Post on 27-Dec-2015
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One Size Does Not Fit One Size Does Not Fit All: An Overview of All: An Overview of
Eating DisordersEating Disorders
Kristin Grasso, Psy.D.Kristin Grasso, Psy.D.Clinical Psychologist and College LiaisonClinical Psychologist and College Liaison
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Spectrum of Eating Spectrum of Eating DisordersDisorders
Diagnosable Disorder
Diagnosable Disorder
DisorderedEating
DisorderedEating
“Normative Discontent”“Normative Discontent”
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Risk FactorsRisk Factors
Female genderFemale gender Ethnicity Ethnicity Weight and Shape factorsWeight and Shape factors Psychiatric historyPsychiatric history Genetic predispositionsGenetic predispositions Participation in activities that Participation in activities that
promote thinnesspromote thinness Certain personality traitsCertain personality traits
What’s the risk of dieting? The more severely girls diet, the more likely
they are to drink frequently and heavily, as well as to use marijuana and other illicit drugs
Adolescent girls who engage in dieting have a 324% greater risk for obesity than those who do not diet (Stice et al., 1999).
95% of all dieters will regain their lost weight in 1-5 years (Grodstein, 1996).
35% of "normal dieters" progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders. (Shisslak & Crago, 1995).
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Anorexia NervosaAnorexia Nervosa
Refusal to maintain minimum body weightRefusal to maintain minimum body weight
Intense fear of gaining weight or becoming Intense fear of gaining weight or becoming fat, even though underweightfat, even though underweight
Disturbance in experience of weight or Disturbance in experience of weight or shape, undue importance of weight or shape, undue importance of weight or shape, or denial of seriousness of problemshape, or denial of seriousness of problem
AmenorrheaAmenorrhea
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Subtypes of ANSubtypes of AN
Restricting Type:Restricting Type: – person does not engage in binge eating person does not engage in binge eating
or purge behavioror purge behavior
Binge Eating/Purging Type:Binge Eating/Purging Type: – person regularly engages in binge person regularly engages in binge
eating or purging (self-induced vomiting eating or purging (self-induced vomiting or misuse of laxatives, diuretics, or or misuse of laxatives, diuretics, or enemas)enemas)
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Bulimia NervosaBulimia Nervosa
Recurrent episodes of binge eatingRecurrent episodes of binge eating– Eating a large amount of food given the Eating a large amount of food given the
context context – An associated sense of loss of controlAn associated sense of loss of control
Recurrent inappropriate Recurrent inappropriate compensatory behaviorcompensatory behavior– E.g., purging, fasting, excessive exerciseE.g., purging, fasting, excessive exercise– Diuretics and laxativesDiuretics and laxatives
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BN cont’dBN cont’d
Binge eating and compensatory Binge eating and compensatory behavior occur at least behavior occur at least twicetwice per per week for week for 3 months3 months
Self-evaluation is unduly influenced by Self-evaluation is unduly influenced by body shape and weightbody shape and weight
Disturbance does not occur exclusively Disturbance does not occur exclusively during episodes of anorexia nervosaduring episodes of anorexia nervosa
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Subtypes of BNSubtypes of BN
Purging Type:Purging Type: – Regularly engages in self-induced vomiting, or Regularly engages in self-induced vomiting, or
the misuse of laxatives, diuretics, or enemasthe misuse of laxatives, diuretics, or enemas
Non-Purging Type:Non-Purging Type:– Regularly engages in other inappropriate Regularly engages in other inappropriate
compensatory behaviors, i.e. fasting or compensatory behaviors, i.e. fasting or excessive exercise,excessive exercise, but has not regularly but has not regularly engaged in the above stated purging behaviorengaged in the above stated purging behavior
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ED-NOSED-NOS
Most commonMost common
Patient has clinically significant Patient has clinically significant disorder, BUT does not meet AN or disorder, BUT does not meet AN or BN criteriaBN criteria
Comparably severe in relation to AN Comparably severe in relation to AN and BNand BN
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Binge Eating DisorderBinge Eating Disorder
Recurrent episodes of binge eatingRecurrent episodes of binge eating Episodes are associated with 3 or Episodes are associated with 3 or
more of the following:more of the following:– Eating more rapidly than normalEating more rapidly than normal– Eating until uncomfortably fullEating until uncomfortably full– Eating large amounts when not hungryEating large amounts when not hungry– Eating alone because of embarrassment about Eating alone because of embarrassment about
how much one is eatinghow much one is eating– Feeling disgusted with self, depressed, or Feeling disgusted with self, depressed, or
guilty after overeatingguilty after overeating
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BED cont’dBED cont’d
Marked distress regarding binge Marked distress regarding binge eatingeating
Binge eating occurs at least Binge eating occurs at least twotwo days days a week for a week for 6 months6 months
Binge eating is not associated with Binge eating is not associated with regular inappropriate compensatory regular inappropriate compensatory behavior, and does not occur behavior, and does not occur exclusively in course of AN or BNexclusively in course of AN or BN
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What’s the difference?What’s the difference?
AN trumps BNAN trumps BN
Presentation of AN vs. BNPresentation of AN vs. BN
The dieting factorThe dieting factor
Binge Eating Disorder and obesityBinge Eating Disorder and obesity
“Drunkorexia” and other terms to be aware of…
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PrevalencePrevalence
Anorexia: .5-1%Anorexia: .5-1%
Bulimia: 1-3%Bulimia: 1-3%
Binge Eating Disorder: .7-4%Binge Eating Disorder: .7-4%
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Etiology Etiology
The etiology of eating disorders is The etiology of eating disorders is multi-factorialmulti-factorial, with importance of , with importance of specific factors varying with each specific factors varying with each individualindividual
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Men and Eating DisordersMen and Eating Disorders
10% of eating disordered 10% of eating disordered individuals are maleindividuals are male
There is a greater stigma There is a greater stigma for males than femalesfor males than females
Eating disorder behavior Eating disorder behavior can present differently can present differently in malesin males
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Beyond Food…Beyond Food…
Eating disorders appear to be all about food…Eating disorders appear to be all about food…they are not.they are not.
Simply eating more/less will not make things Simply eating more/less will not make things better and often, when someone begins to eat, better and often, when someone begins to eat, things get harderthings get harder
Issues related to control, coping with emotions, Issues related to control, coping with emotions, self-esteem, guilt and shame, etc will become self-esteem, guilt and shame, etc will become MORE intense as someone stabilizesMORE intense as someone stabilizes
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Common Comorbid Common Comorbid DisordersDisorders
Major Depressive Disorder or DysthymiaMajor Depressive Disorder or Dysthymia– 50-75%50-75%
Anxiety DisordersAnxiety Disorders– 64%64%
Sexual AbuseSexual Abuse– 20-50%20-50%
Obsessive-Compulsive DisorderObsessive-Compulsive Disorder– 25% (AN); 41% overall25% (AN); 41% overall
Substance AbuseSubstance Abuse– 12-18% (AN); 30-37% (BN)12-18% (AN); 30-37% (BN)
Bipolar DisorderBipolar Disorder– 4-13%4-13%
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Health ConsequencesHealth Consequences AnorexiaAnorexia
– Abnormally slow heart rate & blood pressureAbnormally slow heart rate & blood pressure– Reduction of bone densityReduction of bone density– Muscle loss, weaknessMuscle loss, weakness– Severe dehydrationSevere dehydration– Anemia, LeukopeniaAnemia, Leukopenia– Reproductive consequencesReproductive consequences– 5-20% mortality rate5-20% mortality rate
PHYSICAL SIGNS: lanugo, headaches, feeling cold, PHYSICAL SIGNS: lanugo, headaches, feeling cold, tingling in extremities, feeling faint, dry skin, hair losstingling in extremities, feeling faint, dry skin, hair loss
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Health ConsequencesHealth Consequences
BulimiaBulimia– Electrolyte ImbalancesElectrolyte Imbalances– Esophageal tearsEsophageal tears– UlcersUlcers– Salivary gland enlargementSalivary gland enlargement– Dental DiseaseDental Disease
PHYSICAL SIGNS: headaches, fatigue, tingling in PHYSICAL SIGNS: headaches, fatigue, tingling in extremities, feeling faint, sore throat and swollen extremities, feeling faint, sore throat and swollen glands, Russell’s sign, dental problemsglands, Russell’s sign, dental problems
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Health ConsequencesHealth Consequences
BEDBED– High blood pressureHigh blood pressure– High cholesterol levelsHigh cholesterol levels– Heart disease as a result of elevated Heart disease as a result of elevated
triglyceride levelstriglyceride levels– Secondary diabetesSecondary diabetes– Gallbladder diseaseGallbladder disease
PHYSICAL SIGNS: temperature irregularities, joint PHYSICAL SIGNS: temperature irregularities, joint pain, decreased endurance and fatiguepain, decreased endurance and fatigue
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Treatment: AnorexiaTreatment: Anorexia
Psychopharmacoloy:Psychopharmacoloy: interventions typically recommended after interventions typically recommended after
weight restorationweight restoration Medication can begin earlier with focus on Medication can begin earlier with focus on
maintaining weight and normalizing eatingmaintaining weight and normalizing eating
PsychologicalPsychological Insufficient evidence regarding Insufficient evidence regarding
psychological interventionspsychological interventions CBT, IPT, Family TherapyCBT, IPT, Family Therapy
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Treatment: BulimiaTreatment: Bulimia
PsychopharmacologyPsychopharmacology reduce frequency of disturbed eating reduce frequency of disturbed eating
behaviors.behaviors. FDA approved medication for BN: fluoxetine FDA approved medication for BN: fluoxetine
(Prozac) (Prozac) Bupropion (Wellbutrin) has been associated Bupropion (Wellbutrin) has been associated
with seizures in purging bulimic patients and with seizures in purging bulimic patients and its use is its use is not recommendednot recommended. .
PsychologicalPsychological First line is CBTFirst line is CBT IPT and DBTIPT and DBT
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General Treatment IssuesGeneral Treatment Issues
Require multidisciplinary approachRequire multidisciplinary approach Nutritional counseling and medication must Nutritional counseling and medication must
not be sole treatmentnot be sole treatment
Psychotherapy will generally require Psychotherapy will generally require at least 1 year and most likely longerat least 1 year and most likely longer
Specialist in Eating Disorders Specialist in Eating Disorders preferred over general practitionerpreferred over general practitioner
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Levels of CareLevels of Care
InpatientInpatient
Partial HospitalizationPartial Hospitalization
Intensive OutpatientIntensive Outpatient
Outpatient Outpatient
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Indicators for HospitalizationIndicators for Hospitalization
In general:In general:– individual is below estimated healthy individual is below estimated healthy
weight weight – Rapid, persistent decline in oral intake or Rapid, persistent decline in oral intake or
weight and/or or uncontrollable purgingweight and/or or uncontrollable purging– weight at which physical instability is likely weight at which physical instability is likely
to occur to occur – Serious medical abnormalities Serious medical abnormalities – Comorbid psychiatric issues that warrant Comorbid psychiatric issues that warrant
increased supportincreased support
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PrognosisPrognosis AnorexiaAnorexia
– 50% recover50% recover– 33% improve somewhat33% improve somewhat– 20% remain chronically ill20% remain chronically ill
****mortality is 6x peers without anorexia mortality is 6x peers without anorexia and is the highest of any psychiatric and is the highest of any psychiatric illness!!illness!!
BulimiaBulimia– 50% recover50% recover– 18-30% improve somewhat18-30% improve somewhat– 20% continue to meet full criteria20% continue to meet full criteria
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ReferencesReferences Deshmukh, R. & Franco, K. (2003). Deshmukh, R. & Franco, K. (2003). Eating DisordersEating Disorders. Retrieved December . Retrieved December
9, 2006, 9, 2006, http://www.clevelandclinicmeded.com/diseasemanagement/psychiatry/eatihttp://www.clevelandclinicmeded.com/diseasemanagement/psychiatry/eating/eating.htmng/eating.htm
Grodstein, F., Levine, R., Spencer, T., Colditz, G.A., Stampfer, M. J. (1996). Three-year follow-up of participants in a commercial weight loss program: can you keep it off? Archives of Internal Medicine. 156 (12), 1302.
National Eating Disorders Association's Information website: www.NationalEatingDisorders.org
Practice Guideline for the Treatment of Patients with Eating Disorders (3Practice Guideline for the Treatment of Patients with Eating Disorders (3rdrd Edition) Edition) http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=EatingDisorders3ePG_04-28-06file=EatingDisorders3ePG_04-28-06
Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18 (3), 209-219.
Stice, E., Cameron, R., Killen, J. D., Hayward, C., & Taylor, C. B. (1999). Naturalistic weight reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. Journal of Consulting and Clinical Psychology, 67, 967-974.
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For More Information:For More Information:
http://www.nationaleatingdisorders.org– NEDA Educator ToolkitNEDA Educator Toolkit
http://www.eatingdisorders.org– The Center for Eating Disorders at The Center for Eating Disorders at
Sheppard PrattSheppard Pratt http://www.something-fishy.org Handbook of Treatment for Eating Handbook of Treatment for Eating
Disorders: 2Disorders: 2ndnd Edition by David Garner Edition by David Garner Ph.D. and Paul E. Garfinkel, M.D.Ph.D. and Paul E. Garfinkel, M.D.