eating behavior Introverted Turns away from food in order to cope Preoccupation with losing more and more weight Recognizes abnormal eating behavior Extroverted Turns to food in order to cope Preoccupation with attaining an “ ideal ” but often unrealistic weight

29. Eating D isorder Not O therwise S pecified This category is for disorders of eating that do not meet the criteria for any specific eating disorder

30. Eating D isorder Not O therwise S pecified For females, all of the criteria for AN are met except that the individual has regular menses All of the criteria for AN are met except that, despite significant weight loss, the individual’s current weight is in the normal range

31. Eating D isorder Not O therwise S pecified All of the criteria for BN are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of < 2x a week or for a duration of < 3 months The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amount of food

32. Eating D isorder Not O therwise S pecified Repeatedly chewing and spitting out, but not swallowing, large amount of food Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristics of BN

33. E tiology Genetic Theory Biochemical Theory Psychodyamic Theory Family Systems Theory Sociocultural Theory Personality Factors

34. Genetics The chances for identical twins sharing the disorder are greater than for fraternal twins When ancestors were faced with famine, those who denied starvation and became hyperactive may have been more likely to search for food.

35. AN Personality Traits Resistance to acknowledge they have a problem Obsessional thoughts about doing things right Hyper-rigid behaviors Difficulty learning from experience Greater risk avoidance (compared to controls) Emotionally restrained

36. AN Personality Traits Conformity to authority Trait obsessionality Inflexible thinking Social introversion Limited social spontaneity

37. BN Personality Traits Problems identifying internal stress contributing to feelings of helplessness (self-regulation) Variable moods: fatigue and depression to agitation, which contribute to impulse control difficulties Sense of loss of control related to bodily experience

38. BN Personality Traits Low self-esteem, personal efficacy, leading to self-doubt and uncertainty Highly self-critical and punitive in self-evaluation Self-conscious, sensitive to rejection from others

39. Personality traits contribute to the development of eating disorders because: Food and the control of food is used as an attempt to cope with feelings and emotions that seem overwhelming Having followed the wishes of others... Not learned how to cope with problems typical of adolescence, growing up, and becoming independent People binge and purge to reduce stress and relieve anxiety Anorexic people thrive on taking control of their bodies and gaining approval from others Highly value external reinforcement and acceptance

40. Cultural Effect Learned restraint in cultures that idealize thinness Ultra-thin models Doctored photos in magazines, advertisements, and other forms of media Pressure to be thin “Thin-ideal”

41. The Celebrity Thin Ideal

42. The Impact of Media 90% of all girls ages 3-11 yrs have a Barbie Doll If Barbie were a real woman, her measurements would be 38-18-33 The body type portrayed in advertising as the ideal is possessed naturally by only 5% of females The diet industry came on the scene in the 1960 ’ s

43. Barbie and Bodies Seven feet tall 38 inch chest 21 inch waist 36 inch hips Virtually unattainable for an adult woman

44. Obesity

45. Obesity Defined as 20% over ideal body weight or BMI > 30 Not an eating disorder per se and unlike an eating disorder is not an mental illness. However, many people who binge eat become obese and can have mental health problems

46. Obesity Women > Men Increases with age up to 60 years old Common in children (US) Onset: 15-25 years old

47. T reatment Medical Management Psychopharmacology Psychotherapy

48. T reatment Medical Management weight restoration n utritional rehabilitation rehydration c orrection of electrolyte imbalances

49. T reatment Psychopharmacology a mitriptyline (Elavil) c yproheptadine ( Periactin ) o lanzapine ( Z yprexa ) f luoxetine (Prozac)

50. T reatment Psychotherapy Family therapy Individual therapy Cognitive behavioral therapy

51. Eating Disorder Treatment Individual Therapy Allows a trusting relationship to be formed Difficult issues are addressed, such as: Anxiety, depression, low self-esteem, low self-confidence, difficulties with interpersonal relationships, and body image problems Several different approaches can be used, such as: Cognitive Behavioral Therapy (CBT) Focuses on personal thought processes Interpersonal Therapy Addresses relationship difficulties with others Rational Emotive Therapy Focuses on unhealthy or untrue beliefs Psychoanalysis Therapy Focuses on past experiences