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Chapter 10

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Suzanne Sicchia

Chapter 10: Eating Disorders  Lifetime prevalence for: o Anorexia: 0.9% women & 0.3% men o Bulimia: 1.5% women & 0.5% men o Binge eating: 3.5% women & 2% men  In a 2006 survey of Canadian 15 and older 0.5% reported diagnosis within the 12 months before (0.8% women & 0.2%men)  Among women 15-24 1.5% reported an eating disorder  Do you think anorexia or bulimia is the most common eating disorder diagnosis ? wrong – that would be EDNOS  Eating disorder not otherwise specified: most common eating disorder diagnosis characterized by heterogeneous symptoms and other features that do not fit the symptoms of other eating disorders – applied to between 40- 70% of patients  Purging disorder: a form of bulimia, that involves self-induced vomiting or laxative use at least once a week for a minimum of 6 months.  Clear feature of purging disorder is high impulsivity – sometimes it become so extreme that it manifests as an impulsive disorder  1/6 eating disorders also has impulse control disorder, and typically the onset of the impulse control disorder preceded eating disorders  most common impulse disorders in women – compulsive buying disorder and kleptomania Anorexia:  anorexia nervosa: a disorder in which a person refuses to eat or retain any food or suffers a prolonged diminished appetite. They have an intense fear of becoming obese, feel fat even when thin, refuses to maintain a minimal body weight and loses atleast 25% of their original body weight.  anorexia – loss of appetite, and nervosa – this is for emotional reasons  however most patients don’t lose their appetite and actually become preoccupied with food  4 main features: 1. Person refuses to maintain a normal body weight – they weigh less than 85% of what is considered normal for their age and height 2. Person has an intense fear of gaining weight, and fear is not reduced by weight loss – they will never be thin enough 3. Distorted sense of body shape (especially around abs, buttock and thighs). Their self esteem is closely linked to maintaining thinness – “overvaluation of appearance” 4. Amenorrhea: loss of the menstrual period  Eating disorder Inventory (EDI) – developed in Canada and is one of the most widely used measures to assess self-reported aspects of eating disorders  In another assessment, patients are shown a variety of body sizes and shapes and asked to pick out the one that resembles them and one that resembles their ideal shape – AN patients usually overestimate their own size and chose a thin figure as their ideal  2 subtypes of anorexia: o restricting type: limiting food in-take o binge eating-purging type: engages in binge eating and purging. This subtype is more psychopathological, they exhibit more personality disorders, impulsive behavior, social withdrawal and suicide attempts. Usually weigh more in childhood, come from heavier families and use more extreme methods of weight loss.  Presence of anxiety disorders is a huge risk factor  Comorbidity is high- people at risk for eating disorder are also prone to depression, panic disorder, and social phobia. Women were at a greater risk for mania, agoraphobia, and substance dependence  No link between anorexia and drug use, but there is a clear link between bulimia and drug use Physical Changes in Anorexia Nervosa:  Decreased blood pressure, slower heart rate, kidney and GI problems, bone mass declines, skin dries, nails become brittle, hormone levels change and mild anemia may occur  Some patients los scalp hair, and develop laguna: a fine soft, hair on their bodies  Levels of electrolytes such as potassium and sodium alter  Such electrolytes are essential for the process of neural transmission – lowered levels can lead to tiredness, weakness, cardiac arythmias and even sudden death  Brain size decreases, EEG abnormalities are frequent  Deficits in white matter are restored but deficits in grey matter volume seem irreversible.  70% of patients eventually recover – takes 6/7 years and relapses are common  death rates are 10 x times higher than general population & 2 times higher than people with other disorders – usually from physical complications of the disorder  standardized mortality rate: ratio of observed deaths relative to expected deaths  in a BC study it was found to be 10.5 for AN patients – with their leading cause of death as suicide followed by pneumonia, hypoglycemia, and liver disease  25 year reduction in life expectancy  suicide rates are higher in AN patients than BN although BN patients are more likely to have suicidal ideations  btwn ages 16-21 16.9% of people cut  average age of onset is 15  most common forms of self harm: cutting, scratching and self hittin  3/10 first year students self harm  reasons for self harm: 1. interpersonal reasons 2. to suppress an unwanted social stimulus 3. suppress negative emotion 4. generate feelings among those who need to feel emotion Bulimia:  Bulimia nervosa: a disorder characterized by episodic uncontrollable eating binges followed by purging either by vomiting or taking laxatives  Binge- eating an excessive amount of food within less than 2 hours  Binges usually occur in secret, triggered by stress – (particularly social interactions stressors)  Symptom requires: purging occurs twice a week for at least three months  2 subtypes: purging type and non purging type, which usually involves fasting or exercise  more common than anorexia in adolescence  girls 12-18: 27% had disordered eating attitudes and 1/7 engaged in binging  70% recover, 10% remain fully symptomatic  usually overweight before onset, and binging begins during dieting  twin study found that bulimia and depression are genetically related  associated with: depression, personality disorders, borderline personality disorder, substance abuse, conduct disorder,  causes: potassium depletion, laxatives cause diarrhea which can lead to changes in electrolytes, vomiting leads to tearing of the tissue in the stomach, throat and tooth enamel, salivary glands become swollen  mortality is muc
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