Eating Disorders

Eating Disorders Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder

Diagnostic Criteria: Anorexia Nervosa 1. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

Diagnosis for Anorexia • 2. Intense fear of gaining weight or becoming fat, even though underweight • 3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight on self-evaluation, or denial of the seriousness of current low body weight.

Diagnosis for Anorexia • 4. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. Restricting Type: the person has not regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Anorexia: Binge-Eating/Purging Type Binge-Eating/Purging Type: the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Anorexia Nervosa: Medical Complications • Cardiac abnormalities (slow heart rate, disturbances heart’s rhythm) • Dangerously low blood pressure • Dangerously low body temperature • Low white blood cell count • Chronic constipation • Osteoporosis (brittle, weak bones) • For teens, slowed growth or development, short stature • Loss of menstrual periods (amenorrhea) • Infertility • Hair loss and nail destruction

Diagnostic Criteria: Bulimia Nervosa 1. Recurrent episodes of binge eating, characterized by both of the following: A. Eating in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances B. 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).

Diagnosis: Bulimia 2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting, or excessive exercise 3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

Diagnosis: Bulimia 4. Self-evaluation is unduly influenced by body shape and weight. 5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa. Bulimia is Categorized as Purging or Non-Purging Type

Bulimia Nervosa: Medical Complications • Electrolyte abnormalities that can lead to heart rhythm disturbances • Dehydration • Dangerously low blood pressure • Amenorrhea • Destruction of dental enamel and cavities • Bowel abnormalities

Diagnostic Criteria: Binge-Eating Disorder 1.Recurrent episodes of binge eating (characterized by doing so in discrete time period and with lack of control) 2. Episodes are associated with 3 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 being embarrassed by how much one is eating • Feeling disgusted with oneself, depressed, or very guilty after overeating

Diagnostic Criteria: Binge-Eating Disorder 3. Marked distress regarding binge eating is present. 4. The binge eating occurs, on average, at least 2 days a week for 6 months. 5. The binge eating is not associated with the regular use of inappropriate compensatory behaviors and does not occur during the course of Anorexia or Bulimia Nervosa.

Eating Disorder Not Otherwise Specified Category for disorders of eating that do not meet the criteria for any specific eating disorder. Examples include: • For females, all of the criteria for Anorexia are met except that the individual has regular menses. • All of the criteria for Anorexia are met except that, despite significant weight loss, the individual’s weight is in the normal range. • All of the criteria for Bulimia are met, except that the binge eating and compensatory behaviors occur less than twice a week or for fewer than 3 months.

What Causes Eating Disorders?Multiple Factors are Involved Negative Family Influences and Psychological Factors -Parental Behaviors or Attitudes -Family History of Addictions or Emotional Disorders -History of Abuse -Family History of Obesity Genetic Factors Sociocultural Pressures -Emphasis on thinness as the ideal for beauty -Availability and indulgence of food -Role of the media -Obesity and reaction to larger body size Abnormalities of the following: -Thyroid, Hypothalamus/Amygdala/Pituitary Gland, Stress Hormones, Neurotransmitters, Ghrelin production, and Reproductive Hormones

What are the best treatments for eating disorders? • Treated most successfully when diagnosed early • The longer abnormal eating patterns persist, the more difficult it is to overcome the disorder and its effects on the body. • Once diagnosed, the clinician assesses if hospitalization is needed or if patient can be treated as outpatient.

Conditions warranting hospitalization • Excessive rapid weight loss • Serious metabolic disturbances • Clinical depression • Risk of suicide • Severe binge eating and purging • Psychosis

Treatment often involves a combination of interventions including: • Medical monitoring • Individual, group, and/or family psychotherapy • Nutritional counseling • Cognitive therapy • Behavioral therapy • Antidepressant medication

What are the recovery rates for those with eating disorders? • U.S. estimate: 7-10 million women and 1 million men affected • Approximately half of those with anorexia or bulimia have a full recovery • Approximately 30% have a partial recovery • 20% have no substantial improvement in symptoms

Helping Yourself: Be Your Own Best Resource • Daily Check-in: Am I Eating to Feed Emotional Hungers? • Practice Body Acceptance • Resist the Temptation to Weigh Your Self-Esteem • Become Media Literate • Be Wary of Magical Thinking

Be Your Own Best Resource • Combat Weightism in Yourself and the World • Eat Healthfully. Do not Diet—Unless You Want to Gain Weight • If You Think You Have a Problem… talk to someone you trust. You deserve to get the help you need and the professional support to guide you.

Resources • www.nimh.nih.gov – National Institute of Mental Health • www.anad.org – National Association of Anorexia Nervosa and Associated Disorders • www.aedweb.org – Academy for Eating Disorders • www.nationaleatingdisorders.org – Eating Disorders Awareness and Prevention • www.eatright.org – American Dietetic Association • www.aabt.org – Association for Behavioral and Cognitive Therapies • www.psych.org – The American Psychiatric Association • www.aacap.org – American Academy of Child and Adolescent Psychiatry

Eating Disorders