Eating Disorders

ANOREXIA

Mortality is 10x higher than the general population

Anorexia affects the whole body; the disorder brings about a number of associated medical complications

Associated with perfectionistic and obsessive personality traits

90% of anorexia cases are female; prevalence is 0.5%

BULIMIA

To maintain body image, purging occurs after binge eating to compensate for potential weight gain

Often presents as a person appearing to have no weight abnormalities

Bulimia affects the body's systems and brings about a host of medical complications

Age of onset usually mid-adolescence

Bulimia defined as recurrent episodes of binge eating at least once a week for 3 months

Age of onset usually over 15 years

B-E-D

Avoidant behaviors--such as being embarrassed about the large quantity of food one might consume--can be a sign of an eating disorder

It is important to be sensitive about how to address the eating disorder so that the patient and family do not further blame themselves for the disorder

B-E-D is the most common of the eating disorders

Binge eating disorder defined as eating behavior that causes significant distress and is present at least 2 days a week for 6 months; there are no associated compensatory behaviors

Anorexia leads to a more distorted thought process than B-E-D and bulimia

Lower self esteem associated with anorexia than with bulimia or B-E-D

ANOREXIA

People don't typically inherit an eating disorder itself. In the case of anorexia, personality traits such as perfectionism and high anxiety are passed down. People with these personality traits may have decreased central coherence, or find it easy to perceive fine details, but challenging to "zoom out" and take in the greater scope of situations

It is important to rule out diabetes, thyrotoxicosis, cystic fibrosis, bowel diseases, malignancies and other possible causes of weight loss. That said, anorexia is often overlooked as a cause of weight loss in younger individuals and should not be neglected as a possibility.

Clinicians should assess height and weight using growth chart rather than BMI

Treatment is slow and difficult and typically takes 6-7 years to complete

B-E-D & BN

Obesity, substance misuse and depression are more common in families in which a member suffers from bulimia nervosa or binge eating disorder. Borderline personality disorder is also a common comorbid disorder

CBT is the "gold standard" for treating bulimia in both children and adults

The island of Fiji experienced a spike in eating disorders--particularly B-E-D and bulimia--after the introduction of TV. Speaks to the power of society and culture on how people perceive themselves!

It is typical for people with anorexia or bulimia tend to have low insight into the medical implications of the disorders

General medical exam should precede psych assessment for eating disorder

Family support is the first line intervention for eating disorders in children/adolescents

H.1

PPT & DSM

Severity ranges from mild (1-3 binge-eating episodes per week) to extreme (14 or more binge-eating episodes per week)

Most common comorbid disorders are bipolar disorders, depressive disorders, anxiety disorders and substance use disorders

Antidepressants appear to be beneficial in the treatment of bulimia nervosa in young people and adults (60 mg fluoxetine daily) and appear to also be effective in managing B-E-D.