Eating Disorders

anorexia eating too little or starving themselves bulimia eating chaotically 30% to 35% of normal-weight people with bulimia have a history of anorexia nervosa and low body weight 50% of people with anorexia nervosa exhibit bulimic behavior

Eating Disorders
Eating Disorders includes two specific diagnoses, Anorexia Nervosa and Bulimia Nervosa. Anorexia Nervosa is characterized by a refusal to maintain a minimally normal body weight.

Eating Disorders
Bulimia Nervosa is characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as selfinduced vomiting ; misuse of laxatives, diuretics, or other medications; fasting.

Anorexia Nervosa

Anorexia Nervosa
clients refusal or in-ability to maintain a minimally normal body weight intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body refusal to acknowledge the seriousness of the problem or even that one exists

Anorexia Nervosa
body weight that is 85% less than expected for their age and height begins between 14 to18 years of age has 2 subtypes:
Restricting subtype Binge eating and purging subtype

Anorexia Nervosa
Binge eating means consuming a large amount of food in a discrete period of usually 2 hours or less. Purging means the compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics.

Anorexia Nervosa
SYMPTOMS OFANOREXIA NERVOSA
Fear of gaining weight or becoming fat even when severely underweight Body image disturbance Amenorrhea Depressive symptoms such as depressed mood, social withdrawal, irritability, and insomnia

Anorexia Nervosa
Preoccupation with thoughts of food Feelings of ineffectiveness Inflexible thinking Strong need to control environment Limited spontaneity and overly restrained emotional expression Complaints of constipation and abdominal pain

Anorexia Nervosa
Cold intolerance Lethargy Emaciation Hypotension, hypothermia, and bradycardia Hypertrophy of salivary glands Elevated BUN (blood urea nitrogen)

Anorexia Nervosa
Electrolyte imbalances Leukopenia and mild anemia Elevated liver function studies

BULIMIA NERVOSA

BULIMIA NERVOSA
recurrent episodes (at least twice a week for 3 months) of binge eating followed by inappropriate compensatory behaviors to avoid weight gain such as purging, fasting, or excessively exercising amount of food consumed during a binge episode is much larger than a person would normally eat

BULIMIA NERVOSA
engages in binge eating secretly Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these clients begins in late adolescence or early adulthood 18 or 19 years

BULIMIA NERVOSA
Clients with bulimia are aware that their eating behavior is pathologic and go to great lengths to hide it from others. SYMPTOMS OF BULIMIANERVOSA
Recurrent episodes of binge eating Self-evaluation overly influenced by body shape and weight

BULIMIA NERVOSA
Compensatory behavior such as selfinduced vomiting, misuse of laxatives, diuretics, enema or other medications, or excessive exercise Usually within normal weight range, possible underweight or overweight Restriction of total calorie consumption between binges, selecting low-calorie foods while avoiding foods perceived to be fattening or likely to trigger a binge

BULIMIA NERVOSA
Depressive and anxiety symptoms Possible substance use involving alcohol or stimulants Loss of dental enamel Chipped, ragged, or moth-eaten appearance of teeth Increased dental caries Menstrual irregularities

BULIMIA NERVOSA
Dependence on laxatives Esophageal tears Fluid and electrolyte abnormalities Metabolic alkalosis (from vomiting) or metabolic acidosis (from diarrhea) Mildly elevated serum amylase levels

Eating Disorder Not Otherwise Specified

Eating Disorder Not Otherwise Specified

The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder. Examples include:
1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.

Eating Disorder Not Otherwise Specified

2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual's current weight is in the normal range. 3. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for duration of less than 3 months.

Eating Disorder Not Otherwise Specified

4.The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). 5.Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

Eating Disorder Not Otherwise Specified

6.Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.

RELATED DISORDERS

RELATED DISORDERS
Rumination Disorder
repeated regurgitation and rechewing of food

Pica
Persistent ingestion of nonnutritive substances such as paint, hair, cloth, leaves, sand, clay, or soil

RELATED DISORDERS
Feeding Disorder
persistent failure to eat adequately, which results in significant weight loss or failure to gain weight

Night eating syndrome (NES)

morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks

RELATED DISORDERS
Binge eating disorder
recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychological distress

ETIOLOGY
Biologic Risk Factors Developmental Factors Family Influences Sociocultural Factors

Biologic Risk Factors

family history of mood or anxiety disorders Deficits in the lateral hypo-thalamus result in decreased eating and decreased responses to sensory stimuli that are important to eating.

Biologic Risk Factors

Disruption of the ventromedial hypothalamus leads to excessive eating, weight gain, and decreased responsiveness to the satiety effects of glucose, which are behaviors seen in bulimia.

Biologic Risk Factors

Increased levels of the neurotransmitter serotonin and its precursor tryptophan have been linked with increased satiety. Low levels of serotonin as well as low platelet levels of monoamine oxidase have been found in clients with bulimia and the binge and pure subtype of anorexia nervosa

Developmental Factors
ANOREXIA NERVOSA Autonomy and the establishment of a unique identity Autonomy in an overprotective family is hard to achieve, so children belonging to this family begin to control their eating through severe dieting and thus gain control over their weight.

Developmental Factors
Self-doubt and confusion can result if the adolescent does not measure up to the person she or he wants to be.
Body image is how a person perceives his or her body, i.e., a mental self-image. Body image disturbance occurs when there is an extreme discrepancy between ones body image and the perceptions of others and extreme dissatisfaction with ones body image

Developmental Factors
BULIMIA NERVOSA
Self-perceptions of the body can influence the development of identity in adolescence greatly. Self-perceptions that include being overweight lead to the belief that dieting is necessary before one can be happy or satisfied. Clients with bulimia nervosa report dissatisfaction with their bodies as well as the belief that they are fat, unattractive and undesirable.

Family Influences
Girls growing up amid family problems and abuse are at higher risk for both anorexia and bulimia. Childhood adversity has been identified as a significant risk factor in the development of problems with eating or weight in adolescence or early adulthood. Adversity was defined as physical neglect, sexual abuse, or parental maltreatment that included little care, affection, and empathy and excessive paternal control, unfriendliness, or overprotectiveness.

Sociocultural Factors
Culture considers being overweight a sign of laziness, lack of self-control, or indifference; it equates pursuit of the perfect body with beauty, desirability, success, and will power. Media fuels the image of the ideal woman as thin.

Sociocultural Factors
Pressure from coaches, parents, and peers and the emphasis placed on body form in sports such as gymnastics, ballet, and wrestling can promote eating disorders in athletes.

TREATMENT

ANOREXIA NERVOSA
MEDICAL MANAGEMENT

Focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalances. Clients receive nutritionally balanced meals and snacks that gradually increase caloric intake to a normal level for size, age, and activity.

ANOREXIA NERVOSA
MEDICAL MANAGEMENT

Access to a bathroom is supervised to prevent purging as clients begin to eat more food. Weight gain and adequate food intake are most often the criteria for determining the effectiveness of treatment.

ANOREXIA NERVOSA
PSYCHOPHARMACOLOGY

Amitriptyline (Elavil) and the antihistamine Cyproheptadine (Periactin) in high doses (up to 28 mg/day) can promote weight gain in inpatients with anorexia nervosa Olanza-pine (Zyprexa) antipsychotic effect (on bizarre body image distortions) and associated weight gain.

ANOREXIA NERVOSA
PSYCHOPHARMACOLOGY

Flu-oxetine (Prozac) preventing relapse in clients whose weight has been partially or completely restored.

ANOREXIA NERVOSA
PSYCHOTHERAPY

Family therapy may be beneficial for families of clients younger than 18 years. Individual therapy focusing on grief and interpersonal disputes and deficits, role transitions can improve interpersonal functioning and decrease symptoms.

BULIMIA NERVOSA
COGNITIVE-BEHAVIORAL THERAPY

Strategies designed to change the clients thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging, and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept

BULIMIA NERVOSA
PSYCHOPHARMACOLOGY

Desipramine (Norpramin), imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), phenelzine (Nardil), and fluoxetine (Prozac) were prescribed in the same dosages used to treat depression. antidepressants were more effective than were the placebos in reducing binge eating. They also improved mood and reduced preoccupation with shape and weight.

QUIZ EATING DISORDER

1. Persistent ingestion of nonnutritive substances such as paint, hair, cloth, leaves, sand, clay, or soil 2. Occurs when there is an extreme discrepancy between ones body image and the perceptions of others and extreme dissatisfaction with ones body image 3. Morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks.

4-5. Types of Anorexia according to the Diagnostic Criteria for 307.1 Anorexia Narvosa 6-7. Types of Bulimia according to the Diagnostic Criteria for 307.51Bulimia Narvosa

8. Recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychological distress

9. Deficit of this result in decreased eating weight gain and decreased responsiveness of glucose 10. Seen with client who has Night Eating Syndrome.
Bonus Question: > 2 specific diagnosis of Eating Disorders

1. Pica 2. Body image disturbance 3. Night eating syndrome 4. Restricting type 5. Binge/Purging type 6. Purging 7. Non-purging 8. Binge eating disorder 9. Ventromedial hypothalamus 10.obesity

BONUS!!!
1. Bulimia Nervosa 2. Anorexia Nervosa