EATING DISORDERS

unit objectives

to know the different eating disorders that consume

our society

establish the changes from DSM IV - DSM V in

categorizing eating disorder

determine the psychological/social factors that

contribute to eating disorders

identify ways on how eating disorders can be helped

CHANGES from DSM IV-
DSMV
changes in diagnostic criteria in anorexia nervosa &
bulimia nervosa

inclusion of additional disorders

inclusion of binge eating

pica, rumination, and avoidant/restrictive food

intake disorder (used to be under Disorders
Usually First Diagnosed in Infancy, Childhood,
or Adolescence)
two major factors contributing to
eating disorders

psychological factors

social factors
the story of Phoebe
Bulimia Nervosa

Bulimia nervosa is a serious, potentially life-

threatening eating disorder characterized by
a cycle of bingeing and compensatory
behaviors such as self-induced vomiting
designed to undo or compensate for the
effects of binge eating.
clinical description

the hallmark of bulimia nervosa is eating a

large amount of food - typically more junk
food and vegetables - than most of the people
(out of control eating)

compensate big eat by purging techniques:

self-induce vomiting, use of laxatives,
diuretics, excessive exercise
Symptoms of Bulimia

Frequent episodes of consuming very large amount of

food followed by behaviors to prevent weight gain, such
as self-induced vomiting.

A feeling of being out of control during the binge-eating

episodes.

Self-esteem overly related to body image.

NOTE: The chance for recovery increases the earlier

bulimia nervosa is detected. Therefore, it is important to
be aware of some of the warning signs of bulimia nervosa.
warning signs of Bulimia

Evidence of binge eating, including disappearance of large

amounts of food in short periods of time or finding wrappers and
containers indicating the consumption of large amounts of food.

Evidence of purging behaviors, including frequent trips to the

bathroom after meals, signs and/or smells of vomiting, presence
of wrappers or packages of laxatives or diuretics.

Excessive, rigid exercise regimen--despite weather, fatigue, illness,

or injury, the compulsive need to “burn off” calories taken in.

Unusual swelling of the cheeks or jaw area.

Calluses on the back of the hands and knuckles from
self-induced vomiting.

Discoloration or staining of the teeth.

Creation of lifestyle schedules or rituals

to make time for binge-and-purge sessions.

Withdrawal from usual friends and activities.

In general, behaviors and attitudes indicating that

weight loss, dieting, and control of food are becoming
primary concerns.

Continued exercise despite injury; overuse injuries.

health consequences of Bulimia

Bulimia nervosa can be extremely harmful to the body.

The recurrent binge-and-purge cycles can damage the
entire digestive system and purging behaviors can lead to
electrolyte and chemical imbalances in the body that affect
the heart and other major organ functions. Some of the
health consequences of bulimia nervosa include:

Electrolyte imbalances that can lead to irregular heartbeats

and possibly heart failure and death. Electrolyte
imbalance is caused by dehydration and loss of potassium
and sodium from the body as a result of purging
behaviors.
Inflammation and possible rupture of the
esophagus from frequent vomiting.

Tooth decay and staining from stomach acids

released during frequent vomiting.

Chronic irregular bowel movements and

constipation as a result of laxative abuse.

Gastric rupture is an uncommon but possible

side effect of binge eating.
associated psychological disorders

anxiety and mood disorder (depression),

substance abuse
Facts about Bulimia

Bulimia nervosa affects 1-2% of adolescent and young adult women.

Approximately 80% of bulimia nervosa patients are female.

People struggling with bulimia nervosa usually appear to be of average

body weight.

Many people struggling with bulimia nervosa recognize that their

behaviors are unusual and perhaps dangerous to their health.

Bulimia nervosa is frequently associated with symptoms of depression

and changes in social adjustment.

Risk of death from suicide or medical complications is markedly

increased for eating disorders
Julie, the thinner, the better
Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-

threatening eating disorder characterized by
self-starvation and excessive weight loss.
clinical description
intense fear of obesity & relentlessly pursue thinness

severe, almost punishing exercise is common

severe caloric restriction

never satisfied with their weight loss

staying the same weight or gaining any weight will likely cause intense panic,
anxiety, & depression

marked disturbance in body image

seldom seek treatment

show interest in cooking and food

hoard food, looking at it occasionally

symptoms

Inadequate food intake leading to a weight that is

clearly too low.

Intense fear of weight gain, obsession with weight

and persistent behavior to prevent weight gain.

Self-esteem overly related to body image.

Inability to appreciate the severity of the situation.

Binge-Eating/Purging Type involves binge
eating and/or purging behaviors during the
last three months.

Restricting Type does not involve binge

eating or purging.

Eating disorders experts have found that

prompt intensive treatment significantly
improves the chances of recovery. Therefore,
it is important to be aware of some of the
warning signs of anorexia nervosa.
warning signs

Dramatic weight loss.

Preoccupation with weight, food, calories, fat grams, and dieting.

Refusal to eat certain foods, progressing to restrictions against

whole categories of food (e.g. no carbohydrates, etc.).

Frequent comments about feeling “fat” or overweight despite

weight loss.

Anxiety about gaining weight or being “fat.”

Denial of hunger.
Development of food rituals (e.g. eating foods in certain
orders, excessive chewing, rearranging food on a plate).

Consistent excuses to avoid mealtimes or situations

involving food.

Excessive, rigid exercise regimen--despite weather,

fatigue, illness, or injury, the need to “burn off” calories
taken in.

Withdrawal from usual friends and activities.

In general, behaviors and attitudes indicating that

weight loss, dieting, and control of food are becoming
primary concerns.
health consequences

Anorexia nervosa involves self-starvation.; The

body is denied the essential nutrients it needs to
function normally, so it is forced to slow down all of
its processes to conserve energy. This “slowing
down” can have serious medical consequences:

Abnormally slow heart rate and low blood pressure,

which mean that the heart muscle is changing. The
risk for heart failure rises as heart rate and blood
pressure levels sink lower and lower.
cessation of menstruation (amenorrhea)(not
in all cases, not anymore found in DSM V

dry skin, brittle hair or nails, sensitivity to or

intolerance of cold temperatures

cardiovascular problem (chronically low bp,

& heart rate)

if vomiting is part, electrolyte imbalance

resulting to cardiac & kidney problems
Reduction of bone density (osteoporosis), which
results in dry, brittle bones.

Muscle loss and weakness.

Severe dehydration, which can result in kidney failure.

Fainting, fatigue, and overall weakness.

Dry hair and skin, hair loss is common.

Growth of a downy layer of hair called lanugo all over

the body, including the face, in an effort to keep the
body warm.
associated psychological disorders

anxiety & mood disorders are often present,

obessive-compulsive disorder, substance
abuse, suicide
facts about anorexia
Approximately 90-95% of anorexia nervosa sufferers are girls and
women.

Between 0.5–1% of American women suffer from anorexia nervosa.

Anorexia nervosa is one of the most common psychiatric diagnoses in

young women.

Between 5-20% of individuals struggling with anorexia nervosa will die.

The probabilities of death increases within that range depending on the
length of the condition.

Anorexia nervosa has one of the highest death rates of any mental health
condition.

Anorexia nervosa typically appears in early to mid-adolescence.

Binge-eating Disorder

Binge eating disorder (BED) is an eating disorder characterized by

recurrent episodes of eating large quantities of food (often very
quickly and to the point of discomfort);

a feeling of a loss of control during the binge; experiencing shame,

distress or guilt afterwards; and

not regularly using unhealthy compensatory measures (e.g.,

purging) to counter the binge eating.

Binge eating disorder is a severe, life-threatening and treatable eating

disorder. Common aspects of BED include functional impairment,
suicide risk and a high frequency of co-occurring psychiatric
disorders.
The DSM-5, released in May 2013, lists binge
eating disorder as a diagnosable eating disorder.

Binge eating disorder had previously been

listed as a subcategory of Eating Disorder Not
Otherwise Specified (EDNOS) in the DSM-IV,
released in 1994.

Full recognition of BED as an eating disorder

diagnosis is significant, as some insurance
companies will not cover an individual’s eating
disorder treatment without a DSM diagnosis.
BED symptoms & diagnosis

Recurrent episodes of binge eating. An episode of binge

eating is characterized by both of the following:

Eating, in a discrete period of time (e.g., within any 2-

hour period), an amount of food that is definitely larger
than what most people would eat in a similar period of
time under similar circumstances.

A sense of lack of control over eating during the

episode (e.g., a feeling that one cannot stop eating or
control what or how much one is eating).
The binge eating episodes are associated with three (or
more) of the following:

Eating much more rapidly than normal.

Eating until feeling uncomfortably full.

Eating large amounts of food when not feeling

physically hungry.

Eating alone because of feeling embarrassed by how

much one is eating.

Feeling disgusted with oneself, depressed, or very

guilty afterward.
Marked distress regarding binge eating is
present.

The binge eating occurs, on average, at least

once a week for 3 months.

The binge eating is not associated with the

recurrent use of inappropriate compensatory
behaviors (e.g., purging) as in bulimia
nervosa and does not occur exclusively
during the course of bulimia nervosa or
anorexia nervosa.
characteristics of BED

In addition to the diagnostic criteria for binge

eating disorder, individuals with BED may
display some of the behavioral, emotional and
physical characteristics below. Not every person
suffering from BED will display all of the
associated characteristics, and not every person
displaying these characteristics is suffering from
BED, but these can be used as a reference point
to understand BED predispositions and
behaviors.
behavioral characteristics

Evidence of binge eating, including the

disappearance of large amounts of food in short
periods of time or lots of empty wrappers and
containers indicating consumption of large
amounts of food.

Secretive food behaviors, including eating

secretly (e.g., eating alone or in the car, hiding
wrappers) and stealing, hiding, or hoarding food.
Disruption in normal eating behaviors, including eating
throughout the day with no planned mealtimes; skipping meals
or taking small portions of food at regular meals; engaging in
sporadic fasting or repetitive dieting; and developing food
rituals (e.g., eating only a particular food or food group [e.g.,
condiments], excessive chewing, not allowing foods to touch).

Can involve extreme restriction and rigidity with food and

periodic dieting and/or fasting.

Has periods of uncontrolled, impulsive, or continuous eating

beyond the point of feeling uncomfortably full, but does not
purge.

Creating lifestyle schedules or rituals to make time for binge

sessions.
emotional & mental characteristics

Experiencing feelings of anger, anxiety, worthlessness,

or shame preceding binges. Initiating the binge is a
means of relieving tension or numbing negative feelings.

Co-occurring conditions such as depression may be

present. Those with BED may also experience social
isolation, moodiness, and irritability.

Feeling disgust about one’s body size. Those with BED

may have been teased about their body while growing
up.
Avoiding conflict; trying to “keep the peace.”

Certain thought patterns and personality types are

associated with binge eating disorder. These include:

Rigid and inflexible “all or nothing” thinking

A strong need to be in control

Difficulty expressing feelings and needs

Perfectionistic tendencies

Working hard to please others

Physical Characteristics

Body weight varies from normal to mild,

moderate, or severe obesity.

Weight gain may or may not be associated

with BED. It is important to note that while
there is a correlation between BED and
weight gain, not everyone who is overweight
binges or has BED.
Facts

Binge eating disorder affects women slightly more

often than men—estimates indicate that about 60% of
people struggling with binge eating disorder are female
and 40% are male.

In women, binge eating disorder is most common in

early adulthood. In men, binge eating disorder is more
common in midlife.

Binge eating disorder affects people of all

demographics across cultures.
physical & psychological effects

Binge eating disorder has strong associations

with depression, anxiety, guilt and shame.
Those suffering from BED may also
experience comorbid conditions, either due to
the effects of the disorder or due to another
root cause. Comorbid conditions can be both
physical and/or psychological.
physical effects

Most obese people do not have binge eating disorder. However, of

individuals with BED, up to two-thirds are obese; people who struggle with
binge eating disorder tend to be of normal or heavier-than-average weight.

The health risks of BED are most commonly those associated with clinical
obesity. Some of the potential health consequences of binge eating disorder
include:

High blood pressure * Gall bladder disease

High cholesterol levels * Fatigue

Heart disease * Joint Pain

Type II diabetes * Sleep apnea

psychological effects

People struggling with binge eating disorder often express

distress, shame and guilt over their eating behaviors.

People with binge eating disorder report a lower quality

of life than those without binge eating disorder.

Binge eating disorder is often associated with symptoms

of depression.

Compared with normal weight or obese control groups,

people with BED have higher levels of anxiety and both
current and lifetime major depression.
causes of eating disorders
social dimension
competitive environments

looking good is more important than being healthy

glorification of slenderness

friendship cliques

influence of social media

abhorrence of fat

“failure to thrive” affluent family putting into strict diet their

chubby kids
psychological dimensions

diminished sense of personal control and

confidence in their own abilities and talents

low self-esteem

perfectionist attitude
treatment of eating disorder

drug treatments:

bulimia: prozac (antidepressant)

anorexia no effective drug treatment

psychological treatment:

CBTE cognitive behavioral therapy

enhanced
what is obesity

Obesity is a condition where a person has

accumulated so much body fat that it might
have a negative effect on their health.
 If a person's bodyweight is at least 20% higher
than it should be, he or she is considered obese. If
your Body Mass Index (BMI) is between 25 and
29.9 you are considered overweight. If your BMI is
30 or over you are considered obese.

The body mass index (BMI) is a statistical measurement

derived from your height and weight. Although it is
considered to be a useful way to estimate healthy body
weight, it does not measure the percentage of body fat.
The BMI measurement can sometimes be misleading - a
muscleman may have a high BMI but have much less
fat than an unfit person whose BMI is lower. However,
in general, the BMI measurement can be a useful
indicator for the 'average person'.
causes of obesity

spread of modernization

inactive, sedentary lifestyle + high fat foods

genetics (30% of the cause)

environment

psychosocial factors

impulse control, affect regulations, attitudes

Health Conditions

Some hormone problems may cause overweight and obesity, such as

underactive thyroid (hypothyroidism), Cushing's syndrome, and
polycystic ovarian syndrome (PCOS)

Underactive thyroid is a condition in which the thyroid gland doesn't

make enough thyroid hormone. Lack of thyroid hormone will slow
down your metabolism and cause weight gain. You'll also feel tired
and weak.

Cushing's syndrome is a condition in which the body's adrenal glands

make too much of the hormone cortisol. Cushing's syndrome also can
develop if a person takes high doses of certain medicines, such as
prednisone, for long periods.

People who have Cushing's syndrome gain weight, have upper-body

obesity, a rounded face, fat around the neck, and thin arms and legs.
Medicines

Certain medicines may cause you to gain

weight. These medicines include some
corticosteroids, antidepressants, and seizure
medicines.

These medicines can slow the rate at which

your body burns calories, increase your
appetite, or cause your body to hold on to
extra water. All of these factors can lead to
weight gain.
Emotional Factors

Some people eat more than usual when

they're bored, angry, or stressed. Over time,
overeating will lead to weight gain and may
cause over
Smoking

Some people gain weight when they stop

smoking. One reason is that food often tastes
and smells better after quitting smoking.

Another reason is because nicotine raises the

rate at which your body burns calories, so
you burn fewer calories when you stop
smoking. However, smoking is a serious
health risk, and quitting is more important
than possible weight gain.
Age

As you get older, you tend to lose muscle,

especially if you're less active. Muscle loss can
slow down the rate at which your body burns
calories. If you don't reduce your calorie intake as
you get older, you may gain weight.

Midlife weight gain in women is mainly due to

aging and lifestyle, but menopause also plays a
role. Many women gain about 5 pounds during
menopause and have more fat around the waist
than they did before.
Pregnancy

During pregnancy, women gain weight to support their

babies’ growth and development. After giving birth,
some women find it hard to lose the weight. This may
lead to overweight or obesity, especially after a few
pregnancies.

Lack of Sleep

Research shows that lack of sleep increases the risk of

obesity.

People who sleep fewer hours also seem to prefer eating

foods that are higher in calories and carbohydrates,
which can lead to overeating, weight gain, and obesity.
treatment

two objectives:

To achieve a healthy weight.

To maintain that healthy weight.

dietary changes

physical activity

prescription medication

weight loss surgery

Restrictive procedures - These make your
stomach smaller. The surgeon may use a
gastric band, staples, or both. After the
operation the patient cannot consume more
than about one cup of food during each
sitting, significantly reducing his food intake.
Over time, some patients' stomachs may
stretch and they are gradually able to
consumer larger quantities.

Malabsorptive procedures - Parts of the

digestive system, especially the first part of
the small intestine (duodenum) or the mid-
section (jejunum), are bypassed. Doctors may
also reduce the size of the stomach. This
procedure is generally more effective than
restrictive procedures. However, the patient bariatric surgery
has a higher risk of experiencing
vitamin/mineral deficiencies because overall
absorption is reduced.
health hazards
bone & cartilage degeneration

coronary heart disease

gallbladder disease

hypertension

high total cholesterol

respiratory problems

cancer

sleep apnea

stroke

type 2 diabetes
prevention of obesity

exercise regularly

follow a healthy eating plan

know and avoid the food that traps that cause

you to eat

monitor your weight regularly

be consistent
choose to be healthy!