Eating disorder

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Eating disorder

  1. 1. Psychiatry department Beni Suef University
  2. 2.  They are a group of disorders where there is excessive preoccupation with weight, food, and body shape. Two main types are recognized:  1. Anorexia Nervosa  2. Bulimia Nervosa
  3. 3. Clinical Picture  • Weight loss leading to maintenance of body weight to less than 85 % of expected weight  • Intense fear of gaining weight  • Intense disturbance of body image (the patient perceives herself as overweight despite the clear evidence of her thinness)  •Amenorrhea in females  •Anorexia is not an essential feature.  The patient may maintain low body weight by consuming low-calorie diet and by other means such as vigorous exercise 
  4. 4. • Amenorrhea, sometimes early  • Change in the quality of hair, nails and skin  • Constipation or diarrhea  • Dizziness or fainting  • Decreased blood pressure, temperature or pulse rate
  5. 5. • Depressed mood, social withdrawal  • Loss of interest in usual activities  • Anxiety  • Fatigue
  6. 6.  They are due to chronic severe malnutrition and marked reduction in caloric intake. They include the following:  •Cardiological: loss of cardiac muscle, arrhythmias,  prolonged QT interval, bradycardia, sudden death  • Hepatic: fatty degeneration
  7. 7. • Skeletal: osteoporosis  • Hematological: anemia, leucopenia  • Endocrine: low T3, LH and FSH  • Electrolytes: hypokalemia, hypomagnesaemia  • Nervous: neuropathies, cognitive impairment, seizures  Mortality
  8. 8. • Females are 10-20 times more frequently affected than males • 0.5-1 % of female adolescents, 5 % have subclinical forms • Age at onset is in the early adolescence, it may be delayed till the early 20's
  9. 9.  1. Biological Factors  2. Social Factors  3. Psychodynamic Factors  Fears concerning acquisition of feminine shape of body  •Self-discipline over eating is an attempt to gain autonomy due to inability to get separated from the mother  • An attempt to draw attention
  10. 10. • • • • • Obsessive Compulsive Disorder Major Depression Generalized Anxiety Disorder Phobic Disorders Psychotic Disorders
  11. 11.  Ten-year outcome study in the United States:  • 25 % complete recovery  • 50 % improve, functioning well with residual symptoms  " 25 % functioning poorly, including 7 % mortality rate
  12. 12.  It is generally difficult.  Hospitalization (marked weight loss and with medical complications).  Full medical assessment is essential.  cognitive behavioral psychotherapy  pharmacotherapy (antidepressants, anxiolytics and antipsychotics)
  13. 13. Clinical Picture  • Recurrent episodes of binge-eating + lack of control over eating  • At least twice a week for 3 months  • Recurrent, inappropriate compensatory behavior to prevent weight gain, such as the use of purgatives, laxatives or self-induced vomiting  • Body shape and weight unduly influence selfevaluation and self-esteem  • The patient is within normal weight 
  14. 14.  Clinical picture  Behavioral changes  Medical complications  Social problems
  15. 15.  Behavioral Changes  • Secretive behavior (hiding food, spending long periods in the bathroom)  • Restrictive meal patterns or over-concern with dieting and nutrition but with little change in weight
  16. 16.  Physical Changes  • Loss of dental enamel as a result of recurrent vomiting  • Dehydration, fatigue, swollen salivary glands  • Esophageal or gastric tears  • Side effects of emetics, diuretics or purgatives
  17. 17.  Medical Complications  • Gastro-esophageal bleeding  • Cardiac complications (e.g. arrhythmia)  • Muscle cramping due to electrolyte imbalance  • Renal failure  Social Problems  Social isolation  Impairment in family relationships as a result of concealment and lying
  18. 18. • Much higher prevalence in females  • The prevalence of bulimia nervosa is between 3-5% of young women, four times more common than anorexia nervosa  • 40 % of college-aged women have bulimic symptoms  • Usually starts in late adolescence or early adulthood (later than anorexia nervosa)
  19. 19.  1. Biological Factors  2. Social Factors  3. Psychodynamic Factors
  20. 20. 1. Biological Factors  The beneficial effect of antidepressants points the  potential role of serotonin and norepinephrine  2. Social Factors  •Patients are high achievers and respond to societal pressures to be slim  • Families are less close, but more conflictual than those of  anorexia nervosa  • Parents are neglectful and rejecting 
  21. 21.  3. Psychodynamic Factors  • patients exert self-discipline over eating in an attempt to gain autonomy from the mother, but they are more out-going, angry and impulsive.  This leads to bouts of binge-eating.  • They have other behaviors characteristic of weakened impulse control, such as substance abuse, self-destructive sexual relationships, and shoplifting.  • Binge-eating is experienced as ego-dystonic
  22. 22. • Depression (30-70% lifetime rate) • Generalized Anxiety (30-70% lifetime rate) • High rates of other anxiety disorders and panic disorder • Deliberate self harm, e.g., reckless driving, self-injury, suicide, etc... • Alcohol and substance misuse
  23. 23. • The long-term outcome of bulimia nervosa is still under study.  • Without treatment, the disorder usually persists for at least several years, with a waxing and waning course.  • Up to 70% benefit from ttt  full recovery is achieved in 50 % of cases.  • Mortality is approximately 1% due to medical complications and suicide.
  24. 24. • Cognitive-Behavioral Therapy  • Group Therapy  • Family Therapy  • Pharmacotherapy: antidepressants, in particular SSRIs, are very useful

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