Psych Exam 3 Eating D/O

• Normal eating
• Dev of RF
• Partial-Syndrome Eating D/o
• Full-Syndrome Eating D/o
• Tx

A life–threatening eating disorder characterized by refusal to maintain body weight appropriate for age, intense fear of gaining weight or becoming fat, a severely distorted body image, and the refusal to acknowledge the seriousness of weight loss.

describes those individuals that do not regularly engage in binge eating or purging(calorie counters and excessive exercise)

refers to those who regularly engage in binge eating or purging behavior(self-induces vomiting or misuse of laxatives, diuretics, or enemas)

• onset in early adolescence
• chronic condition with relapses characterized by significant weight loss
• it can be cured!
• often continue to be preoccupied with food
• 10% to 25% go on to develop bulimia nervosa
• poor outcome related to initial lower minimum weight, presence of purging, and later age of onset

• *weight loss of 25 pounds and the absence of menses for at least 3 consecutive months or periods*
• refusal to maintain body weight at or above a minimally normal weight for age & height
• intense fear of gaining weight or becoming fat, even though underweight
• disturbance in body image
• perfectionism
• restricting and/or purging

occurs when the individual perceives his or her body disparately from how the world or society views it

an intense physical and emotional process that overrides all physiologic body clues, such as hunger and weakness

describes the sensory response to emotional and visceral cues, such as hunger

Changes in the brain may create a vulnerability to the development of eating d/o. However, research in this area is in its infancy

• This theory postulates that separation-individuation and autonomy are interrupted
• Sexuality fears are underlying

• More than with any other psychiatric condition, society plays a significant role in the development of eating disorders!
• Theories about social norms and expectations explain some of the causes of eating disorders
• media
• family responses

• dieting
• over exercising
• low self-esteem
• body dissatisfaction
• lack of assertiveness
• other eating disorders
• sexual abuse
• comorbid conditions
• distorted body image
• media
• fashion industry
• being an athlete

• Nutritional rehab
• Body image
• Inc coping
• SSRIs not effective in acute, but after wt gain

• weight loss, <75% below ideal
• heart rate, <40 beats/min; children <20 beats/min
• temperature, <36 C (96.8 F)
• blood pressure, <90/60,; children <80/50
• glucose, <60
• serum potassium <3
• severe dehydration
• electrolyte imbalance
• risk for suicide
• severe depression
• failure to comply with treatment
• inadequate response to treatment

• mortality is high, 7%-10%
• long duration of illness
• bingeing and purging
• comorbid illnesses
• substance abuse

• therapeutic relationship; this may be hard due to mistrust, paranoia, impatience and irritability, believe people want to “make them fat”
• use firm, accepting, and patient approach
• provide a rationale for all interventions provides trust
• avoid power struggles over eating

• refeeding; most important and most challenging! Protocol typically starts with 1,500 calories/day and increased slowly until the patient is consuming 3,500/day Weight gain of 1-2 pounds/week
• strict monitoring and recording of intake
• weight-increasing protocols (usually a behavioral plan with positive and negative reinforcements)
• structured, healthy sleep routine
• exercise is generally not permitted during refeeding
• any exercise needs to be monitored

• Inability to experience visceral cues and emotions
• Understanding feelings
• Interpersonal therapy (ITP)
• Pt Education

• particularly long duration of symptoms and low weight when treatment begins predict poor outcomes
• later onset
• family support and involvement generally improves outcome
• comorbid conditions and their severity will influence outcome
• intense outpatient therapy will improve outcome

• real vs. ideal weight
• influence of attitudes, behaviors, teasing
• ways to increase self-esteem
• role of media
• signs & symptoms
• intervention for obesity
• boys at risk also
• observe for rituals
• supervision of eating & exercising

• peer pressure regarding eating, weight
• menses, puberty, normal weight gain
• strategies for obesity
• ways to develop or improve self-esteem
• body image traps: media, retail clothing
• adapting and coping with problems
• reporting friends with signs of eating disorders

an eating disorder in which the individual engages in recurrent episodes of binge eating and compensatory behavior to avoid weight gain through purging methods such as self-induced vomiting, use of laxatives, diuretics, enema, emetics, or through nonpurging methods such as fasting or excessive exercise.

• more prevalent
• older at onset (mean onset 18)
• typically of normal weight
• generally not life-threatening
• treatment is usually outpatient
• outcomes better
• mortality rates lower
• medications are effective

• Similar to anorexia nervosa
• Restricting is followed by binge eating, which is then followed by another period of restricting

Recurrent episodes of binge eating and compensatory purging in the form of vomiting or using laxatives, diuretics, or emetics, fasting or over exercising in order to avoid weight gain. In anorexia the goal is severe weight loss

These episodes must occur at least twice a week for a period of at least 3 months; binge and purge may occur several times a day

• rapid, episodic, impulsive, and uncontrollable ingestion of large amounts of food over a short period of time (1 to 2 hours)
• eating followed by guilt, remorse, self-contempt, and severe dieting, leading to purging

• restricting intake is believed to explain the relationship between dieting and binge behavior
• restrictions are viewed as rules, each binge imposes stricter rules leading to more frequent binges
• treatment is focused on addressing these dietary restraint; when the dietary restraints are resolved binge eating & purging decrease
• restraining intake is predictive of overeating

• usually within normal weight range, possible overweight or underweight
• restriction of total calorie consumption between binges, selecting low-calorie foods while avoiding foods perceived to be fattening or likely to trigger a binge
• increased frequency of depressive symptoms and anxiety symptoms
• possible substance abuse or dependence involving alcohol or stimulants

• -Biologic theories
• Neuropathologic; changes in the brain my be due to eating dysregulation
• Genetic and familial predispositions; ? Gene connection
• Biochemical: ? Lower brain serotonin
• -Psychological and social theories
• Cognitive theory: distorted thinking
• Family: chaotic with few rules and unclear boundaries

• stabilizing and normalizing eating, stop the binge-purge cycle
• restructuring dysfunctional thoughts and attitudes about eating, weight, & shape
• teaching healthy boundary setting
• resolving conflicts about separation-individuation
• treatment is usually on an outpatient bases unless the individual is suicidal or past outpatient treatments have failed

• Cognitive behavioral therapy, CBT (focus on changing problematic behavior & dysfunctional thinking)
• IPT
• SSRIs
• Behavioral techniques such as using a diary to record binges and purges and precipitating emotions and environmental cues
• Nutrition counseling
• Group psychotherapy & support groups

• co-morbid depression and suicide
• risk for self-mutilation
• impulsive behavior ; shoplifting, overspending, financial and legal problems , etc

• CBT/ IPT
• Behavioral Techniques
• Psychoeducation
• Group Therapy

• consists of binge eating which includes both ingestion of large amounts of food in a short time and a sense of loss of control; distress over binge; eating until uncomfortably full; feelings of guilt or depression following binge; and purging does not occur(this differentiates it from BN)
• Individuals have lower dietary restraint and are higher in weight
• 10-30% of obese individuals have BED