Transcript Diapositiva 1

ARION PROJECT
INTERNATIONAL MEETING
GROTTAMMARE
2007,21-25th MAY
EATING DISORDERS (ED): HOW TO INFORM
AND TO TRAIN TEACHERS, IN ORDER TO
DETECT AND PREVENT TEEN AGERS
DISCOMFORT
Emilio Franzoni
Child Neurology and Psychiatry
Regional Center for Eating Disorders in child and
adolescence
S. Orsola-Malpighi Hospital
Bologna University
Italy
Tell me how you eat and I’ll tell you
who are you
I am nervous, anxious, so I don’t
eat (my stomach is closed)
I am nervous, anxious, so I eat
continuosly
Eating Disorders (ED) are mainly
classified as:
•Anorexia Nervosa (AN)
•Bulimia Nervosa (BN)
•Obesity
•Others ED
•ED are a complex pathology
charactherized by psychological,
biological and social components
The real estimate of the of the
phenomenon diffusion is not clear, but
we know that the more frequent age of
onset is between 13-24 years.
AN starts mainly between 13-17, whilst
BN is 16-24.
Any adolescent, sooner or later, may
shows anorexic behaviour.
However this is not always illness.
The distribution over population involves 90% of females
and 10% of males.
Recently the percentage, in males, has increased from 5
to 10%.
However, ED also involve children and pre-adolescents
with different mechanisms and clinical features.
In particular 25% of children with normal mental and
motor development and 35% of children with
developmental problems, may present an eating
difficulty.
A genetic predisposition facilitated by environmental
factors can lead to the true illness.
Statistics About Anorexia Nervosa:
Between 0.5-1% of American women suffer from
anorexia nervosa.
Anorexia nervosa is one of the most common
psychiatric diagnoses in young women (Hsu, 1996).
Between 5-20% of individuals struggling with anorexia
nervosa will die. The probabilities of death increases
within that range depending on the length of the
condition (Zerbe, 1995).
Anorexia nervosa has one of the highest death rates of
any mental health condition.
Anorexia nervosa typically appears in early to midadolescence.
Eating Disorders
Anorexia Nervosa (AN) is a severe, life-threatening disorder in
which the individual refuses to maintain a minimally normal body weight,
is intensely afraid of gaining weight, and exhibits a significant distortion in
the perception of the shape or size of his body, as well as dissatisfaction
with his body shape and size.
Bulimia nervosa (BN) is a severe, life-threatening disorder
characterized by recurrent episodes of binge eating followed by selfinduced vomiting or other purging methods (e.g. laxatives, diuretics,
excessive exercise, fasting) in an attempt to avoid weight gain.
Binge Eating (BE) disorder is a severe, life-threatening disorder
characterized by recurrent episodes of compulsive overeating or binge
eating. In binge eating disorder without purging
Warning Signs of Anorexia Nervosa:
Dramatic weight loss.
Preoccupation with weight, food, calories, fat grams, and
dieting.
Refusal to eat certain foods, progressing to restrictions
against whole categories of food (e.g. no carbohydrates,
etc.).
Frequent comments about feeling “fat” or overweight
despite weight loss.
Anxiety about gaining weight or being “fat.”
Denial of hunger.
Development of food rituals (e.g. eating foods in certain
orders, excessive chewing, rearranging food on a plate).
Consistent excuses to avoid mealtimes or situations
involving food.
Excessive, rigid exercise regimen--despite weather,
fatigue, illness, or injury--the need to “burn off” calories
taken in.
Withdrawal from usual friends and activities.
In general, behaviors and attitudes indicating that weight
loss, dieting, and control of food are becoming primary
concerns.
Anorexia nervosa involves self-starvation. The body is
denied the essential nutrients it needs to function
normally, so it is forced to slow down all of its processes
to conserve energy. This “slowing down” can have
serious medical consequences.
Bulimia Nervosa has three primary symptoms:
Regular intake of large amounts of food
accompanied by a sense of loss of control over
eating behavior.
Regular use of inappropriate compensatory
behaviors such as self-induced vomiting, laxative
or diuretic abuse, fasting, and/or obsessive or
compulsive exercise.
Extreme concern with body weight and shape.
Eating disorder specialists believe that the chance
for recovery increases the earlier bulimia nervosa
is detected. Therefore, it is important to be aware
of some of the warning signs of bulimia nervosa.
Health Consequences of ED:
Abnormally slow heart rate and low blood pressure,
which mean that the heart muscle is changing. The
risk for heart failure rises as heart rate and blood
pressure levels sink lower and lower.
Reduction of bone density (osteoporosis), which
results in dry, brittle bones.
Muscle loss and weakness.
Severe dehydration, which can result in kidney
failure.
Fainting, fatigue, and overall weakness.
Dry hair and skin, hair loss is common.
Growth of a downy layer of hair called lanugo all over
the body, including the face, in an effort to keep the
body warm.
The treatment of ED is based on medical
and psychological intervention.
We know that, at the beginning of the
illness, it is very difficult to convince a
person who suffers from ED, to realise that
he needs a help.
On the other hand, we also know that the
sooner we intervene the better is the
prognosis after the treatment.
Sometimes, in particular when a profound
depression and/or psychotic symptoms
are associated, a pharmachologycal
therapy can be useful.
In addition a nutritional approach must be
done that becames necessary when the
Body Max Index (BMI) is too low or too
high (normal values 18-24)
ED represent just a part of a wider discomfort
that, to day, is evident not only in teen agers, but
also in adults.
We really don’t know why in the last 20 years a
large diffusion of such a disorder has been
happened.
Drugs, addiction, ED, depression (and suicides),
bullyng, delinquency(even murders) are the most
frequent behaviours.
We cannot produce a specific solution to each
type of discomfort and we must find a common
strategy to connect the whole world of young
people.
What is Eating Disorders Prevention?
Prevention is any systematic attempt to change the circumstances that
promote, initiate, sustain, or intensify problems like eating disorders.
Primary prevention refers to programs or efforts that are
designed to prevent the occurrence of eating disorders
before they begin. Primary prevention is intended to
help promote healthy development.
Secondary prevention (sometimes called "targeted
prevention") refers to programs or efforts that are
designed to promote the early identification of an eating
disorder---to recognize and treat an eating disorder
before it spirals out of control. The earlier an eating
disorder is discovered and addressed, the better the
chance for recovery.
Basic Principles for the Prevention of Eating
Disorders
Eating disorders are serious and complex problems. We need to be
careful to avoid thinking of them in simplistic terms, like
"anorexia is just a plea for attention," or "bulimia is just an
addiction to food." Eating disorders arise from a variety of
physical, emotional, social, and familial issues, all of which need
to be addressed for effective prevention and treatment.
Eating disorders are not just a "woman`s problem" or "something
for the girls." Males who are preoccupied with shape and weight
can also develop eating disorders as well as dangerous shape
control practices like steroid use. In addition, males play an
important role in prevention. The objectification and other forms
of mistreatment of women by others contribute directly to two
underlying features of an eating disorder: obsession with
appearance and shame about one`s body.
disorders, and, when appropriate, receive referrals to sources of
competent, specialized care.
Prevention efforts will fail, or worse, inadvertently
encourage disordered eating, if they concentrate solely
on warning the public about the signs, symptoms, and
dangers of eating disorders. Effective prevention
programs must also address:
Our cultural obsession with slenderness as a physical,
psychological, and moral issue.
The roles of men and women in our society.
The development of people`s self-esteem and selfrespect in a variety of areas (school, work, community
service, hobbies) that transcend physical appearance.
Whenever possible, prevention programs for schools,
community organizations, etc., should be coordinated
with opportunities for participants to speak confidentially
with a trained professional with expertise in the field of
eating
Attention and prevention take back the responsability;
First of all the educational institutions (family and
school) must reflecton the opportunities to rebuilt its
educational skills
The families delegate too frequently the education of
their children to school.
School, on its own, is not often prepared to give
instruction and education toghether.
Which strategies can be used to approach these
complexes problems?
At the same time we cannot forget adults who
need often help and training either parents (or
future) or teachers, in dealing with ED.
We must know and we must live as we speake.
It is very important for young people to see that
you do what you say.
On the other hand we must
remember the different educational
target of family and school.
Family look after the relationship
between single person
School look after the relationship
among the social community
In conclusion:
Have we usefull advises?
•Self-esteeme
•Listening
•Respect for the Person (I would like to
underline that would only exist the
Person and not the Person categories
THANK YOU FOR
ATTENTION