Understanding Eating Disorders. Amelia McBride MS, RD, CD Primary Children s Medical Center Salt Lake City, Utah

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1 Understanding Eating Disorders Amelia McBride MS, RD, CD Primary Children s Medical Center Salt Lake City, Utah

2 Objectives: Describe the different kinds of eating disorders. Recognize signs and symptoms of various eating disorders. Identify ways of addressing your concerns with someone you suspect may struggle with an eating disorder.

3 A Few Facts Over ½ of teenage girls and nearly 1/3 of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and laxative use. (2005) 81% of 10 year olds are afraid of being fat. (1991) 42% of 1 st -3 rd grade girls want to be thinner. (1991) 35% of normal dieters progress to pathological dieting. Of those, 20-25% progress to partial of full-syndrome eating disorders. (1995) June 1,

4 A Few Facts, cont It is estimated that 8 million Americans have an eating disorder- seven million women and one million men. One in 200 American women suffers from anorexia nervosa. Two to three in 100 American women suffers from bulimia nervosa. Eating disorders have the highest mortality rate of any mental illness The mortality rate associated with anorexia nervosa is 12 times higher then the death rate of all causes of death for females years old. 20% of people suffering from anorexia nervosa will prematurely die from complications related to the eating disorder, including suicide and heart problems. June 1,

5 What are Eating Disorders? A group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individuals physical or mental health. Classifications Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Eating Disorders Not Otherwise Specified

6 Disordered Eating vs. Eating Disorders Disordered eating: a general term used to describe the spectrum of abnormal and harmful eating behaviors that are used in a misguided attempt to lose weight or maintain an abnormally low or unhealthy body weight. Eating disorder: refers to one of the three clinically diagnosable conditions, recognized by the American Psychiatric Association. Beals, K.A. (2004) Disordered Eating Among Athletes- A Comprehensive Guide for Health Professionals. Illinois: Human Kinetics

7 Continuum of Disordered Eating Anorexia Nervosa Normal Eating Bulimia Nervosa

8 Normal Eating Normal eating is going to the table hungry and eating until you are satisfied. It is being able to chose food you like and eat it and truly get enough of it- not just stopping because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving your self permission to eat sometimes because you are happy, sad, or bored, or just because it feels good.

9 Normal Eating, cont Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be under eating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating Normal eating takes up some of your times and attention, but keeps its place as only one important area in your life. June 1,

10 Anorexia Nervosa (AN) Refusal to maintain body weight at or above a minimally normal weight for age and height. Intense fear of gaining weight or becoming fat, even though underweight. Disturbances in the way in which one s body weight or shape is experienced. In postmenarcheal females, amenorrhea. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author

11 Anorexia Nervosa, cont. Subcategories Restricting Type: the person has not regularly engaged in binge-eating or purging behaviors. Binge-Eating/Purging Type: the person regularly engaged in binge-eating or purging episodes. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author

12 Bulimia Nervosa (BN) Recurrent episodes of binge eating: Eating in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time A sense of lack of control over eating during the episode Recurrent inappropriate compensatory behavior in order to prevent weight gain. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months. Self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of Anorexia Nervosa American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author

13 Bulimia Nervosa, cont Subcategories Purging Type: the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Non-purging Type: the person has used other inappropriate compensatory behaviors such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author

14 Eating Disorder, Not Otherwise Specified (EDNOS) Used to describe disorders of eating that do not meet the criteria for any specific eating disorder. Examples: All criteria for AN are met, except the individual continues to have regular menses. All criteria for AN are met, except that despite significant weight loss, the individuals weight remains within a normal range. All criteria for BN are met except that the binge eating and inappropriate compensatory behavior occur at a frequency of less than twice a week or for less than 3 months Regular use of compensatory behavior by an individual of normal body weight after eating small amounts. Binge Eating Disorder American Psychiatric Association. (2000). Diagnostic and

15 Binge Eating Disorder (BED) Recurrent episodes of binge-eating. Eating, in a discrete period of time, an amount of food that is definitely larger than most people would in a similar time frame under similar circumstances. A sense of lack of control over eating during the episode. The binge-eating episodes are associated with three or more of the following: 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 being embarrassed by how much one is eating. Feeling disgusted with oneself, depressed, or very guilty after overeating. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author

16 Binge Eating Disorder, cont Marked distress regarding binge eating is present. The binge eating occurs, on average, at least 2 days a week for 6 months. The binge eating is not associated with the regular use of inappropriate compensatory behaviors. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.).

17 What Causes an Eating Disorder Social Biology Psychology

18 What to Watch For: Signs and Symptoms Physical Sudden weight loss, gain, or fluctuations in short time period Abdominal pain Feeling full or bloated Feeling faint, cold, or tired Dry hair or skin, dehydration, blue hands/feet Lanugo hair June 1,

19 What to Watch For: Signs and Symptoms, cont Behavioral Diets or chaotic food intake; pretends to eat, then throws away food; skips meals Exercises for long periods/excessively Constantly talks about food Makes frequent trips to the bathroom Wears baggy clothing Fatigue, dizziness Avoids cafeteria Carries own food in backpack/purse Show some type of compulsive behavior June 1,

20 What to Watch For: Signs and Symptoms, cont Emotional Change in attitude/performance Expresses body image complaints/concerns Talks about dieting; avoid nutritious foods because they are fattening Is overweight but appears to eat small portions in the presence of others Appears sad/depressed/anxious/expresses feelings of worthlessness Target of body or weight bullying Spends increasing amount of time alone Obsessed with maintaining low weight to enhance performance in sports, dance, acting, or modeling June 1,

21 Health Consequences Heart failure Brittle hair and nails Anemia Swollen joints Reduced muscle mass Osteoporosis Erosion of tooth enamel Inflammation the esophagus Stomach damage Irregular heart beat Electrolyte imbalance Constipation Death June 1,

22 Addressing Your Concerns Express concerns Avoid confrontation I versus you Focus on feelings Respect privacy Avoid comments on body size and shape Avoid simple solutions Be prepared for resistance Provide resources for assistance Maintain appropriate boundaries Educate yourself

23 Remember, it is not a matter of just eating/gaining weight/stop purging/etc. An eating disorder is a complex psychological disorder. Food is a symptom, not the underlying issue!

24 Questions? THANK YOU!

Eating and Weight Disorders Quick overview. Eunice Chen, Ph.D. Adult Eating and Weight Disorders University of Chicago

Eating and Weight Disorders Quick overview Eunice Chen, Ph.D. Adult Eating and Weight Disorders University of Chicago Weight and Our Culture Discrepancy between biology and culture Culture of harmful messages