Wellness Journal 3
e.raymond
KIN1600-EatingDisorders1.pptxEating Disorders
Emily Caire, RD, LDN
Registered Dietitian/Nutritionist
Student Health Center
Wellness and Health Promotion
Trigger Warning & Disclosure
What Lies Beneath
Eating Disorders are biologically-based serious mental illnesses
Nutrition education alone is ineffective as is therapy/counseling alone
Both physical restoration and cognitive/emotional restoration have to occur
Eating Disorder vs. Disordered Eating
Difference lies between the degree and severity of symptoms
Eating Disorder:
Often characterized by abnormal or disturbed eating habits
A life threatening, diagnosable mental health condition that has significant emotional and physical effects on the mind and body
Coping method
Disordered eating:
Problematic relationship with food, dieting, body image, and exercise
Poor eating/lifestyle habits
Prevalence
In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life
Men are less likely to seek treatment
25% of college aged women engage in bingeing and purging as a method of managing their weight
Eating disorders have the highest mortality rate of any mental illness
Spring 2017 LSU NCHA Survey
LSU Students reported:
7% used compensatory behaviors of vomiting, taking laxatives, or using diet pills in the last month
19% engaged in binge or loss of control eating
32% experienced obsessive thinking about food/body
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Recognized by the American Psychiatric Association used by clinicians, researchers, and public health employees to diagnose and discuss mental disorders
There is a diagnostic chapter specifically designed for Feeding and Eating Disorders
Types of Eating Disorders
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge Eating Disorder (BED)
Compulsive Exercising
Avoidant/Restrictive Food Intake Disorder
Orthorexia Nervosa
Pica
Other Specified Feeding or Eating Disorder
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Anorexia Nervosa
Extreme calorie restriction
Unwillingness to maintain healthy body weight
Fear of gaining weight
Distorted body image
Loss of menses
Hair loss
Lanugo (growth of fine hair all over the body)
Decrease in internal body temperature
SIGNS AND SYMPTOMS
Bulimia Nervosa
Binge-eating behaviors
Compensatory behaviors (purge, excessive exercise, laxatives, etc.)
Swollen glands in neck and below jaw
Tooth decay
Gastrointestinal distress, potential for ulcers
Severe dehydration
Frequent weight fluctuations (could appear healthy weight)
Electrolyte imbalance
SIGNS AND SYMPTOMS
Binge Eating Disorder
Eating large quantities in a specified amount of time
Loss of control
Secretive eating
Lack of compensatory behaviors
Guilt, shame, and distress
Feelings of depression
SIGNS AND SYMPTOMS
Compulsive Exercising
Exercise purging
No concern for safety or injury
Excessive amounts of exercise
Feelings of guilt and anxiety
Lack of satisfaction
Dehydration
Stress fractures
SIGNS AND SYMPTOMS
Avoidant/Restrictive Food Intake Disorder (ARFID)
Feeding or eating disturbance manifested by a persistent failure to meet appropriate nutritional or energy needs associated with one or more of the following:
Significant weight loss
Significant nutritional deficiency
Dependence on supplemental nutrition (oral)
Interference with psychosocial functioning
SIGNS AND SYMPTOMS
ARFID
Not related to body image disturbance
Often younger than those with other EDs
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ARFID
Many children with ARFID report the following symptoms:
food avoidance
decreased appetite
abdominal pain
emetophobia (fear of vomiting)
More likely to have anxiety disorders or other medical conditions such as: Autism, ADHD, learning disabilities or other cognitive delays:
1/3 of children with ARFID have a mood disorder
3/4 have an anxiety disorder
20% have autism spectrum condition
Orthorexia Nervosa
Obsession with “pure” or “perfect” diet
Excessive food-related thoughts and talk
Consumes an excessive amount of time
Feelings of guilt if deviated from plan
Pica
Persistent eating of non-nutritive substances
Ice, dirt, clay, sand, paint chips, etc.
Inappropriate to the developmental level of the individual
Not part of a culturally supported or socially normative practice
Occurs with medical condition (pregnancy, malnourished) or with other mental health disorders
Autism Spectrum Disorder, Mental Retardation
Uncommon, primarily affecting women and children
Other Specified Feeding or Eating Disorder (OSFED)
Examples of OSFED
Subclinical AN/BN/BED
Orthorexia Nervosa
Compulsive Exercise
Body Dysmorphia
Defining Body Image
Body image consists of the evaluations about one’s own physical appearance, as well as perceptions of how others view one’s own body, coupled with the emotions and cognition as a result of these evaluations and perceptions.
Body image is context bound and culturally-derived. That is, individuals with similar body types who grow up in different cultures or in different time-periods may have vastly different body images.
Negative/Distorted Body Image
SIGNS AND SYMPTOMS
Preoccupation with appearance
Has a distorted perception of body
Feels ashamed, self-conscious, and anxious about their body
Feels uncomfortable and awkward in their body
Media Influence
• The body type portrayed in advertising as the ideal is possessed naturally by only 5% of American females
• 47% of girls in 5th-12th graders reported wanting to lose weight because of magazine pictures
• 69% of girls in 5th-12th graders reported that magazine pictures influenced their idea of a perfect body shape
Social Media
One study of teen girls found that social media users were significantly more likely than non-social media users to have internalized a drive for thinness and to engage in body surveillance.
Another study found social media use is linked to self-objectification, and using social media for merely 30 minutes a day can change the way you view your own body.
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Risk Factors
Certain situations and events might increase the risk of developing an eating disorder. These risk factors may include:
Females - EDs are 10 times more likely in females than males
Age - More common during the teens and early 20s
Mental health disorders - People with depression, anxiety disorder or obsessive-compulsive disorder are more likely to have an eating disorder
Risk Factors cont…
Dieting - over restricting can lead to binge eating
Family history
Sports, work and artistic activities - Athletes, actors, dancers and models may be at higher risk of eating disorders
Health Implications
Eating disorders can cause dangerous and life-threatening damage to the body, including:
Dehydration
Digestive complications
Electrolyte imbalances
Kidney damage
Cardiac damage
Irregular heart rhythms
Decrease immune system
https://www.nationaleatingdisorders.org/health-consequences
Eating disorders have the second highest mortality rate of all mental health disorders, surpassed only by opioid addiction
Among those who struggle with anorexia, 1 in 5 deaths is by suicide
Eating disorders are serious conditions that can have a profound mental and physical impact, including death. This should not discourage anyone struggling—recovery is real, and treatment is available. Statistics on mortality and eating disorders underscore the impact of these disorders and the importance of treatment.
Eating disorders have the second highest mortality rate of all mental health disorders, surpassed only by opioid addiction.
Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13(2), 153-160.
Anorexia has an estimated mortality rate of around 10%.
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724-731.
Among those who struggle with anorexia, 1 in 5 deaths is by suicide
A Swedish study of 6,000 women who were treated for anorexia nervosa found that, over 30 years, women with anorexia nervosa had a six-fold increase in mortality compared to the general population. The researchers also found an increased mortality rate from ‘natural’ causes, such as cancer, compared to the general population. Younger age and longer initial hospitalizations were associated with improved outcomes, while comorbid conditions (e.g., alcohol addiction) worsened the outcome.
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Common Psychological Comorbidities
Anxiety
Mood Disorders
Post-Traumatic Stress Disorder
Substance Abuse
Personality Disorders
Treatment is likely to include…
Counseling or psychotherapy
Medication
Medically supervised weight restoration
Nutritional education
Support groups
Treatment Goals/Objectives
Correct life-threatening medical and psychiatric symptoms
Interrupt eating disorder behaviors (restriction, compensatory behaviors, binge eating and or purging)
Establish and or normalize healthy eating behaviors/habits
Challenge unhealthy eating disorder thoughts and behaviors
Address medical and mental health issues/concerns
Establish a relapse prevention plan
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Levels of Care
outpatient/intensive outpatient
Medically stable and does not need daily medical monitoring
Psychiatrically stable and has symptoms under sufficient control to be able to function in normal social, educational, or vocational situations and continue to make progress in recovery
PARTIAL HOSPITAL
Medically stable, but:
Impaired functioning without immediate risk
Needs daily assessment of physiologic and mental status
Psychiatrically stable, but:
Unable to function in normal social, educational, or vocational situations
Engages in daily binge eating, purging, fasting or very limited food intake, or other pathogenic weight control techniques
Levels of Care
RESIDENTIAL
Medically stable and requires no intensive medical intervention
Psychiatrically impaired and unable to respond to partial hospital or outpatient treatment
INPATIENT
Medically unstable as determined by:
Unstable or depressed vital signs
Laboratory findings presenting acute health risk
Complications due to coexisting medical problems
Psychiatrically unstable as determined by:
Rapidly worsening symptoms
Suicidal
Cost
Inpatient treatment
$500 to $2,000 a day
Average cost for a 30-day stay in a treatment facility is $30,000
Outpatient care can reach upwards of $100,000
The cost of any patient’s treatment can vary widely from these figures, depending on the severity and duration of the eating disorder
Challenges and Barriers to Appropriate Treatment
Awareness and recognition
Community and treatment resources
Insurance/cost
Family support
If you are concerned about a friend or family member…
Avoid
Waiting until consequences have escalated to a serious level before you confront the person
Focusing on weight or calories
Using “you” statements
Placing blame or arguing
Trying to problem-solve or fix the problem
Gossiping
Statements to Avoid…
“Are you sick?”
“Would you just eat already!”
“I don’t understand why you don’t just eat…”
“Why are you doing this to me?”
“Would you look at what you’re doing to your boyfriend/husband/wife/kids…”
“Why are you doing this to yourself?”
“You have good things in your life, what’s the problem?”
“If you’d just stop, then everything would be fine!”
“You are acting irresponsibly.”
Being Supportive
Learn the common signs and symptoms that might indicate a problem
Express caring and concern
Use “I” statements
Focus on specific behaviors, not on the individual as a whole
Listen
Prepare for defensiveness and denial
Establish boundaries
Respect the individual’s confidentiality
Familiarize yourself with campus and community resources
Do Say…
“I’m concerned about you because you refuse to eat breakfast or lunch.”
“It makes me afraid to hear you vomiting.”
“I’m here to listen.”
Campus Outreach – ED Awareness Week
Resources
www.nationaleatingdisorders.org – National Eating Disorders Association
www.anad.org – National Association of Anorexia Nervosa and Associated Disorders
www.lsu.edu/shc - LSU Student Health Center
www.namedinc.org – National Association of Males with Eating Disorders
Questions?
