Download Eating Disorders

Eating
Disorders
Anorexia and Bulimia:
Symptoms, Sequelae,
Causes and Strategies
Presented by
Christopher
Haymaker, Ph.D.
Northeast Iowa Family
Medicine Residency
Program
October 15, 2014
Eating Disorder Facts
 Begins
in adolescence
 Approximately 1% of female adolescents;
 Lifetime prevalence approaches 5%
 More common on college campuses
 More women than men
 Mortality rate greater than 10%
Anorexia Criteria (DSM-V)
 Restriction
of energy intake relative to
requirements
 Intense fear of gaining weight or
becoming fat
 Disturbance in body image or selfevaluation based on body image
 Restricting versus Binge/Purge
 Severity Specifiers tied to BMI
Bulimia Criteria (DSM-V)
 Recurrent
episodes of binge eating
 Inappropriate compensatory behavior
 Binge/compensatory behavior occurs
frequently
 Self evaluation unduly shaped by bod
image and weight
 Severity specifier based on frequency
Anorexia Symptoms/Sequelae
 Depression
 Anxiety
 Irritability
 Obsession
with food
 Low Energy
 Slower thinking
Anorexia Sequelae (2)
 Low
Hormone Levels
 Amenorrhea
 Protein Loss
 Dehydration
 Decrease in Liver Function
 Heart Problems
Anorexia Sequelae (3)
 Electrolyte
Imbalance
 Damaged Hair
 Thick Body Hair
 Hematology: Leukopenia, Anemia,
thrombocytopenia
Anorexia Sequelae (4)
 Heart
Damage
 Failure to Accumulate Bone Mass
 Osteoporosis
 Death
Bulimia Symptoms/Sequelae
 Electrolyte
Abnormalities (Which may
have cognitive and physical affects)
 Scarring of the hand
 Menstrual Irregularity/Amenorrhea
 Metabolic Alkalosis
 Cardiac and Skeletal Myopathy (Ipecac)
Bulimia Sequelae
 Metabolic
Acidosis (Laxatives)
 Erosion of Upper GI
 Laxative Dependence
 Osteoporosis
 Potentially Fatal Complications
The Cycle of Escape
Fear of Fat
Escape increases
fear
Dieting behavior
Result: Escape
from Fear
(Momentarily)
The Cycle of Addictive Brain
Chemistry
Bad Feelings
Guilty Feelings
about Purging
Eating Activation of
Parasympathetic
Purging Release
of Endorphins
Improved Mood
Guilty Feelings
about Eating
Inpatient hospitalization from
Society for Adolescent Medicine
One or more of the following:
 Sever malnutrition (<75% average body
weight for age, sex, height)
 Dehydration
 Electrolyte disturbance
 Cardiac Dysrythmia
 Physiologic Instability (Brydycardia,
Hypotention, Orthostatic Changes)
 Arrested
growth/development
 Failure of outpatient treatment
 Acute food refusal
 Uncontrollable binging and purging
 Acute medical complications of
malnutrition
 Acute psychiatric emergency
 Comorbid diagnosis
Treatment modalities
 During
acute phase, stabilize medically
and make use of behavioral therapy
 Once medically stable, intensity of
treatment depends on severity
 When possible, involve the family
 When possible, CBT
 Medical monitoring is important for long
term outcomes
Treatment
 Must
regain weight
 Reduce disordered behavior
 Change cognitions
 Deconstruction of unrealistic body image
 New coping techniques
Risk Factors
 Individual
 Familial
 Group
 Societal
Individual Risk Factors
 Stress
(Life Transition)
 Distorted Cognition
 Low Interoceptive Awareness
 Greater Dissatisfaction with Body Shape
 Positive Attributes
Familial Risk Factors
 No
one specific factor
 Transmission of body image from mother
to daughter
 Higher incidence of weight problems,
alcoholism, and physical illness in families
of children with eating disorder
Group Risk Factors
 Competition
 Social
reinforcement
 Shared Features
 Sports
Societal Risk Factors
 Increased
concern about body image
 Concern with weight loss
 Increased concern at younger age
 Why?
Body Image and Beauty
 Focus
on physical beauty
 Ascription to slender body image
 The choice between healthy and beautiful
Media
 Media
link body shape to happiness, love
and success for women
 Effect of repeated exposure
 Unattainable ideal
 Disproportionate focus on weight loss
 Focus on superficial beauty
 Morality messages
90% of Girls own a Barbie
Miss Diet?
Insert photo of Miss Diet
What’s the message from
Calvin Klein?
Photo to go here
What’s the message from
Guess?
Photo goes here
What’s the message from
Gucci?
Photo goes here
What’s the message from
Lycra?
7 women photo shot