Wk 7: Eating disorders Flashcards
What is an eating disorder?
= Characterised by the negative beliefs and behaviours people that have about themselves and their eating, body shape and weight.
Negative beliefs lead to restrictive eating, binge eating and compensatory behaviours.
- forms someones sense of who they are
- Emotional and physical consequences of beliefs and behaviours maintain the disorder, resulting in high mortality rate from malnutrition, suicide and physical issues e.g. electrolyte imbalance
- Can be experienced by the person as helping them to function by numbing their emotions, providing distraction or a sense of accomplishment, helping them to feel in control, and can form a part of a person’s sense of who they are
- Recovery affected by physical complications, psychiatric comorbidities, ego syntonic nature of illness
What is the concept of body image? and what related disorders does the DSM 5 acknowledge?
- The way a person thinks and feels about their body and how others view them.
- It can be positive or negative
- Poor body image can lead to depression, anxiety, substance abuse and eating disorders
DSM 5 acknowledges the following body images disorders:
* Body Dysmorphic (Disorder where a person feels negatively towards a part of their body e.g. hate their nose before and after surgery)
* Muscle Dysmorphia (person feels they are inadequately muscular, dangerous as can lead to steroid use)
* Gender Dysphoria (feels as though they don’t identify with their gender)
What is disordered eating?
= not a disorder but a symptom of an eating disorder.
- Behaviours that reflect many but not all of the symptoms of feeding and eating disorders.
- They are the most common indicators of development of eating disorder
- Linked to reduced ability to cope with stressful situations and suicidal thoughts and behaviours
- dieting is the single most strong risk factor for eating disorder
Examples include
- Fasting or chronic restrained eating
- Skipping meals
- Binge eating
- Self-induced vomiting
- Restrictive dieting
- Unbalanced eating (Keto, gluten free)
- Laxative, diuretic, enema misuse
- Steroid and creatine use
- Diet pills
What are some of the impacts of eating disorders?
- High levels of psychological distress, risk of long-term mental illness
- recovery can last 7-8 years
- Medical complications= leading to increased risk of premature death
- Increased risk of suicide
- Highest impact on health related quality of life of all psychiatric disorders
- Most frequently start in youth so impact on education, identity formation and physical growth
- Can impact on health and quality of life for entire lifespan
- Substantial impact on family includes caregiver stress, loss of income, disruption fo
family relationships, high suicide risk - Stigma
What are some lived experience and understandable characteristic some people with an eating disorder may display?
- fear and terror
- embarrassment and humility
- denial and minimisation
- hypersensitivity
- anger
- grandiosity and infatuation with disorder
- seeking secondary gain(people always asking how they are)
- bargaining
- manipulation
- splits and power struggles
- a deep sense of unworthyness
- relief
What are the three categories of risk factors may trigger the commencement or increase the continuity of the disorder? and what may be included in each of these?
These factors may trigger the commencement or increase the continuity of the disorder.
Genetic
- do have strong evidence of genetic basis
Psychological
- Low self-esteem
- Perfectionism
- Negative emotions
- Stress
- Depression
- Trauma
- Overvaluing body image in defining self-worth
- Harm avoidance
* the eating disorder gives a feeling of control over life when these factors and experiences can deplete this feeling.
Sociocultural
- dieting is the number one risk factor for an eating disorder
- Involvement in sport/industry that empahsises a specific body shape
- Societal pressure to achieve
- Peer pressure
- Teasing, bullying, violence, abuse
- Internalising Western beauty ideals
* Internet (‘thinspo’, ‘fitspo,’ ‘pro-eating disorder’)
What are the three categories of protective factors and what may be included in each of these?
- as a RN/RM we really want to be focusing on these
Individual
- High self-esteem
- Positive body image
- Critical processing of media images (i.e. media literacy)
- Emotional well-being
- School achievement
- Being self-directed and assertive
- Good social skills with success at performing multiple social roles aka media literacy
- Problem solving and coping skills
Family
- Belonging to a family that does not overemphasise weight and physical attractiveness
- Eating regular meals with the family
Socio-cultural
- Culture that accepts a range of body shapes and sizes
- Sport or industry where there is no emphasis on physical attractiveness or thinness
- Peer or social support structures and relationships where weight and physical appearance are not of high concern
Describe the eating disorder: Pica
Pica= where people eat things that aren’t considered food.
- common in people with disabilities
e.g. eating gravel and dirt
Describe the eating disorder: Rumination disorder
= when people regurgitate their food and re-chew it and re-swallow it.
Describe the eating disorder: Avoidant/restrictive food intake disorder (ARFID)
aka extreme picky eating
= highly selective eating habits and disturbed feeding patterns or both.
Describe the eating disorder: OSFED/Other specified feeding or eating disorder
= what a person present with multiple symptoms of other eating disorders but does not meet the full criteria.
Describe the eating disorder: orthorexia
*not currently recognised as an official eating disorder.
= persons obsessed with healthy or clean eating and not necessarily the quality.
What are the three criteria for a diagnosis of anorexia nervosa as per the DSM V?
- Restriction of energy intake
- Intense fear of weight gain
- Disturbance in the way the person views their body
a) Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
b) Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
c) Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
What are the two subtypes of anorexia nervosa?
Restrictive type: during the last 3 months the person has not recurrent engaged in episodes of binge eating or purging behaviours (self-induced vomiting, miss use of laxatives, diaretics,enemas)
- this is diagnosed with the presentation where weight loss is achieved primarily though fasting, dieting or exercise.
Binge-eating/purging type: when during the last 3 months the individual has engaged in recurrent episodes of binge eating or purging behaviour.
If someone meets the DSM V criteria for ?anorexia nervosa, what must then be assessed?
The specific type:
- restrictive type
- binge-eating/purging type
Specify if:
- in particular remission
- in full remission
Specify current severity: (this is adult)
- Mild: BMI ≥ 17 kg/m2
- Moderate: BMI 16–16.99 kg/m2
- Severe: BMI 15–15.99 kg/m2
- Extreme: BMI < 15 kg/m2
Describe the levels of anorexia remission as per the DSM V criteria
Partial remission
- when after the full criteria for anorexia nervosa was previously met. Part A has not been met for an extended period but either criteria B or C is still met.
Full remission
- after full criteria was previously met, none of the criteria have been met for a sustained period of time.
Define binge eating disorder as per the DSM V criteria.
A. Recurrent episodes of binge eating.
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop
B. The binge-eating episodes are associated with three (or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts of food when not feeling physically hungry.
- Eating alone because of feeling embarrassed by how much one is eating.
- Feeling disgusted with oneself, depressed, or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
Define binge eating
An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Once diagnosed, what are some considerations for binge eating disorder?
Specify if:
- In partial remission:
- In full remission: .
Specify current severity:
Mild: 1–3 binge-eating episodes per week.
Moderate: 4–7 binge-eating episodes per week.
Severe: 8–13 binge-eating episodes per week.
Extreme: 14 or more binge-eating episodes per week
What is the DSM V criteria for bulimia nervosa?
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both
of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Once established that someone has bulimia nervosa as er the DSM 5 what other things should be assessed?
Specify if:
- In partial remission:
- In full remission:
Specify current severity:
The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.
Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week.
Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week.
Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per
What are some key points for identification and assessment for people with eating disorders?
- can present in a range of settings
- people with eating disorders should be assessed and receive treatment at the earliest opportunity
- early recovery = shorter recovery process
- Early treatment is particularly important for those at risk of severe emaciation. Treatment should be prioritized.
- Comprehensive assessment, aim is to develop a biopsychosocial formulation
Biopsychosocial formulation= biological, psychosocial and social factors. Formulate a treatment plan with protective factors from these factors and address risks from these settings.
What is a biopsychosocial formulation?
Biopsychosocial formulation= biological, psychosocial and social factors. Formulate a treatment plan with protective factors from these factors and address risks from these settings.
When might you refer someone for medical assessment for diet or food restrictions?
- Unusually low or high BMI or body weight for their age
- Rapid weight loss
- Dieting or restrictive practices
- Family members/ carers reporting changes in behaviours
- Social withdrawal, particularly around food situations
- Other MH problems
- Disproportionate concern about weight or shape
- Menstrual/ endocrine/ GI disturbances
- Abdominal pain
- Physical signs of
- Malnutrition
- Compensatory behaviours (do they go to the bathroom straight after eating) - Unexplained electrolyte imbalance or
hypoglycemia - Atypical dental wear (erosion)
- Participation in activities associated with eating disorder risk.
What observations would cause you to refer someone for urgent medical assessment in relation of food and eating disorders?
- BMI <12
- Systolic BP <80 mmHg
- Postural drop BP <20 mmHg
- HR <40 or >120
- T <35 or cold/blue extremities
- ECG: Anny arrhythmia, not specific ST or T wave changes
- BGL: BP <2.5mmol/L
- Sodium: <125 mmol/L
- Neutrophils: <1.0 x 109/ L
What observations would cause you to refer someone for urgent psychiatric assessment in relation of food and eating disorders?
Suicidal ideation
Active self-harm
Moderate to high agitation and
distress
What are the priorities of treatment of someone with an eating or food disorder?
- engage the person in care
- stabilise them medically
- reverse cognitive effects of starvation
- provision of structured psychological treatment (?use of mental health act)
how should we decide where someone is treated?
**least restrictive means possible.
- consider
Tertiary hospital: specialist inpatient with a multidisciplinary team. Focus on medical stabilisation and engagement in treatment and to prep the individual for treatment post-discharge.
Local hospital interventions: focus on medical stabilisation. e.g. mental health wards, local inpatient medical ward
Specialist eating disorder interventions: day programs/out-based clinical, dieticians. Focous: enhance the quality of life and recovery.
Community: less sever e.g. GP
What are the general principles for treating all eating disorders in all settings?
- Person-centred informed decision-making.
- Involving family and significant others
- Recovery-oriented practice
- Least restrictive treatment context
- Multidisciplinary approach
- Stepped and seamless care
- A dimensional and culturally informed approach to diagnosis and treatment
- Indigenous care
