Eating Disorders
Cognitions & Personality Traits
Assessment
Eating and feeding disorders need a multi-disciplinary evaluation involving physical investigations, food diaries, growth charts, and psychiatric assessment
All patients suspected for an ED also need to be evaluated by there PCP
Need to rule out diabetes, bowel disease, thyroid disorder, CF
Treatment
Avoid all drugs that prolong QTC
Family support is best hope for patient getting better
Possibly a more distorted thought process in anorexia as compared to bulimia and binge eating disorder
Overlap with OCD, obsessions and compulsions pertaining to body image and food intake
Perfectionist personality type in anorexia
Persistent thinking around food and weight
Patients may have low or limited insight into the condition and consequences
Low self-esteem prominent in anorexia
Alexithymia- difficulty recognizing feelings common in anorexia
Clinician Barriers/Pit falls and Techniques
MI is important technique needed to formulate treatment plan
Don’t blame the family, externalize the disorder rather than internalize the disorder in the family or patient
Responsibility for recovery is explicitly placed with the family in partnership with professionals. It is assumed families “know best” how to feed their children.
The adults re-take control until the child can feed herself autonomously again. They are urged to use all their existing skills and to learn new ones where necessary to bring this about
Treat co-morbid condition after addressing ED. Well-meaning efforts to treat depression in an extremely low weight patient are likely to meet with limited success unless re-nutrition is in progress
Clinicians who explore ambivalence sensitively, seeking to understand both pros and cons of the eating disorder, are more likely to find themselves on the side of the patient against the disorder. Patients find it less daunting to give up their eating disorder if they can learn alternative coping skills
Clinicians should acknowledge sympathetically, not angrily, the benefits which undoubtedly come with a serious eating disorder: its power to oblige people to care and placate, the relief from social and sexual demands, the sense that one’s body is now controlled rather than terrifyingly unpredictable. Young patients need new techniques for coping with these aspects of life without having to starve themselves.
Binging – sense of lack of control over eating
Bulimia – impulsive, self critical
Co-morbid with depression, anxiety, personality disorders, highest co-morbid % with social anxiety
Conclusions about the presence of a primary anxiety disorder should wait until the effects of starvation have abated.
In differentiating between anxiety disorder and ED, scope of intrusive thoughts, the scope of avoidance, and any other symptoms of fear may help clarify how these features are directly part of AN or more correctly attributed to another primary anxiety disorder
Poor prognosis – Anorexia 40% fully recover, 6-7 years
AN has the highest mortality rate of all psychiatric disorders
Shortage of services often results in prolonged waiting lists for assessment, meaning that by the time of assessment, patients may be demotivated or otherwise less likely to engage in what is offered
Bulimia >50% remission at 5 years
Compared to adolescents, younger children <13 years with ED were more likely to be male, less likely to be diagnosed with bulimia, but no difference in anorexia between age groups. Younger pt weight less in percentile to ideal body weight and lost weight more rapidly than older adolescents.
attitudes of health professionals, including mental health specialists towards EDs, are not always positive
Assessment interviews should leave the patient with a sense of dignity and that they have been heard. The assessment interaction should be seen as an important therapeutic interaction to begin building a therapeutic alliance, balancing both an atmosphere of acceptance yet firmness without being over-confident or paternalistic.
Adolescents is typical age of onset
Adolescents simultaneously experience the challenge of living with a changing and growing body, new hormone-driven urges, the new cultural expectations, sexual, intellectual and social demands, and the need to process all these with a brain that is itself anatomically and chemically in a state of flux