chapter 15

theories of etiology

"Brain Disorders" 53-83% of eating disorders can be accounted for by genetic factors Chromosomal regions Reward centers Altered serotonin, neuropeptide, and neurocircuitry systems are seen in both AN and BN

restricting type

: during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

atypical anorexia

A diagnosis for individuals who do not fit the criteria for AN because despite significant weight loss, the individual's weight is within or above the normal range Diagnosed as: "Other Specified Feeding or Eating Disorder"

recent changes in diagnostic criteria

Change from DSM-IV to DSM-V in 2013 Greater than ½ of hospitalized patients with eating disorders did not fit diagnostic criteria (thus lacking coverage) Changes: Anorexia Nervosa Amenorrhea no longer a requirement Change from "expressed fear of gaining weight" to "persistent behavior that interferes with weight gain" Bulimia Nervosa Frequency of behaviors for diagnosis reduced from 2x/week to 1x/week Binge Eating Disorder Was not previously a diagnosi

effects on sports performance

Decreased performance may not occur for some time, and the athlete may wrongly believe that the disordered eating behavior is harmless. Endurance performance is likely to deteriorate if liver and muscle glycogen levels are low or if the athlete becomes dehydrated or anemic. Dehydration is common in both AN and BN, this can also lead to loss of motor skill and coordination. The athlete will also experience difficulty maintaining comfortable body temperature. Electrolyte disturbances are detrimental to muscle function, and with time, a loss of lean body mass will reduce strength and power.

dual diagnosis

EDs frequently exist with psychological comorbid conditions such as depression, anxiety, borderline personality disorder, OCD, and substance use.

spectrum disorder

Eating Disorders are spectral disorders; they exist on a continuum of severity and often become more severe the longer they are present

effects on athletes health

Energy and macronutrient deficiency in people with anorexia may affect mood, endocrine status, growth, reproductive function, and bone health. Inadequate intakes of calcium, iron, and B vitamins are of serious concern for female athletes. Depression is a common symptom Stunted growth in adolescent athletes may occur during prolonged periods of inadequate energy. (gymnasts, wrestlers). Delayed onset of puberty.

ancel keys, early starvation study

Minnesota Starvation Study (1950's) Physically and psychologically healthy male volunteers Many of the symptoms that might have been thought to he specific to anorexia nervosa and bulimia nervosa are actually the results of starvation It is absolutely essential that weight be returned to "normal" levels so that psychological functioning can be accurately assessed

theories in treatment

Multidisciplinary approach is absolutely necessary. This team includes nutrition, medical, and mental health professionals. This provides counseling, diet education, medication management, lab monitoring, etc. And also tackles the issue of "splitting" Maudsley Method: family-based therapy approach found provide effective treatment for individuals <18 y/o, with AN and BN of short duration (<3 years) Research with college-aged individuals and couples Levels of Care: Residential Inpatient Partial Hospitalization Intensive Outpatient Outpatient

nature of eating disorders

People do not choose to have EDs EDs have an emotional/behavioral component and a neurophysiological/genetic component. The NP/G component sets the stage for ED development. A "trigger" will begin the process. The E/B component begins with the trigger, such as weight loss Many ED psychological symptoms resolve with physical restoration. Often very resistant to treatment, and prone to deception, which leads to very slow progress. Individuals with EDs are not purposefully attempting to be uncooperative or manipulative ED's often co-exist with other psychiatric illnesses, especially anxiety related disorders. Dual-diagnosis is very common. Physical restoration alone does not constitute recovery

common notes about anorexia nervosa

Prevalence of AN is ~0.4% among young females 10:1 female-to-male ratio Commonly begins during adolescence or young adulthood, but can occur at any age Onset is often associated with a stressful life event 5% mortality rate Comorbidity is very common, especially bipolar, depression, anxiety, and OCD

prevalence of BED

Prevalence of BED among US adult females and males is 1.6% and 0.8% respectively

bulimia nervosa

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (<2 hours), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances A sense of lack of control over eating during the episode (cannot stop eating or control what or how much one is eating) Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise The binge eating and inappropriate compensatory behaviors both occur, on average, at least 1x/week for 3 months Self-evaluation is unduly influenced by body shape and weight The disturbance does not occur exclusively during episodes of Anorexia nervosa

binge eating disorder

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (<2 hours), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances A sense of lack of control over eating during the episode The binge-eating 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 feeling embarrassed by how much one is eating Feeling disgusted with oneself, depressed or very guilty afterward Marked distress regarding binge eating is present The binge eating occurs, on average, at least 1x/week for 3 months The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in BN and does not occur exclusively during the course of BN or AN.

anorexia nervosa

Restriction of energy intake relative to requirements, leading to a significantly low body weight Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

maintenance period

Return to Normal" period Begins after an individual is physically and nutritionally restored Long/prolonged duration d/t persistent psychological disturbances (years) RD's remain instrumental during this period Weight maintenance Caloric adjustment as exercise is resumed/increased Relearning normal eating patterns Engaging in social eating activities

female athlete triad

The 3 conditions that are prevalent in female athletes- amenorrhea, disordered eating, and osteoporosis- are collectively known as the Female Athlete Triad Syndrome The Female Athlete Triad can occur in any athlete, including those without clinical ED's

risk factors

The biggest risk factor is gender. Females have a 10x greater risk of developing an eating disorder than males. Being an athlete does not place a person at increased risk for an eating disorder. Dieting is an established risk factor for eating disorders injury or off season wt gain being told to lose weight diet Personality traits: low self esteem, self critical, impulsivity, addiction

unspecificed eating disorder

This category applies to presentations in which symptoms characteristic of an eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders. Often used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific eating disorder, likely due to insufficient information at the time (first visits, emergency room settings, etc.) (Formerly "EDNOS")

bulimia nervosa facts

Typically normal weight or overweight Prevalence of BN among young females is ~1.0-1.5% 10:1 female-to-male ratio 2% mortality rate

eating disorder types

anorexia nervosa, bulimia nervosa, binge eating disorder, unspecified eating disorder

eating disorders are

mental illness not a choice

subtypes anorexia nervosa

restricting types, binge eatin/pursing type

observations

spontaneity and flexibility concerning po participation in social situations with food Abnormal speed of po Inability to define or eat a balanced meal Disproportionate time spent thinking about food Excessive use of condiments Cutting food into very small pieces before eating "debiting" po

binge eating/purging type

the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (self-induced vomiting, laxatives, diuretics, or enemas)