Module Nine EATING DISORDERS

1. Module NineEATING DISORDERS • Lesson 1: Anorexia Nervosa • Lesson2:Bulimia Nervosa

2. Lesson 1 ANOREXIA NERVOSA

3. Step 1: Theory presentation In reality Anorexia Nervosa is not an eating disorder. • It is a chronic disorder mainly manifested to young women (10 women to 1 man). • It is manifested in 15 women over 100.000 people.. • It is usually manifested in wealthy people. • In some groups, like fitness instructors, dancers etc. is manifested more often. • Many people with this disorder, manifest during their life other mental disorders as well, mainly Depression. • It is estimated that 15% of these cases end up to death.

4. Step 2: Slide projection Slide 9.1.1: Causal factors of Anorexia Nervosa Psychological • Avoidant personality characteristics. • Perfectionist personality characteristics (“child’s image”) • Disorder in figure’s perception • Equalize the slim figure with emotion of value or possibility to control oneself. • Retrogression for fear of adult sexuality.

5. Step 2 (continued) Family • High percentages of mental disorders in the family. • Dominating mother, passive and ineffective father, inflexible family with over involved members and avoidance of conflicts.

6. Step 2 (continued) Cultural • Society which considers important being fit • Conflict and fluid expectations regarding woman’s role • Use of food as communication mean

7. Step 2 (continued) Biological • Connection with Depression, as it appears from the manifestation in the same families. • Neurochemical disorders (serotonin decrease, hypothalamus abnormalities etc.) which might also be a result of starvation

8. Step 3: Slide projection Slide 9.1.2: Clinical manifestation of Anorexia Nervosa • The person denies to maintain the appropriate weight regarding its age and height. • Is afraid of putting on weight. • Cause vomiting after eating. • Takes too much exercise. • Uses diuretics. • Has distorted body image. • Absence of menstruation. • Might manifest depressive symptoms. • In advanced progress states manifest hypothermia, ankle oedema, low heart rate, hypotension, thin and soft hair as a newborn’s, coma, death.

9. Step 4: Slide projection Slide 9.1.3: Therapeutical interventions for Anorexia Nervosa • Diagnosis and treatment of physical disturbances • Gain of normal weight • Eating training • Psychotherapy • Pharmacotherapy

10. Step 5: Questions and comments (5΄)

11. Lesson2 BULIMIA NERVOSA

12. Step 1: Introduction • Bulimia Nervosa, characterized also as “dietetic chaos syndrome”, is a disorder manifested in young girls during adolescence or early adulthood. • About 4% of girls in this age are attacked. • These girls usually have long history of eating difficulties and about one third of these has manifested Anorexia Nervosa in the past.

13. Step 2: Slide projection Slide 9.2.1: Clinical manifestations of Bulimia Nervosa • Continuous occupation with food • Normal weight • Recurrent episodes of overeating • Causing vomiting after eating • Alternative periods of starvation • Use of diuretics • Intense fear of weight gain

14. Step 3: Slide projection Slide 9.2.2: Similarities and differences between Anorexia Nervosa and Bulimia Nervosa Similarities Gender: mainly women Age: adolescence or early adulthood History: long lasting eating problems Clinical image: fear of weight gain, causing vomiting, use of diuretics Etiology: multifactor (psychological, family, cultural, biological factors) Therapeutical treatment: versatile (Cognitive, Behavioral, Family therapy, Eating training, Antidepressants)

15. Step 3 (continued) Differences Age: BN later than AN Rate of incidence: BN more frequent than AN Clinical image: AN : distorted image of oneself, AN : many physical distortions, BN: normal weight, BN: overeating episodes Therapeutical treatment: AN: hospitalization often required, AN: Chlorpromazine Expectations (prognosis) : AN: 15% death from complications BN: much better, but often subsides

16. Step 4: Questions and comments (5΄)