Eating disorders

1. Eating disorders Anorexia

2. Eating Disorders: • Def: • “Psychiatric sickness where food is used to help cope with unsettling emotions and personal life issues” • Persistent disturbance of eating behavior or a behavior intended to control wt • Significantly impairs physical health or psychosocial fx • Not secondary to a general medical condition or another psychiatric disorder Michel and Willard (2003) Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2), 359-374.

3. Anorexia: • First described in medical literature in __________. • Main feature: relentless pursuit of thinness & refusal to maintain minimum bodyweight for age and height. Klein and Walsh (2003)

4. Personality Characteristics: • ________________________ • Greater harm avoidance • Conscientiousness • Perfectionism • Obsession Klein and Walsh (2003)

5. Developmental factors: • Onset: during adolescence or young adulthood & rarely begins before _____________. • Cause: psychological reactions to maturing body, changing peer relationships, and new life roles. • Cause: Stress Klein and Walsh (2003)

6. Clinical Features: • Weight loss usually from reduction in food intake, in stages • _______________ • Meat • Foods that could potentially contain fat • As the wt loss carries on, thinness becomes more of an obsession. Klein and Walsh (2003)

7. Social avoidance can aid progressive weight loss • e.g, pts avoid situations where ______________. • Psych components of starvation include: • Irritability • Poor concentration • Fatigue Klein and Walsh (2003)

8. Over-Activity: • Forms of excessive physical activity: • Planned sports • Walking • Standing • Maintenance of __________________ (to burn more calories) Klein and Walsh (2003)

9. Assessment and Diagnosis: • Assessment: developmental, past psychiatric & medical history, current psychosocial fxing & supports. • Diagnosis: based on behavioral, psychological, & physical Klein and Walsh (2003)

10. Warning Signs of Anorexia: • __________________________ • Frequent weighing • Sleep difficulties • Frequent exercising before and after eating • Use of laxatives Michel and Willard (2003)

11. Loss of menstrual cycle (female) • Preparing __________________, but not for yourself • Attempts to obtain diet instructions/pills from doctors • Isolation from peers and families Michel and Willard (2003)

12. 0 BULIMIA

13. DEFINITION OF BULIMIA NERVOSA • Recurrent episodes of binge eating followed by inappropriate behaviors to __________________ (e.g., self-induced vomiting) Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2), 359-374.

14. RISK FACTORS • History of Anorexia Nervosa (AN) • Familial correlation • Females age 10-25 • ________________________ • Athletes, models, gymnasts Bulimia Nervosa. (2005 September 13). Retrieved September 19, 2005 from http://en.wikipedia.org/wiki/Bulimia

15. Students under stressful workload • Suffered traumatic events (sexual abuse, child abuse) • ________________ • Personality (higher reactivity) • Perfectionists/overachievers Bulimia Nervosa. (2005 September 13). Retrieved September 19, 2005 from http://en.wikipedia.org/wiki/Bulimia

16. SIGNS AND SYMTOMS • Distorted body image (focus on shape) • Disturbed eating patterns • Consuming large amounts of food, then “purging” • Poor _____________________ • Dental erosion Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2), 359-374.

17. DIAGNOSIS • DSM-IV criteria • Binge eating (more than usual w/ lack of control) • Compensatory behaviors • Purging (vomiting) • Misusing medication • Laxatives, diet pills, diuretics • Weight control • Fasting, excessive exercise • At least 2x’s/wk for _________

18. PURGING TYPE Vomiting NON-PURGING TYPE No vomiting Excessive exercise, fasting SUBTYPES • Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2), 359-374.

19. COMORBIDITY • Anxiety disorders (onset before BN/AN) • ________ most common • Social phobia • Specific phobia • Generalized anxiety disorder • Mood disorders • Depression Kaye, W.H., Bulik, C.M., & et al. (2004). Comorbidity of Anxiety Disorders with Anorexia and Bulimia Nervosa. The American Journal of Psychiatry, 161, 2215-2221.

20. TREATMENT • Respond ________________ to treatment than AN 2 treatment approaches: • Short-term (4-6 months) • Psychological treatment • Cognitive behavioral therapy • Long-term • Anti-depressant therapy • Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2), 359-374.

21. OUTCOME • Study showed 5-10 years later…. • 50% patients fully recover • 20% continued to meet diagnosis • 30% _________________ • Klein, D.A., Walsh, T.B. (2004). “Eating Disorders: Clinical Features and Pathophysiology.” Physiology and Behavior, 81(2), 359-374.

22. FYI • Can consume up to ____________ calories in a single binge episode! • Eating disorders have one of the highest death rates of mental illness • 1-3% women in US have ED • Those with BN usually have a normal weight • More cases of BN than AN

23. Obesity

24. What is obesity? • Physicians consider obese if weighs more than 20% above the expected weight for age, height, & body build. • _________________ or morbidly obese: If 100 pounds above expected wt Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic.  Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Web:  http://www.anred.com/obese.html

25. What are the causes of obesity? • Consumption of more calories than are burned through work, exercise, and other activities • Attempts to _______________ emotional pain & distress • Diets & prolonged caloric restriction. (ex: yo-yo dieting) • Specific biological problems (ex: malfunctioning thyroid or pituitary glands; physical problems or disabilities that limit/prohibit exercise, strenuous work, or physical activity) Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic.  Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Web:  http://www.anred.com/obese.html

26. Certain genetic processes • __________________________ • New research shows that there is a biological link between stress & the drive to eat. Comfort foods seem to calm the body’s response to chronic stress. • Researchers believe that in most cases obesity represents a complex relationship between genetic, physiological, metabolic, socioeconomic, lifestyle, & cultural factors. Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic.  Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Web:  http://www.anred.com/obese.html

27. Health Risks Associated With Obesity: • Hypertension • _______________ • Cardiovascular disease • Cancer Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic.  Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Web:  http://www.anred.com/obese.html

28. Endocrine problems • Gall bladder disease • Lung and breathing problems • __________________ • Premature death Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic.  Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Web:  http://www.anred.com/obese.html

29. What can be done about obesity?? • The simplistic answer : eat less & exercise more!! • The realistic answer: • Work with a physician to identify & correct any underlying problems that contribute to excess wt gain. • Talk with a counselor to see if you are using food for purposes that it cannot fulfill: love, comfort, escape, boredom, etc. Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic. Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Wide Web:  http://www.anred.com/obese.html

30. Never diet or restrict calories when you are _____________________! If you do, binge eating might be a result. • Eat normal, reasonable, moderate amounts of a wide range of foods. Portion control is one of the most important factors in a successful weight management program. Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic. Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Wide Web:  http://www.anred.com/obese.html

31. Eat _________________!! • Get plenty of sleep each night!! • Exercise!! • Find a support system. Friends, family, & support groups are key components of a healthy life. • Be realistic with yourself. Losing wt takes time & commitment – don’t give up!! Brownell, K.D., Foster, G.D., Wadden, T.A.  (2002).  Obesity: Responding to the Global  Epidemic. Journal of Consulting and Clinical Psychology, 70 (3), 510-525.Anorexia Nervosa and Related Eating Disorders, Inc.  (2002).  Retrieved September 13, 2005 from the World Wide Wide Web:  http://www.anred.com/obese.html

32. Pica The compulsive, recurrent consumption of nonnutritive items (Steigler, Spring 2005)

33. From the Latin word for “magpie” • Most commonly observed ED with ________ & other developmental disorders (DD) • Nonfood items consumed repeatedly over a month or longer, despite efforts to restrain • Frequently under identified, underreported, & under treated (Steigler, Spring 2005)

34. Only suspected when: (a) Nonfood items consumed repeatedly over month or longer, despite efforts to restrain behavior (b) Behavior considered inappropriate for developmental age (beyond _____________) (Steigler, Spring 2005)

35. (c) Not found in _________________ (d) Behavior is a sx of other mental disorder & is of sufficient concern to warrant medical attention (Steigler, Spring 2005)

36. Etiologies • Nutritional Factors- Iron and/or zinc ___________ • Environmental Factors- Stressful events Impoverished environment Lack of active participation in activities Insufficient levels of human interaction (Steigler, Spring 2005)

37. Mental Health Factors- Observed in individuals with normal intellect & those diagnosed with mental illnesses (OCD, schizophrenia, emotional disturbance, depression, pathological anxiety) • Sensory/ Physiologic Factors- Taking pleasure in the _________, smell, and/or taste of the objects (Steigler, Spring 2005)

38. Health Risks ______________- Lead poisoning Parasitic Infections- pinworms (geophagia~ dirt, clay & coprophagia~ feces) Malnutrition- could eat substances that cause excessive calorie intake (cornstarch) (Steigler, Spring 2005)

39. Oral & Dental- dental trauma, oral lacerations, gum disease, erosion of tooth enamel Obstructions & Perforations- gastrointestinal or respiratory tracts- ______________ could be necessary Other- may be extremely aggressive in their search for these items - Pushing away peers & caregivers (Steigler, Spring 2005)

40. Treatments Nutritional Interventions-Iron or Zinc ________________ Psychological Interventions- Counseling, psychotherapy Pharmacological Interventions- Selective serotonin reuptake inhibitors (antidepressant drugs) (All information was obtained from the article Understanding Pica Behavior: A Review for Clinical and Education Professionals by Lillian N. Stiegler; published in the journal Focus on Autism and Other Developmental Disabilities, Vol. 20, Number 1, Spring 2005: p. 27-38)

41. Behavioral Interventions- • _________________ • Facial Screening/ Physical Restraint Procedures • Aversive Substances • Edible/ Nonedible Discrimination Training Sensory Approaches- replace bad objects with safe objects of same texture/appearance (All information was obtained from the article Understanding Pica Behavior: A Review for Clinical and Education Professionals by Lillian N. Stiegler; published in the journal Focus on Autism and Other Developmental Disabilities, Vol. 20, Number 1, Spring 2005: p. 27-38)