Lecture 10: Eating Disorder

Question 1

Disordered Eating

Answer 1

• Abnormal eating practices to lose weight
• Usually mild or short-term and does not cause long-term consequences or illness
• Unhealthy relationship with food & body image
• Disordered eating can cross-over into an eating disorder, which is a clinical psychiatric disorder

Question 2

Disordered Eating & Students

Answer 2

• 91% of students surveyed on a college campus had attempted to control their weight through dieting
• > 50% of teenage girls and ~33% of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives
• 25% of college-aged women engage in bingeing and purging as a weight-management technique

Question 3

Eating Disorders

Answer 3

• Clinical psychiatric disorder characterized by severe disturbances in body image & eating behaviors
  
  • Severe food restrictions, bingeing, purging, weight changes
  • Perceptions of body image cause extreme distress/ concern
• Starts with a diet + stress & lack of coping= loss of control
  
  • Puberty, school, sports, dysfunctional family
• Must involved professional intervention
• May result in heart conditions, kidney failure and death
• ED have the highest mortality rate of any mental illness
• 5% American women will develop AN or BN in their lifetime
• Frequently occur with other psychological disorders: depression, obsessive-compulsive disorder, borderline personality disorder, anxiety, substance abuse
  
  • 20-25% AN have a co-morbid psychological disorder
  • ~50% ED patients have depression
• 6-10 times more common in females
• Occurs in all ethnic, SES, age & gender groups

Question 4

Media

Answer 4

• 47% of girls in 5th-12th grade reported wanting to lose weight because of magazine pictures.
• 69% of girls in 5th-12th grade reported that magazine pictures influenced their idea of a perfect body shape.

Question 5

Anorexia Nervosa“Loss of appetite; Disgust with one’s body”

Answer 5

Characterized by:

• Self-starvation with extreme weight loss
• Irrational fear of weight gain & obesity
• Distorted body image with a discrepancybetween actual vs perceived wt
• Exhibit obsessive-compulsivebehaviors and perfectionism

Psychological conflict, rigid control:

• Family structure, overbearing mother, absent father, high family expectations, overprotection, rigidity
• Lack of coping mechanisms, so they can control eating

-Life-threatening thinness: 5-10% will die within 10 yrs of dx

Question 6

Anorexia Nervosa

Answer 6

• Refusal to maintain body weight at or above a minimally normal weight for age and height (usually <17.5).
• Intense fear of weight gain or being fat even though they are considered underweight.
• Disturbed experience with weight. Feeling overweight despite dramatic weight loss. -Extreme concern with body weight and shape. -Denial of the seriousness of the low body weight.
• Amenorrhea

Question 7

Anorexia Nervosa Treatment

Answer 7

-Multidisciplinary Team : physicians/NP, dietitians, psychologists, family, friends, coach/trainer

• Medical care: hospitalization or outpatient care
• Psychological : address underlying emotional problems
• Nutrition
• Build trust
• Prevent further weight loss with slow gain
• Restore appropriate food habits

Question 8

Bulimia Nervosa “Great hunger; Disgust with one’s body”

Answer 8

• Recurrent episodes of binge eating:
  
  • Eating increase amount food w/in 2 hr period & lack of control during binge
• Recurrent compensatory behavior: self-induced vomiting, laxatives, diuretics, enemas, medications, excessive exercise, fasting
• 2 X per week for at least 3 months
• Extreme concern with body weight and shape, self-evaluation based on this.Often have elaborate foods rules: avoiding all sweets, breaking rule causes guilt and leads to binge/purge

Question 9

Bulimia Nervosa

Answer 9

-Turn to food in crisis vs anorexia
-Recognize behavior as abnormal vs anorexia
*They feel ashamed, frustrated, out of control, guilt (especially after a binge)
-Low self-esteem, 50% have depression
-4% adolescents & college-age women have -BN, occurs in men too
*Prevalence underestimated because
~most are at or above normal weight
~ secretive

Question 10

Bulimia Nervosa: Health Risks

Answer 10

-Dehydration & electrolyte imbalance: irregular
heartbeat & heart failure, death
-GI: inflammation, ulceration, rupture of esophagus & stomach
-Irregular BM, constipation w/laxatives
-Teeth (dental decay/ staining)
-Mouth (swollen salivary glands)
-Blood (Anemia) 
-Kidney problems with over diuretic use

Question 11

Bulimia Nervosa Treatment

Answer 11

• Multidisciplinary Team : Physicians/NP, dietitians, psychologists and others
• Psychological : Address underlying emotional problems, improve self-acceptance
• Nutrition
• ↓ episodes of binge & purge & amount of food at binge
• Change the “all-or-none” attitude & misconceptions about food
• Establish normal eating habits

Question 12

Binge Eating Disorder

Answer 12

• Binge eating at least 2x/wk x 6 mo, without compensatory purging
• Triggered by stress, depression, anger etc.
• 8% obese population has binge-eating disorder
• Professional help: address hidden emotions
• Learn to eat in response to hunger & in moderation
• Avoid restrictive diets which can intensify problems
• Antidepressants

Question 13

Eating Disorder Not Otherwise Specified

Answer 13

Diagnostic and Statistical Manual of Mental Disorders*

Clinically significant problems but do not meet set criteria:

• Criteria for AN met except regular menses
• AN criteria met, but despite wt loss, wt in normal range (started obese)
• BN criteria except binge < 2 X/week or < 3 mos
• BN criteria but after normal food intake (ex. self-induced vomiting after the consumption of 2 cookies).
• Chewing/spitting out - no swallowing

Question 14

Other Eating-Related Disorders

Answer 14

• Muscle Dysmorphia: obsessive concern ofhaving underdeveloped muscles eventhough they are muscular
• Orthorexia: obsession with eating healthfully & the “right” foods, “health food disorder” , “pure” food. Can lead to significant weight loss and mental preoccupation.

Question 15

Preventing Eating Disorders

Answer 15

• Recognize it is normal to think about food, diet, weight, have fluctuations in weight, variations in diet
• Learn healthy behaviors as a child
• Intuitive eating
• Build self-esteem
• Targeted prevention for those with warning signs