Eating Disorders: What you need to know. Heather Gallivan, PsyD, LP Clinical Director, Melrose Center

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1 Eating Disorders: What you need to know Heather Gallivan, PsyD, LP Clinical Director, Melrose Center

2 Anorexia has the highest premature mortality rate of any psychiatric disorder

3 10 Million Males. 20 Million Females.

4 Only 1 in 10 men and women with eating disorders receive treatment

>50% Teen girls >30% Teen boys use unhealthy weight control behaviors such as skipping

5 46% 9-11 Year olds..are sometimes or very often on diets. Also, 82% of those families are also sometimes or very often on diets. >50% Teen girls >30% Teen boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives. Adolescent girls who diet are 12 times more likely to binge eat

6 Over 80% of 10 year olds are afraid of being fat 42% of 1 st -3 rd grade girls want to be thinner

7 What Does an Eating Disorder Look Like?

8 DSM-5 Anorexia Ner vosa B u l i m i a N e r v o s a Binge- Eating Disorder O t h e r S p e c i f i e d F e e d i n g o r E a t i n g Disorder ( O SFED) A v o i d a n t / R e s t r i c t i v e F o o d I n t a k e D i s o r d e r

9 Food restriction Low body weight Fear of gaining weight Extreme concern with body, weight and shape Binge/Purge subtype ANOREXIA

10 Anorexia- signs and symptoms Weight Loss Falling off growth curve Lanugo (soft, downy body hair) Always dressed in layers Pacing, constant movement Rigid, restrictive eating Not wanting to eat around others, making excuses not to eat Severe distress on discussion of weight or food

11 BULIMIA Eating a large amount of food in a discrete period of time with lack of control Compensatory Behavior exercise, purging, laxatives, diuretics Once a week for 3 months Extreme concern with body weight and shape

12 Bulimia- signs and symptoms Can be any weight Dental problems Going to the bathroom or showering after meals

13 BINGE EATING DISORDER No weight criteria Binge eating No compensatory behavior 1 binge a week for 3 months 30% of obese patients are binge eaters

14 What is Binge Eating? Eating, in a discrete period of time (e.g. within any 2- hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. A sense of lack of control over eating during the episode

15 What is Binge Eating? Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of feeling embarrassed by how much one is eating Feeling disgusted with oneself, depressed or very guilty afterward

16 Binge eating disorder - signs and symptoms Obesity and associated complications Repeated diet failure High overlap with obesity Usually restrict eating when around others

17 Avoidant/Restrictive Food Intake Disorder Extreme picky eating Significant weight loss (or failure to achieve expected weight gain) Significant nutritional deficiency Dependence on enteral feeding or oral supplements Marked interference with psychosocial functioning

18 Who is at Risk? Males and Females History of OCD, depression, anxiety History of substance abuse Perfectionistic or impulsive Certain family dynamics Dancers, gymnasts, runners, swimmers, body builders, wrestlers, jockeys Vulnerable to teasing and peer pressure Early maturation People who diet History of physical or sexual abuse

19 The influence of Social Media

20 General Clues to an Eating Disorder Eliminating entire food groups. Skipping meals, I m not hungry or I already ate. Lots of diet soda, gum, water, mints, etc. Isolation from friends, activities. Eating erratically, lots of rules. Constant talk of food/weight/calories. Eating in isolation (hiding the eating). Going to the bathroom or showering after eating.

21 What do I do? as a professional? Build trust and rapport with patient/client and family Avoid psychologically loaded terms such as fat, weight gain Avoid giving your opinion on the patient s weight or physical appearance

22 What to say? as a professional? Tell me how you feel about your body. How do you feel when you are eating? I m worried about your How much time do you spend thinking about food? eating. I would like you to see a specialist to talk more about your eating and how you are feeling about yourself.

23 Questions to ask high -risk 1. In your past, have you had fluctuations in your weight, high to low or low to high? 2. Have you ever used something to manage your weight gain or loss? Dieting, laxatives, enemas, diuretics, supplements, vomiting, appetite suppressants, excessive exercise 3. Do you feel a lack of control over eating or food intake? 4. Are you comfortable with your current weight/shape? 5. What is a typical day of food and water intake like for you? Are you vegetarian or on another type of diet? 6. How much and how often do you exercise? Why? 7. Is there a family history of eating disorders, depression, obesity, substance use issues?

24 SCOFF QUESTIONNAIRE 1. Do you make yourself Sick because you feel uncomfortably full? 2. Do you worry you have lost Control over how much you eat? 3. Have you recently lost more than One stone (15 lbs) in a 3-month period? 4. Do you believe yourself to be Fat when others say you are too thin? 5. Would you say that Food dominates your life? A score of 2 or more indicates possible risk for eating disorder and warrants further assessment

25 What do I do as a parent? Family meals are important! Avoid talking about child s weight or physical appearance Eat healthy but Model good body image and end fat talk I m worried about your eating. I would like you to see a specialist to talk more about your eating and how you are feeling about yourself. Get help from professionals

26 Treatment of Eating Disorders Best Practice for treatment is a multidisciplinary team including: Primary Care Physician Psychologist/Therapist Registered Dietitian Psychiatrist AED & AAP recommends family involvement. Treatment includes an initial assessment to assess patient s current medical and psychological status. The vast majority of patients only require an outpatient level of care.

27 GOALS OF TREATMENT Stabilize medical condition Restore or stabilize weight Interrupt and reduce eating disorder symptoms Re-establish normal eating patterns Implement new behavioral strategies Prevent relapse

28 TREATMENT OF EATING DISORDERS Family Based Therapy Cognitive Behavioral Therapy- Enhanced Dialectical Behavioral Therapy Interpersonal Psychotherapy

29 S o u r c e s f o r a d d i t i o n a l information Melrose Center or National Eating Disorders Association National Association of Anorexia Nervosa and Associated Disorders (ANAD) Academy of Eating Disorders Eating Disorders Coalition The Ellyn Satter Institute

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