1 / 42

Eating Disorders (EDs)

Eating Disorders (EDs). Anorexia Nervosa (AN). Refusal to maintain 85% of ideal body weight Intense fear of gaining weight or becoming fat Disturbed perception of the shape or size of the body Denial of the seriousness of the problem Amenorrhea—3 months without period. Subtypes of AN.

jimmyi
Télécharger la présentation

Eating Disorders (EDs)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Eating Disorders (EDs)

  2. Anorexia Nervosa (AN) • Refusal to maintain 85% of ideal body weight • Intense fear of gaining weight or becoming fat • Disturbed perception of the shape or size of the body • Denial of the seriousness of the problem • Amenorrhea—3 months without period

  3. Subtypes of AN • Restricting • Lose weight primarily through dieting, fasting, or excessive exercise • Binge-eating/Purging • Person regularly engages in binge eating or purging • Purging is self-induced vomiting, misuse of laxatives, diuretics, or enemas

  4. Bulimia Nerovsa (BN) • Recurrent episodes of binge eating (eating a large amount of food given the context with an associated sense of loss of control) • Recurrent inappropriate compensatory behavior (purging, fasting, excessive, exercise) • Binge eating and compensatory behavior occur at least 2 times per week • Clients are usually normal body weight or overweight

  5. Subtypes of BN • Purging type • Person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas • Non-purging type • Person regularly engages in other inappropriate compensatory behavior—fasting or excessive exercise

  6. Who’s at Risk for AN and BN? • Adolescents • Athletes • Appearance focused professionals

  7. Demographic Factors • Females comprise 95% of those with EDs • Onset of AN ranges from pre-puberty to the 30s, but generally occurs between 12-18 • Onset of BN typically begins during late adolescence or early adulthood

  8. Statistical Data • 10-18% mortality rate • Highest mortality rate of any of the psychiatric disorders • Death most frequently occurs by starvation, electrolyte disturbances, or suicide • People who have had the disease greater than 20 years have a 20-25% increased mortality rate • Long term data—no more than 50% recover completely

  9. Statistical Data (cont) • Prevalence rates of 0.5-1% among females in late adolescence and early adulthood who meet full criteria for AN • 1-3% with BN

  10. Risk Factors

  11. Psychological Factors • Low self-esteem • Perfectionism and unrealistically high standards • Difficulties in self-soothing and mood modulation

  12. Biological Factors • 8 times the risk if family member has ED • 50% concordance in monozygotic twins, 15% for dizygotic • A family history of mood or anxiety disorders or OCD increases the risk of EDs

  13. Biological Factors • Many neurochemical changes occur with EDs • Low NE levels are seen in clients during periods of restricted intake • High levels of 5-HT and its precursor tryptophan have been linked to satiety • Low levels of 5-HT have been found in clients with BN and the binge-purge subtype of AN

  14. Family Factors • AN • Family is rigid about values and rules • Overprotective • Unable to deal with conflict • BN • Family is chaotic with loose boundaries • Perceived as less caring • Unrealistic expectations for achievement • Parental concerns with weight

  15. Sociocultural Factors • Cultural ideal of being thin • Media focus on beauty, thinness, and fitness • Chronic dieting, particularly among young women

  16. Comorbid Illnesses

  17. Comorbid Illnesses • AN • Depression • Dysthymia • OCD/OCPD • Anxiety Disorders • Avoidant PD

  18. Comorbid Illnesses • BN • Depression • Dysthymia • Substance abuse • BAD • BPD • Avoidant PD

  19. Medical Complications of EDs Related to Weight Loss

  20. Dermatologic Complications • Dry skin • Lanugo-like hair • Alopecia • Brittle nails • Pale skin • Cyanosis

  21. Cardiac Complications • Low heat rate—30-40s common • Low BP • Decrease in heart size • CHF—biggest risk factor for death • MI • Arrhythmias • Death

  22. Respiratory Complications • Decrease in the number of breaths per minute • Decrease in respiratory muscle tone

  23. Gastrointestinal Complications • Delayed gastric emptying • Bloating • Constipation • Abdominal pain • Gas • Diarrhea

  24. Musculoskeletal Complications • Loss of muscle mass • Loss of fat • Osteoporosis • Pathologic fractures

  25. Hematologic Complications • Leukopenia • Anemia • Thrombocytopenia • Hypercholesterolemia • Hypercarotonemia

  26. Neuropsychiatric Complications • Abnormal taste sensation • Apathetic depression • Mild organic mental sx • Sleep disturbances

  27. Medical Complications of EDs Related to Purging

  28. Metabolic Complications • Electrolyte abnormalities • Particularly hypokalemia and hypomagnesemia • Elevated BUN

  29. GI Complications • Salivary gland enlargement • Pancreatic inflammation with elevated serum amylase • Esophageal irritation • Gastric erosion

  30. Dental Complications • Erosion of dental enamel

  31. Neuropsychiatric Complications • Seizures • Mild neuropathies • Fatigue • Weakness • Mild organic mental sx

  32. Laboratory Abnormalities

  33. Labs • Routine labs include: • CBC • Electrolytes • Serum glucose levels

  34. Labs (cont) • RBCs—low • Hgb and Hct elevated due to hemoconcentration • WBCs—low • Na, K, Cl—low in purging, diuretic, or laxative use • Serum glucose—low

  35. Treatment of EDs

  36. Rx • Cognitive behavioral therapy • Pharmacologic therapy

  37. CBT • Use strategies designed to change the client’s thinking (cognition) and actions (behaviors) about food • Focus on: • Interrupting the cycle of dieting, binging, and purging • Altering dysfunctional thoughts and beliefs about food, weight, and body image

  38. Pharmacology • SSRIs have shown success with weight maintenance and treatment resistant AN • Prozac and Celexa • Zyprexa—being researched to treat low weight and rx resistant individuals with high levels of anxiety • May need meds to treat co-morbid illness • WB--contraindicated

  39. Refeeding • Calorie calculation • 25-35 kcl x current weight • Increase calories by 200-300 kcl every 2-3 days (1-2 lb gain/week) • Fluid intake of at least 1500cc/day • Daily weights

  40. Refeeding Syndrome • Greatest risk of cardiac complication is within the 1st two weeks of refeeding • The myocardium is less able to withstand the stress of increased metabolic demands because left ventricular mass and contractility have been reduced • Hypophosphatemia—causes decreased cardiac stroke volume • Electrolyte abnormalities

  41. Recovery • Long-term study of AN • 50% fully recovered • 25% had intermediate outcomes • 10% still met criteria for AN • 15% had died of causes r/t AN • Best indicator for recovery is return of menses

  42. Recovery • 50 % recover fully • 20% continue to meet criteria for BN • 30% have episodic bouts • Death rate with BN is estimated to be 0-3%

More Related