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.