Eating Disorders

Carla R Marchira
Dept of Psychiatry Faculty of Medicine
Universitas Gadjah Mada
 Learning Objectives
• General : To understand the magnitude of
clinical and psychosocial problems of eating
disorders

• Specific :To understand eating disorders

management

2
 Range of Eating Disorders
• Early Childhood
– Feeding disorder of infancy/early childhood
– Pica
– Failure to thrive

• Later Childhood/Adolescence
– Anorexia
– Bulimia

• Obesity – medical condition

 PICA
• An eating disorder in which non-nutritional objects
are eaten
• Comes from the latin word for magpie, a bird which
will eat anything
PICA
PICA
PICA
PICA
 Negative Effects of Pica
• Pica is a serious eating disorder that can result in
severe health problems such as:
 Lead poisoning
 Intestinal blockages
 Parasitic infections
 Choking
 Malnutrition/Starvation
 Infection
 Death if left untreated
 Treatment for Pica
 This may include Iron supplementation for
Anemia
 Mental Health Counseling
 Medication to help with OCD or
psychological disorders
 Removal of items from the surroundings
 Prognosis

• Prognosis success varies. In many cases, the

disorder lasts several months, then disappears
on its own. In some cases, it may continue into
the teen years or adulthood, especially when it
occurs with developmental disorders.
 Anorexia and Bulimia
Strict diet?

Risk factors:
• family history: eating disorders, obesity
• affective illness or alcoholism
• ballet, gymnastics, modeling
• personality traits: perfectionism
• physical or sexual abuse
• low self esteem
• body image dissatisfaction
• excessive dieting, skipped meals,
compulsive exercise

ANOREXIA NERVOSA BULIMIA NERVOSA

 Factors associated with
eating disorders
• Serotonin (neurotransmitter regulates the appetite)
• Major depression (association between anorexia and
major depression 65% cases, with social phobia 34%,
with OCD 26%)
• Familial
• Social (life style, role model, social demand and body
image)
• Epidemiology 4% in adolescent and young adults
• 10-20 times more in girls/women
 Anorexia nervosa
Greek: Lost of Appetite

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR):

1. Refusal to maintain body weight at or above a minimally

normal weight for age and height (<85%)
2. Intense fear of becoming fat or gaining weight, even though
underweight
3. Disturbed body image, undue influence of shape or weight
on self evaluation, or denial of the seriousness of the current
low body weight
4. Amenorrhea or absent of at least 3 consecutive menstrual
cycles

American Academy of Pediatrics Committee on Adolescence. Identifying

and treating eating disorders. Pediatrics 2003;111:204-10.
 Anorexia nervosa
Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR):

Types:

Restricting – no regular bingeing or

purging (self-induced
vomiting or use of
laxative and diuretics)
Binge eating/ purging – regular
bingeing and purging in a
patient who also meet the above
criteria for anorexia nervosa
Anorexia Nervosa
Anorexia Nervosa
Anorexia Nervosa
Anorexia Nervosa
Anorexia Nervosa
Anorexia Nervosa
Anorexia Nervosa
Anorexia Nervosa
 Bulimia nervosa
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR):

1. Recurrent episodes of binge eating, characterized by:

- Eating a substantially larger amount of food in a discrete
period of time (ie in 2 hr), than would be eaten by most
people in similar circumstances during that same time
period
2. Recurrent inappropriate compensatory behavior to prevent
weight gain, ie, self-induced vomiting, use of laxatives,
diuretics, fasting, or hyperexercising
3. Binges or inappropriate compensatory behaviors occurring,
on average, at least twice weekly for at least 3 months
4. Self evaluation unduly influenced by body shape or weight
5. The disturbance does not occur exclusively during episodes
of anorexia nervosa
 Bulimia nervosa
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR):

Type

Purging – regularly engages in self-induced vomiting or use of

laxatives or diuretics
Non-purging – uses other inappropriate compensatory behaviors, ie,
fasting or hyperexercising, without regular use of vomiting or
medications to purge

What is the main different with Anorexia Nervosa?

Bulimia nervosa
Bulimia nervosa
Bulimia nervosa
 KEY ASPECTS OF NUTRITIONAL CARE FOR EATING DISORDERS

GOAL ESTABLISHMENT
Daily gain during life threatening phase of malnutrition: 0.3-0.4 lb/d
Weekly gain in acute outpatient phase of malnutrition: 1-2 lb/wk
Intermediary goals (10th, 15th, 25th, 50th percentile) until normal
weight-for-height is reached, with normal menstrual status for
pubertal stage
Dietary intake to support adequate gain and health

DIETARY GUIDELINES
Early stages – educate and counsel to support patient normalizing
food consumption – crisis stage plan menu or patient chooses food,
determined by team approach to intensive treatment
Rehabilitation phase – enable patient to replace outside control
with self management
Dietary prescriptions (above) are guides to nutrient needs at various
stages of disorder
Food types and composition equivalents translate prescriptions into
dietary pattern
 Treatment
• Cognitive Behavior therapy

• Family therapy

• Pharmacotherapy
Obesity

32
Obesity

33
Obesity
 Weight-related issues that may
affect quality of life include:

• Depression
• Disability
• Sexual problems
• Shame and guilt
• Social isolation
• Lower work achievement
 Complications
• High triglycerides and low high-density lipoprotein (HDL) cholesterol
• Type 2 diabetes
• High blood pressure
• Metabolic syndrome — a combination of high blood sugar, high blood
pressure, high triglycerides and low HDL cholesterol
• Heart disease
• Stroke
• Breathing disorders, including sleep apnea, a potentially serious sleep
disorder in which breathing repeatedly stops and starts
• Gallbladder disease
• Gynecologic problems, such as infertility and irregular periods
• Erectile dysfunction and sexual health issues
• Nonalcoholic fatty liver disease, a condition in which fat builds up in
the liver and can cause inflammation or scarring
• Osteoarthritis