EATING DISORDER

BY DOON PSYCHOTHERAPEUTIC CENTRE

 Introduction
 Eating disorders are extreme disturbances in an individual’s
relationship to food, weight and body image
 Wide range in level of functioning
 Threatening psychological & physical illness
 Consuming small or huge amount of food
 Mostly teenage woman
 Eating disorders are characterized by:
 abnormal and harmful eating behaviours.
 motivated by unhealthy beliefs concerning eating,
weight, and body shape.
 difficulty accepting and feeling good about themselves.
 What is ―Normal‖ Eating?
 Going to the table hungry and eating until satisfied most of the times
—but may overeat at times or under-eat at times.
 Not thinking in terms of ―good‖ and ―bad‖ foods.
 Being able to give some thought to your food selection so you get
nutritious food, but not being so wary and restrictive that you miss out
on enjoyable food
 Giving yourself permission to eat sometimes because you are happy, sad
or bored, or just because it feels good
 Responding to and respecting hunger, then choosing foods based on
what the body says it wants or doesn’t want (most of the times)
 Aiming for enjoyment by staying connected to taste buds and the
feelings of fullness and satisfaction
 What is Disordered Eating?
 Disordered eating is when a person’s attitudes about
food, weight and body size lead to very rigid eating
and exercise habits that can jeopardize one’s health
and happiness.
 Preoccupation over calories, grams, portions

 Preoccupation over weight loss or control of food

 Guilt, shame, disgust attached to foods

 Constantly eating for reasons other than hunger or true

cravings
 Believing that one’s identity and self worth is based on

size, weight, or what one eats

 What are Eating Disorders?
 Serious psychological conditions that can affect the
body physically and cause significant harm
 Coping mechanisms in which a sufferer uses food or
eating as a way of dealing with difficult, thoughts,
emotions and experiences over a period of time
What causes Eating Disorders?
Warning signs that may indicate an
eating disorder include:
ICD-10-CM Codes for Common Eating
Disorders
 TYPES

Anorexia
Nervosa

Binge Bulimia
Eating Nervosa
Disorder
 ANOREXIA NERVOSA

an – lack of

orexis – appetite

Nervosa - nervous
Anorexia Nervosa:
Diagnosis and Definition
 Restriction of energy intake leading to significantly
low body weight
 Intense fear of becoming fat even though
underweight
 Distorted body image

 Excessive influence of body weight or shape on self-

esteem
 Lack of recognition of the seriousness of the current
low body weight
 Anorexia Nervosa
 Eating disorder characterized by self-induced starvation and excessive
weight loss.
 • Third most common chronic illness among adolescents
 DSM-5 Criteria
 Restriction of energy intake relative to requirements leading to a
significantly low body weight in the context of age, sex, developmental
trajectory, and physical health.
 Intense fear of gaining weight or becoming fat, or persistent behavior that
interferes with weight gain, even though at a significantly low weight.
 Disturbance in the way in which one's body weight or shape is experienced,
undue influence of body weight or shape on self-evaluation, or persistent
lack of recognition in the seriousness of the current low body weight
 Subtypes
 Restricting AN
 Binge-eating/purging AN
Behavioural Signs and Symptoms
 Fear of fat; drive for thinness
 Preoccupation with food, weight, body shape
 Compulsive exercise
 Perfectionism
 Highly self-critical
 Low self-esteem
 Feelings of ineffectiveness
 Overly concerned with approval from others
 Body image distortion of delusional proportions
 Physical Signs and Symptoms
 Thinning of the bones (osteopenia or osteoporosis)
 Brittle hair and nails
 Dry and yellowish skin
 Growth of fine hair all over the body (lanugo)
 Mild anemia and muscle wasting and weakness
 Severe constipation
 Low blood pressure, slowed breathing and pulse
 Damage to the structure and function of the heart
 Brain damage
 Multi-organ failure
 Drop in internal body temperature, causing a person to feel cold all the time
 feeling tired all the time
 Infertility.
 General Features
 90% female
 Prevalence of 0.5 to 1% among female adolescents
and young adults using strict criteria; much higher
incidence of sub-threshold cases
 Onset usually between 14-18
 Prevalence higher in industrialized countries
 Co morbid symptoms of depression are common
 Obsessive-Compulsive Disorder in 10-13% of cases
 Treatment
 Restore patients to healthy weight
 Treat physical complications
 Nutritional education and counselling
 Family education and therapy when appropriate
 Medications for co morbid depression and/or
anxiety
 Continue..
 Cognitive Behavior Therapy: Correct core
maladaptive thoughts, attitudes and feelings
related to the eating disorder.
 Behaviour therapy: Self-monitoring
 Mindfulness-based therapy: increase awareness of
internal states
 Trauma-informed therapy when appropriate
 Continue.
 Collaboration between patient, therapist and
dietician is critical
 Sensitivity to trust issues can help decrease power

struggles
 In chronic, treatment refractory cases, focus on

quality of life issues and stabilization vs. weight

gain.
 BULIMIA NERVOSA
 Introduction
 consuming large amount of food
 Lack of control over episodes
 Followed by:
 Forced vomiting
 Fasting
 Excessive use of laxatives(diet pills)
 Excessive exercise
 Maintain healthy & normal weight
 Bulimia Nervosa
 Eating disorder characterized as binging (excessive or compulsive
consumption of food) and purging(e.g. vomiting, use of
laxatives/diuretics, fasting and/or excessive exercise)
 DSM-5 Criteria
 Recurrent episodes of binge eating characterized by
 BOTH of the following:
 1) Eating in a discrete amount of time (within a 2 hour period)large
amounts of food AND feeling lack of control over eating during an
episode.
 2) Followed-by a recurrent inappropriate compensatory behaviour
in order to prevent weight gain
 The binge eating and compensatory behaviours both
 occur, on average, at least once a week for three months.
Symptoms of bulimia nervosa
Behavioural Signs and Symptoms
 Binge eating, disappearance of large quantities of
food
 Self-induced vomiting, frequent trips to the bathroom

 Abuse of laxatives, diuretics, diet pills, ipecac and/or

enemas
 Preoccupation with food, weight and exercise

 Secretiveness with regard to eating

 Dichotomous thinking

 Poor body image

 PHYSICAL SYMPTOMS
 Chronically inflamed and sore throat
 Swollen salivary glands in the neck and jaw area
 Worn tooth enamel, increasingly sensitive and decaying
teeth as a result of exposure to stomach acid
 Acid reflux disorder and other gastrointestinal problems
 Intestinal distress and irritation from laxative abuse
 Severe dehydration from purging of fluids
 Electrolyte imbalance (too low or too high levels of
sodium, calcium, potassium and other minerals) which
can lead to heart attack
THIS YOUNG WOMAN HAS LOST ALMOST ALL
ENAMEL FROM THE PALATAL SURFACES
OF HER ANTERIOR TEETH (YELLOW DENTIN IS
EXPOSED). A THIN WHITE RIM OF
REMAINING ENAMEL IS SEEN AT GUM LINE AND
AMALGAM FILLINGS STAND "HIGH AND
DRY" AS THE TEETH ERODE AROUND THEM FROM
REPEATED CONTACT WITH VOMIT
 How Bulimia Destroys Teeth

 https://youtu.be/-baAmEoYKfs?t=10m17s
 Individual Dynamics
 Binge-purge behaviour provides escape from self-
awareness
 Attempt to regulate mood by purging unwanted

thoughts and feelings (―stuffing feelings‖)

 Difficulties expressing anger

 Low self-esteem
 Risk Factors
 Childhood obesity
 Early puberty

 Social anxiety disorder and overanxious disorder

of childhood
 Weight concerns and internalization of a thin body

ideal
 Depressive symptoms

 Suicide risk is elevated

 Treatment
 Cognitive Behaviour Therapy and Dialectical
 Behaviour Therapy are effective
 Cessation of purging behaviours mitigates binge
 eating episodes
 Normalization of eating
 Weight stabilization
 Medical stabilization
 Antidepressants and mood stabilizers for co morbid
symptoms/disorders
 treatment
 Increased verbalization of feelings; assertiveness
skills
 Mindfulness skills to increase interoceptive

awareness
 Behavior therapy: self-monitoring

 Family education and therapy

 Trauma-informed therapy when appropriate

 Substance-related treatment when appropriate

Self-Monitoring
 BINGE-EATING DISORDER
 BED: Binge Eating Disorder
 Recognized as its own disorder in DSM-5
 Most common ED in the U.S.
 Estimated 3.5% of women, 2% of men, and 30-40% of those seeking wt loss
treatment can be clinically diagnosed with BED
 DSM-5 Criteria

 At least 1 > week, for 3 months:

• Experience loss of control over eating AND consume an abnormally large amount of
food in a short period of time
 Episodes feature at least 3 of the following:
• consuming food faster than normal;
• consuming food until uncomfortably full;
• consuming large amounts of food when not hungry;
• consuming food alone due to embarrassment;
• feeling disgusted, depressed or guilty after eating a large amount of food.
 Marked distress regarding binge eating present

 No evidence of regular compensatory behavior associated with BN, nor do they

binge eat solely during an episode of BN or AN.
 Introduction
 lose of control over eating
 not followed by purging (vomiting)
 eating throughout the day
 over weight/ obese
 feeling of shame & guilt (lead to more binge-eating)
 Eating much more rapidly than normal.
 Eating until feeling uncomfortably full.
 Eating large amounts of food when not physically hungry.
 Eating alone because of feeling embarrassed about how
much one is eating
 Feeling disgusted with oneself, depressed, or very guilty
afterward
 PHYSICAL SYMPTOMS
 High blood pressure
 High cholesterol
 Gall bladder disease
 Diabetes
 Heart disease
 Certain types of cancer
 TREATMENT
 CBT
 Individual, group, and/or family psychotherapy
 Medical care and monitoring
 Nutritional counseling
 Medications.
 no treatment for chronic cases yet
 Medication
 Selective serotonin reuptake inhibitors (SSRIs) or
atypical antipsychotics—
 Antianxiety medications may enable patients to
deal
 with the anticipatory anxiety of confronting meals.
 Zinc (50 to 100 mg elemental zinc) to improve
weight restoration.
 Appetite stimulants
 Psychotherapies
 Increasing patient’s own self-awareness and motivation
for change
 Persuading and helping them to recognize, challenge,

and replace their overvalued beliefs regarding the

desirability of weight loss and their phobic fear of
fatness.
 Encourage acceptance of healthy, normal,

individualized body weights and the skills for self

regulation.
 Continue..
 Family involvement is essential, with various
elements of family education, counseling,instruction,
and therapy incorporated into treatment.
 Interpersonal therapies, family therapies, or
psychodynamically informed psychotherapies
 MANAGEMENT
 Imbalanced nutrition: less than body requirements related
to ingestion of large amounts of food followed by self-induced
vomiting.
 Deficient fluid volume related to abnormal fluid loss caused

by self-induced vomiting.
 Ineffective coping related to feelings of helplessness.

 Anxiety related to lack of control in life situation.

 Disturbed body image/low self-esteem related to unrealistic

 expectations (on the part of self and others)

 Interventions
 If client is unwilling to maintain adequate oral intake,
liquid diet is to be administered via nasogastric tube.
 Explain to client, the details of behavior modification
program.
 Sit with client during mealtimes. A limit (usually 30
minutes) should be imposed on time allotted for meals.
 Client should be observed for at least 1 hour following
meals.
 Client may need to be accompanied to bathroom if
self-induced vomiting is suspected.
 Continue.
 Keep strict record of intake and output.
 Strict documentation of intake and output.

 Daily weight monitoring

 Assess skin turgor.

 Assess moistness and color of oral mucous membranes.

 Encourage frequent oral care.

 Establish a trusting relationship.

 When nutritional status has improved, begin to explore

with client the feelings associated with his or her extreme

fear of gaining weight.
 Continue.
 Remain calm and provide reassurance of safety.
 Review client’s methods of coping and identify his
strengths and weaknesses.
 each client to recognize signs of increasing anxiety.
 Offer positive reinforcement for independently
made decisions.
 Help client realize that perfection is unrealistic
 THANK YOU