Eating Disorders 101 Understanding Eating Disorders - Cigna (PDF)

Eating Disorders 101 Understanding Eating Disorders Anne Marie O’Melia, MS, MD, FAAP Chief Medical Officer Eating Recovery Center 1  Learning Objectives 1. List the diagnostic criteria and review the typical clinical symptoms for common eating disorders. 2. Become familiar with the biopsychosocial model for understanding the causes of eating disorders. 3. Understand treatment options and goals for eating disorder recovery 2  Declaration of Conflict of Interest I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider (s) of commercial services discussed in this CE/CME activity. 3  What is an eating disorder? Eating disorders are serious, life- threatening, multi-determined illnesses that require expert care. 4  Eating Disorders May Be Invisible • Eating disorders occur in males and females • People in average and large size bodies can experience starvation and malnourishment • Even experienced clinicians may not recognize the medical consequences of EDs 5  Importance of Screening and Early Detection  Delay in appropriate treatment results in – Associated with numerous med/psych/social complications – These may not be completely reversible – Long-lasting implications on development  Longer the ED persists, the harder it is to treat – Crude mortality rate is 4 - 5%, higher than any other psychiatric disorder (Crow et al 2009). – Costs for AN treatment and quality of life indicators, if progresses into adulthood, rivals Schizophrenia (Streigel- Moore et al, 2000). 6  AN-Diagnostic Criteria • Restriction of energy intake relative to requirements resulting in low weight • Intense fear of gaining weight or interference in gain • Disturbance in weight or shape experience, excessive influence on self-evaluation, or lack of recognition of seriousness of low weight • Severity levels – Mild (>17), Moderate (16-16.9), Severe (15-15.9) Extreme (<15) (APA, 2014) 7  AN-Diagnostic Criteria Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas) *Amenorrhea NO longer included in criteria 8  Anorexia Nervosa Warning signs • Eat only “safe foods”, those low in calories or fat • Have odd rituals, such as cutting food into small pieces • Spend more time playing with food than eating it • Cook meals for others without eating • Engage in compulsive exercise • Dress in layers to hide weight loss • Spend less time with family and friends, become more isolated, withdrawn, and secretive Symptoms • Menstrual periods may cease • Osteopenia or osteoporosis through loss of calcium and estrogen • Hair/nails become brittle • Skin dries and can take on a yellowish cast • Mild anemia and muscles, including the heart muscle, waste away • Severe constipation • Drop in blood pressure, slowed breathing and pulse rates • Internal body temperature falls, causing person to feel cold all the time • Depression and lethargy 9  Avoidant/Restrictive Food Intake Disorder (ARFID) An eating or feeding disturbance (lack of interest in eating or food; avoidance of certain food groups, textures/smells). Failure to meet the appropriate nutritional/energy needs. There is significant weight loss, nutritional deficit, relies on supplements, interference with day-to-day functioning. • Seek treatment at average age of 12 (Fisher, 2014) • 14% of patients incoming to treatment centers have ARFID 30% are male (Fisher, 2014) • Examples: – Traumatic experience with a certain food, i.e. choking once on a green bean. Now afraid to eat all green food. – Picky or fussy eating as a child which progresses to ARFID. 10  Definition of a “Binge” (1)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 (2)A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). 11  Bulimia Nervosa • Recurrent episodes of binge eating • Recurrent inappropriate compensatory behaviors to prevent weight gain – Misuse of laxatives, self-induced vomiting, diuretics, enemas, fasting, exercise • Binge and purge episodes occur on average once per week for three months • Self-evaluation is unduly influenced by shape/weight • The disturbance does not occur exclusively during episodes of Anorexia Nervosa • Categorized severity based on number of episodes of compensatory mechanisms per week i.e. mild average of 1-3, severe avg. of 14+ (APA, 2014) 12  Purging Methods • Self-induced vomiting • Laxative abuse • Diuretic misuse • Enemas • Exercise 13  Bulimia Nervosa Symptoms from chronic vomiting • Chronically inflamed and sore throat • Swollen parotid glands (“chipmunk cheeks”) • Tooth enamel wears off; decay due to exposure to stomach acids • GERD • Severe dehydration • Muscle loss and muscle pain, electrocardiographic changes, congestive heart failure, arrhythmia, and sudden death Symptoms from laxatives/diuretics abuse • Intestinal problems • Kidney problems • Muscle weakness, fatigue, cardiac arrhythmias, dehydration • Electrolyte imbalance such as low potassium, high blood pH, mild elevations of serum amylase, low magnesium and low phosphorous 14  Binge Eating Disorder • Recurrent episodes of binge eating • Binge eating episodes are associated with at least three: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not physically hungry. 4. Eating alone because of embarrassment. 5. Feeling disgusted with oneself, depressed, or very guilty after overeating. • Marked distress regarding binge eating. • At least once a week for 3 months. • No recurrent use of inappropriate compensatory behavior. 15