2. What
is
an
Eating
Disorder?
• Four
eating
disorders
that
are
recognised
by
the
(DSM).
• Deadly
mental
illness.
• Highest
mortality
rate.
• NOT
a
choice
or
a
diet
gone
‘too
far.’
3. Dual
Diagnosis
or
Co-‐Morbidity
• The
presence
of
one
or
more
diseases
or
disorders
in
one
individual.
• A
person
with
an
eating
disorder
will
often
be
diagnosed
with
another
mental
health
problem.
• Eating
disorders
are
most
commonly
accompanied
by
depression
and
anxiety
disorders;
however,
substance
abuse
and
personality
disorders
are
also
prevalent.
• Approx
60%
of
people
with
an
eating
disorder
will
also
meet
diagnosis
for
one
of
these
other
psychological
disorders.
4. Signs
&
Symptoms
• Due
to
the
nature
of
EDs
many
characteristics
&
behaviours
may
be
concealed.
• A
person
with
an
ED
will
go
to
great
lengths
to
hide,
disguise
or
deny
behaviours,
or
don’t
recognise
that
there
is
anything
wrong.
• Disturbed
eating
behaviours
coupled
with
extreme
concerns
about
weight,
shape,
eating
and
body
image.
5. E.D.D.D
! Eating
Disorders
Don’t
Discriminate.
! No
longer
the
“white
rich
girl”
disease.
! ALL
genders.
! Both
adolescents
and
adults.
! ALL
cultural
backgrounds.
! ALL
financial
backgrounds.
6. EDs
in
Asia
! In
the
past
five
years,
the
“self-‐starvation”
syndrome
has
spread
to
all
socioeconomic
and
ethnic
backgrounds
across
Asia.
! Now
estimated
to
afflict
one
in
100
young
Japanese
women,
almost
the
same
incidence
as
in
the
United
States.
! Debate
as
to
causes:
! Western
pathologies
that
have
“infected”
their
cultures
via
globalized
fashion,
music
and
entertainment
media,
or
are
an
ailment
of
affluence,
modernization
and
the
conflicting
demands
placed
on
individuals.
7. EDs
in
Asia
! Thin
is
in,
fat
is
out!
! Weight
plays
an
important
role
in
whether
someone
can
find
employment
and
how
good
a
job
he
or
she
can
get.
! The
Attitude
is:
“The
better
you
look,
the
more
opportunity
you
have”.
! Dangerously
unhealthy
practices
used
as
ways
of
“dieting”
or
as
“weight
loss”
tools
where
mothers
restrict
children’s
intakes
to
as
low
as
500
calories
a
day
or
teach
them
to
purge
their
food
to
stay
skinny.
9. DSM-‐5
Anorexia
Nervosa
1. Restriction
of
energy
intake
leading
to
a
significantly
low
body
weight
(in
context
of
age,
sex,
developmental
trajectory,
and
physical
health).
2. Intense
fear
of
gaining
weight
or
becoming
fat,
even
though
underweight.
3. Disturbance
in
the
way
in
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.
10. • Significant
weight
loss;
Distorted
body
image
• Intense
fear/anxiety
about
gaining
weight
• Preoccupation
with
weight,
calories,
food
• Feelings
of
guilt
after
eating;
Excuses
for
not
eating
• Denial
of
low
weight
&
hunger
• High
levels
of
anxiety
and/or
depression;
Low
self-‐esteem
• Self-‐injury
• Withdrawal
from
friends
and
activities
• Food
rituals
Intense,
dramatic
mood
swings
Potential
Warning
Signs
11. ! Amenorrhea
! Bradycardia
! Hypotension
! Anaemia
! Hypothermia/
Poor
circulation
(esp
in
hands
and
feet)
! Muscle
loss
and
weakness
(including
the
heart)
! Dehydration/kidney
failure;
Edema
! Memory
loss/disorientation
! Chronic
constipation
! Growth
of
lanugo
hair
! Bone
density
loss/Osteoporosis
Health
Implications
12. DSM-‐5
Bulimia
Nervosa
! Recurrent
episodes
of
binge
eating
characterized
by
BOTH
of
the
following:
! Eating
large
amounts
of
food
in
a
discrete
amount
of
time
(within
a
2
hour
period).
Lack
of
control
over
eating
during
an
episode.
! Recurrent
inappropriate
compensatory
behaviours
in
order
to
prevent
weight
gain
(purging).
! The
binge
eating
and
compensatory
behaviors
both
occur,
on
average,
at
least
once
a
week
for
three
months.
! Self-‐evaluation
is
unduly
influenced
by
body
shape
and
weight.
! The
disturbance
does
not
occur
exclusively
during
episodes
of
anorexia
nervosa.
13. •
Preoccupation
with
food;
Secretive
eating
and/or
missing
food
• Visits
to
the
bathroom
after
meals
• Excessive
weight
fluctuations
• Self-‐injury
• Excessive
and
compulsive
exercise
regimes
—
despite
fatigue,
illness,
or
injury
• Abuse
of
laxatives,
diet
pills,
and/or
diuretics
• Swollen
parotid
glands
in
cheeks
and
neck
• Broken
blood
vessels
in
eyes
and/or
face
• Calluses
on
the
back
of
the
hands/knuckles
from
self-‐induced
vomiting
• Heartburn/reflux
• Feelings
of
shame
and
guilt;
Self-‐criticism
and
low
self-‐esteem
• High
levels
of
anxiety
and/or
depression
Potential
Warning
Signs
14. ! Electrolyte
imbalances
that
can
lead
to
irregular
heartbeat
and
seizures
! Edema/swelling
! Dehydration
! Vitamin
and
mineral
deficiencies
! Gastrointestinal
problems
! Chronic
irregular
bowel
movements
and
constipation
! Inflammation
and
possible
rupture
of
the
esophagus
! Tears
in
the
lining
of
the
stomach
! Chronic
kidney
problems/failure
! Discoloration
and/or
staining
of
the
teeth;
Tooth
decay
Health
Implications
15. DSM-‐5
Binge
Eating
Disorder
! Recurrent
episodes
of
binge
eating,
characterized
by
both
of
the
following:
! Eating,
in
a
discrete
period
of
time
(i.e.
within
a
2-‐hour
period),
an
amount
of
food
excessive
to
what
most
would
consume
in
a
similar
period
of
time.
! A
sense
of
lack
of
control
over
eating
during
the
episode
(i.e.
a
feelings
of
inability
to
stop
eating
or
control
what
or
how
much
one
is
eating).
! Binge-‐eating
episodes
are
associated
with
3
(or
more)
of
the
following:
! Eating
much
more
rapidly
than
normal.
! Eating
until
uncomfortably
full.
! Eating
large
amounts
of
food
when
not
feeling
physically
hungry.
! Eating
alone
due
to
feeling
embarrassed
by
how
much
one
is
eating.
! Feeling
disgusted,
depressed,
out
of
control
or
very
guilty
afterwards.
16. ! Eating
large
quantities
of
food
(without
purging),
even
when
not
hungry
! Eating
until
uncomfortably/painfully
full
! Weight
gain/fluctuations
! Feelings
of
shame
and
guilt
! Self-‐medicating
with
food
! Eating
alone/secretive
eating
! Hiding
food
! High
levels
of
anxiety
and/or
depression
! Low
self-‐esteem
Potential
Warning
Signs
17. ! Overweight
or
obese
! Type
II
Diabetes
! Osteoarthritis
! Lipid
abnormalities
(hypercholesterolaemia)
! Hypertension
! Chronic
kidney
problems
! Gastrointestinal
problems
! Heart
disease
! Gallbladder
disease
! Joint
and
muscle
pain
! Sleep
apnea
Health
Implications
18. DSM-‐5
Other
Specified
Feeding
or
Eating
Disorder
(OSFED)
! Disturbances
in
eating
behaviours
that
don’t
necessarily
fall
into
the
specific
category
of
anorexia,
bulimia,
or
binge
eating
disorder.
! Most
common
ED
diagnosis.
! Warning
signs
and
related
medical/psychological
conditions
of
OSFED
are
similar
to,
and
just
as
severe
as,
those
for
the
other
eating
disorders.
19. • Atypical
Anorexia
Nervosa:
All
criteria
of
AN
met,
except
despite
significant
weight
loss,
individual's
weight
is
within
or
above
the
normal
range.
• Bulimia
Nervosa
(of
low
frequency
and/or
limited
duration):
Occurs
less
than
once
a
week
and/or
for
less
than
3
months.
• Binge-‐Eating
Disorder
(of
low
frequency
and/or
limited
duration):
Occurs,
on
average,
less
than
once
a
week
and/or
for
less
than
3
months.
• Purging
Disorder
(in
the
absence
of
binge
eating):
to
influence
weight
or
shape
(i.e.
self-‐induced
vomiting,
laxatives,
diuretic
or
other
medication
abuse).
• Night
Eating
Syndrome:
Recurrent
episodes
of
night
eating,
as
manifested
by
eating
after
awakening
from
sleep
or
by
excessive
food
consumption
after
the
evening
meal.
Presentation
Signs
20. ! Avoid
eating
out
due
to
mistrust
in
food
preparation
or
fear
of
“contamination”.
! May
originate
from
several
sources
(i.e.
family
habits/beliefs,
society
trends,
recent
illness,
or
overhearing
negative
comments
about
a
food
groups
(i.e.
sugar
make
you
fat),
which
then
leads
to
ultimately
eliminating
the
food
or
foods
from
their
diet.
! The
severe
restrictive
nature
of
Orthorexia
has
the
potential
to
morph
into
Anorexia.
Orthorexia
21. Orthorexia
! Defined
as
an
obsession
with
"healthy
or
righteous
eating”.
! Often
begins
with
a
simple
and
genuine
desire
to
live
a
healthy
lifestyle.
! Fixation
on
defining
“organic”
“clean”
or
“right”
foods.
! Time
and
energy
spent
obsessing
about
food
(similar
to
Anorexia
or
Bulimia).
! May
not
think
in
terms
of
calories,
but
about
overall
"health
benefits"
and
how
food
was
processed,
grown
or
prepared.
22. While
adolescence
represents
a
peak
period
of
onset,
eating
disorders
can
occur
in
people
of
all
ages.
Regardless
of
age
of
onset,
there
can
be
considerable
period
of
time
before
first
treatment.
Common
misdiagnosis
by
health
professionals
before
receiving
a
correct
diagnosis.
Delay
in
treatment
negatively
influences
the
duration
of
the
ED
and
outcomes
of
treatment.
Early
diagnosis
and
intervention
can
greatly
reduce
the
duration
and
severity
of
an
eating
disorder.
Onset
&
Duration
23. Several
factors
can
contribute
to
the
onset
of
an
eating
disorder.
No
1
single
cause
of
eating
disorders
has
been
identified;
however,
known
contributing
risk
factors
include:
! Genetic
vulnerability.
! Psychological
factors.
! Socio-‐cultural
influences.
Why
Me?
24. ! Socio-‐cultural
influences
can
play
a
key
role
in
the
development
of
eating
disorders,
particularly
among
those
who
internalise
the
Western
beauty
‘ideal
of
thinness’.
! Predominant
images
in
media
suggest
that
beauty
is
equated
with
thinness
for
females
and
a
lean,
muscular
body
for
males.
! Internalising
this
‘thin
ideal’
leads
to
a
greater
risk
of
developing
body
dissatisfaction
which
can
lead
to
eating
disorder
behaviours.
! Like
most
other
psychiatric
illnesses
and
health
conditions,
a
combination
of
several
factors
may
increase
the
likelihood
that
a
person
will
experience
an
eating
disorder
at
some
point
in
their
life.
Why
Me?
25. Eating
Disorders
in
Adolescents
! Period
of
intense
change
which
can
bring
with
it
a
great
deal
of
stress,
confusion
and
anxiety.
! Enormous
physical
transformations
intertwined
with
feelings
of
self-‐consciousness,
low
self
esteem
and
comparison
with
peers.
! Hormonal
and
brain
changes
take
place,
which
affect
them
physically,
mentally,
emotionally
and
psychologically.
! Social
and
environmental
changes
in
a
short
period
of
time
-‐
changing
schools,
friendship
groups
and
developing
interests
in
the
opposite
or
same
sex.
26. Eating
Disorders
in
Adolescents
!
Tremendous
pressure
and
feelings
of
confusion
to
find
“my
place
in
the
world”.
! Struggle
to
deal
with
the
whirlwinds
of
change,
uncertainty
and
often
low
self
esteem.
! EDs
are
very
often
a
coping
mechanism
in
attempts
to
“gain
control”.
! When
quest
for
control
goes
too
far,
the
risk
of
developing
an
eating
disorder
dramatically
increases.
! In
addition,
body
image
concerns
and
peer
pressure
are
heightened
during
adolescence,
and
are
potential
risk
factors
in
the
development
of
an
eating
disorder.
27. Eating
Disorders
in
Adolescents
! Thinness
is
now
at
our
“fingertips”.
! 95%
of
adolescents
use
social
media
on
a
daily
basis
–
facebook,
instagram,
snap
chat,
etc…
!
Social
Media
serve
as
platforms
teaching
adolescents
to
obsess
over
their
appearance
-‐
hello
“selfie’,
-‐
their
weight,
and
whether
their
bodies
are
"good
enough”.
! By
the
time
they
reach
high
school,
1
in
10
students
will
have
an
eating
disorder.
28. How
to
Deal
with
a
Suspected
Eating
Disorder?
! Evidence
shows
the
sooner
treatment
for
an
eating
disorder
starts,
the
shorter
the
recovery
process
will
be.
! Seeking
help
at
the
first
warning
sign
is
much
more
effective
than
waiting
until
the
illness
is
in
full
swing.
! Address
and
tackle
eating
disorders
as
early
as
possible.
! Do
NOT
ignore
it,
it
will
NOT
go
away.
! No
right
or
wrong
ways
to
start
this
discussion
as
every
situation
and
person
is
different,
however
there
are
some
points
to
consider…….
29. ! Be
calm,
honest
and
open
about
your
concerns
for
the
person.
! Think
about
what
you
would
like
to
say
to
maximise
chances
of
a
positive
conversation.
! Use
your
knowledge
of
the
person
to
decide
the
best
way
and
time
to
approach
them.
(Role
play
your
conversation
with
another
person,
or
role
play
your
approach
in
your
own
mind).
! Express
genuine
care
and
concern,
rather
than
coming
across
as
making
accusations
or
judgments.
! Use
‘I’
statements
rather
than
‘You’.
‘You’
statements
can
lead
to
the
person
feeling
attacked.
Communicate
30. Communicate
! Avoid
Judgmental
Language.
! Focus
on
behavioural
changes,
rather
than
weight,
food
consumption
or
physical
appearance.
! Try
to
avoid
the
words
“eating
disorder”
and
focus
more
generally
on
your
concerns
about
his
or
her
moods,
behaviours,
or
isolation.
! Pick
a
safe
comfortable
place
to
have
the
conversation,
when
you’re
both
feeling
calm
and
are
unlikely
to
have
distractions.
31. How
Will
She/or
He
Respond?
Be
prepared
for
emotional
reactions,
which
may
be:
! Anger
–feelings
of
privacy
being
threatened,
embarrassed
or
ashamed.
! Denial
–
denial
there
is
a
problem
due
to
feelings
of
guilt
or
shame.
They
may
feel
protective
about
their
eating
disorder,
especially
if
it
serves
a
purpose
for
them.
! They
may
be
confused
or
shocked
because
they
had
not
yet
identified
themselves
as
having
an
eating
disorder.
! Relief
–
they
may
feel
relieved
that
you
noticed
and
offered
them
support
or
help.
32. ! Reassure
him/or
her
that
you
are
there
to
help
and
support,
and
that
they’re
not
alone
in
their
situation.
! Encourage
them
to
seek
support
from
the
people
in
their
life
who
love
them,
such
as
friends,
family,
parents.
! The
importance
of
seeking
help
as
soon
as
possible
cannot
be
overstated.
! Strong
evidence
supports
that
the
earlier
help
is
obtained,
the
shorter
the
duration
of
the
disorder
and
the
greater
the
likelihood
of
a
full
recovery.
Seek,
Help,
Support…
33. ! Have
a
referral
resource
list
on
hand
for
medical
professionals
who
are
specifically
trained
to
help
people
with
Eating
Disorders.
! Consider
speaking
to
one
of
these
professionals
before
approaching
the
person
you
care
about
(or
prior
organising
an
intervention
or
conversation).
! Remember
everyone
responds
differently
to
different
types
of
treatment
so
a
specialist
will
advise
you
on
which
treatment
will
be
most
beneficial.
Know
Who
to
Talk
to
34. A
group
of
specialised
clinicians
who
are
able
to
guide
someone
with
an
eating
disorder
through
the
treatment
and
recovery
process:
! GP
or
Pediatrician
(may
not
be
formally
trained
in
detecting
presence
of
an
eating
disorder,
but
can
be
a
good
‘first
base’
for
discussing
your
concerns).
! Registered
Dietitian.
! Clinical
Psychologist.
! Psychiatrist.
! RNs
&
Mental
Health
Nurse.
The
Therapeutic
Team…
35. "I.D.E.A."
Code
word
used
online
by
sufferers
of
eating
disorders
-‐
Short
for
the
chilling
slogan:
“I
don't
eat
anymore”
-‐
2015
Q&A…
36. "I.D.E.A."
Gabrielle
K
Tuscher
MS
RDN
Registered
Dietitian/Nutrition
Therapist:
Eating
Disorders
&
Mental
Health
Disorders,
Global
Nutrition
&
Wellness
Consultant:
Hospitality,
F&B
&
Spas
Tüscher
Nutrition
International:
Los
Angeles:
9730
Wilshire
Blvd.,
Suite
205A,
Beverly
Hills,
CA
90212
Asia:
1
D'Aguilar
Street,
Central,
Hong
Kong
Global:
Consultancy
&
Skype
Consultations
US
Mobile:
+1
(310)
864
6800
973
/
HK
Mobile:
(+852)
6085
3066
Email:
tuschernutrition@yahoo.com
or
inquiry@nutrituscher.com
Skype:
tigertush
Website:
http://www.nutrituscher.com
