Eating Disorders

M.S Sara Dawod

Introduction

• They include bulimia, Anorexia nervosa.

• Bulimia has chronic course while others have one episode.

Anorexia Nervosa

• Anorexia: loss of appetite.

• Nervosa: loss due to emotional reasons.

Anorexia Nervosa

• Individual refuses to maintain normal weight or above minimally normal weight for age and height (weight less than 85% of that expected).

• Fear of gaining weight even underweight.• Denial the seriousness of the problem and lack of

insight.

• In postmenarcheal females, amenorrhea (absence of 3 menstrual cycles).

Anorexia Nervosa • They may use self induced vomiting or laxatives or

diuretics) and also stealing, drug abuse and suicide are common.

• Pt manifests: depression, social withdrawal, insomnia, irritability, loss of interest in sex, OCD related or unrelated to food, inflexible thinking, concern about eating in public.

• occurs during mid to late adolescence (14-18) and more in females: 90% (10 times than men).

• Hospitalization to restores weight may be required and recover may takes (6-7 years). Death risk: 10 times than population.

Bulimia Nervosa • It means “ox hunger”.• Diagnosis:A. Recurrent episodes of binge eating which is

characterized as the following:1. Eating within any 2 hours period a large amount of

food than other most people during similar period of time.

2. Sense lack of control over eating during the episodes.B. Inappropriate behaviors to prevent weight gain: laxatives, enemas, tasting, excessive exercises, vomiting.

Bulimia Nervosa C. It occurs at least twice a week for 3 months.D. Self evaluation is influenced by body shape and weight.E. It doesn’t occur exclusively during anorexia nervosa.• Other notes:• They are within normal weight, or lightly less or

above normal weight.• Select low calorie diet.• Has depression and anxiety disturbances.

Bulimia Nervosa • F more than M• Starts late adolescence or early adult life (12-40 years

old).• It begins after dieting failure.• The majority have depressive symptoms.• Dental problems and electrolytes imbalance are

common.• Bulimia may occur in anorexia.• Severe weight loss and amenorrhea in anorexia are

the major symptoms that differentiate it from bulimia.

Etiology of eating disorders• Genetic factors: 10 times higher in first degree relative

for anorexia and 5 times for bulimia, MZ more than DZ.• Neurobiological factors: hypothalamus (regulate

hunger and eating) problems, serotonin deficit.• Sociocultural factors: ideal female body, high class,

media effect, negative attitude toward obesity (not smart, lazy, stupid, stigma).

• Gender influences: women viewed through their bodies but men through accomplishment, self objectification (women see their body through the eyes of others).

Etiology of eating disorders• Psychodynamic views: disturbances in parent child

relationship, personality trait (low self esteem, perfectionism), to overcome their feeling of helplessness, ineffectiveness and to gain respect, and powerlessness), facing the demand of adolescence for identity and control. Mother daughter conflict relation (food is symbol of this relation and binging represents hate and love of mother).

• Personality: perfectionism, shy, low self esteem, anxious.

Etiology of eating disorders

• Family characteristics: family problems, conflict, illness (depression, personality disorders), enmeshment (over involvement and intimacy in which the parent may speak for their children because they believe they know exactly how they feel), over protectiveness, rigidity, lack of conflict resolution.

• Child abuse (physical and sexual).

Etiology of eating disorders

• Cognitive behavioral views:• Anorexia nervosa: fear of fatness and body

image disturbance which lead to dieting and we weight loss to reinforce self control, thinness is the ideal by media, criticism from parent and peers, phobic response to sexual changes associated with puberty.

Etiology of eating disorders

• Bulimia nervosa: over concerned with weight gain and body appearance to reduce anxiety. They have low self esteem so they focus on the controllable features of self (weight & shape) to feel better.

Treatment

• Pt typically deny the problem.

• Medication:• Bulimia: antidepressant: fluoxetine, Prozac.• Anorexia: antipsychotic : zyprexa: reduce

anxiety and increase weight gain.

Treatment • Psychological treatment:• Anorexia: behavior therapy to gain weight, family

therapy (lunch session), response prevention technique: require the patients to be in the presence of other patients for 2 hours after meal.

• Bulimia: CBT to question society standard of physical attractiveness to change beliefs, develop normal pattern of eating (3 meals and shacks between meals), challenge negative thoughts, individual and group therapy, response prevention technique.