What are feeding and eating disorders characterized by?
Feeding and eating disorders are characterized by alterations in normal eating patterns that are marked by distinct and persistent disturbances in eating behaviors, weight regulation, and perceptions towards body weight and shape.
Key points about eating disorders
- alterations in normal eating patterns (note that there is a change from a person’s usual eating patterns)
- distinct and persistent disturbances in eating behaviours (is more than just having a couple of days when not feeling hungry)
- weight regulation and
- perceptions towards body weight and shape (so really, EDs involve cognition)
Risk factors associated with the development of eating disorders:
- Body image distortion
- Struggling with finding one’s identity
- History of trauma
- Difficult transition time
- Perfectionism
- Emotional eating
- BULLYING
- SOCIETAL MESSAGES
- COMPETITIVE SPORTS - NEED TO MAINTAIN A CERTAIN BODY WEIGHT FOR SOME SPORTS (Boxing, weightlifting, etc.)
- PERFORMING ARTS- NEED TO MAINTAIN A CERTAIN BODY WEIGHT (e.g., ballet, theatre, modelling, etc.)
- LGBTQ2
Several warning signs that may indicate Disordered Eating
- Changes in regular eating habits
- Changes in mood, social relationships
- Rituals with food or exercise
- Physical changes - weight, etc.
- Rules about food intake
- Secretiveness around eating
Percentage of those who fully recover from anorexia nervosa is ____
Moderate
Anorexia Nervosa: Etiology
Biological theories
Genetic Disposition
Biochemical
Psychosocial theories
Separation-individuation theory
Struggles around identity, body image, perfection, control
Cognitive – all or nothing thinking
Family-based theories
Altered family dynamics, negative parental comments
Sociocultural theories
Societal messages, idealization of thinness/ achieving the “perfect body”.
Anorexia Nervosa DSM 5 Criteria
Body Weight - Restriction of energy intake relative to requirements leading to a significantly low body weight (defined as a weight that is less than minimally normal, or for children/adolescents, less than that minimally expected)
Fear of Weight Gain - Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
Body Image Distortion - Disturbance in the way one’s body weight or appearance is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current body weight
Anorexia nervosa: Physical Complications
Whole body:
Weakness, lassitude r/t malnutrition
Neuro:
Decreased brain volume, increased ventricular size, neurological deficits in cognitive processing
CNS:
Apathy, poor concentration r/t cognitive impairment, depression
Cardiovascular:
Palpitations, weakness, SOB, chest pain r/t orthostatic hypotension, irregular slow pulse, peripheral vasoconstriction
Arrythmias most common cause of death
Skeletal:
Bone pain with exercise r/t arrested skeletal growth
Muscular:
Weakness, muscle aches r/t muscle wasting (loss of fat)
Reproductive:
Arrested psychosexual development, loss of menses
Endocrine:
Fatigue, cold intolerance, diuresis, vomiting, hypothermia
Hematologic:
Bruising, clotting abnormalities
Gastrointestinal:
Vomiting, abdominal pain, constipation, abnormal bowel sounds, abdominal distention, diarrhea
Genitourinary:
Pitting edema r/t lowered glomerular filtration rate; danger of renal calculi
Dermatologic:
Lanugo a common development, dry cracking skin and brittle nails due to dehydration, acrocyanosis, hair thinning
Who’s likely to develop bulimia nervosa?
- Lifetime prevalence, 1 to 3% (more prevalent than anorexia nervosa)
- Onset is between ages 18-24 (older than anorexia nervosa)
- First-degree relatives more likely to develop
- Ratio of male-to-female ~ 1:4
- Related to Western culture social values
- Comorbid conditions, including anxiety, depression, substance use disorders, BPD, ADHD
Bulimia nervosa etiology
Biological:
- Dieting
- Neuropathic changes reverse when symptoms subside.
- Genetic – some indications that there are genetic influences
- Biochemical – serotonin levels
Psychosocial Theories
- Separation – individuation theories
- Cognitive theory explains distorted thinking.
- Chaotic families with unclear boundaries
Bulimia Nervosa – DSM 5 Criteria
- Recurrent episodes of binge eating
*Large amount of food in a discrete period of time
*A sense of lack of control - Recurrent inappropriate compensatory behaviour such as self-induced vomiting, use of laxatives, etc.
- Binge eating and purging occur at least once a week over 3 months
- Self-evaluation is unduly influenced by body shape and weight
- Supporting Diagnosis
- Individuals may not be underweight (typically “normal” to slightly overweight)
Bulimia Nervosa: Physical Complications
Cardiac:
Cardiac abnormalities r/t cardiomyopathies
Metabolic:
Electrolyte abnormalities, weakness, poor skin turgor
Reproductive
Fertility problems, scant menses
Gastrointestinal:
Abdominal pain, automatic vomiting, esophagitis, bowel problems in laxative users
Integumentary:
Scarring, callouses on dorsum of hand
Oropharyngeal:
Dental erosion, pharyngeal pain
Assessment of Eating Disorders History of Illness
- Current weight, height, BMI, weight history (maximum and minimum weights)
- Age of onset
- First concern with weight, shape, appearance
- Progression of symptoms, diet history
- Cognitive Symptoms
- Concentration/Memory/Interest
- Insight/Judgment
- Preoccupation with food
- Co-occurring Disorders
- Social Functioning
- Exploring Goals for Recovery – “where do you see yourself moving forward in your recovery?
Screening: ESP Questionnaire
- Are you satisfied with your eating patterns?
- Do you ever eat in secret?
- Does your weight affect the way you feel about yourself?
- Have any members of your family suffered with an eating disorder?
- Do you currently suffer with or have you ever suffered in the past with an eating disorder?
Eating Disorders: Recovery Interdisciplinary Treatment
- Matching therapeutic interventions to the individual’s goals, severity of symptoms, and frequency of behaviors
- Physical Recovery – Is a priority
- Normalization of eating
- Cognitive Therapy
- Social Rehabilitation
- Spiritual Care
- Interdisciplinary team
Eating disorder treatment: physical recovery
- Nutritional Therapy – Note potential for “Refeeding Syndrome”
- Weight restoration
- Set point weight (healthy target weight) vs. desired weight
- Normalization of digestion and elimination functions
- Normalization of homeostasis (BP, temp, HR)
- Normalization of blood work (K+, Na+, CO2)
- Normalization of hormonal function
Refeeding syndrome
potentially life-threatening occurring within 4 to 45 days after the person starts eating again. Severe electrolyte changes and potential for cardiovascular symptoms, seizures, coma and potentially death. Nutritional therapy, refeeding is very closely monitored – refeeding is done slowly in calorie increments.
Eating disorders treatment: behavioural recovery
- Understanding purpose of the behaviors as attempts to manage anxiety and other uncomfortable emotions
- Developing new behavioral repertoire with food, body
Eating disorders treatment: cognitive recovery
- Beliefs about weight, shape, and appearance
- Core beliefs about perfection, control, self-esteem
- Coping with anxiety
Eating disorders treatment: emotional recovery
- Experiencing anxiety
- Coping with uncomfortable emotions
Eating disorders treatment: spiritual recovery
- Exploring, developing a sense of self, identity, purpose
- Interpersonal relationships
Mechanical eating
Means eating by prescription, according to a preset meal plan designed to meet individual’s nutritional needs.
Nutrition is scheduled over the day in the form of 3 meals and 3 snacks per day.
Do not rely on hunger or satiety (the condition of being full or gratified beyond the point of satisfaction), food rules, or rituals
Is about 100% nutrition
This is a way of normalizing eating – scheduling of food intake at proper intervals – to retain the body’s internal cues – which have been disrupted – and reducing the risk of over and under eating.
Work with the nutritionist and dietician.
Cognitive Behavioural Therapy
- The indicated treatment for individuals with bulimia (best practice guidelines)
- Treatment efficacy for individuals with anorexia equal to other therapies
- Eating disorder behaviours are seen as the individual’s best attempt to avoid anxiety associated with breaking faulty rules and beliefs (cognitions)
- Uses specific tools to uncover cognitions: food diaries, thought records, anxiety hierarchies
Exposure and Response Therapy action, aim, and modes
Action: present tasks that will elicit anxiety in an individual
Aim: prevention of the eating disorder response or ritualized behavior
Modes: flooded or graduated (see hierarchy diagram)
Eat
Buy the food at the store
Watch the food eaten
Go to the food’s aisle in the store
Think of a forbidden food
