Eating Disorders PPT PDF

Eating Disorders Prepared by: Ahmad Al Sayeh, MSN, RN OUTLINE: Anorexia Nervosa. Bulimia Nervosa. Bing eating. Obesity. Assessment and management for each disorder. 01/03/2025 DSM-V 2 Learning Objective  After this lecture the student will be...

Eating Disorders Prepared by: Ahmad Al Sayeh, MSN, RN OUTLINE: Anorexia Nervosa. Bulimia Nervosa. Bing eating. Obesity. Assessment and management for each disorder. 01/03/2025 DSM-V 2 Learning Objective  After this lecture the student will be able to:  Identify and differentiate among the various eating disorders.  Discuss epidemiological statistics related to eating disorders.  Understand the diagnostic criteria of eating disorder.  Identify how to assess patient with eating disorder. 01/03/2025 DSM-V 3 Introduction The hypothalamus contains the appetite regulation center within the brain. This complex neural system regulates the body’s ability to recognize when it is hungry and when it has been sated. Society and culture have a great deal of influence on eating behaviors. DSM –IV-TR 01/03/2025 DSM-V 4 Introduction History reveals a regularity of fluctuation in what society has considered desirable in the human female body. Archives and historical paintings from the 16th and 17th centuries reveal that plump, full-figured women were considered fashionable and desirable 01/03/2025 DSM-V 5  Bulimia nervosa is more prevalent than anorexia nervosa, with estimates up to 4 percent of young women. Obesity has been defined as a body mass index (BMI; weight [kg]/height [m]2) of 30 or greater. 01/03/2025 DSM-V 6 Anorexia Nervosa Anorexia: prolonged loss of appetite Body image: A subjective concept of one’s physical appearance based on the personal perceptions of self and the reactions of others Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. 01/03/2025 DSM-V 7 Anorexia Nervosa It was initially believed that anorexics did not experience sensations of hunger. However, research indicates that they do indeed suffer from pangs of hunger, and it is only with food intake of less than 200 calories per day that hunger sensations actually cease. - Age at onset is usually early to late adolescence 01/03/2025 DSM-V 8 Anorexia Nervosa The distortion in body image is manifested by the individual’s perception of being “fat” when he or she is obviously underweight or even emaciated (very thin). Weight loss is usually accomplished by reduction in food intake and often extensive exercising. Self-induced vomiting and the abuse of laxatives or diuretics also may occur. 01/03/2025 DSM-V 9 Anorexia Nervosa Weight loss is excessive. For example, the individual may present for health-care services weighing less than 85 percent of expected weight. Other symptoms include: hypothermia, bradycardia, hypotension, edema, and a variety of metabolic changes. Amenorrhea usually follows weight loss, but sometimes it happens early on in the disorder, even before severe weight loss has occurred. 01/03/2025 DSM-V 10 Anorexia Nervosa Individuals with anorexia nervosa may be obsessed with food.??? For example, these individuals may store or hide food, talk about food and recipes (how to make the food) at great length, or prepare elaborate meals for others, only to restrict themselves to a limited amount of low-calorie food intake. Compulsive behaviors, such as hand washing, may also be present. 01/03/2025 DSM-V 11 Anorexia Nervosa Types Restriction Type: during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtypes is accomplished primarily through dieting, fasting, and/or excessive exercise. 01/03/2025 DSM-V 12  Binge-eating/purging type: during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). 01/03/2025 DSM-V 13 Anorexia Nervosa Severity Mild : BMI > 17 Moderate : BMI 16 – 16.99 Severe : BMI 15 – 15.99 Extreme : BMI < 15 01/03/2025 DSM-V 14 Diagnostic criteria for AN 01/03/2025 DSM-V 15 Bulimia Nervosa Bulimia Excessive, insatiable appetite (there is no sensation of satiety). Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (binging), followed by inappropriate compensatory behaviors to eliminate the body of the excess calories. 01/03/2025 DSM-V 16 Bulimia Nervosa To rid the body of the excessive calories, the individual may engage in purging behaviors (self-induced vomiting, or the misuse of laxatives, diuretics, or enemas) or other inappropriate compensatory behaviors, such as fasting or excessive exercise. 01/03/2025 DSM-V 17 Bulimia Nervosa There is a persistent over concern with personal appearance, particularly regarding how they believe others perceive them. Weight fluctuations are common because of the alternating binges and fasts. However, most individuals with bulimia are within a normal weight range—some slightly underweight, some slightly overweight. 01/03/2025 DSM-V 18 Bulimia Nervosa Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. Gastric acid in the vomitus also contributes to the erosion of tooth enamel. In rare instances, the individual may experience tears in the gastric or esophageal mucosa. 01/03/2025 DSM-V 19 Bulimia Nervosa Some people with this disorder are subject to mood disorders, anxiety disorders, substance abuse or dependence, most frequently involving amphetamines or alcohol. 01/03/2025 DSM-V 20 Bulimia Nervosa Severity Mild : an average of 1-3 episodes of inappropriate compensatory behaviors per week. Moderate : an average of 4-7 episodes of inappropriate compensatory behaviors per week. Severe : an average of 8-13 episodes of inappropriate compensatory behaviors per week. Extreme : an average of 14 or more episodes of inappropriate compensatory behaviors per week. 01/03/2025 DSM-V 21 Diagnostic criteria for BN 01/03/2025 DSM-V 22 Etiological Implications Associated with Anorexia Nervosa and Bulimia Nervosa Genetics: In their study of monozygotic and dizygotic twins, Bulik and associates (2006) concluded that genetic factors account for 56 percent of the risk for developing anorexia nervosa. Other genetic studies have suggested possible linkage sites for anorexia nervosa on chromosomes 1, 2, and 13 (Halmi, 2008). Anorexia nervosa is more common among sisters and mothers of those with the disorder than among the general population. 01/03/2025 DSM-V 23  Neuroendocrine Abnormalities. Some speculation has occurred regarding a primary hypothalamic dysfunction in anorexia nervosa. Neurochemical Influences. Neurochemical influences in bulimia may be associated with the neurotransmitters serotonin and norepinephrine. 01/03/2025 DSM-V 24 Psychodynamic Influences Psychodynamic theories suggest that eating disorders result from very early and profound disturbances in mother-infant interactions. The result is retarded ego development in the child and an unfulfilled sense of separation-individuation. This problem is compounded when the mother responds to the child’s physical and emotional needs with food. Manifestations include a disturbance in body identity and a distortion in body image. 01/03/2025 DSM-V 25 Conflict Avoidance. In the theory of the family as a system, psychosomatic symptoms, including anorexia nervosa, are reinforced in an effort to avoid spousal conflict. Parents are able to deny marital conflict by defining the sick child as the family problem. In these families, there is an unhealthy involvement between the members (enmeshment); the members strive at all costs to maintain “appearances”; and the parents endeavor (trying) to retain the child in the dependent position. 01/03/2025 DSM-V 26 Elements of Power and Control The issue of control may become the overriding factor in the family of the client with an eating disorder. These families often consist of a passive father, a domineering mother, and an overly dependent child. A high value is placed on perfectionism in this family, and the child feels he or she must satisfy these standards. Parental criticism promotes an increase in obsessive and perfectionistic behavior on the part of the child, who continues to seek love, approval, and recognition. 01/03/2025 DSM-V 27 Obesity Obesity is not classified as a psychiatric disorder in the DSM-V, but because of the strong emotional factors associated with the condition, it may be considered under “Psychological Factors Affecting Medical Condition.” 01/03/2025 DSM-V 28 Binge-Eating Disorder (BED) Research criteria for binge-eating disorder (BED) are included in the DSM-V(see Box 22–3). Obesity is a factor in BED because the individual binges on large amounts of food (as in bulimia nervosa) but does not engage in behaviors to rid the body of the excess calories. 01/03/2025 DSM-V 29  The following formula is used to determine extent of obesity in an individual: Body mass index = Weight (kg)/Height (m)2 The BMI range for normal weight is 20 to 24.9. Studies by the National Center for Health Statistics indicate that overweight is defined as a BMI of 25 to 29.9 (based on U.S. Dietary Guidelines for Americans). 01/03/2025 DSM-V 30  Based on criteria of the World Health Organization, obesity is defined as a BMI of 30 or greater. 01/03/2025 DSM-V 31 Diagnostic criteria for BED 01/03/2025 DSM-V 32 Predisposing factors Implications Associated With Obesity Biological Influences Genetics. Genetics have been implicated in the development of obesity in that 80 percent of offspring of two obese parents are obese (Halmi, 2008). Studies of twins and adoptees reared by normal and overweight parents have also supported this implication of heredity as a predisposing factor to obesity. Recent discovery in genetics have found that people differ in their perceptions of hunger and satiety on genetics basis. 01/03/2025 DSM-V 33 Physiological Factors. Lesions in the appetite and satiety centers in the hypothalamus may contribute to overeating and lead to obesity. Hypothyroidism is a problem that interferes with basal metabolism and may lead to weight gain. Weight gain can also occur in response to the decreased insulin production of diabetes mellitus and the increased cortisone production of Cushing’s disease. 01/03/2025 DSM-V 34 Lifestyle Factors. On a more basic level, obesity can be viewed as the ingestion of a greater number of calories than are expended. Weight gain occurs when caloric intake exceeds caloric output in terms of basal metabolism and physical activity. Many overweight individuals lead sedentary lifestyles, making it very difficult to burn off calories. 01/03/2025 DSM-V 35 Psychosocial Influences The psychoanalytical view of obesity proposes that obese individuals have unresolved dependency needs and are fixed in the oral stage of psychosexual development. The symptoms of obesity are viewed as depressive equivalents, attempts to regain “lost” or frustrated Nurturance and caring. Depression and binge eating are strongly linked. 01/03/2025 DSM-V 36 Summary & Key Points The incidence of eating disorders has continued to increase over the past 30 years. Individuals with anorexia nervosa, a disorder that is characterized by a morbid fear of obesity and a gross distortion of body image, literally can starve themselves to death. The individual with anorexia nervosa believes he or she is fat even when emaciated. The disorder is commonly accompanied by depression and anxiety. 01/03/2025 DSM-V 37 Summary & Key Points Bulimia nervosa is an eating disorder characterized by the consumption of huge amounts of food, usually in a short period of time, and often in secret. With bulimia nervosa, tension is relieved and pleasure felt during the time of the binge, but is soon followed by feelings of guilt and depression. 01/03/2025 DSM-V 38 Summary & Key Points Individuals with bulimia nervosa “purge” themselves of the excessive intake with self-induced vomiting or the misuse of laxatives, diuretics, or enemas. They also are subject to mood and anxiety disorders. Compulsive eating can result in obesity, which is defined by the National Institutes of Health as a body mass index (BMI) of 30. Obesity predisposes the individual to many health concerns, and at the morbid level (a BMI of 40), the weight alone can contribute to increases in morbidity and mortality. 01/03/2025 DSM-V 39 Summary & Key Points Predisposing factors to eating disorders include genetics, physiological factors, family dynamics, and environmental and lifestyle factors. Treatment modalities for eating disorders include behavior modification, individual psychotherapy, family therapy, and psychopharmacology. 01/03/2025 DSM-V 40 References American Psychiatric Association, 2013, diagnostic and statistical manual of mental disorder, (fifth edition). Townsend, 2013, Essential of psychiatric mental health nursing, (sixth edition). 01/03/2025 DSM-V 41  Thank you 01/03/2025 DSM-V 42