Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating

Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder

Anorexia Nervosa DSM-V Criteria • Restricted intake of nourishment leading to significantly low body weight. • Intense fear of gaining weight, even though significantly underweight • Disturbed body perception, undue influence of weight or shape on self-evaluation or persistent denial of the seriousness of the current low weight. (This means no matter how emaciated someone is, he/she believes she is overweight)

Anorexia Facts • 90 -95% of all anorexia cases occur in females • Peak age of on-set is 14 -18 years • Rarely begins before puberty (early on-set) or after age 40 (late on-set) • Most often associated with a stressful life event. • Data shows that most victims recover. 12 for every 100, 000 commit suicide

Types of Anorexia (not in text) • Restricting Type: During the last 3 months, the individual has not engaged in binge eating/purging behaviors. Weight loss is accomplished through dieting, fasting and/or excessive exercise • Binge-eating/Purging Type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging

Medical Complications Associated with Anorexia • Amenorrhea (loss of menstruation for women) • Loss of Bone Mineral Density/Osteoporosis (bone disease leading to increased risk of fracture) • Dehydration • Bradycardia (heart beats very slowly at under 60 beats per minute. Normal heart rate is 72 beats per minute) • Hypotension (low blood pressure) • Hypothermia (body’s core temperature drops to 95 degrees. Temperature ranges from 97. 7 and 99. 5, with a normal body temp steady around 98. 6) Could lead to lowered heart rate and/or death • Constipation • Lanugo (body hair turns extremely fine) • Edema (Swelling) • Yellowing of the skin

Bulimia Nervosa DSM-V Criteria • Recurrent episodes of binge eating • Recurrent compensatory behaviors in order to prevent weight gain • SX continuing, on average, at least once a week for 3 months. • Undue influence of weight or shape on selfevaluation

Bulimia Facts • Typically those diagnosed with Bulimia are of normal weight or somewhat overweight • Commonly begins in early adolescence or young adulthood • 10: 1 female to male ratio

What are binges? • A person eats massive amounts of food very rapidly, often in secret, with minimal chewing. • Food content is normally sweet, high-caloric foods with soft texture (ice cream, donuts etc. ) • Food is hardly tasted • As many as 10, 000 calories per episode • Snacking on small amounts of food all day is NOT considered binge-eating

Binges Usually brought on by feelings of great stress Person feels powerless over urge to eat During binge, person feels unable to stop During binge, the stress is relieved After binge there is enormous SHAME, guilt, depression, fear of gaining weight and fear of being “caught” • This leads to purging (compensatory behavior) • • •

Compensatory Behaviors After the binge, people try to compensate and “undo” the binge. This is called PURGING: • Self – induced, excessive vomiting (This could lead to breakdown of enamel/loss of teeth) • Misuse of laxatives and diuretics • Excessive exercise

Severity of Bulimia • Mild = Average of 1 -3 episodes of compensatory behaviors per week • Moderate = Average of 4 -7 episodes per week • Severe = Average of 8 -13 episodes per week • Extreme = Average of 14 or more episodes per week

Anorexia vs Bulimia Major Similarities • Both disorders involve individuals who fear becoming overweight • Both disorders involve a preoccupation with food, weight and appearance Major Differences • Those with Anorexia present emaciated while those diagnosed with Bulimia are of normal weight or somewhat over weight. • Most women with Anorexia lose their menstrual cycle. Only half of women with bulimia experience this.

Binge-Eating Disorder DSM-V Criteria • Recurrent episodes of binge eating • Binge eating episodes are associated with 3 or more of the following: – Unusually rapid eating – Eating large amounts without hunger – Eating until uncomfortably full – Eating alone because of embarrassment – Feelings of self-disgust, depression or severe guilt after binges.

Binge Eating Disorder DSM-V Criteria Continued • Significant distress regarding binge eating • Binge eating occurs, on average at least once a week for 3 months. • No pattern of inappropriate compensatory behavior

Features Associated with Binge Eating • • • Lack of a feeling of control Shame Guilt Feelings of Disgust Depression

Causes of Eating Disorders Multidimensional Risk Perspective • If you have another Psychological Disorder, especially a Depressive Disorder, you are at a greater risk to develop an eating disorder • Biological Factors (Hypothalamus is the part of the brain that controls eating and produces hunger) • Socio-cultural Factors (Family, Society and cultural pressures) • Less is currently known about the causes of Binge Eating Disorder. More studies are currently being conducted

Treatment Goals for Anorexia First GOAL: Correct dangerous eating pattern QUICKLY. (Regain lost weight, recover from malnutrition and eat normally again) • This could happen in-patient and/or out-patient in a hospital depending on the severity. The treatment consists of a combination of nursing care, nutrition counseling and diet monitoring. • Nursing care seeks to gradually increase a patient’s diet to about 3, 000 calories per day (sometimes more if needed. ) • Nursing care seeks to educate patients about program, track progress and help the patient to understand that gaining the weight gain will not cause obesity. These programs normally take 8 -12 weeks

Treatment Goal 2: Address broader psychological and situational factors that have led to eating problem. • Individual Psychotherapy, Family Therapy Techniques: • Monitor food intake, hunger level and feelings associated with food by keeping a diary • Examine “Core Beliefs. ” These are deep understandings they have developed that have led them to believe they are judged harshly by the shape and weight of their bodies. (Core belief worksheets) • Meetings with entire family looking at dysfunctional family patterns

Treatment for Bulimia • Eating disorder clinics are effective in assisting patients to eliminate binge patterns and establish healthy habits. • Address underlying psychological issues and challenge negative thoughts that come up before the urge to binge such as “I have no control. ” “I might as well give up because I always fail anyway. ” • Keep diaries of level of hunger and fullness

Inventory for Eating Disorders • Those diagnosis comes from the DSM-V Criteria, researchers need to find easier and simpler ways to diagnose in order to accept candidates for studies. On page 285 in your text, there’s a sample of inventory questions to be answered “always” “usually” “often” “sometimes” “rarely” “never” – I eat when I am upset – I feel extremely guilty when I overeat – I have gone on eating binges where I felt I could not stop

Treatment for Binge Eating Disorder Now that Binge-eating disorder has been established in the DSM-V, more specialized treatment programs will most likely emerge. Most likely, these will involve behavioral and cognitive approaches. Note: Since 1974, the obesity rate has quadrupled for children and adolescents in the US.