Lecture 20 Flashcards
What is the definition of ED by Academy of Eating Disorders
“Eating disorders are serious mental illness with significant life-threatening medical and psychiatric morbidity. Anorexia nervosa has the highest mortality rate of any psychiatric disorder, risk of premature death is 6-12 times higher in woman with anorexia nervosa compared to general population, adjusting for age”
What is the def of Ed by Dr. Jeffery Desarbo, Ed psychiatrist from Long Island, NY
“an eating disorder is a neurobiologically drive process with psychological and medical consequences; it is not a choice”
What is not an eating disorder?
- disordered eating
ex. emotional eating, bored eating, dieting
- ed will happen unless they are prone to it
What is the spectrum related to eating disorder
- body and food acceptance
- body image and eating concerns
- disordered eating
- eating disorders
What are the DSM-5 diagnostic categories and terminology of ED
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
- ARFID (Avoidant/restrictive food intake disorder)
- OSFED & USFED (other specified and unspecified feeding eating disorder)
explain anorexia nervosa
- restriction of energy intake relative to requirements, leading to a significantly low body weight
- intense fear of gaining weight
- disturbance in the way in which on’s body weight or shape is experienced
explain the restricting type of anorexia nervosa
- during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour
- weight is lost primarily through dieting, fasting, and/or excessive exercise
explain binge-eating/purging type in anorexia nervosa
- during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour
ex. self-induced vomiting, or misuse of laxatives, diuretics or enemas
explain bulimia nervosa
- eating, in a discrete period of time, an amount of food that is larger than what most individuals would eat
- a sense of lack of control over eating during the episode
- recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
- at least once a week for 3months
- self evaluation is unduly influenced by body shape and weight
What are 2 ways you can specify AN and BN
- in partial remission, if full criteria was met, but currently no longer fully meets all criteria
- in full remission, if full criteria was met, but now none of the criteria has been met for a sustained period of time
what is binge eating disorder
- regular and sustained binge eating episode
- characterized by both eating in a discrete period of time and a sense of lack of control over eating during the episode
What is avoidant/restrictive food intake disorder?
- AFRID is a new category in DSm-5
- is like AN, except without the body image disturbance or weight/shape overvaluation
What is other specified and unspecified feeding eating disorder?
- OSFED and USFED is new term in DSM-5
- includes atypical AN, BMI in normal range
- purge disorder - sub-threshold forms of BN
- BED on the basis of insufficient frequency or duration of ED behaviours
- night eating syndrome
What is the age of onset for AN
- peak early to mid-adolescence, but may occur at any age, even in childhood
- primarily seen in girls, but boys are seen more frequently in the childhood years
what is the age of onset for BN?
- in later adolescence and young adulthood
what is the age of onset for BED
- young adulthood and mid-life disorder
- more even gender distribution
Who can make the diagnosis
officially:
- medical practitioners, physicians and psychiatrists
- registered clinical (PhD) psychologists
What are the mortality rates of AN and BN
AN - 9-20%
BN - 3%
Death from AN is more than _____ higher than any other chronic illness in 15-24 year old females
12 times
- life expectancy reduction of 20-25 years for chronic anorexia (Harbottle et al., 2008)
estimated ____ in Canada meet the diagnostic criteria for an Ed
- 1 million
review more stats for ED
- 1 IN 10; IE. 10% WITH ED DIE FROM THE DISORDER; 30% RECOVER/ 30% SEMI RECOVER/ 30% ED WILL PERSIST
- EDS HAVE THE HIGHEST OVERALL MORTALITY RATE OF ANY MENTAL ILLNESS, WITH ESTIMATES BETWEEN 10-15% (PER NIED FINDINGS, CANADA)
- SUICIDE IS THE SECOND LEADING CAUSE OF DEATH (AFTER CARDIAC ISSUES) AMONG THOSE WITH AN ED
- 20% OF PEOPLE WITH AN AND 25-35% OF PEOPLE WITH BN MAY ATTEMPT SUICIDE IN THEIR LIFETIME.
What causes an eating disorder
genetics
- epigenetics
Environmental
- ex. childhood exposure, interpersonal interactions, medications, diseases, medical state, microbiome, illicit drug use/chemical exposures, cultural expectations
Individual’s susceptibility
- ex. psychological state, mood, stressors, personality
What are the risk factors?
the 3P’s!!!
Predisposing Factors
- ex. genetics, biology
Precipitating Factors
- turns on the ED
- ex. biology, weight loss, dieting, being sensitive
Perpetuating Factors
- keeps the ED going
- ex. family dynamics
What are some ways for early diagnosis and timely intervention? (8 signs)
- restricting/dieting/binging
- excessive exercise or extreme physical training
- compensatory behaviour to manage weight
— exercise, purging, laxatives, IPECAC - precipitous weight loss or gain or failure to gain expected weight/height in a child or adolescent
- electrolyte/lab abnormalities
- bradycardia
- fainting
- menstrual irregularities or amenorrhea, unexplained infertility
does age matter?
- yes, younger individuals may have higher chance of changing habit/ways of thinking, better prognosis
- younger may have more significant, long term impact
- irreversible - brains, bones and babies
What are the behavioural symptoms of Ed
- restrict
- purge (vomit, laxatives, IPECAC, physical activity)
- binge
- chew and spit
What is the brain-body axis of ED
- cognitive condition
- emotional condition
What is the impact of chronic malnutrition?
- starvation affects thinking and behaviour
- reversible
ex. “they starved so that others be better fed”
What is gastrointestinal system known as
- second brain
- 30+ neurotransmitters including dopamine and serotonin (more receptors than in the brain)
What happens when the peristalsis is problematic?
1 complaint
- constipation
- reflux
- feeling full
What does anorexia affect?
the whole body!
Brain and nerves - can’t think right, fear of gaining weight, sad, moody, irritable, bad memory, fainting, changes in brain chemistry
Hair - hair thins and gets brittle
Heart - low blood pressure, slow heart rate, fluttering of the heart (palpitations), heart failure
Blood - anemia and other blood problems
Muscles and Joints - weak muscles, swollen joints, fractures, osteoporosis
Kidneys - kidney stones, kidney failure
Body Fluids - low potassium, magnesium and sodium
Intestines - constipation, bloating
Hormones - periods stop, bone loss, problems growing, trouble getting pregnant. if pregnant, higher risk of miscarriage, having a C-section, baby with low birthweight, and post partum depression
Skin - bruise easily, dry skin, growth of fine hair all over body, gets cold easily, yellow skin, brittle nails
What are the symptoms of BN
- can be normal or overweight
- salivary glans enlargement
- enamel erosion
- esophagitis
- arrhythmias
- blood abnormalities (electrolytes, amylase, etc.)
- fingers/back of hand may have callus
- diarrhea/constipation
- edema in ankle
What is the never-ending cycle
- feel hungry, deprived
- eat forbidden foods/binge
- overeat forbidden foods (since they have already wrecked the diet)
- feel guilt, fat and bad, may purge
- insufficient nutrition, from purge
REPEAT
What are the 4 cardiac complications?
- hemodynamic instability
- conduction abnormalities
- structural abnormalities
- impact of re-feeding and physical activity on cardiac function
What does the QT measure?
- myocardial repolarization linked to HR
What is the prolongation of the QT associated in
- associated in general with sudden death and ventricular arrhythmia
How does it affect bone development?
- adolescence is a critical window to developing peak bone mass
- the peak bone mass achieved is a major determinant of final bone density and future risk of fractures
review about the brain and ED
- ++100 billion neurons in the brain
- electrical chemical energy - talk to each other
- many brain region changes with. anED, even brain cellular volume loss with an ED
- damages to diff part. ofbrain region with ED
- brain-derived neurotrophic factor (BDNF) = neural protection
How does ED change in brain anatomy?
- changes in blood flow, patterns altered significantly for body image perception
- parietal lobe of brain - cellular loss. andincrease drive for thinness (if lose weight after Rx, and if prone to this creation, the cellular volume loss will result in a drive to decrease weight more and more)
- volume loss in grey matter; loss with ED adults 3.7-5.6%; children 7.6%
- volume loss in white matter volume: adults 2.2-3.8%; children 3.2%
- decreased grey matter and drive for thinness with restricting AN
what is the impact on puberty
- estrogen required for development of female sex organs
- uterine and ovarian volumes changes with age in response to estrogen
- FSH, LH and estradiol
Explain lanugo hair
- reversible
- keep warmth
Why is the skin yellow
- can’t procross keratin or smth
- reversible
What are some treatments for Ed
- resolve medical issues asap
- work on psychological
- family dynamic (as appropriate)
- psychoeducational
- beward refeeding syndrome
What are the 2 research informed best practices
- family based therapy (FBT)
- cognitive behavioural therapy (CBT)
What are the 3 emerging research practices
- dialectic behavioural therapy (DBT)
- acceptance and commitment therapy (ACT)
- emotional focused therapy (EFT) (or EFFT with family)
What is dialectic behaviour therapy?
- use imagery: take a vaction in your mind!
- stand up, stretch, get that blood flowing… movement does that…
- picture in your mind a place. otgo on vacation
How did COVID impact ED
- impacted individuals with ED with increased psychological stress, more symptoms and decreased motivation for recovery
- in-person medical evaluation was still strongly recommended
- virtual care holds promise for treatment and support
What is the current support for clients and families in the health system?
- primary care (GPS, nurse practictioners)
- secondary services (publicly funded) - multi-dsiciplinary team throughout BC)
- tertiary care services (BCCH and St. Paul’s) intensive programs: inpatient, day treatment, residential; some intensive outpatient services
- private, fee for services
- kelty mental health
- looking glass residence and foundation
- NEDIC (National ED Information Centre)
what is the support for healthcare providers in BC?
- ED toolkit for primary care practitioners (for children and youth)
- “race” line (rapid access consultative expertise) - phone support from tertiary ED teams (BCCH and St. Paul’s)
- secondary, or regional ED teams, foundry
- compass
What does NIED stand for and who is it run by?
- National Initiative for ED “education, Understanding, Action”
- ran by parents
what is the purpose for NIED
- exists to give hope and support to individuals with an ED and their caregivers
how does NIED do this?
- by developing and sharing educational resources, information, research and taking action to address the needs of Canadians impacted by eating disorders
- unite all the ED treatment, prevention education, actions across Canada
What are some NIED findings?
- patients do not have reasonable acces s to timely, comprehensive and specialized care
- provincial cost of an on long term disability = $101.7 million/year
- canadian doctors feel unprepared to treat patients
What are some NIED findings?
- patients do not have reasonable acces s to timely, comprehensive and specialized care
- provincial cost of an on long term disability = $101.7 million/year
- canadian doctors feel unprepared to treat patients
What is the Eating Disorder Strategy 2019-2029?
- the Canadian Eating D
What is the Eating Disorder Strategy 2019-2029?
- the Canadian Eating Disorder alliance (CEDA) developed a document “Canadian ED Strategy: 2019-2029”
- developed from listening to stakeholders across Canada in 2016-2019
- 50 recommendations under 6 pillars of activity
- pillars = prevention, public education/awareness, treatment, caregiver support, training and research
— each pillar is co-chaired by respected researchers, clinicians, caregivers, health care professionals and social service providers from across Caanda who conduct research on Eds and related illness, and/or treat and support people directly affected by Eds
What deos the CEDA consist of?
- national eating disorder information centre (NEDIC)
- eating disorders association of Canada - association des troubles alimentaires du Canada (EDAC-ATAC)
- eating disorders foundation of canada (EDFC)
- National initiative for eating disorders (NIED)
What is CEDA’s vision?
- all affected by ED and related mental illnesses have equitable access to publicly covered healthcare to support their recovery
What is CEDA’s main goal
- to improve health and social outcomes for people living with and affected by EDs
What is public education and awareness of Ed
- educational interventions targeting stigma and mental health literacy are needed in Canada to change misconceptions about Ed symptoms held by the public as well as health professionals working with those who may be affected by Eds
- Canadian context, a lack of education, as well as misinformation about Ed, are barriers to treatment and recovery
What are treatments of Ed?
- must have equitable access to services, no matter where they live and without discrimination
- create, fund and implement specialized services
- improve communication and sharing of best practices and evidence-based care
- improve transitions from youth to adult services
- develop stronger partnerships with primary care to ensure that individuals with Eds are identified early
What is effective for prevention?
- programs
ex. the body project, feminist-informed approaches, social justice, media literacy programs, media activism
What are some more preventions
- develope a common language or definition of what prevention means in the context of Eds and a culture influenced by weight bias
- develop messaging for the general population about prevention
- educate practitioners, educators, policy makers, medical and obesity professionals, and other relevant groups
ex. fitness professionals; dance coaches; education professionals; dentists; media - appropriate messaging in specific settings
ex. schools
