Eating Disorder Flashcards
Prevelance
NORMAL WEIGHT teens” 40-60% believe themselves to be too heavy
At any given time, 60% of female teens are on a diet
70% of female teens report body shape is important to their self-worth
½ of teen girls and 1/3 of teen boys use unhealthy means of controlling weight
Prevalence:
anorexia: 0.4% Bulimia: 1.5% Binge Eating Disorder: 0.8-1.6% 3:1 F/m mid teens onset higher rates among of Annorexia among non-latina whites
DSM:
low body weight (BMI <18.5kg/m2, less than 5 percentile (numbers are all different for children becasue of development scale)
Intense fear of gaining weight or becoming fat despite being underweight
Denial
Subtypes of annorexia
restricting type binge-purge type severity: mild: BMI>17 Moderate: BMI: 16-17 Severe: BMI: 15-16 Extreme: BMI: <15
LO: Identify societal and personal risk factors for eating disorders
Family history of anorexia
*ADOLESENCE who go on a diet and lose weight is a precipitating factor
Onset of puberty Athletics Life/family stressors Anxious, obsessive personality structure Low conflict, highly controlling family dynamics
Health consequences of AN
10-20% mortality rate (all-cause: starvation, suicide, other health complications)
HIGHEST IN ANY PSYCHIATRIC DISORDER
(some is suicide, but some is the heart disease associated with annorexia)
Orthostasis or hypotension
Bradycardia, arrhythmia, heart failure
Bone loss / osteoporosis
Physical changes related to AN:
more CSF on T2 weighted brain scan
Brain shrinking!
Cerebral atrophy – associated with weight loss, not just low BMI
Treatment of AN – Evidence
1: medical stabilization/restoration of weight
Evidence based treatment; Family based treatment (learning to refeed in a healthy way, and then handing control back over to the teenager)
Family Based Treatment is Also called the Maudsley Method (name of hospital in London where started)
Prognosis:
of Thirds: 1/3 Recover, 1/3 have milder symptoms, and 1/3 have chronic severe course
If still young, parents can still enforce some reshaping of your eating habits and you can still recover
If you’ve been annorexic for 7 years as an adolescent, there’s a very low chance for remission
DSM-5: Bulimia Nervosa
Recurrent episodes of binge eating
Recurrent episodes of compensatory behavior (purge)
vomiting, laxatives, diuretics, excessive exercise
Binge and purge occur >1x/week for at least 3 months
(IF YOU VOMIT 12X IN A ROW, THAT’S 1 PURGE)
*IF NOT UNDERWEIGHT AND STARVING YOURSELF _______
IF YOU ARE OVER WEIGHT AND PURGING AFTER MEALS _______
YOU CAN’T BE DIAGNOSED WITH AN
YOU CAN BE DIAGNOSED WITH BULIMIA
IF YOU ARE DIAGNOSED WITH BULIMIA:
YOU CAN’T ALSO HAVE ANNOREXIA
RISK FACTORS BULIMIA:
CHILDHOOD OBESITY (BEING PICKED ON FOR BEING OVERWEIGHT)
EARLY PUBERTAL MATURATION
TRAUMA HISTORY-SEXUAL ABUSE
SELF-HARM, CUTTING
SEVERE FOOD RESTRICTION (TABOO- NO WHITE FOODS) YOU END UP THINKING ABOUT THAT ONE THINGS ALL DAY, AND THEN YOU TRIGGER A BINGE AND HAVE 12
Treatment of BN
CBT + SSRI
High dose fluoxetine (60mg/day)
*Contraindicated = bupropion (Wellbutrin)
Increased seizure risk
Treatment of BN
CBT + SSRI
High dose fluoxetine (60mg/day)
*Contraindicated = bupropion (Wellbutrin)
Increased seizure risk
DIALECTIBAL BEHAVIORAL THERAPY
TREATMENT FOR BN, chain analysis, mindfulness, etc
so you purged, what triggered it? What happened right before? What about before that? Then you identify the warning signs and you are able to protect against them in the future
Prognosis – BN
1/3 remit every year, 1/3 relapse into full diagnostic criteria
later you start, the worse off
*distinguishing factor of AN vs BN:
AN: underweight; BN: Normal or overweight
AN: dopes with stress/emotions by not eating
BN: copes with stress by eating
AN: focus on just losing more and more, the thinner the better
BN: tend to focus on an “ideal” weight
AN: denial; BN: shame
*distinguishing factor of AN vs BN:
AN: underweight; BN: Normal or overweight
AN: dopes with stress/emotions by not eating
BN: copes with stress by eating
AN: focus on just losing more and more, the thinner the better
BN: tend to focus on an “ideal” weight
AN: denial; BN: shame
Binge Eating Disorder
Recurrent episodes of binge eating
Associated with 3 or more of:
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not physically hungry
Eating alone due to embarrassment of amount eaten
Feeling disgusted, depressed, or guilty afterward
*Binge Eating Disorder
Recurrent episodes of binge eating WITHOUT PURGING
Associated with 3 or more of:
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not physically hungry
Eating alone due to embarrassment of amount eaten
Feeling disgusted, depressed, or guilty afterward
NOT ALWAYS OBESE BUT MOST LIKELY
note: group therapy
harmful for AN and BN bc they get together and compare each other’s shape and share secrets
Binge Eating disorder:
helpful to talk openly about addiction
No to #1 or yes to any of other 3 is a positive screen and other questions should be asked!!!
Are you satisfied with your eating patterns?
Does your weight affect the way you feel about yourself?
Have any members of your family suffered from an eating disorder?
Do you currently suffer from or have you ever suffered from an eating disorder?
