Eating disorders

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Eating disorders

  1. 1. EATING DISORDERS<br />BULIMIA<br />ANOREXIA NERVOSA<br />
  2. 2. EPIDEMIOLOGY<br />Up to 4% of adolescent & young adults<br />Most common age of onset bet. 14 & 18 yrs<br />0.5% to 1 % of adolescent girls<br />20X more common in females<br />Professions requiring thinness<br />COMORBIDITY<br />Depression 65%;social phobia 34% OCD 26%<br />ANOREXIA NERVOSA<br />
  3. 3. BIOLOGICAL<br />opiods- deny hunger<br />hypercortisolemia<br />Non suppression on DST<br />Thyroid fxn-supressed<br />Amenorrhea- low LH, FSH, GRH<br />Enlarged ventricles<br />Higher caudate metabolism<br />Dysfunction in DA, S, NE<br />Delayed release of insulin<br />SOCIAL<br />Close but troubled relationship with parents<br />High levels of chaos, hostility, isolation<br />Low levels of nurturance and empathy<br /> ANOREXIA NERVOSA ETIOLOGY<br />
  4. 4. A. REFUSAL TO MAINTAIN BODY WEIGHT AT OR ABOVE A MINIMALLY NORMAL WEIGHT FOR AGE & HEIGHT(e.g. weight loss leading to maintenance of body weight less than 85% of that expected; failure to make expected weight gain during period of growth, leading to body weight less than 85% that expected).<br />DSM CRITERIA FOR ANOREXIA NERVOSA<br />
  5. 5. B. INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT EVEN THOUGH UNDERWEIGHT<br />C. DISTURBANCE IN THE WAY WHICH ONE’S BODY WEIGHT OR SHAPE IS EXPERIENCED, UNDUE INFLUENCE OF BODY WEIGHT OR SHAPE ON SELF- EVALUATION,OR DENIAL OF THE SERIOUSNESS OF THE CURRENT LOW BODY WEIGHT<br />DSM CRITERIA FOR ANOREXIA NERVOSA<br />
  6. 6. D. IN POSTMENARCHEAL FEMALES, AMENORRHEA,(ABSENCE OF AT LEAST 3 CONSECUTIVE MENSTRUAL CYCLES)<br />TYPES<br />1. RESTRICTING- DURING THE CURRENT EPISODE OF ANOREXIA NERVOSA, THE PERSON HAS NOT REGULARLY ENGAGED IN BINGE EATING OR PURGING BEHAVIOR<br />2. BINGE EATING/PURGING TYPE- SELF- INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR ENEMAS)<br />DSM CRITERIA FOR ANOREXIA NERVOSA<br />
  7. 7. Onset between 10 and 30 years<br />Behavior and psychopathology present for at least 3 months; HALF WILL HAVE BULIMIA WITHIN ONE YEAR<br />Peculiar behavior about food<br />Comorbidity with obsessive compulsive behavior, depression and anxiety<br />Delayed psychosocial sexual development<br />PE- hypothermia, dependent edema, hypotension, lanugo hair<br />Laboratory- hypokalemia, ECG changes<br />CLINICAL FEATURES<br />
  8. 8. CLINICAL FEATURESMORTALITY 5 TO 18%<br />RESTRICTING TYPE<br />BINGE EATING/PURGING TYPE<br />OBSESSIVE COMPULSIVE TRAITS<br />LOWER SUICIDE<br />LOWER RECOVERY<br />SUBSTANCE ABUSE,IMPULSE CONTROL &PERSONALITY DISORDER<br />HIGHER SUICIDE<br />HIGHER RECOVERY<br />
  9. 9. VERSUS DEPRESSION<br />NORMAL APPETITE<br />HYPERACTIVITY PLANNED & RITUALISTIC<br />FEAR OF OBESITY<br />VERSUS SCHIZOPHRENIA<br /> INVOLVE CALORIC INTAKE<br />HYPERACTIVE<br />DIFFERENTIAL DIAGNOSIS<br />
  10. 10. MORE PREVALENT<br />LATER ONSET<br />MAINTAIN NORMAL WEIGHT<br />FEMALES>MALES 10:1 <br />BULIMIA NERVOSA<br />
  11. 11. BIOLOGICAL FACTORS<br />NE & SEROTONIN<br />RAISED ENDORPHINS<br />SOCIAL FACTORS<br />DEPRESSED AND MORE CONFLICTUAL FAMILIES<br />Describe parents as NEGLECTFUL & REJECTING<br />PSYCHOLOGICAL FACTORS<br />MORE ANGRY, OUTGOING AND IMPULSIVE<br />EGO DYSTONIC <br />LACK OF TRANSITIONAL<br />OBJECT , struggle with separation <br />Ambivalent attitude <br />BULIMIA-ETIOLOGY<br />
  12. 12. A. RECURRENT EPISODES OF BINGE EATING. AN EPISODE OF BINGE EATING IS CHARACTERIZED BY both of the following:<br />(1) EATING, IN A DISCRETE PERIOD OF TIME(WITHIN ANY 2 HOUR PERIOD) , AN AMOUNT OF FOOD THAT IS DEFINITELY LARGER THAN MOST PEOPLE WOULD EAT DURING A SIMILAR PERIOD OF TIME AND CIRCUMSTANCES<br />(2) A SENSE OF LACK OF CONTROL OVER EATING DURING THE EPISODE<br />DSM CRITERIA FOR BINGE EATING DISORDER AND BULIMIA<br />
  13. 13. B. RECURRENT INAPPROPRIATE COMPENSATORY BEHAVIOR IN ORDER TO PREVENT WEIGHT GAIN<br />C. THE BINGE EATING AND INAPPROPRIATE COMPENSATORY BEHAVIOR BOTH OCCUR ON AVERAGE,AT LEAST TWICE A WEEK FOR 3 MONTHS<br />D. SELF EVALUATION IS UNDULY INFLUENCED BY BODY SHAPE AND WEIGHT<br />DSM CRITERIA FOR BULIMIA<br />
  14. 14. E. THE DISTURBANCE DOES NOT OCCUR EXCLUSIVELY DURING EPISODES OF ANOREXIA NERVOSA<br />TYPE:<br />1. PURGING TYPE: ENGAGED IN SELF INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR ENEMAS<br />2. NON PURGING TYPE- EXCESSIVE EXERCISE OR FASTING <br />DSM CRITERIA FOR BULIMIA<br />
  15. 15. MOST HAVE NORMAL WEIGHT<br />SEXUALLY ACTIVE<br />HIGH RATES OF MOOD AND IMPULSE CONTROL DISORDER (15%)<br />HIGHER RECOVERY THAN ANOREXIA NERVOSA<br />CLINICAL FEATURES<br />
  16. 16. B. THE BINGE EATING EPISODES ARE ASSOCIATED WITH 3 OR MORE OF THE FOLLOWING:<br />1. EATING MUCH MORE RAPIDLY THAN NORMAL<br />2. EATING UNTIL UNCOMFORTABLY FULL<br />3. EATING LARGE AMOUNTS OF FOOD WHEN NOT PHYSICALLY HUNGRY<br />4. EATING ALONE BECAUSE OF BEING EMBARRASSED BY HOW MUCH ONE IS EATING<br />5. FEELING DISGUSTED WITH ONESELF, DEPRESSED, OR VERY GUILTY AFTER OVEREATING<br />DSM CRITERIA FOR BINGE EATING DISORDER<br />
  17. 17. C. MARKED DISTRESS REGARDING BINGE EATING IS PRESENT<br />D. THE BINGE EATING OCCURS, ON AVERAGE, AT LEAST 2 DAYS A WEEK FOR 6 MONTHS<br />E. THE BINGE EATING IS NOT ASSOCIATED WITH THE REGULAR USE OF INAPPROPRIATE COMPENSATORY BEHAVIORS, AND DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF ANOREXIA NERVOSA OR BULIMIA NERVOSA<br />CRITERIA FOR BINGE EATING DISORDER<br />

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