Eating Disorders

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T h e C l o w n C a r

Objectives

• Discuss who is at risk • Define types of eating disorders • Discuss signs and symptoms of eating disorders • Treatment options: psychological, medical & holistic • Discuss what you can do for someone at risk or who has an eating disorder • Test your knowledge with a game

Prevalence

• Anorexia Nervosa 0.9% of women and 0.3% of men • Bulimia 1.5% of women and 0.5% of men • Binge Eating 3.5% of women and 2% of men

Highest rate of mortality for any mental disorder

Who is at risk?

• Female: 10x more likely than males • Age: adolescents at highest risk • Perfectionism • Obesity & or over-exercising • Low self-esteem & peer pressure • Media: Distorted body image • Athletes: dancers, swimmers, & wrestlers • Family influences • Sexual abuse & comorbid conditions • Anxiety disorder

· Have you lost a lot of weight?

· Do you eat only certain foods for fear of gaining weight? · Are you spending a lot of time thinking about your body, weight, calories, food, or dieting?

· Have you developed ways of eating, such as rearranging food on your plate, excessive chewing or eating food in a certain order?

· Do you talk to others about feeling fat? · Do you avoid mealtimes and eating?

· Do you frequently weigh yourself?

· Do you prefer to eat alone? · If some asks you to eat something, do you say no, even if you know you should? · Do you wear baggy clothes or form-fitting clothing? · Do you exercise more than 2 hours per day so that you can burn off the calories from the food you have eaten? · Are you feeling moody, depressed, or withdrawn on a regular basis?

If you answered yes to three or more of these questions, you may have anorexia.

Barbie

What’s an Eating Disorder?

• Unhealthy eating patterns • They are defined as mental illnesses • Physical consequences, sometimes fatal

To name a few…

• Anorexia Nervosa • Bulimia Nervosa • Eating Disorder NOS [EDNOS] • Binge Eating Disorder [BED] Disorders of Childhood: • Pica • Rumination Disorder [barf, rechew, swallow]

Anorexia Nervosa: OCD for thinness

– Not eating type: “restrictive” – Binge OR Purge type • Fat Phobic, Food Phobic • Obsessions: weight, exercise, calories, etc • Addiction: THIN • DSM Criteria: – Refusal to maintain weight [85%] – Fat Phobic – Denial of low body weight – Amenorrhea for 3 months

Bulimia Nervosa

Think “binge,” not “barf” – Purging type – Non-purging type: fasting or exercising 101 ways to purge DSM-IV Criteria: Binging= within 2 hours Feels lack of control over binge Recurrent inappropriate behavior to prevent weight gain At least 2x per week for 3 months

Eating Disorder NOS [EDNOS]

This is like the catch-all: • AN with regular periods • AN with weight loss but weight is in the normal range (for now.) • BN symptoms less than 2x per week or for less than 3 months.

• Repeatedly chewing and spitting out, but not swallowing, large amounts of food.

• Purging after not-binging: – After the consumption of three cookies – constructing intricate desserts for the purpose of destruction – a five mile run after two bowls of broth • Binge eating disorder

Binge Eating Disorder or Compulsive Overeating Disorder

May be

most common ED

• Recurrent episodes of binging • Feels lack of control over eating Binging and: 1. Eating until feeling uncomfortably full 2. Binging when not hungry 3. Eating much more rapidly 4. Eating alone because embarrassed 5. Feeling disgusted, depressed, or guilty after overeating Marked distress regarding binge eating is present • At least 2 days a week for six months • No purging

Others:

Dibulimia Drunkorexia Manorexia

EATING DISORDER WARNING SIGNS (Anorexia, Bulimia, Compulsive Eating) • Food Behaviors • Appearance and body image behaviors • Exercise behaviors • Thoughts and beliefs • Feelings • Social behaviors • Other behaviors

General Signs And Symptoms Of Eating Disorders To Watch For

Physical

• Weight loss or no gain in height and weight (unless under the direction of a physician) • Loss of or irregular menstrual period • Fine, downy hair on body • Callus formation on back of hands, poor teeth from vomiting

Eating Behaviors

• Avoiding certain foods • Dieting • Change in types of food – normal to low-calorie and low fat choices, or vegetarian • Counting calories, grams of fat or weighing food • Food missing in the house • Unusually high interest in food, such as reading cookbooks or watching cooking shows • Doesn’t enjoy food

Social and Psychological Changes

• Mood changes and irritability • Overly concerned about body shape, size and weight • Wearing bulky clothes to keep warm and hide weight loss • Spending a lot of time in the bathroom • Social isolation

Criteria for Hospitalization

• Weight loss, <75% below ideal • Heart Rate, <40 beats/min • Temperature, <36oC • Blood Pressure <90/60mmHg • Glucose <60 mg/gL • Serum Potassium,<3mEq/L • Severe Dehydration • Electrolyte Imbalance

Emergency Hospital Treatment

• Careful introduction of fluids and nutrients – Fluids and electrolytes – Protein, Carbs, Fats – Vitamins and minerals – Limited amounts (100mL) • Tube feeding • Intravenous feeding [‘TPN’] • Monitor lab tests • Supervised meals • Privileged earning program

Refeeding Syndrome and Hypophosphatemia

Not-enough-phosphate-in-the-blood causes: • Muscle dysfunction: low cardiac output, cardiac arrest, and respiratory depression • Confusion, delirium, and coma. • White blood cell destruction • Muscle Breakdown [Rhabdomyolysis] • Blood cells burst [hemolytic anemia] Drops in Potassium, Magnesium, Glucose also occur

Interdisciplinary Care

Biopsychosocial Model

• Nutrition Counseling, – Proper meal planning – Multivitamins and mineral supplements • Medical monitoring, – Psychiatric counseling – Psychotherapeutics • Psychosocial intervention – Cognitive behavioral therapy – Family therapy – Group therapy – Interpersonal Therapy

Holistic Treatments

• Traditional Chinese medicine • Acupuncture • Aromatherapy • Massage • Yoga • Meditation • Homeopathic remedies • Orthomolecular therapy

What can you do?

• Show concern • Encourage seeking help • Do not only focus on food & diet topics • Avoid comments about a person’s appearance • You cannot force someone to eat, so avoid power struggles • It is up to the person to change • Learn about eating disorders

If you think someone you know has an eating disorder:

Information & Referral Helpline 800.931.2237

Treatment is available.

Recovery is possible.

References • • • • • • • Alta Bates Summit Eating Disorder Program (510)204.4569

American Psychiatric Association (1994).

Diagnostic and Statistical Manual of Mental Disorders

(DSM-IV). 4th Edition. Washington, DC: American Psychiatric Association.

Boyd, M., (2008).

Psychiatric Nursing: Contemporary practice.

Lippincott Williams & Wilkins: Philadelphia PA. 24(505-534) (4th Edition). Guo Ke Ren, et al.(1999). Treating 30 Cases of Anorexia with Acupuncture at Zu San Li.

Journal of Acupuncture

, 19(7):427.

Hearing, S. 2004. Refeeding syndrome is underdiagnosed and undertreated, but treatable.

BMJ Publishing Group Ltd.

Kelsie Forbush, K Heatherton, T, Keel, P. 2008. Relationships between perfectionism and specific disordered eating behaviors.

International Journal of Eating Disorders

40:1 37 –41 2007 LeMone, P., Burke, K. (2008).

Medical-Surgical Nursing: Critical Thinking in Client Care

. (4th Edition). Pearson Prentice Hall: Upper Saddle River, New Jersey. 22(644 652) • Murphy, K., NP, DNS. (2007). The Skinny on Eating Disorders.

Nursing Made Incredibly Easy.

40: May/June(44-47). Retrieved April 27, 2008 • NationalEatingDisorder.org

• Pratt, Woolfenden (2002). Interventions for preventing eating disorders in children and adolescents.

Cochrane Database of Systematic Reviews.

April 2002, Issue 2. Art. No.: CD002891.