Eating Disorders

1. Eating Disorders Zainab hashem Alia�a hassan

2. Three types:

3. Patients with anorexia or bulimia have a disturbed body image and use extensive methods to avoid gaining weight. Binge eating may occur in all of the eating disorders.

4. ANOREXIA NERVOSA It�s psychiatric illness that describes an eating disorder characterized by extremely low body weight and body image distortion with an obsessive fear of gaining weight. Patients are highly concerned with their weight, body image, and being thin.

5. Patients are known to control body weight commonly through the means of voluntary starvation, excessive exercise, or other weight control measures such as diet pills or diuretics drugs. 2 main subdivisions: A-Restrictive type: eat very little amount and may vigorously exercise. More often have obsessive-compulsive traits. B-Binge eating/purging type: eat in binges followed by purging, laxatives use and excessive exercise. Associated with increased incidence of major depression and substance abuse.

6. Risk Factors Family history. Psychiatric illness. Obesity. Chronic medical illness. History of sexual abuse. Homosexuals.

7. Epidemiology 10-20 times more common in women than men. In 4% of adolescents and young adults. Onset b/w ages 10 & 30. Increased incidence of comorbid mood disorders.

8. Epidemiology More common in developed countries and professions requiring thin body. Etiology involved environmental, social, psychological and genetic factors.

9. Diagnosis (DSM IV criteria) : Body weight at least 15% below normal Have intense fear of gaining weight or becoming fat. Disturbed body image. Amenorrhea.

10. Co-morbid Psychiatric disorder Major Depression Obsessive compulsive disorder Alcohol or substance abuse

11. Physical findings and complications: Amenorrhea Electrolyte abnormalities Arrhythmias Hypotension Dry skin Hypercholesterolemia Lanugo Melanosis coli

12. Physical findings and complications: Leukopenia Hypothermia and cold intolerance Lethargy Osteoporosis Patients are often preoccupied with food rituals, intensely fear becoming fat, and judge themselves by their weight.

13. Differential Diagnosis: Medical conditions Major depression Mental disorders Bulimia.

14. Course and prognosis: Variable� Mortality rate�

15. Treatment: Early treatment centers on monitoring caloric intake to stabilize weight and then focuses on weight gain. Treated as outpatients- unless; their weight is more than 20% below ideal body weight, or in severe cases to restore nutritional status and/or correct electrolyte imbalances. Later treatment includes individual, family, and group psychotherapy. SSRIs may help treat comorbid depression such as Paroxetine.

16. BULIMIA NERVOSA An eating disorder which is characterized by recurrent binge eating, followed by compensatory behaviors. Patients are usually ashamed of their eating behaviors, tend to keep them secret, and often maintain normal body weight. Has a 3-5% prevalence rate among late adolescent girls. Can be classified into; purging & nonpurging types.

17. Diagnosis (DSM �IV criteria) Recurrent episodes of binge eating. Recurrent inappropriate attempts to compensate for overeating and prevent weight gain. These behaviors occur at least twice a week for 3 months. Perception of self-worth is excessively influenced by body weight and shape.

18. Co-morbid Psychiatric disorder Mood disorders Anxiety disorder Personality disorders Substance abuse

19. Physical findings and complications: Dental enamel erosion Salivary glands hypertrophy Calloused knuckles Menstrual irregularities Electrolyte imbalance (hypochloremic hypokalemic alkalosis) Laxative dependence Patients� self-esteem is overly dependant on body weight.

20. Epidemiology Affects 1-3% of adolescents and young females. More common in females than males. More common in developed countries. High incidence of comorbid mood disorders, impulse control disorders and alcohol abuse/dependence

21. Course & prognosis: Better prognosis than anorexia nervosa. Symptoms exacerbated by stressful conditions. One half fully recover with treatment. One half have chronic course with fluctuating symptoms.

22. Treatment: Individual psychotherapy, cognitive-behavior therapy, group therapy. Pharmacotherapy: SSRIs as a first line treatment then TCAs

23. BINGE-EATING DISORDER An eating disorder characterized by periods of extreme over-eating, but here they DO NOT try to control their weight by purging or restricting calories as do anorexics or bulimics. Patients with this disorder suffer emotional distress over their binge eating. So they are obese.

24. Diagnosis (DSM-IV CRITERIA) Recurrent episodes of binge eating ( excessive amounts of food in a 2 hour period associated with lack of control). Sever distress over binge eating. Bingeing occurs at least 2 days a week for 6 months and NOT associated with compensatory behaviors.

25. Cont. diagnosis � Three or more of the following: 1. Eating very rapidly. 2. Eating until uncomfortable full. 3. Eating large amounts when not hungry. 4. Eating alone. 5. Feeling disgusted, depressed, or guilty after overeating.

26. What trigger Binge eating? Dysphoric mood Interpersonal stressors Intense hunger after dietary restrain

27. Complications: People with binge eating disorder may become ill due to a lack of proper nutrition. People with binge eating disorder are usually very upset by their binge eating and may become very depressed. Obesity has many adverse effects on health Depression, sometimes called post binge anguish, often follows the episode.

28. Treatment: Individual psychotherapy and behavioral therapy with strict diet and exercise program. Comorbid mood disorders or anxiety disorders should be treated. Pharmacotherapy: used adjunctively to promote weight loss. Include: -Stimulants: phentramine and amphetamine. -Orlistat (Xenical). -Sibutramine.