Eating disorders


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This is a powerpoint presentation for eating disorders based on DSM-IV TR.

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Eating disorders

  1. 1. Eating Disorders
  2. 2. Eating Disorders  anorexia - refers to loss of appetite  nervosa - indicates that the loss is due to emotional reasons.
  3. 3. Eating Disorders  The term is something of a misnomer because most individuals with anorexia nervosa actually do not lose their appetite or interest in food.
  4. 4. Eating Disorders  On the contrary, while starving themselves, most individuals with the disorder become preoccupied with food; they may read cookbooks constantly and prepare gourmet meals for their families.
  5. 5. True story of Isabel Anorexia's Childhood Roots (CBS News)
  7. 7.  A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).  B. Intense fear of gaining weight or becoming fat, even though underweight. DIAGNOSTIC CRITERIA FOR ANOREXIA NERVOSA
  8. 8.  C. 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.  D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.) DIAGNOSTIC CRITERIA FOR ANOREXIA NERVOSA
  9. 9. Two Types of Anorexia Nervosa  Restricting Type: during the current episode of Anorexia Nervosa, the person has NOT regularly engaged in binge-eating or purging behavior (i .e., self-induced vomiting or the misuse of laxatives, diuretic;, or enemas)  Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
  10. 10. Eating Disorders Inventory  The distorted body image that accompanies anorexia nervosa has been assessed in several ways, most frequently by a questionnaire such as the EATING DISORDERS INVENTORY (Garner et al. cited in Davison et al., 2007).  Some of the items on this questionnaire are presented in the table below.
  11. 11. Drive for thinness I think about dieting. I feel extremely guilty after overeating. I am preoccupied with the desire to be thinner. Bulimia I stuff myself with food. I have gone on eating binges where I have felt that I could not stop I have the thought of trying to vomit in order to lose weight. Body dissatisfaction I think that my thighs are too large. I think that my buttocks are too large. I think that my hips are too big. Ineffectiveness I feel inadequate. I have a low opinion of myself. I feel empty inside (emotionally). Perfectionism Only outstanding performance is good enough in my family. As a child, I tried hard to avoid disappointing my parents and teachers. I hate being less than best at things. Subscales and Illustrative Items from the Eating Disorders Inventory
  12. 12. Interpersonal distrust I have trouble expressing my emotions to others. I need to keep people at a certain distance (feel uncomfortable if someone tries to get too close). Interoceptive awareness I get confused about what emotion I am feeling. I don’t know what’s going on inside me. I get confused as to whether or not I am hungry. Maturity fears I wish that I could return to the security of childhood. I feel that people are happiest when they are children. The demands of adulthood are too great. Source: From Garner et al., 1983 Note: Responses use a six-point scale ranging from always to never. Subscales and Illustrative Items from the Eating Disorders Inventory
  13. 13. Assessment of Body Image  In another type of assessment, individuals with anorexia nervosa are shown line drawings of women with varying body weights and asked to pick the one closes to their own and the one that represents their ideal shape.
  14. 14. Assessment of Body Image  Individuals overestimate their own body size and choose a thin figure as their ideal.  Despite this distortion in body size, individuals with anorexia nervosa are fairly accurate when reporting their actual weight, perhaps because they weight themselves frequently.
  15. 15. Anorexia Nervosa  Women with anorexia nervosa are frequently diagnosed with depression, obsessive- compulsive disorder, phobias, panic disorder, alcoholism, and various personality disorders
  16. 16. Anorexia Nervosa  Men with anorexia nervosa are also likely to have a diagnosis of a mood disorder, schizophrenia, or substance dependence
  17. 17. PHYSICAL CHANGES IN ANOREXIA NERVOSA  Blood pressure often falls  Heart rate slows  Kidney and gastrointestinal problems develop  Bone mass declines  Skin dries out, nails become brittle  Hormone levels change  Mild anemia may occur  EEG abnormalities and neurological impairments  Structural brain changes,
  18. 18. PREVALENCE  The lifetime prevalence of Anorexia Nervosa among females is approximately 0.5%.  It is at least 10 times more frequent in women than in men.  The incidence of Anorexia Nervosa appears to have increased in recent decades.
  19. 19. COURSE  Anorexia Nervosa typically begins in mid- to late adolescence (age 14-18 years).  The onset of this disorder rarely occurs in females over age 40 years.  Hospitalization may be required to restore weight and to address fluid and electrolyte imbalances.  Death most commonly results from starvation, suicide, or electrolyte imbalance.
  20. 20. PROGNOSIS  About 70% of patients with anorexia eventually recover.  Recovery often takes 6 or 7 years, and relapses are common  Anorexia nervosa is a life-threatening illness  Death rates are 10 times higher among individuals with the disorder than among the general population and twice as high as among individuals with other psychological disorders.  Death most often results from physical complications of the illness – for example, congestive heart failure – and from suicide
  22. 22. Bulimia Nervosa  Bulimia is from a Greek word meaning “ox hunger.”  This disorder involves episodes of rapid consumption of a large amount of food, followed by compensatory behavior, such as vomiting, fasting, or excessive exercise to prevent weight gain.
  23. 23. Bulimia Nervosa  The DSM defines a BINGE as eating an excessive amount of food within less than 2 hours.
  25. 25. Diagnostic Criteria for Bulimia Nervosa
  26. 26. Diagnostic Criteria for Bulimia Nervosa A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) eating, in a discrete period of time (e.g., 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 under similar circumstances (2) a sense of lack of (control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
  27. 27. Diagnostic Criteria for Bulimia Nervosa B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
  28. 28. Diagnostic Criteria for Bulimia Nervosa D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
  29. 29. Two types of Bulimia Nervosa  Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
  30. 30. Two types of Bulimia Nervosa  Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
  31. 31. Bulimia Nervosa  In bulimia, binges typically occur in secret; they may be triggered by stress and the negative emotions it arouses, and continue until the person is uncomfortably full
  32. 32. Bulimia Nervosa  Foods that can be rapidly consumed, especially sweets such as ice cream and cake, are usually part of a binge.  A recent study found that women with bulimia nervosa were more likely to binge while alone and during the morning or afternoon.
  33. 33. Bulimia Nervosa  Avoiding a craved food on one day was associated with a binge episode the next morning  Other studies show that a binge is likely to occur after a negative social interaction, or at least the perception of a negative social exchange
  34. 34. Bulimia Nervosa  Patients report that they lose control during a binge, even to the point of experiencing something akin to a dissociative state, perhaps losing awareness of their behavior or feeling that it is not really they who are binging.  They are usually ashamed of their binges and try to conceal them.
  35. 35. Bulimia Nervosa  After the binge is over, disgust, feelings of discomfort, and fear of weight gain lead to the second step of bulimia nervosa – purging to attempt to undo the caloric effects of the binge.
  36. 36. Bulimia Nervosa  Individuals with bulimia most often stick fingers down their throats to cause gagging, but after a time many can induce vomiting at will without gagging themselves.  Laxatives and diuretic abuse as well as fasting and excessive exercise are also used to prevent weight gain.
  38. 38. Is twice a week a well- established cut-off point?  Probably not. Few differences are found between patients who binge twice a week and those who do so less frequently, suggesting that we are dealing with a continuum of severity rather than a sharp distinction
  39. 39. PHYSICAL CHANGES IN BULIMIA NERVOSA  Although less common than in anorexia, menstrual irregularities, including amenorrhea, can occur, eventhough bulimia patients typically have a normal body mass index (BMI)  The BMI is calculated by dividing weight in kilograms by height in meters squared and is considered a more valid estimated of body fat than many others For women, a normal BMI is between 20-25.
  40. 40. PHYSICAL CHANGES IN BULIMIA NERVOSA  Frequent purging can cause potassium depletion.  Heavy use of laxatives induces diarrhea, which can also lead to changes in electrolytes and cause irregularities in the heartbeat.
  41. 41. PHYSICAL CHANGES IN BULIMIA NERVOSA  Recurrent vomiting may lead to tearing of tissue in the stomach and throat and the loss of dental enamel  Salivary glands may become swollen.
  42. 42. PREVALENCE  The lifetime prevalence of Bulimia Nervosa among women is approximately 1 %-3%;  the rate of occurrence of this disorder in males is approximately one- tenth of that in females.
  43. 43. COURSE  Bulimia Nervosa usually begins in late adolescence or early adult life.  The binge eating frequently begins during or after an episode of dieting.  The course may be chronic or intermittent
  44. 44. PROGNOSIS  Long-term follow-ups of individuals with bulimia nervosa reveal that about 70% recover, although about 10% remain fully symptomatic
  45. 45. PROGNOSIS  Individuals with bulimia nervosa who binge and vomit more, and have comorbid substance abuse or a history of depression, have a poorer prognosis than patients without these factors
  46. 46. Key Point:  One striking difference between anorexia and bulimia is weight loss; individuals with anorexia nervosa lose a tremendous amount of weight whereas individuals with bulimia nervosa do not.
  47. 47. ETIOLOGY OF EATING DISORDERS GENETIC FACTORS  Both disorders (Anorexia and Bulimia) tend to run in families, and twin studies support the role of genetics in the actual disorders.  Research findings on the role of serotonin in anorexia are mixed.
  48. 48. ETIOLOGY OF EATING DISORDERS GENETIC FACTORS  Serotonin may play a role in bulimia, with studies finding a decrease in serotonin metabolites, smaller responses to serotonin agonists, and an increase in cognitions related to eating disorders, such as feeling fat, among formerly bulimic individuals who had their serotonin levels reduced.
  49. 49. ETIOLOGY OF EATING DISORDERS GENETIC FACTORS Newer research suggests dopamine may play a role in restrained eating
  50. 50. ETIOLOGY OF EATING DISORDERS SOCIOCULTURAL STANDARDS  As sociocultural standards changed to favor a thinner shape as the ideal for women, the frequency of eating disorders increased.
  51. 51. ETIOLOGY OF EATING DISORDERS PSYCHOLOGICAL LEVEL  Psychodynamic theories of eating disorders emphasize parent-child relationships and personality characteristics.  Food becomes a symbol of this failed relationship. The daughter’s binging and purging represent the conflict between the need for the mother and the desire to reject her.
  52. 52. ETIOLOGY OF EATING DISORDERS PSYCHOLOGICAL LEVEL  Studies of personality have found that patients with eating disorders are high in neuroticism and perfectionism and low in self-esteem.  Many women with eating disorders report being abused as children, but early abuse does not appear to be a specific risk factor for eating disorders.
  53. 53. COGNITIVE BEHAVIORAL THEORIES  Cognitive behavioral theories of eating disorders propose that fear of being fat and body-image distortion make weight loss a powerful reinforcer.
  54. 54. COGNITIVE BEHAVIORAL THEORIES  Among patients with bulimia nervosa, negative affect and stress precipitate binges that create anxiety, which is then relieved by purging.
  55. 55. PSYCHOLOGICAL TREATMENT OF ANOREXIA NERVOSA  Therapy for anorexia is generally believed to be a two-tiered process.  Immediate goal is to help the patient gain weight in order to avoid medical complications.  Second goal of treatment—long term maintenance of weight gain.
  56. 56. PSYCHOLOGICAL TREATMENT OF ANOREXIA NERVOSA  Family therapy  The therapist sees the family at a family lunch session.
  57. 57. Family Therapy  One strategy is to instruct each parent to try individually to force the child to eat. The other parent may leave the room. The individual efforts are expected to fail. But through this failure, the mother and father may now work together to persuade the child to eat.
  58. 58. Family Therapy  Thus, rather than being a focus of conflict, the child’s eating will produce cooperation and increase parental effectiveness.
  59. 59. PSYCHOLOGICAL TREATMENT OF BULIMIA NERVOSA  The overall goal of treatment in bulimia nervosa is to develop normal eating patterns.  Patients need to learn to eat 3 meals a day and even some snacks in between meals without sliding back into binging or purging.
  60. 60. PSYCHOLOGICAL TREATMENT OF BULIMIA NERVOSA  Cognitive behavior therapy (CBT) is the best validated and most current standard for the treatment.  Cognitive behavioral treatment for bulimia focuses on questioning society’s standard for physical attractiveness, challenging beliefs that encourage severe food restriction, and developing normal eating patterns.
  61. 61. PSYCHOLOGICAL TREATMENT OF BULIMIA NERVOSA  One intervention that is sometimes used in the cognitive behavioral treatment approach asks the patient to bring small amounts of forbidden food to eat in the session.  Relaxation is employed to control the urge to induce vomiting.
  62. 62. PSYCHOLOGICAL TREATMENT OF BULIMIA NERVOSA  To improve on CBT, some investigators are examining one important aspect –exposure and ritual prevention (ERP – aspect of CBT of obsessive-compulsive disorder). This ERP component involves discouraging the patient from purging after eating foods that usually elicit an urge to vomit.  Patients with bulimia nervosa are also taught assertiveness skills to help them cope with unreasonable demands placed on them by others.
  63. 63. ANTIDEPRESSANTS  Although somewhat effective, drop-out rates from drug-treatment programs are high and relapse is common when patients stop taking the medication.  Treatment of anorexia often requires hospitalization to reduce the medical complications of the disorder. 
  64. 64. Eating Disorder Not Otherwise Specified
  65. 65. Eating Disorder Not Otherwise Specified The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder. 1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses. 2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual 's current weight is in the normal range.
  66. 66. Eating Disorder Not Otherwise Specified 3. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months. 4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). 5.Repeatedly chewing and spitting out, but not swallowing, large amounts of food. 6.Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.
  67. 67. PREVENTIVE INTERVENTIONS FOR EATING DISORDERS  Psychoeducational Approaches. The focus is on educating children and adolescents about eating disorders to prevent them from developing the symptoms;  De-emphasizing Sociocultural Influences. The focus here is on helping children and adolescents resist or reject sociocultural pressures to be thin;
  68. 68. Society’s Preoccupation with Thinness  After winning Miss Universe (1996), she gained a few pounds, some people became outraged and suggested she give up her crown.
  69. 69. PREVENTIVE INTERVENTIONS FOR EATING DISORDERS  Risk Factor Approach. The focus here is on identifying individuals with known risk factors for developing eating disorders (e.g., weight and body concern, dietary restraint) and intervening to alter these factors.
  70. 70. Thank You!!!