Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia...

48
Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa

Transcript of Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia...

Page 1: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Part I – Eating Disorders:

General Trends/IssuesEarly Eating Disorders

Anorexia NervosaBulimia Nervosa

Page 2: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Prevalence/PatternsPrevalence

Increases in prevalence over past 4 years; changing norms regarding size and shape of women*Historically confined to middle to upper SESIn college-age American women, 10 % or more have some symptoms of an eating disorderEstimated to occur in 0.5% to 3% of all teenagersAmong athletes and performers, range from 15% to 60%.

Gender & Age Differences90-95% of affected individuals are femaleLittle is known about nature of disorder in malesLess frequently occurs before adolescence or after age 25

Page 3: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

*Prorated Trend of Women’s Actual Body Weights Compared with the Trend for Playboy Centerfolds &

Miss America Contestants

Page 4: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

General Risk FactorsSelf-Ideal Body Image Discordance

General sociocultural norms idealizing extremes of thinness in women in Western cultures

This pressure may lead to development of intrusive and pervasive perceptual biases regarding how fat they are

Lead women to believe that men prefer more slender shapes than they in fact do

Related to decreases in self-esteem usually apparent during mid-adolescence in girls

While women’s actual weight has been increasing over past four decades, the weight of cultural beauty icons has decreased at the same rate

Page 5: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.
Page 6: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.
Page 7: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Barbie DollInteresting Facts

In 1945 Ruth and Elliot Handler form Mattel. In 1957 Ruth conceives of a three dimensional adult-like doll. The body is based on German doll called "Lilli" which is sold as a sex toy for men. If Barbie was human sized, she would stand 5 foot 6 inches tall, weigh 110 pounds, and have a 39 inch bust, 18 inch waist and 33 inch hips.

Page 8: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.
Page 9: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

General Risk FactorsDevelopmental Risk Factors

Continuum of “eating pathology” from pickiness and dieting to clinical syndromes

Early eating habits: stability of problem eating in young children (e.g., pickiness, binging, pica (eating non-food items))

Drive for thinness: key motivational factor underlying dieting and body image (e.g., “losing weight will make them like me more”)

Dieting: between grades 5-8, 1/3 students diet and 45% want to lose weight

Biological Resistance to weight changeBodies will resist, and try to compensate, for marked variation from one’s “set point” (individual norm)Physiological compensations include enhanced hunger drive and slowing of metabolism at decreased caloric intake

Page 10: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Early Eating DisordersFeeding Disorder of Infancy or Early Childhood

Sudden or marked deceleration of weight gain in an infant or young child and a consequent slowing of emotional and social development.Relatively common (up to 1/3 of infants affected); more often found in high-risk families, where abuse or neglect may be presentOutcome depends on timing and level of intervention

Failure to ThriveWeight below 5th percentile for age, and/or deceleration in rate of weight gain from birth to present of at least 2 standard deviationsBeen associated with poor attachment, poverty, family disorganization, limited social supportOutcome highly related to child’s home environment

Page 11: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Early Eating DisordersPica

Ingestion of inedible substances for period at least 1 monthAffects mostly very young kids and those with MRCauses: poor stimulation and supervision in the home; in some cases of MR also genetic/biological factorsSeverity often related to degree of environmental deprivation and intellectual impairmentMost clinical interventions emphasize operant conditioning

Shaping and reinforcement of appropriate eating behavior

Page 12: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Anorexia NervosaCore Characteristics

Refusal to maintain body weight at or above a minimally normal weight for age and height (less than 85%)Intense fear of gaining weight of becoming fat, even though under-weightDisturbance in experience of body weight or shape by self-evaluation, or denial of seriousness of current low weightAmenorrhea (absence of 3 consecutive menstrual cycles)

Two Types:Restricting TypeBinge-Eating/Purging Type

Page 13: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Anorexia NervosaAssociated Features

Comorbid ConditionsDepressionOCD & extreme self-control (in restricting types)Substance abuse disorders (in binge-eating/purging type)Personality disorders (esp. anxious-fearful)

Behavioral PatternsIsolation from peers; social awkwardnessSevere dietary restriction, excessive exercise (RT)Misuse of laxatives, diuretics, enemas, self-induced vomiting (B-E/PT)

Page 14: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Anorexia NervosaSpecific Risk Factors

Personality CharacteristicsEmotionally reserved and cognitively inhibitedPreference for routine, order, and predictable environments; poor adaptationShow heightened conformity and deference to othersAvoid risk and react to stressful events with strong feelings of distressFocus excessively on perfectionismMaturity fears

Family PatternsMothers described as: excessively dominant, intrusive, overbearing, and less affectionate, discouragement of autonomyFathers described as: emotionally absentFamilies described as: limited tolerance of disharmonious affect or tension, poor conflict resolution skills, preoccupation with desirability of thinness, dieting, and good physical appearance

Page 15: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Anorexia NervosaTreatment Goals

Stabilize PatientRestoring hormonal function and bone densityMaximize chances for full and lasting recovery

Treatment ComponentsHospitalization

Renourish and reestablish weight to ensure survival

Psychological Treatment (Out/Inpatient)Family therapyCognitive-behavioral therapyNutritional counseling

Page 16: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Anorexia NervosaPrognosis: Long-term Physical Effects

Heart diseaseMost common medical cause of death in people with severe anorexia. Heart develops dangerous rhythms, blood flow is reduced and blood pressure may drop, heart muscles starve, losing sizeCholesterol levels tend to rise

Electrolyte ImbalancesAnemiaReproductive and Hormonal Abnormalities

Low levels of reproductive hormones& changes in thyroid hormones

Neurological ProblemsNerve damage and seizures, disordered thinking, loss of feeling, or other nerve problems in the hands or feet. Structural changes and abnormal activity during anorexic states; some damage may be permanent.

Page 17: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Anorexia NervosaPrognosis

At this time, no treatment for anorexia is completely effective. Many remain very thin and displayed characteristics of the disorder, including perfectionism and drive for thinness, that keep them at risk for recurrence of the eating disorder. Recovery can take between 4 and nearly 7 years. Comorbid disorders increase for poor outcome.

Risk of DeathDeath rates ranging from 4% to 20%. The risk for early death is twice as high in bulimic anorexics as it is in the anorexic-restrictor types.Increased suicide rates.

Page 18: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Bulimia NervosaCore Characteristics

Recurrent episodes of binge eatingEating in a discrete period of time (i.e. 2hrs) an amount of food that is definitely larger than most people would in similar circumstances A sense of lack of control over eating during the episode

Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or medications, fasting, or excessive exerciseBoth behaviors occur on average at least twice a week for 3 mosSelf-evaluation unduly influenced by body shape and weightTwo Types:

Purging TypeNon-purging type

Page 19: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Bulimia NervosaAssociated Features

Comorbid ConditionsAnxiety disorders (esp. GAD)Substance use disordersPersonality disorders (esp. Cluster B – emotional, dramatic, emotional, erratic)

Behavioral PatternsPurging types show greater physical and psychological dysfunctionPreoccupation with efforts to conceal disorder and master impulse to bingeBinge episodes usually involve intake of about 1000 calories approx. 14 times per week

Page 20: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Bulimia NervosaSpecific Risk Factors

Personality CharacteristicsLong-standing pattern of excessive perfectionismNegative self-evaluationMaturity fearsImpulsivity

Family PatternsHigh parental expectationsOther family members dietingHigher criticism by family members about shape, weight, or eatingDecreased allowance for autonomy

Page 21: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Bulimia NervosaTreatment

AntidepressantsCognitive-Behavioral Therapy

Clearly superior to medication

Emphasis on normalizing eating patternsTemporal regularitySocial eating

Focus on distorted cognitive patternsDichotomous thinking

Page 22: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Bulimia NervosaPrognosis

Less major health problems associated with bulimia, where normal weight is maintainedIn general, the outlook is better for bulimia than for anorexia. Mortality rate about 1% for those in treatment; 20% have life-long patterns of disorder

Physical EffectsTeeth erosion, cavities, and gum problemsLoss of fluid and low potassium levelsAcute stomach distress, rupture of the esophagus, or food pipe

Page 23: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Boys and Body ImageGrowing awareness regarding the pressure men and boys are under to appear muscular.

Many males are becoming insecure about their physical appearance as advertising images raise the standard and idealize well-built men.

Alarming increase in obsessive weight training and the use of anabolic steroids and dietary supplements that promise bigger muscles or more stamina for lifting.

Number of boys affected is increasing and that many cases may not be reported, since males are reluctant to acknowledge any illness primarily associated with females.

Page 24: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Part II - Obesity:

An EpidemicCurrent Treatments

A New Approach: BCT

Page 25: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1985

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 26: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1986

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 27: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1987

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 28: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1988

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 29: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1989

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 30: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1990

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 31: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1991

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 32: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1992

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 33: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1993

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 34: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1994

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 35: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1995

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 36: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1996

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 37: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1997

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 38: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1998

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 39: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 1999

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 40: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 2000

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 41: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Obesity Trends* Among U.S. AdultsBRFSS, 2001

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Page 42: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

A National CrisisThe rates of overweight and obese

individuals have been steadily climbing.

Rates of obesity alone have doubled in the last decade.

1998, the World Health Organization labeled Obesity “an Epidemic.”

65% of the population are now either overweight or obese (2004).

The trend is continuing with no end in sight.

Page 43: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Who is Overweight or Obese?

Height-Weight Tables >120% desirable weight

BMI (kg of body weight / height (in meters) squared)Normal < 25 kg/m2

Overweight 25-30Class I Obesity 30-34.99 Class II Obesity 35-39.99 Class III Obesity >40

Percent Fat >25% males; >32% females

Waist Circumference >40 in. males; >35 in. females

Page 44: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Physical & Emotional Burdens

Risk of major chronic diseases increases with increases in BMI and central obesity:

Metabolic SyndromeCardiovascular Diseases

Type 2 DiabetesCancers

OsteoarthritisSleep Apnea

Gall bladder DiseasePsychological Disorders

Social and Employee Discrimination

Page 45: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

$100 billion dollars spent annually on obesity-related health care utilization.$329.2 billion dollars spent in 2002 on CVD-related illness.$50 billion dollars spent annually on diet related products.

The Financial Burden

Page 46: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

The Ultimate CostDirect link between Obesity and Years of Life Lost (Fontaine et al, 2003)

Young adults with morbid obesity had a 22% reduction in life span.Ethnic differences in optimal BMI

23 to 25 for Caucasian (men and women) 23 to 30 was optimal for African American (men and women).

Obesity-related illness accounts for >280k deaths annually (Manson, 2003)

Obesity mortality is positively correlated with CVD mortality

950,000 people die each year from cardiovascular disease (CDC, 2003)

Page 47: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

US Cardiovascular Disease Rates

400

420

440

460

480

500

520

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0

Years

MenWomen

Dea

ths

in t

he

Th

ousa

nd

s

Cardiovascular disease mortality trends for males and females in the United States, 1979-2000. Reprinted from the American Heart Association.

Page 48: Part I – Eating Disorders: General Trends/Issues Early Eating Disorders Anorexia Nervosa Bulimia Nervosa.

Explanation

Biological

Psychological

Social

Engel, 1977, 1980; Schwartz, 1982