PNM Cell Group CME: Overview of Eating Disorders, in particular Bulimia Nervosa Overview of...
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Transcript of PNM Cell Group CME: Overview of Eating Disorders, in particular Bulimia Nervosa Overview of...
PNM Cell Group CME:Overview of Eating
Disorders, in particular Bulimia Nervosa
Overview of Epidemiology, Aetiology, DiagnosisOverview of Evidence-Base re TreatmentQ+A and Cases from Group
Epidemiology of Eating Disorders
Anorexia Nervosa – relatively rare BUT more severe, relapsing-remitting and/or chronic NZ Community Sample – lifetime risk - 0.3-0.5% Female risk 10x male risk Age of onset usually adolescence Mortality rate highest of any psychiatric condition Suicide rate higher than Major Depression Co-morbidity very common – Major Depression, OCD,
Personality Disorder
Epidemiology of Eating Disorders
Bulimia Nervosa – more common BUT less severe NZ Community Sample – lifetime risk using formal
diagnostic criteria - 1.5-3.0% Secondary school girls – rates of binge
eating/vomiting high – up to 20% - mostly self-limiting/does not progress to full disorder
Female risk 10x male risk Co-morbidity very common – Major Depression, A+D
conditions, Personality Disorder
Aetiology of Eating Disorders
Multifactorial Stress-vulnerability model useful framework
for conceptualising “why this person, why now?” – commonly precipitated by stressful event in a vulnerable individual
Cultural component – attitudes to women’s ideal body size/image, media/advertising images and messages, societal pressure etc.
Ballerina’s, Gymnasts, Models at higher risk Very rare in PI women in Islands, NZ PI women
same rate as pakeha by 3rd generation in NZ Onset often after a period of “normal” dieting
Aetiology of Eating Disorders
Contd… Genetic Component – increased risk among 1st-
degree relatives of individuals with an eating disorder, twin studies show high concordance rates identical twins
Genetic Component – also increased risk of mood disorders and A+D conditions among first degree relatives of individuals with an eating disorder
?Family factors – contentious, some evidence Early life disruption/trauma – increased risk of
Eating Disorder, most often co-morbid with Personality Disorder, A+D issues etc.
Diagnosis – Anorexia Nervosa
Weight loss/refusal to maintain body weight above 85% of expected weight for age/height
Intense fear of gaining weight/becoming fat even though under weight
Body image disturbance Amenorrhoea Restricting type vs Binge-Eating/Purging
type
Diagnosis – Bulimia Nervosa
Recurrent episodes of binge eating, associated lack of control over eating – at least 2x wkly for at least 3 mths
Associated compensatory behaviour to avoid weight gain – dieting, purging, excessive exercise, misuse of laxatives/diuretics
Self-evaluation unduly influenced by body shape/weight, some degree of body image distortion
Purging type vs Non-Purging type
Eating Disorders – Medical Complications
Purging – dental decay, parotid enlargement, fluid/electrolyte disturbance esp. hypokalemia (subsequent risk of arrythmias)
Starvation – anaemia, hypotension, hypothermia, elevated LFT, impaired renal function, sinus bradycardia and arrythmias, EEG abnormalities, enlarged brain ventricles/cerebral atrophy, osteoporosis
Eating Disorders – Evidence-Based Treatments
Best treatment approach multidisciplinary/multidimensional – Medical – assess for and treat medical
complicationsDietician – dietary advice/prescriptionPsychology – CBT/Family TherapyPsychiatry – symptomatic treatment,
treatment of co-morbid conditions
Eating Disorders – Evidence-Based Treatments
Behavioural Interventions –Eating diaryPsychoeducation, advice re healthy eating
and body weightMotivational interviewing
Eating Disorders – Evidence-Based Treatments
Medications –Some evidence for benefit of high-dose SSRI
in BulimiaOtherwise no effective drug treatmentBenefits from treating co-morbid conditions
e.g., depressionMedication can be helpful targeting specific
symptoms – e.g., sleep disturbance, anxiety
Eating Disorders – Evidence-Based Treatments
Psychotherpeutic interventions -Family Systems Therapy and CBT both
effectiveSome evidence for Family Therapy better in
teens/unemancipated individuals, CBT better in adult/emancipated
Group CBT programme very cost-effective in treating Bulimia Nervosa
Cognitive Behaviour Therapy (CBT)
Structured, time-limited, ‘here and now’ Specific skills for now and future Five components to problem (“Five-Part
Model”) Cognitive model Evidence Balanced thinking
CBT - 5-Part Model
Thoughts orCognitions
Physiology,Sensations
Behaviours,Actions
Feelings,Emotions
Environment (Past & Present), Situation
CBT - 5-Part Model (contd)
SITUATIONAUTOMATIC
THTS ANDIMAGES
REACTION
EMOTIONAL
BEHAVIOUR
PHYSIOLOGYLENS OR FILTER THROUGH WHICH WE PRECEIVE ORINTERPRET SITUATIONS
COGNITIVE COMPONENT