Download Session 25-Brown, Payne

Eating Disorder Awareness and
Prevention
The mental and physical consequences
of eating disorders in
children and adolescents
Kimberly Payne, MA, LMHC
Jessika Brown, MS, RD/LDN, CEDRD, CSSD
Just eat!
Eating Disorders:
50% Psychological
50% Physiological
Physiological
Psychological
Overview
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Physiological and Psychological Presentation of an
Eating Disorder
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Anorexia
Bulimia
Binge Eating Disorder
Commonalities Across All Eating Disorder Types
Messages Student Receive
Sending a New Message
Anorexia Nervosa
The DSM-5 defines Anorexia
Nervosa as:
• Persistent restriction of energy
intake leading to significantly low
body weight.
• Intense fear of gaining weight or
becoming fat.
• Disturbance in the way one’s
body weight or shape is
experienced.
• Undue influence of body shape or
weight on self-evaluation.
Recognizing the “Red Flags” of
Anorexia Nervosa
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Preoccupation with weight,
calories, and dieting
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Avoidance of meal time or
situations involving food
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Perfectionistic personality
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Difficulty in experiencing pleasure
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Rigidity
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Withdrawal from friends and
activities
The Biology of Starvation
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“The Biology of Human Starvation”
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1950 Ancel Keys and colleagues studied the effects
of starvation and rehabilitation
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36 (32) healthy men ages 20-33
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12 week control diet; 24 weeks of semi-starvation
to induce ~25% weight loss; 12 weeks of
rehabilitation
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During starvation- what was observed?
Resting Energy Expenditure
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Keys found that the rate of decrease in metabolic
rate is in direct proportion to the rate of weight
loss.
As metabolic rate decreases, all the chemical
reactions in the body slow down
Hormone Changes
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Hunger hormones are generated in part due to
consistency and timing of meals
May be intensified if meals are skipped
May be altered if ignored
– Leptin resistance
– Reduced ghrelin
– Increased NPY
Electrolyte Changes
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The body switches from using carbohydrate to
fat and protein as the main source of energy
Intracellular minerals become depleted
although serum levels remain normal
– Phosphorus- major intracellular mineral (P)
– Potassium- major intracellular cation (K+)
– Magnesium- predominant intracellular
cation
K+
P
Mg+
Refeeding Syndrome
K+
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P
Mg+
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P
K+
Mg+
Intracellular ions become
depleted, even when serum
levels appear normal
Consuming <500 calories per
day for greater than 5 days
puts patient at high risk
Addition of carbohydrates can
cause an influx of potassium
and phosphorus into the cell...
leading to cardiac arrest
Detrimental Fat Loss
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Essential body fat
– 12% women
– 3% men
Superior Mesenteric
Artery Syndrome
Gastrointestinal Changes
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Small intestines diameter shrinks with lack of food
Stomach size changes
Decrease microbiota variability in GI tract
Bulimia Nervosa
The DSM-5 defines Bulimia
Nervosa as:
• Repeated episodes of binge
eating (A feeling that one
cannot stop eating or control
what or how much one is
eating)
• Repeated inappropriate
compensatory behaviors to
prevent weight gain
• Undue influence of body shape
or weight on self-evaluation.
Recognizing the “Red Flags” of
Bulimia Nervosa
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Evidence of Binge eating
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Disappearance of large amounts of
food
Excessive wrappers
Evidence of Purging behaviors
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Frequent trips to the restroom after
meals
Rigid exercise regimen
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Impulsive behavior (substance
abuse, self harm, suicidality, etc.)
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Withdrawal from friends and social
activities
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Continued exercise despite injury
Diabulimia
• Diabulimia is not currently
recognized in the DSM-5
• Diabulimia is a co-occurring
condition with Type I
Diabetes
• Purging occurs through the
misuse of insulin to induce
weight loss.
• Purging calories occurs
through glycosuria (the loss
of glucose through urine)
Specific “Red Flags” of
Diabulimia
• Avoidance of going to the Endocrinologist
• Hyperglycemic symptoms (extreme thirst,
frequent urination, sleepiness, etc.)
• Irregular menses or loss of menses
• Secretive blood sugar testing or lack of testing
Bulimia Myth: Purging Leads to
Weight Loss
• “Purging” can be performed via excessive exercise,
self induced vomiting, laxatives, ipecac, or fasting
• Frequent binge/purge cycles frequently lead to
weight gain
• Body dissatisfaction highest in bulimia nervosa (LaportaHerrero, 2016)
• Laxative abuse causes water retention and
micronutrient losses
Bulimia Myth: Purging
Reducing Caloric Intake
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Purging leads to less calories consumed and effectively
compensates for a binge
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Up to 1200 calories is absorbed despite vomiting (Kaye,
1993)
Exercise purging throws the metabolism, leads to further
fatigue, opening up likelihood of another binge
Macronutrients begin digestion before micronutrientstherefore purging likely robs the body of digesting
micronutrients entirely, but not necessarily
macronutrients
Pseudo-Barters Syndrome
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Defect in the kidney’s
ability to reabsorb sodium
causing a rise in
aldosterone
Aldosterone excretes
potassium from the body
(potassium wasting)
Secondary
hyperaldosteronism
occurs despite taking
electrolyte replacement
Hypokalemic alkalosis
Amplified if dehydrated
Bulimia and
Malnutrition
Macronutrients begin
breakdown before
micronutrientstherefore purging likely
robs the body of
digesting micronutrients
entirely, but not
necessarily
macronutrients
Physical Symptoms
of Purging
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Acute sialadenitis:
“Chipmunk cheeks”; bacterial
infection or due to fluid loss
causes the swelling of the
parotid glands; may be
permanent; can appear 3
days after purging
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Russell’s sign: scarring on
dorsum of the hand from
acid during vomiting
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Edema
Binge Eating Disorder
The DSM-5 defines Binge Eating
Disorder as:
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Recurrent and persistent
episodes of binge eating
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Marked distress regarding
binge eating
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Absence of compensatory
behaviors
Recognizing the “Red Flags” of
Binge Eating Disorder
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Eating large amounts when not
physically hungry
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Secretive food behaviors
including eating alone and
stealing or hiding food
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Creating life style schedules or
rituals to make time for binges
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Feeling disgusted, depressed, or
guilty following the binge
How we perceive food matters
Crum, 2011
Food Makes Us Feel Better
• Saturated fat appears to fend
off negative emotions:
• Under the study of fMRI brain
scans, the effect of saline vs.
fatty acids on sad emotions was
investigated
• Results: The behavioral and
neural responses to sad emotion
induction were attenuated by
fatty acid infusion
Oudenhove 2011
Food
Addiction?
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Dopamine is a
neurotransmitter that
• Signals when rewards
are present
• Motivates us to seek
rewards
• Promotes exploring
and learning about
rewards
• Maintain awareness
about reward-related
cues
Distribution of Food Intake
The psychological profile of
those with Eating Disorders
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Depression
Anxiety
Obsessive/Compulsive
Avoids Conflict
Feelings of ineffectiveness
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Highly emotional and
“sensitive”
Unable to identify
and/or express
emotions
Unable to experience
pleasure of play
Common characteristics in
Eating Disorders
• Focus on body shape or
size
• Body image distortion
• Body checking
(pinching skin, staring in
the mirror, focusing on a
specific body part)
• Obsessive weighing
• Food Rituals
• Secretive behavior
• Avoidance of social
activities
• Compulsive behaviors
• Rigidity
Common Characteristics of
Families in which Eating Disorders
Occur
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Perfectionistic
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Don’t hurt anyone’s feelings.
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Think of others first.
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Always be a good boy/girl.
Overprotective
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What am I going to do when you
are gone?
No one will treat you the way we
do.
• Chaotic
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No Consistency
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No Reliability
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No Structure
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All-for-None-and-None-for-All
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I have to be completely selfreliant
The Influence of Families
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When families feel out of control or
overly-controlling eating disorders
thrive.
“Too much ‘too muchness’ or
Too much ‘not enough-ness’”
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High achievement standards
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Fixation on “eating healthy”
(Orthorexia)
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Athleticism
Highly common in the
development of Eating Disorders
in males
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Mother-daughter competition
Individuals with Eating Disorders
Do Not Know How to Talk
The behaviors in the Eating Disorder
represent the unspoken language
Body Image Distortion
is a common characteristic in
Eating Disorders
The Language of the
Eating Disorder
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Keeps one’s world manageable and predictable
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Provides a sense of control
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Self-soothes (a way to “cope”)
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Says “NO”
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Prevents or Forces Separation and Individuation
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Strengthens/tests power and boundaries in the
family
Core Thoughts in the Eating
Disorder
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I don’t measure up
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I’m worthless
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I should be invisible
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I’m not loveable
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I can’t take up
space
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I shouldn’t exist
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I need to be
perfect in order to
deserve…
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I’m not good
enough
Messages that are Being Sent to
Children and Adolescents
Messages that are Being Sent
to Children and Adolescents
There are only TWO food
groups:
Good and Bad Foods
Photoshop and Filters
Sending a New Message
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Self-worth and value is based on much more
than appearance
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Separation and individuation can happen in a
healthy way
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Every person is valuable and deserves to take
up space/time/attention
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There is no such thing as “perfect”
Send a New Message
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What can you talk about besides diet and
exercise?
What can you compliment before appearance?
Can you legalize all foods?
Can you let go of labeling foods as good/bad?
Can you portray the value of living in your body as
an instrument, rather than an ornament?
The Role of the School
• Delivering appropriate messages
about health and weight
• Sending appropriate messages
about health vs. being “thin” or
“ideal”
• Education about eating disorders
and the consequences of these
behaviors
• National Eating Disorders
Awareness Week
• Identifying the warning signs
Ways to Support Individuals
with Eating Disorders
• Encourage seeking treatment from professionals
specializing in eating disorders
• Do NOT comment on their appearance
• Offer time and space for children/adolescents to
have supervised meals
• Model appropriate relationships with food and
weight
• Communicate with outside providers when
concerns arise
The Treatment Team
The treatment team for children/adolescents
includes:
• Parents/guardians
• Dietitians
• Therapists
• Primary Care Physician
• School Nurse(s)
• School Counselor(s)
• Teachers
Schools are a BIG part of creating a supportive
environment during treatment
EATING DISORDERS
TREATMENT CENTER, LLC
A warm, safe and friendly atmosphere … a special place to heal.
5203 JUAN TABO BLVD. NE, SUITE 2A
ALBUQUERQUE, NM 87111
PHONE: 505.266.6121
FAX: 505.221.5710
WWW.EATINGDISORDERSABQ.COM
Whatever seed
you water… it will
grow!