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Eating Disorders for Be Your Own Kind of Beautiful Student Association

Dr. Lara Ostolosky MD, FRCP (C) Psychiatrist University of Alberta Hospital January 16, 2014

Prevalence of obesity in teens has tripled over twenty years 15% of teen girls and boys are overweight An additional 15-20% of these kids are at risk Over of teen girls and of teen boys use unhealthy weight control behaviours like:
skipping meals, fasting, cigarette smoking, vomiting and laxatives

Dieting leads to weight gain NOT weight loss in teens Girls who diet are 12x more likely to binge eat as girls who do not diet and boys dieting are at 7x greater risk for binge eating

Clues to EDs

Anorexia Nervosa
Self starvation and weight loss to the extreme Extreme fear of being overweight Restrict food, may exercise to extremes May also engage in dangerous weight control behaviours like self induced vomiting, laxative abuse, diet pill overuse, etc. Very rigid and limiting in food choices, amounts and become obsessed with process of weight loss Do not see how thin they are becoming When emaciated, there are many medical complications - loss of the menstrual cycle and impairment in growth

Bulimia Nervosa
Starts as effort to lose weight
Have more difficulty in starving themselves and will start to eat huge amounts of food (i.e. binge eat) Purge food by inducing vomiting, taking laxatives, abusing diuretics to induce loss of fluids, attempt fasting afterwards for days, they may use excessive exercise for weight control or may abuse medicines and illicit substances to prevent weight gain Binge eating and purging becomes cyclical, obsessive

Fear of weight gain, have a fear of fat

Feel completely out of control around food

Bulimia Nervosa
Can be any weight (over, under, normal) Mentality and fears same as in anorexia 5-10% of these patients die Rarely admit to their behaviours Binge eating and purging also serves the purpose of regulating negative emotional states such as anger, depression, guilt and shame The behaviours become calming or numbing in the same way that alcohol or drugs can be anxiety relieving

Eating Disorder NOS

A person has some but not
all of the criteria of either anorexia or bulimia Can be just as serious A regurgitation syndrome for example

Fear of weight has to be there

Makes up the largest group of individuals with eating disorders

Binge Eating Disorder

Food seeking in the absence of hunger Eating large amounts of food more than needed nutritionally A feeling of a lack of control over eating Eating food to regulate a negative mood

Eating as a sense of reward

Sneaking or hiding food No purging

Paralyzing Sense of Ineffectivenes s

Pro ANA website

Warning Signs
Unexplained weight loss Pale or sallow skin Puffiness No/little growth in height No/little weight gain Looking older or younger then age Preoccupied thoughts of food, weight and exercise Inappropriate clothing or clothing that does not fit Complaints of fatigue Amenorrhea Compulsive exercise Social withdrawal Excessive weighing or looking in the mirror

No energy or over energetic regarding exercise

Warning signs
Food cravings and preoccupation with food Mood disturbance & increased anxiety Lack of motivation Insomnia More bodily complaints - somatic Odd food rituals Social isolation

Behaviour becomes more rigid, driven

Warning signs
Suicidal thoughts
Self harm behaviours, cutting or drug and alcohol use Perceptual disturbance - visual and sensory perception are the most affected See themselves as fat, feel fat Become intolerant to any sense of gastric fullness/will say they cannot have food in them Intellect is not usually compromised Frontal neuronal cell loss, cognitive impairment and disinhibition Judgement starts to become impaired

Psychiatric Co-Morbidity
Anxiety disorders co-morbidity common in AN and BN Obsessive-compulsive disorder but more social anxiety disorder Major depression is present in to of individuals Alcohol dependence Illicit drug dependence Personality Disorders present in half of those presenting with an eating disorder - Cluster C personality in AN and cluster B in BN

Treatment is a very hard concept to consider if you do not feel sick. It took me four months of dealing with some very serious physical problems to admit that the physical problems were connected to my binging and purging. If I was going to live I had to start changing. And I needed to find who knew it would take time to give this up, because it was all I had. I needed to get something else in exchange. I just couldnt stop without filling the void that would be left in my life. But I wanted my life. Looking back, I can see how I had to get over my fear, understand how I got sick, and then allow someone to help me figure out how I could help myself. I know Im alive today because my doctor stood by me and I trusted him.
Excerpt from I. Sacker