EATING DISORDERS AND TREATMENT

RECOMMENDATIONSWOMEN IN MEDICINE SEMINAR

ST. GEORGE’S UNIVERSITYTHURS. SEPT. 19, 2013

6PM CARIBBEAN HOUSE

Dr. Julie M. Mullany – Postdoctoral Resident

Psychological Services Center

St. George’s University, Grenada

West Indies

OVERVIEWIntro : my background & experience Prior Counseling Services work & collaboration with: Wellness Education Services – nutritionists,

dieticians Student Health Services – medical perspective Eating Disorder Treatment Team work

Goal of today’s Presentation is:To provide information about body image & Eating Disorders (focusing on mainly just Anorexia & Bulimia for purposes today) as well as insight into some treatment approaches. Will also review appropriate ways to talk to your patients in a way that encourages and models attitudes and behaviors that help prevent eating disorders and body image issues and increase healthy self-esteem.

 

BODY IMAGEWhat is body image?

“the picture of our body which we form in our mind”

It involves our perception, imagination, emotions, and physical sensations about our bodies

Changes / fluctuates throughout life Can be positive or negative!

BODY IMAGE CONT.Psychological in nature

o Influenced by self-esteemo Influenced by what is expected

culturallyo Both men and women can suffer from

body image dissatisfaction. (not liking one’s body or specific body parts)

BODY IMAGE & SELF-ESTEEM

Body image can help form self-imageCulturally some of us learn that how

we look defines who we are

So…the worse we feel about our body, the worse we feel about ourselves

Self-esteem = how worthy one feels

WHAT CONTRIBUTES TO NEGATIVE BODY IMAGE?

Media – often values an unattainable level of thinness

Culture – can vary based upon where you’re from

Interpersonal messages – what values do you hear from friends, family members, partners?

Personal – what messages do you tell yourself?

Diseases/health concerns – ex) cancer, pregnancy

WHAT INFLUENCESNEGATIVE BODY IMAGE?

Culture – Think about the US - What are images of successful men/women valued in US culture? What does that culture say about heavy vs. thin, muscular vs. lean?

Culture of “shame” around body image Size discrimination Fat stigma Hatred of fat prejudice

Personal - What personal characteristics contribute to a negative body image?

Perfectionism Low self-esteem All or nothing thinking Difficulty focusing on positive qualities “Life would be better if…”

WAYS OF IMPROVING OR DEVELOPING HEALTHY BODY IMAGE

o Listen to your bodyo Be realistic about size, appearance o Exercise regularly in an enjoyable way o Expect normal weekly and monthly

changes in weight and shape o Work towards self acceptance and self

forgiveness o Ask for support and encouragement

from friends, family, etc.o Decide how to spend your energy: -

pursuing the “perfect body image” or enjoying life!

EATING DISORDERS:CAUSES AND CONTRIBUTING

FACTORSo Eating disorders are illnesses with a biological basis that

are often influenced by emotional, cultural, environmental and societal factors

o In the US alone there are over 10 million females and 1 million males struggling with anorexia and / or bulimia

o There are millions of others that struggle with binge eating disorder as well

o ED’s are the no. # 1 cause of death amongst all psychiatric disorders

o 3 types were classified in the old DSM-IV – Anorexia, Bulimia, & ED NOS (DSM-5 allows for more broader classifications)

o BIOLOGY: current research indicates that brain chemistry is altered in individuals with ED’s

o ENDORPHINS released when restricting and bingeing occurs

o GENETICS play a role: family members with ED’s, other addictions or mental illness

o CULTURAL/FAMILIAL INFLUENCE: focus on weight, appearance, body image related to self-worth

EATING DISORDERS:CAUSES AND CONTRIBUTING

FACTORS

o ENVIRONMENTAL: change in portion sizes, unhealthy choices, culture of convenience & the decrease in activity

o SOCIETAL: thin messages, fit/healthy skewed, models with ED’s, magazines digitally enhancing and altering photos, women’s progression in work force often still based on looks over ability

o CO-OCCURRING / CO-MORBID DISORDERS such as depression, anxiety, bipolar disorder, OCD, low self-esteem, self-injury, substance abuse

o EMOTIONAL TRAUMA: physical, emotional, sexual abuse survivors, trauma, grief (sense of control)

o Utilizes ED as a MEANS OF COPING and surviving, control

EATING DISORDERS: SOME SHIFTS AND CURRENT TRENDS

Began as white middle to upper class female disease – which led to a major paradigm shift

ED’s currently do not discriminate Males, other ethnicities and races as well as

economic status & sexual orientation ED’s can be seen in those as young at 6

years old to as old as 70 + Increase occurring for the first time with

middle aged women Increase in instances of ED’s among gay men Prevalence of ED’s with women in Substance

Abuse recovery – Athletes

EATING DISORDERS:GENERAL SIGNS AND SYMPTOMSo Dieting or restricting foodo Purging – self-induced vomiting,

laxatives, diureticso Exhaustion or chronic fatigueo Excessive weight losso Loss of menseso Changes in mood o Lack of motivation o Decreased concentrationo Fainting, dizziness or light-

headednesso Isolation/withdrawal from peers, or

activities

EATING DISORDERS:DANGERS AND HEALTH CONCERNS Low potassium Electrolyte Imbalance Heart attack Esophageal rupture Intestinal problems and disorders Hair loss Hair growth (Lanuga) Lower than normal bone destiny

(Osteopenia) ..a precursor to bone disease

(Osteoporosis)

ANOREXIA NERVOSA Anorexia is disorder in which someone

refuses to eat, even though they may be hungry. They choose not to eat because they are afraid to gain weight, typically have a distorted body image & carry emotional pain

Some physical signs & symptoms specific to Anorexia

- severe weight loss - low blood pressure - slow heartbeat - growth of fine hair on body

HOW IS IT DIAGNOSED?: Anorexia:

- eats foods with low calories & low fat

- cutting food into small pieces- playing with food rather than

eating- cooking meals for others, not

eating- compulsive exercise, skipping

meals- dressing in layers to hide weight

loss- becomes more isolated & secretive- increasing defensiveness - frequently weighing oneself

BULIMIA Bulimia is a disorder in which people will

eat a large amount of food in a short period of time (binge episode) and then either take laxatives or engage in self-induced vomiting (purging). Over-exercise (for both those with anorexia or bulimia) is also considered a form of “purging.”

Some physical signs & symptoms specific to bulimia sufferers:

- damaged teeth or gums from acid in vomit

- persistent sore throat- dehydration

HOW IS IT DIAGNOSED: Bulimia –

- secretive about food- spends time planning next binge- taking many trips to the bathroom

after eating- take food or hoard in strange

places- compulsive / impulsive eating

habits

EATING DISORDERS:GENERAL TIPS ON HOW TO HELP

Learn as much as you can about Eating Disorders

Voice your concern in a non-judgmental, caring, open and honest manner

Serve as a healthy role model to the individual

Inform someone else if necessary Assist the individual with

referrals/info on where to go for help (individual counseling, nutritionist, group &/or family therapy)

TREATMENT OVERVIEW: Address immediate health problems first Make long term treatment plan: - inpatient treatment

- Individual & or group therapy- family therapy- eating disorder education- nutritional counseling- continued medical monitoring

SPECIFIC PSYCHOLOGICAL TREATMENTS FOR ED’S: For Anorexia and Bulimia:- family therapy - addresses unhealthy family dynamics at play / allows eating patterns & routines to be observed (Maudsley model)- Cognitive behavioral therapy or DBT –

can help individuals change the unrealistic negative thoughts they have about their appearance & gradually change destructive eating behaviors

- Interpersonal therapy – helps individuals improve quality of their relationships, learn how to address conflicts head-on, expand social network & deal with emotions more effectively

EATING DISORDER TREATMENT TEAM

Ideally, and proven the most effective – is an Eating Disorder Treatment Team approach: A multi-systemic approach to treatment and includes:

o Mental Health Counseling – individual & group

o Psychiatryo Nutritional Counselingo Medical Monitoringo Further Linkages and referrals

WHAT TO SAY OR NOT SAY OR DO: Focus on health rather than weight or

looks Do not blame, criticize or judge the

patient Check your misconceptions about ED’s Do no minimize or joke, listen & be

patient Redefine rather than confront resistance Avoid argumentation or defensiveness Empathize self-efficacy, will-power, self-

determination & empower the patient Develop discrepancy between their

present behavior & patient’s personal goals

FURTHER CONSIDERATIONS: Do not instantly jump to give advice &

opinions Avoid talking in great detail of weight or

food & eating habits as these aren’t the real issues but symptoms of deeper, more complex underlying emotional issues (& often trauma)

Do not get angry with these individuals Encourage them to seek help but never try

to force them to eat Assure them they are not alone, that you

care & want to help them in any way you can.

Expect reactions of anger or denial – don’t push them but say you are there if they want help

MORE TIPS TO DISCUSSING ISSUES: Assume cognitive distortions &

reasoning errors, don’t assume they know facts, clarify

Educate about health risks but utilize warmth, compassion & nurturing empathy

Discuss a Team approach w/patient to allow them to feel they have control rather than that they are being controlled

Validation and good communication reduces defensiveness & splitting behaviors, increases trust & can provide hope & empowerment

RECENT DSM-5 CHANGES FOR DIAGNOSING EATING DISORDERS

One of the biggest changes in the new DSM-5 is the removal of the multiaxial system in place of the establishment of 20 diagnostic classes or categories of mental disorders – categories based on groupings of disorders sharing similar characteristics that are not given particular rank.

DIAGNOSTIC CHANGES CONT. While the DSM-IV(TR) considered 3

Eating Disorders and were listed under the Axis 1 disorders section:- Anorexia Nervosa- Bulimia - or ED-NOS – has characteristics of both

…they are now found in Feeding and Eating Disorders and include more types - allowing for additional diagnostic nuance.

DSM-5 CHANGES CONTINUED This diagnostic category includes the

following list of specific Feeding & Eating disorders

- Anorexia Nervosa - Bulimia Nervosa - Binge Eating Disorder (lacks purging

component) - Pica, Rumination Disorder - Avoidant/Restrictive Food Intake

Disorder Note - binge-eating disorder has been taken

out of the Appendix & has become its own free-standing diagnosis in the new DSM-5.

RECOURSES FOR REFERRAL:

- Psychological Services Center (PSC) at SGUCampeche Hall (2nd Floor)North & South Wings(473) 439-2277

- Search online at eating disorder websites

- Consult with counselor, MD, nurse, or PCP

- Call the National Eating Disorders Association hotline no# - 1-800-931-2237