EATING DISORDERS,TYPES,CAUSES &TREATMENT

I HAVE MADE THIS PPT FOR THE HEALTH CARE PROFESSIONALS, STUDENTS,ACAMEDICIANS FOR AND SPECIFICALLY SPORTS PERSONS WHO SHOULD KNOW HOW EATING DISORDER IMPACT ON THEIR CAREER.

1. Dr.Sonia Kapur Clinical Psychologist and Assistant Professor EATING DISORDERS

2. DEFINITIONS....

3. TYPES OF EATING DISORDERS...

4. Anorexia Nervosa

5. Continue... Symptoms include: Extremely restricted eating Extreme thinness (emaciation) A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight Intense fear of gaining weight Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

6. Continue...

7. Anorexia patient...

8. Bulimia nervosa- Bulimia nervosa is a condition where people have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or over overweight.

9. Symptoms include: Chronically inflamed and sore throat. Swollen salivary glands in the neck and jaw area. Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid. Acid reflux disorder and other gastrointestinal problems. Intestinal distress and irritation from laxative abuse. Severe dehydration from purging of fluids. Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack.

10. Female Athlete Triad (FAT)- Disordered eating: extreme or harmful methods of weight control including binge-eating and purging and restricting food intake. Amenorrhea: Primary amenorrhea defined as the absence of menstruation in a girl by age 16 with secondary sex characteristics; Secondary amenorrhea defined as the absence of 3 consecutive menstrual cycles after menarche. Osteoporosis: Bone mineral density more than 2.5 standard deviations below the mean for young adults.

11. Unspecified Feeding And Eating Disorders (UFED). UFED is diagnosed when an individual’s symptoms do not line up with those of another disorder, or when there is simply not enough information to determine a more specific diagnosis. This UFED label can change once more information is gathered, or as symptoms change over time. The presence of disordered thoughts and behaviors regarding food and body image is not enough to warrant an eating disorder diagnosis. These thoughts and behaviors must be severe enough to cause significant distress to the individual. The exact prevalence of UFED is unknown, though it is not believed to be common among the eating disorder community. As Jennifer J. Thomas, Ph.D., confirms, “In her study of DSM-5 changes at the Klarman Eating Disorders Center, just 1 of 150 patients had UFED. This patient struggled with bingeing and purging but didn’t have the intense shape and weight concerns that are required for a bulimia diagnosis.

12. Disordered Eating Behaviors Symptoms of UFED include disordered eating behaviors that cause significant distress or impairment. Disordered behaviors can vary greatly. Common behaviors include restriction, bingeing, and/or purging. Restriction is characterized by limiting caloric intake to an extreme. This is one of the primary symptoms of anorexia nervosa, though it is a common facet of many eating disorders. Binge eating occurs when an individual consumes a large quantity of food, typically in secret and until uncomfortably full. Bingeing is often uncontrollable and leaves the individual feeling guilty and shameful. In some cases, this leads to compensatory behaviors, such as self-induced vomiting or laxative abuse. An individual can engage in compensatory behaviors, otherwise known as purging, regardless of the size of the meal. Bingeing and purging is characteristic of bulimia nervosa, and bingeing without the use of compensatory behaviors would likely be diagnosed as BED. Purging following a small or “normal” meal might fall under the category of anorexia nervosa or purging disorder. This is dependent on the other symptoms and their severity. Purging can take many forms, including compulsive exercise. This occurs when an individual has an obsession with burning calories recently consumed, and does so through excessive exercise. Compulsive exercise is a common symptom present in many eating disorders.

13. Lesser-known Behaviors There are many disordered behaviors that are less common and therefore not as openly discussed within the eating disorder community. Chewing and spitting is a behavior in which individuals chew their food to get the sensation of eating, then spit it out to avoid the caloric intake or feeling full. This is different than rumination disorder, in which an individual swallows, then regurgitates and typically re-chews the food. Pica is an eating disorder characterized by eating non-food substances, such as carpeting or paper products. The ingestion of hair is known as trichophagia, closely connected to the hair-pulling disorder trichotillomania.

14. Prevalence Symptoms-

15. Various researches have summarized the prevalence of eating disorders in sport- Female athletes, in general, reported higher frequencies of eating disorders than male athletes, which is similar to the general population. Male athletes with eating disorders are less prevalent and thus have not been studied as extensively as female athletes. A significant percentage of athletes engage in disordered eating or weight loss behaviors (e.g., binge eating, rigorous dieting, fasting, vomiting, use of diuretics), and these behaviors are important to examine even though they are subclinical in intensity. Eating disorders among athletes and their use of pathogenic weight loss techniques tend to have a sport-specific prevalence (e.g., they occur more among gymnasts and wrestlers than in archers or basketball players). Up to 66% of female athletes may be amenorrheic compared with approximately 2% to 5% of nonathletes. These data (along with higher levels of disordered eating by female athletes) suggest that female athletes may eventually develop osteoporosis, which can result in increased bone fractures, increased skeletal fragility, and permanent bone loss.

16. Causes of eating disorders in sports-  Knowing these factors might help you prevent or reduce the probability that an eating disorder (or disordered eating) will occur in someone—or yourself. Weight Restrictions and Standards Coach and Peer Pressure Sociocultural Factors Judging Criteria Critical comments about body, weight and shape Genetic and biological factors Mediating factors Recognition and Referral of an Eating Problem

17. Weight Restrictions and Standards- Sports such as weightlifting, wrestling, and boxing commonly use weight classifications to subdivide competitor groups. Often athletes try to “make weight” so they can compete at a lower weight classification, which presumably would give them an advantage against a lighter opponent. This can result in their trying to drop up to 10 or even 15 pounds immediately before weigh-ins, usually resulting primarily in rapid dehydration. Techniques to achieve this rapid weight loss include fasting; fluid restriction; and the use of diuretics, laxatives, and purging. But weight loss and dieting are not limited to athletes, because these behaviors are a common problem among young people. Coaches, trainers, and parents should discourage these weight loss methods, even those that are embedded in the sport culture. Researchers (Sedula, Collins, & Williamson, 1993) investigating more than 11,000 high school students found that more than 40% of the females were attempting to lose weight through some type of diet. 

18. Coach and Peer Pressure- Coaches and peers can play an important role in shaping the attitude and behaviors of athletes. Unfortunately, coaches sometimes knowingly or unknowingly exert pressure on athletes to lose weight, even when they have information about safe and effective weight management procedures.

19. Sociocultural Factors- Although genetics can certainly influence disordered eating, the current thinking is that the condition has more to do with the cultural emphasis on thinness, which can lead to widespread body dissatisfaction (especially in women). Eg- the American Society for Aesthetic Plastic Surgery reported that more than 200,000 cosmetic surgeries were done in 2007 on children under 18 years of age so they could look a certain way (Marcus, 2009). Our culture values thinness, and according to some figures, up to 95% of women overestimate their body size as 25% larger on average than it actually is. In essence, the media constantly tell us that we should look thin and beautiful like the models we see on billboards and television.

20. Performance Demands- The last 20 years have seen an increased focus on the relationship between body weight or body fat and performance. In fact, research has indicated that there is a correlation between a low percent body fat and high levels of performance in a number of sports (Wilmore, 1992). This has led many coaches and athletes to focus on weight control for the purpose of reaching optimal weight. However, lower body fat does not always mean better performance.

21. Judging Criteria- In sports in which physical attractiveness, especially for females, is considered important to success (gymnastics, figure skating, diving), coaches and athletes may perceive that judges tend to be biased toward certain body types. When athletes do not conform to these images, they may stand out among their teammates and experience incredible pressure to achieve unrealistic and unhealthy body weights and shapes.

22. Critical comments about body, weight and shape- Although there has long been anecdotal evidence that critical comments about body shape and weight (e.g., “fat cow,” “Pillsbury dough boy,” “tubby”) particularly negatively affect female athletes, little empirical research was conducted. In 2008, Muscat and Long found that athletes who recalled more critical comments and more severely critical comments than others reported greater disordered eating as well as more intense negative emotions (shame, anxiety). . In addition, females at the highest level of competition (i.e., international) were more likely to remember critical comments than athletes performing at lower competitive levels.

23. Genetic and biological factors-  “Why do only a small fraction of individuals (mostly females) go on to develop an eating disorder?” In an excellent review article, Striegel-Moore and Bulik (2007) discuss a number of studies investigating biological as well as sociocultural predictors of eating disorders. There seems to be ample evidence that biology plays a role in the development of eating disorders from the findings of twin studies and molecular-genetic studies.

24. Mediating factors- The personality factors of asceticism, submissiveness, and conformity were all related to eating pathology among athletes. Researchers (de Bruin, Bakker, & Oudejans, 2009) have found that athletes who are ego-oriented tend to display more disordered eating, and thus they recommend that coaches emphasize a mastery-oriented climate focusing on improvement

25. Recognition and referral of an eating problem- Practitioners are in an excellent position to spot individuals with eating disorders (Thompson, 1987). Thus, they must be able to recognize the physical and psychological signs and symptoms of these conditions. People with anorexia often pick at their food, push it around on their plate, lie about their eating, and frequently engage in compulsive or ritualistic eating patterns such as cutting food into tiny morsels or eating only a very limited number of bland, low calorie foods. People with bulimia often hide food and disappear after eating (so they can purge the food just eaten) or simply eat alone. Whenever possible, fitness educators should observe the eating patterns of students and athletes, looking for abnormalities.

26. Treatments of eating disorders- Treatments for eating disorders vary depending on the type and your specific needs. Even if you don’t have a diagnosed eating disorder, an expert can help you address and manage food-related issues. Treatments include: Psychotherapy Maudsley approach Medications Nutrition counseling

27. Psychotherapy:  A mental health professional can determine the best psychotherapy for your situation. Many people with eating disorders improve with  cognitive behavioral therapy  (CBT). This form of therapy helps you understand and change distorted thinking patterns that drive behaviors and emotions. Maudsley approach:  This form of family therapy helps parents of teenagers with anorexia. Parents actively guide a child’s eating while they learn healthier habits. Medications:  Some people with eating disorders have other conditions, like anxiety or depression. Taking  antidepressants  or other medications can improve these conditions. As a result, your thoughts about yourself and food improve. Nutrition counseling:  A registered dietitian with training in eating disorders can help improve eating habits and develop nutritious meal plans. This specialist can also offer tips for grocery shopping, meal planning and preparation.

28. Prevention of Eating Disorders- Some suggestions for being proactive in reducing eating disorders in athletes and exercisers. Promote proper nutritional practices- Research indicates that many sport participants have limited information or have incorrect views about proper sport nutrition. Many individuals turn to coaches, trainers, and peers for nutritional advice, and these exercisers and athletic personnel should therefore become educated about good nutrition and methods of weight control (Coaches’ Guide to Nutrition and Weight Control [Eisenman, Johnson, & Benson, 1990] is one good source of nutritional information.) Focus on fitness, not body weight- We must move away from obsessing about weight to focusing on health and fitness itself. There is no ideal body composition or weight for an athlete or exerciser, because weight and body composition fluctuate greatly, depending on the type of sport, body build, and metabolic rate. Rather, an ideal range might better be targeted, with input from professionals such as nutritionists and exercise physiologists. Be sensitive to weight issues- Athletic personnel should be made aware of the issues athletes contend with regarding weight control and diet, and they should act with sensitivity in these areas. Coaches and fitness leaders often exert powerful influence on individuals, and they should exercise care when making remarks about weight control. Practices such as repeating weigh-ins, associating weight loss with enhanced performance, setting arbitrary weight goals, and making unfeeling remarks must be avoided at all costs.

29. Promote healthy management of weight- As the incidence of and focus on disordered eating practices in sport and exercise have increased in recent years, so too has the availability of educational material. For example, the NCAA produced an informative set of three videos along with supportive educational material on eating disorders in sport (National Collegiate Athletic Association, 1989). Sport and exercise science professionals need to keep up with the latest information regarding weight loss and eating disorders.   Use a cognitive-dissonance intervention- Recent research (Smith & Petrie, 2008) has demonstrated that cognitive dissonance may be helpful in reducing some of the negative feelings and thoughts typically held by athletes with disordered eating.In their study, Smith and Petrie had female athletes (who described themselves as having disordered eating) engage in a variety of exercises (in three sessions), which called into the question the ideal thin female body type to create dissonance. Results revealed that the intervention produced some positive effects, particularly with respect to decreases in sadness and depression and in internalization of a physically fit and in-shape body type and increases in body satisfaction.

30. Assessment tools-

31.                     Thank you