What are Eating Disorders? / DIAGNOSTIC Criteria by DSM 1V

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1 What are Eating Disorders? / DIAGNOSTIC Criteria by DSM 1V Anorexia Nervosa [AN ] AN is characterised by extreme wt loss and restrictive dieting. 1. Low wt if body wt less then 85% of what is expected based on wt and height. 2. Intense fear of gaining wt, even though at a very low wt 3. Distorted image of shape or weight 4. Amenorrhoea not having a menstrual period for at least 3 consecutive months [ difficult to evaluate if on the pill ] Bulimia Nervosa [ BN ] BN patients often have an average body weight. BN is characterised by repeated cycles of binge eating [a large amount, in a discrete period of time, with lack of control]. 1. Reoccurring binge eating episodes 2. Reoccurring purging behaviours to prevent wt gain- excessive exercise, vomiting, fasting, or abusing laxatives, diuretics, enemas or other medications 3. Bingeing and purging occur at least 2/week for 3 months 4. Overemphasis on shape or wt in evaluating self 5. These difficulties do not occur during an episode of AN Binge Eating Disorder [BED ] It is sometimes referred as compulsive overeating. There is no compensatory behaviour 1. Repeated binge eating episodes 2. Episodes of binge eating include 3 or more of a) Eating much faster then usual b) Eating while full and uncomfortable c) Eating large quantities of food even though not hungry d) Eating alone and feeling ashamed by the amount of food eaten e) Having feelings of disgust, depression or guilt after overeating 3. Experiencing distress due to binge eating 4. Binge eating occurs 2 / week for 6 months 5. No regular purging behaviours, and binge eating is not occurring during episodes of Anorexia or Bulimia. Eating Disorder Not Otherwise Specified [ EDNOS ] Have symptoms of an eating disorder but do not meet all the criteria for a specific diagnosis. For example, women who are low wt, fear wt gain, and are preoccupied with their shape but continue to get their period would be diagnosed with ED-NOS.

2 Warning signs To help you catch the problem before it becomes worse, you can have a look at the checklist of common warning signs for anorexia and bulimia nervosa. The checklist is developed from National Eating Disorders Association. Possible signs Skips meals Takes very small portions Avoids eating in front of others / eats in secret Eats in a ritualistic way Has very rigid rules about eating Chews food but spits it out before swallowing Likes to shop and cook, but does not eat the meals prepared Regularly has excuses not to eat food Boasts about eating healthy food Becomes vegetarian, but does not eat the necessary fats and oils Chooses primarily low-fat items to eat Chooses primarily low-calorie items to eat Read food labels all the time Always drinks diet sodas or chews gums Rearranges food on plate to make it look like he or she is eating Feels disgusted by foods he or she used to like, especially high fat items Categorizes food as safe or good versus dangerous or bad Thinks irrational thoughts about eating [ eg., If I am thin, then I will be happy. If I eat after 10p.m., I ll gain twice the weight ] Competes with others to eat the least and be thinnest Becomes irrational or sulks when someone talks to them about their eating Buys large amounts of a food Secretly takes food from a cupboard or a fridge Leaves empty food packages around Wants to change shape and weight Wears baggy clothes or layers to hide body shape Obsesses about clothing size Spends lot of time inspecting self in the mirror Exercises to lose wt, rather than to promote health

3 Serious signs Binge eats Dramatic wt loss [ more than 5 percent of normal wt, even though not ill ] Preoccupied with thoughts about food and wt Denies hunger Binges to escape stress and negative emotions, and avoids talking about feelings Goes to the bathroom immediately after eating, and you notice signs of vomiting [ eg., running water or hair dryer to cover noise of vomiting, excessive use of mouthwash ] Buys laxatives, diet pills, diuretics or natural wt loss products Shows physical signs of vomiting [eg., calluses on hands, swelling of the cheeks or jaws, discoloration of teeth ] Has frantic fears of gaining wt Insists you cannot feel good about yourself unless thin Exercises immediately after food Exercises more than normal Exercises even in bad weather

4 How Serious Are Eating Disorders? Medical Complications Slow heart rate and low blood pressure, leading to increased risk of heart failure Muscle loss and weakness Severe dehydration, which can result in kidney failure Reduction of bone density [ osteoporosis ], which results in dry, brittle bones Dry hair and skin, and hair loss Growth of a downy layer of hair called lanugo Electrolyte disturbances Potential for gastric rupture during periods of binge eating Inflammation and rupture of oesophagus from repeated vomiting Tooth decay and staining from stomach acids released during frequent vomiting Irregular bowel movements and constipation Heart disease Secondary Diabetes due to binge eating disorder Psychological Problems Depression, sometimes severe enough to lead to suicide Feeling of being out of control and helpless to do anything Anxiety, self-doubt Guilt and shame Suspicion, slight paranoia Fear of discovery Obsessive thoughts and preoccupations Compulsive behaviours Feelings of alienation and loneliness Feelings of hopelessness

5 Symptoms of Semi-Starvation Emotional 1. Depression 2. Irritability and anxiety 3. Muddled thoughts 4. Withdrawal and isolation Behavioural 1. Dramatic increase in preoccupation of food 2. Hoarding of food 3. Total devotion to food and eating 4. Eating slowly and chewing thoroughly 5. Increased hunger Physical 1. Gastro-intestinal discomfort 2. Decreased need for sleep 3. Dizziness, headaches 4. Hypersensitivity to noise and light 5. Reduced strength 6. Hair loss 7. Poor tolerance to cold temperatures 8. Decrease in metabolism

6 What makes someone vulnerable to Eating Disorders? There are many possible contributing causes of eating disorders in any one person, as everyone is unique. Features of Family Life Avoidance of conflict in the family One parent over-involved and the other passive Family rules so strong that it is difficult to express individuality Abuse-Physical, sexual, emotional High achieving parents with high expectations Acute sibling rivalry Different experiences and meanings of food: eg. Obese & accused of being greedy; being deprived of food in childhood; comforted or bribed with food in times of emotional trauma Adolescent Crisis Developing a sense of identity- period of uncertainty in academic ability, sexuality, social skills Fears about adulthood & taking risks If a child feels controlled by parents, may seek other ways of gaining control refusing to eat Feeling in control of weight can generate feelings of empowerment and superiority in someone suffering from low self-esteem Low Self-esteem As a child growing up with the belief that one is not as worthy as others In adolescence- agonising over how one matches up to others, becoming self critical In crises loss of occupation, desertion by partner, self doubt may arise Can make people vulnerable-accepting unhealthy relationships or jobs where they are exploited. This can lead to depression. Search for autonomy Pursuit of thinness may be based on the need to be seen as an individual- to exercise self-will in at least one area of life Western ideal of feminine beauty slender; slim= successful Pressure to be thin Conveyed in magazines, media images of female perfection Contradictions: Models have legs of teenagers, yet are voluptuous an elusive ideal

7 What triggers an eating disorder? Adverse comments on appearance Separation / loss Increased pressure to succeed Sexual conflicts Family / relationship conflicts Feeling fat and dieting Stress- difficulties in coping with emotions What keeps an eating disorder going? Fear of fatness; rewards of weight loss Increased sense of self control and self approval Increased concern from others Increased avoidance of adolescent tasks Biological effects of weight loss-starvation syndrome Body image distortion which increase with increasing weight loss Difficulties in coping with emotions-using avoidance Binges divert attention from painful emotions Unhelpful and outdated ways of thinking An Eating Disorder can be seen as- An avoidance mechanism in that the person, by concentrating all his/her energies around food and eating, can avoid facing other more painful issues in his/her life A way of coping with a life which otherwise appears to be fraught with insoluble problems A way of exerting control over his / her body and life in general in a situation where the person feels that others are controlling him/her A reaction to stress that may go back many years

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