Understanding Eating Disorders: Symptoms, Demographics, and Treatment

1. Eating Disorders:Current Topics & Trends Rebecca L. Rogers, Ph.D. Augusta State University

2. “Do not allow the body to attain extreme thinness, for that, too, is treacherous, but bring it only to a condition that will naturally continue unchanged, whatever that may be.” -Hippocrates

3. Anorexia Nervosa • refusal to reach or maintain 85% body weight • fear of fat • disturbance in body image, excessive influence of weight/shape, denial of seriousness of problem • absence of at least 3 consecutive menstrual cycles • Restricting and Binge-Eating/Purging subtypes

4. Demographics • mean age of onset is 17 years old • mostly in industrialized societies • majority female • majority Caucasian • primarily in middle upper class • prevalence among late adolescent and young adult females = 0.5% - 1.0% • increase risk in first degree biological relatives • mortality rates reported as high as 1/5

5. Physical signs: • emaciated • lanugo hair • discolored and/or dry skin • decrease in subcutaneous fat • hair loss • bradycardia, hypotension • hypothermia • decrease in estrogen, loss of menses • edema, especially with refeeding

6. Associated medical complications: • arrhythmias • cardiomyopathy • congestive heart failure • gastrointestinal dysfunction • mild anemia • osteoporosis/osteopenia • ovarian cysts • gray matter deficits

7. Associated psychological features: • Axis I • depression • anxiety • social phobia • obsessive compulsiveness • Axis II • cluster C, cluster A • obsessiveness • dependency

8. Recent etiological theories • biological factors: • serotonin • leptin • psychological factors • Axis I • Axis II • social factors • prevalence is higher in industrialized societies • prevalence is higher is certain subcultural groups

9. Treatment goals: • normalize body weight • correct irrational preoccupation with weight • prevent relapse

10. Bulimia Nervosa • recurrent episodes of binge eating & compensatory behaviors to prevent weight gain • 2x/week for 3 months • excessive influence of weight/shape • Purging and Nonpurging subtypes

11. Demographics • modal age between mid-adolescence and age 20 • greater diversity in ses and ethnicity • majority female • prevalence among teen and young adult females = 1.0% - 2.7% • increased frequency in first degree relatives

12. Physical signs: • scars on hands • puffy cheeks • gastritis • bradycardia, hypotension • edema, especially after cessation of purging • menstrual irregularities • dental problems

13. Medical complications: • fluid and electrolyte abnormalities • dehydration • muscle weakness, fatigue • arrhythmias • seizures • cardiac and skeletal myopathies • gastrointestinal problems (e.g., reflux, gastritis, hiatal hernia, gastric dilation)

14. Associated psychological features: • Axis I • depression • anxiety • social phobia • substance abuse/dependence • Axis II • cluster B • impulsiveness • dependency

15. Recent etiological theories • biological factors • restricted intake • disturbed satiety • serotonin • psychological factors • Axis I • Axis II • social factors • increased incidence • prevalence is higher in industrialized societies • prevalence is higher in certain subcultural groups

16. Treatment goals: • terminate compensatory behaviors • normalize eating behaviors • correct irrational preoccupation with weight • prevent relapse

17. Eating Disorder NOS • disorders of eating that do not meet full criteria for any specific eating disorder • examples • females who meet criteria for AN except for lack of menstrual cycle • criteria for AN except, despite significant weight loss, person is not considered underweight • criteria for BN except frequency or duration of binge eating and compensatory behaviors • regular use of inappropriate compensatory behaviors by normal weight person eating small amounts • repeated chewing and spitting out (but not swallowing) large amounts of food • binge eating disorder

18. Binge Eating Disorder • recurrent episodes of binge eating without compensatory behaviors • eating and unusually large amount of food in a discrete period of time • sense of being out of control • eating when not hungry • eating quickly • eating until uncomfortably full • eating in secrecy • feelings of shame or guilt • ~ 2/week for 6 months • the person experiences distress

19. Demographics • onset is usually late adolescence or early twenties, often soon after significant weight loss from dieting • more common in women • more evenly distributed across age, gender, ses, ethnicity than other eating disorders • chronic course • prevalence rates in weight control programs = 15% - 50% • prevalence rates in nonpatient community samples = .7% - 4.0%

20. Physical signs • Medical complications • Associated psychological features • Axis I • Axis II

21. Recent etiological theories • biological factors • genetic predisposition to obesity • history of restricting diet • unstructured eating behaviors • psychological factors • non-specific risk factors for psychiatric disorders (e.g., adverse parental depression) • feelings of depression, anxiety, tension • dissociative quality • social factors • ?

22. Treatment goals: • structure eating • correct irrational preoccupation with weight • prevent relapse

23. “Do not allow the body to attain extreme thinness, for that, too, is treacherous, but bring it only to a condition that will naturally continue unchanged, whatever that may be.” -Hippocrates