Welcome !!!

1. Welcome !!! CRH AASSA-2007

2. Eating Disorders Why and How to Care Cecile Rausch Herscovici, Ph.D.

3. Increase in variety of food & stimuli to consume Advertising links food to social status & sexuality Eating is no longer familial & social Eating has become indiscriminate (anything, anywhere) Fitness is today’s morality Good=beautiful =thin At age 13, 80% of girls & 10% of boys are dieting Discomfort with body increases with age 90% of women want to lose weight; 16% are obese; 75% diet; 90% fail Social change and eating habits CRH AASSA-2007

4. Importance of eating disorders • Are the most frequent mental disorder and third most frequent chronic illness in adolescent females (5-10% ED or borderline condition) • Anorexia nervosa has the highest mortality of all mental illnesses • Dramatic increase in prevalence in past 3 decades • ED have changed through time: age of onset, symptoms, and social group affected. CRH AASSA-2007

5. Complications • Mortality (death rates) • Morbidity • Personal well being • Self esteem • Social life • Family life CRH AASSA-2007

6. Unhealthy eating habits Unhealthy weight control practices Obsessive attitudes related to weight, body shape,food, and/or exercise. Sense of loss of control and of efficacy Obsessionality, anxiety, guilt & distress Disturbed relationship with oneself and with others Physical imbalances Eating Disorders CRH AASSA-2007

7. Eating Disorders • Disturbed eating behavior • Distress • Extreme concern about body shape & appearance • Physical implications • Not due to lack of will power, rather a treatable medical illness. High hereditability of AN & BN. • Often co-occur with anxiety, depression & substance abuse. CRH AASSA-2007

8. Risk Factors in 0-5 years • Maternal restraint and drive for thinness + < BMI in the child, predict overeating during the first 5 years of life. • Maternal dishinibition, hunger, body dissatisfaction, bulimic symptoms, >BMI & paternal overeating predict secretive eating • Stice, Agras & Hammer, 1999. CRH AASSA-2007

9. Gender Age Body weight Body dissatisfaction Dieting Low self esteem Depression Impaired affect regulation Poor impulse control Sexual and Physical abuse Individual Risk Factors for ED CRH AASSA-2007

10. Family Parental attitudes (performance, weight, criticism). Structure (attachment, autonomy). Illness: Depression, ED (genes), alcoholism. Peers Attitudes Teasing Culture Media influences on: a) Thinness as a goal b) Role performance Social Risk Factors for ED CRH AASSA-2007

11. Conclusions • Parental problems, obesity risk, parental psychiatric disorder, physical or sexual abuse and premorbid psychiatric disorder are associated with case status. • Bulimia is more likely to develop in dieters who are at risk of obesity and psychiatric disorder in general CRH AASSA-2007

12. Triggers • Hurtful comments • Dieting • An illness that resulted in weight loss • Family member or friends with an eating disorder • Imposed weight or fat limits/criteria • TV shows/health classes about eating disorders CRH AASSA-2007

13. Anorexia Nervosa • Intense and irrational fear of gaining weight • Relentless pursuit of thinness &/or denial of the risk of current low weight • Body image disturbance • Self evaluation determined by weight • In post-menarcheal women, infrequent or absence menstrual cycles • Lifetime prevalence for females: 0.5-3.7 CRH AASSA-2007

14. Bulimia Nervosa • Repeated binge/purge episodes • Sense of loss of control • Purging behavior after a binge • Frequent diet/fasting behavior • Great preoccupation with weight and body shape • Lifetime prevalence for females: 1.1-4.2 CRH AASSA-2007

15. Binge Eating Disorder • Eats large amounts of food when not hungry • Eats until feeling uncomfortably full • Often eats alone because of shame • Feels depressed, disgusted or guilty after eating • Has a history of marked weight fluctuations • Prevalence: 2-5% in a 6 month period • Affects 35% of males CRH AASSA-2007

16. EDNOS • 14.5% AN 25.5% BN 60.0% EDNOS • Comparable duration, psychopathology and degree of psychosocial impairment • Different intensity &/or combination of clinical features of AN and BN (mixed or subthreshold) • Affect mostly young women • Dieting/body image behaviors • Purging/binge-eating behaviors CRH AASSA-2007

17. The transdiagnostic solution • Extreme dietary restraint and restriction • Binge eating • Self-induced vomiting and misuse of laxatives • Driven exercising • Body checking and avoidance • Over-evaluation of control over eating, shape and weight CRH AASSA-2007

18. Preoccupied with food, calories, nutrition Presence of abnormal eating habits Hides/hoards food Eats alone (shame) Cooks, bakes and feeds others Restricts the quality and amount of food Denies hunger Food disappears Engages in binge eating Quarrels during meals Feels guilt about eating Self-esteem = food Demand of strict schedule Sudden changes in plans Drinks excess of fluids Warning signs (food & eating) CRH AASSA-2007

19. Frequent weighing Exercises obsessively Attempts to diet but fails Uses bathroom after meals Wears loose clothing Disturbed sleep pattern > activity (sport or study) Irritable, depressed Defiant & stubborn Fixed daily routines Self-depreciative Socially isolated Distorted body image Nocturnal eating Self-harming behavior Warning signs (behavior) CRH AASSA-2007

20. Weight loss or fluctuation Menstruation cessation or irregularity Dizziness-blackouts Refers abdominal pain & undue satiety Fatigue, feels unduly cold Dry skin, swollen glands Bad circulation Loss or thinning of hair Feels uncomfortably full Constipation/diarrhea Eats extremely quickly Dental problems Russell sign Heartburn Warning Signs (body) CRH AASSA-2007

21. Main Principles(Bryant-Waugh & Lask, 2004) • Nobody chooses to have an ED & often fears loosing it. • Resistance to change and to accept help are normative. • ED are always an issue of self-worth. • Recovery will not occur immediately. • ED are not a form of rebellion, but a distorted way of expressing distress. • Professional advice should always be sought. CRH AASSA-2007

22. Treatment Strategies • Often people with ED do not admit they are ill • Multidisciplinary team: medical monitoring; psychosocial interventions; nutritional counseling • Medication management • Family therapy • Day hospital • Hospitalization CRH AASSA-2007

23. Outcome of Eating Disorders • Impossible to predict outcome for one case • Course of BN is more benign than AN or BED • For cure, we need to know more about maintenance factors (body image, self esteem and tension regulation) • Hope is the most important factor in cure • Patients differ and so should treatments CRH AASSA-2007

24. How to face an Eating Disorder. Dos • Do show you want to help • Do understand she is suffering and needs help and care • Do pick the right timing to discuss your concerns • Do be prepared to encounter denial • Do try to seek professional help a.s.a.p. • Do learn everything you can about ED CRH AASSA-2007

25. How to face an Eating Disorder. Dos • Do be patient and understanding • Do watch for signs of deteriorating physical or emotional health • Dohighlight the person’s strengths • As parents dokeep a united stance of support • Do keep your message consistent through time • Do avoid getting caught in power struggles CRH AASSA-2007

26. How to face an Eating Disorder. Don’ts • Don’t blame yourself • Don’t try to cure the eating disorder on your own • Don’t comment on her appearance (or your own) • Don’t compare her to others • Don’t get involved in discussions about weight • Don’t refer to foods as good or bad • Don’t agree to keep her eating disorder a secret • Don’t try to analyze or interpret her behavior CRH AASSA-2007

27. How can parents prevent eating disorders • Revise the influence that weight and gender stereotypes have on beliefs regarding the body • Revise your expectations regarding your loved ones. (Do I overemphasize thinness and beauty?) • Foster physical activity for pleasure • Do not avoid activity or clothes that expose your body CRH AASSA-2007

28. How can parents prevent ED (2) • Value people for their human worth, not for their appearance • Take a proactive stance to point out distorted messages in the media • Educate boys about weight prejudice and other forms of violence towards women • Support children’s enjoyment of their bodies and do not promote food restriction • Support the child's self worth and avoid gender stereotype CRH AASSA-2007

29. How can parents prevent ED (3) Become knowledgeable and talk to their children about • the hazards of dieting • healthy eating habits & physical activity • avoiding the dichotomy of good or bad food • emphasize development of self esteem and self respect • be a good role model CRH AASSA-2007

30. Prevention Programs • Interactive • Multisession • Targeted (females; those over age 15). • Stice & Shaw; Psychol Bull 2004;130:206–27 CRH AASSA-2007

31. Internet Insights • www.cecilerh.com.ar • www.bulimia.com • www.something-fishy.org • www.nationaleatingdisorders.org • www.eatright.org • www.eatingdisorderinfo.org • www.anad.org CRH AASSA-2007

32. Contact information • Cecile Rausch Herscovici, Ph.D. • cecilerh@fibertel.com.ar • Phone: 4807-4488 4805-3319 http: //www.cecilerh.com.ar CRH AASSA-2007