ANOREXIA

bimodal peak age of onset, anorexia

12-13 years old 17 years old

binge eating effects ___ of the population

2 percent

____% increase in eating disorders among middle-aged women in the past 15 years

400% increase in eating disorders among middle-aged women in the past 15 years

average duration b4 presentation bulimia

5 yrs

comorbidity and anorexia

50% have comorbid psychiatric disorder(s)

bulimia demos

90% of those affected are female

demos of anorexia

90% of those affected are female

precipitating event

: Feels lack of control

bulimia A sense of lack of _____over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

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).

cultural consids and eating disorders

African American women Lower incidence of AN Higher incidence of BED Latina women Higher incidence of BED and BN Sexual orientation Gay men experience a high incidence of all three primary eating disorders Lesbian women may be slightly protected from eating disorder development

endocrine issues

Amenorrhea Oligomenorrhea Low bone mineral density Increased risk of fractures Osteoporosis

period and anorexia

Amenorrhea - if on bc, then no

________ has the highest mortality rate of any psychiatric disorder (up to 20%).

Anorexia Nervosa has the highest mortality rate of any psychiatric disorder (up to 20%).

Anorexia Nervosa: Up to ____% experience full recovery in their lifetime with early hospitalization, achievement of ideal body weight, and years of outpatient work.

Anorexia Nervosa: Up to 75% experience full recovery in their lifetime with early hospitalization, achievement of ideal body weight, and years of outpatient work.

anorexia Antidepressant medication is _____effective for ED psychopathology but helpful for comorbidities Atypical antipsychotics are ______effective for ED psychopathology

Antidepressant medication is not effective for ED psychopathology but helpful for comorbidities Atypical antipsychotics are more effective for ED psychopathology

feeding and eating disorders not otherwise specified

Atypical anorexia nervosa: Criteria for anorexia nervosa are met, except that despite significant weight loss, the individual's weight is within or above normal range. Bulimia nervosa (of low frequency and/or limited duration): Criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur less than once a week/less than 3 months. Binge-eating disorder (of low frequency and/or limited duration): Criteria for binge-eating disorder are met, except binge eating occurs less than once a week/less than 3 months. Purging Disorder: Recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications) in the absence of binge eating. Night eating syndrome: Recurrent episodes of night eating after awakening or after the evening meal with awareness and recall.

bulimia Binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for __ months Binges can occur in frequency up to _____times per day Food is often ____in calories Bingeing is done in _____ Feelings of _______occur after binges The disturbance does not occur exclusively during episodes of __________

Binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months Binges can occur in frequency up to several times per day Food is often high in calories Bingeing is done in secret Feelings of shame occur after binges The disturbance does not occur exclusively during episodes of Anorexia Nervosa

bing eating frequency

Binge eating occurs at least 2 days per week for 6 months

Bulimia Nervosa: ___% experience full recovery, 30% continue to struggle with symptoms, and ____% continue in their eating disorder.

Bulimia Nervosa: 50% experience full recovery, 30% continue to struggle with symptoms, and 20% continue in their eating disorder.

problems associated w/ refeeding syndrome

Cardiac/respiratory failure GI problems Delirium Death

cardiorespiratory issues

Chest pain Palpitations Arrhythmias/brady-cardia Shortness of breath Edema

types of therapy

Cognitive Behavioral Therapy (CBT) Mindfulness

obesity definition

Defined as at least 20% over ideal body weight Morbid obesity defined as 100% over ideal body weight

________`` in the way in which one's body weight or shape is experienced.

Disturbance in the way in which one's body weight or shape is experienced.

skin and anorexia

Dry skin Lanugo edema brittle hair/nails

cmp and ed

Dysregulated BG Low sodium Low potassium

gi issues

Early satiety Delayed emptying GERD Hematemesis Hemorrhoids/rectal prolapse Constipation

men and eating disorders

Eating disorders occur at a ratio of 2-3:1 in community samples

BINGE EATING Eating much more rapidly than normal Eating until uncomfortably full Eating large amounts when not physically hungry Eating alone due embarrassment Feeling depressed, guilty, or disgusted with oneself afterwards

Eating much more rapidly than normal Eating until uncomfortably full Eating large amounts when not physically hungry Eating alone due embarrassment Feeling depressed, guilty, or disgusted with oneself afterwards

binge eating Eating, in a discrete period of time (e.g., within any ____-hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances A sense of lack of _____over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

Eating, in a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances 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)

bulimia Eating, in a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely _____ than most people would eat during a similar period of time and under similar circumstances.

Eating, in a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

lft and ed

Elevated ALT/AST

genetic concerns

Genetic heritability 50%-70% of risk factors are heritable Concordance in monozygotic twins is 3 to 4 times higher than dizygotic twins Hypothalamic dysfunction Increased cortisol levels Decreased dopamine regulation Medical conditions Type I diabetes mellitus Polycystic Ovarian Syndrome (PCOS) Neurochemical factors

body temp and anorexia

Hypothermia - dehydration, ellimante fluid

ANOREXIA Intense _____of gaining weight or becoming fat, even though underweight.

Intense fear of gaining weight or becoming fat, even though underweight.

meal support therapy

Interrupt food rituals Develop portion control/estimation Monitor binge/purge behaviors Teach pacing of eating Model appropriate food behavior Provide supportive environment Experiential/creative art therapy

derm issues

Lanugo Hair loss Yellow skin discoloration Russell's sign Poor wound healing

lithium not recommended for anorexia bc of

Lithium:(mood stabliizer_ not recommended due to sodium/fluid depletion causing increased risk of toxicity

cbc and ed

Low WBC count Anemia

binge eating and other eating disorders

May be a prodromal phase for other eating disorders women more than men

binge eating disorder and compensation

No compensatory behaviors after binges

thyroid and ed

Normal or slightly low TSH/T4

anxiety disorders and ed

Obsessive Compulsive Disorder, GAD, Panic Disorder

traits of anorexia

Obsessive-compulsive traits Perfectionistic traits

mood disorders and ed

Occur in 40-70% of patients with eating disorders Include MDD, BPAD II, Persistent Depressive Disorder (PDD) High risk of suicide

after initial treatment episode One third of patients _____ One third of patients ______ with residual symptoms One third of patients continue to _______

One third of patients improve One third of patients struggle with residual symptoms One third of patients continue to deteriorate

onset/denial and anorexia

Onset can be associated with a stressful event Denial

oral/dental issues

Oral trauma Dental erosion Parotid enlargement

Over 70% of those who die from anorexia nervosa are >___ years old

Over 70% of those who die from anorexia nervosa are >65 years old

kids and eating disorders

Over 85% of eating disorders have onset prior to age 20

subj assesment

Past history of an eating disorder? Eating patterns? Food/weight preoccupations? Use of laxatives, diuretics, or diet pills? Body weight/shape distortion? Exercise pattern? Menstrual history?

refeeding syndrome definition

Potentially fatal shift of fluid and electrolytes that can occur when refeeding a malnourished patient

subtypes of bulimia

Purging type Non-purging type

ekg and ed

QT prolongation Bradycardia

2 subtypes of anorexia

Restricting type Binge-eating/purging type

Anorexia Nervosa Restriction of energy intake relative to ______requirements leading to a significantly _____ body weight in the context of age, sex, developmental trajectory, and physical health.

Restriction of energy intake relative to body requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

bulimia meds _____ and topiramate are most effective for reduction in binge/purge frequency

SSRIs and topiramate are most effective for reduction in binge/purge frequency

binge eating _____, topiramate, and lisdexamfetamine are very effective for reduction in binge frequency

SSRIs, topiramate, and lisdexamfetamine are very effective for reduction in binge frequency

primary cognitive appraisal

Self-concept is threatened Influenced by genetics, past experiences, current circumstances

bulimia Self-evaluation is _____influenced by body shape and weight

Self-evaluation is unduly influenced by body shape and weight

compensatory mechs of bulimia

Self-induced vomiting Misuse of laxatives, diuretics, enemas, and other medications Excessive exercise

type of weight loss w anorexia

Severe and profound weight loss

psych and binge eating

Shame or guilt in discussing eating patterns Hopelessness, helplessness about weight

reasons t o starve/binge

Stability Avoidance Emotional numbing Emotion regulation Mental strength Control Self-confidence Identity Secure care Gain attention Communicate what I can't say Perpetuate trauma cycle Disappearance/death

Substance use disorders Personality disorders Cluster C Cluster B

Substance use disorders Personality disorders Cluster C traits common in AN: Perfectionistic, sensitive, self-critical Cluster B traits common in BN: Impulsivity, unstable moods, emotional intensity

subj assessment cont

Suicidal thoughts? Sleep pattern? Social functioning? Mood disorder diagnoses? Addictive behaviors? Family functioning? Sexual history/orientation?

psych issues and eating disorders

Temperament AN: Perfectionism, concrete thinking, obsessionality BN: Impulsive/risk-seeking, mood instability, affect intolerance Low self-esteem Low tolerance for change Psychiatric disorders Depressive disorders Anxiety disorders (OCD, PTSD) High need for control

Treatment must be as complex as the illness Nutritional Medical Psychiatric Psychotherapy: Individual, group, and family Team communication is essential Varied levels of care

Treatment must be as complex as the illness Nutritional Medical Psychiatric Psychotherapy: Individual, group, and family Team communication is essential Varied levels of care

risk factors refeeding Undernourished >____ days _____weight loss (even if normal weight) Concurrent _____use ____, _____, or _____misuse ______labs

Undernourished >10 days Rapid weight loss (even if normal weight) Concurrent EtOH use Diuretic, laxative, or insulin misuse Abnormal labs

anorexia ________ influence of body weight or shape on self-evaluation. Denial of the _______ of the current low body weight.

Undue influence of body weight or shape on self-evaluation. Denial of the seriousness of the current low body weight.

compensatory mechs and anorexia

Use of inappropriate compensatory behaviors Excessive exercise Fasting Misuse of medications Self-induced vomiting Laxative/diuretic abuse

secondary cognitive appraisal

Weak ego strength leads to inability to use coping skills effectively Defense mechanisms include denial, regression, rationalization

goals of treatment Weight restoration to >----% ideal body weight Normalize ---patterns _______ medical complications _____________ urges to self-harm ________cognitive distortions __________emotional awareness and acceptance

Weight restoration to >90% ideal body weight Normalize eating patterns Reduce/eliminate medical complications Reduce/eliminate urges to self-harm Address cognitive distortions Improve emotional awareness and acceptance

bulimia and menstration

abnormal menses fatigue

anorexia pharm

atypical antipsychotics tcas ssris mirtzapine

most prevalant eating disorder

binge eating

bulimi and gi

bloating constipation abd pain diahrrea

heart and anorexia

bradycardia chest pain dizziness

bulimia peak onset

college age

gi and anorexia

constipation abdominal pain

bulimia and mouth

freq sore throat dental caries erosion of dental enamel mouth ulcer

bp and anorexia

hypotension cyanotic extremities

therapies Early detection and intervention are ___

imperative

weigt range and bulimia

normal 30% hx of obesity 20% hx of AN

binge eating - weight clinical feature

obesity Continued unexplained steady weight gain Sudden rapid weight gain

level of care levels

ouptient iop day/partial residential inpatient

Stress/Adaptation Model of Eating Disorders 4 components

precipitating event primary cognitive appraisal secondary cognitive appraisal maladaptive response

maladaptive reponse

restrict, binge, purge

bulimia and skin

russell's sign swelling in extremeties swelling in cheeks

binge eating

ssri mood stabilizer stimulant

bulimia pharm

tricyclic antidepr (but can kill) maoi (not good) ssris mood stabilizers - lithim may be ok