“I know what to do. I just can’t do it”

• She is 5’4”and weighs 180 lbs.
• Things started in college and her weight quickly increased from 135
lbs. as a first year student to 160 lbs by graduation.
• She has been treated for hypertension and high cholesterol for the last
5 years. 
• “I know what to do. I just can’t do it. I cannot control myself.”
• A 14-year-old girl, was brought by her parents to the clinic for amenorrhoea for three months.
• She attained menarche at 12 years old.
• Her menstruation cycle had been regular, 28-30 days cycle with five to seven days duration.
• She denied having any boyfriend or involvement in sexual activity.
• She had been dieting since seven months prior,which had caused her to lose weight.
• She frequently missed breakfast and lunch.
• During dinner, she would secretly put the food in a plastic bag and threw it into the dustbin. She
avoided food that was high in fat.
• She denied inducing vomiting, purging or doing excessive exercise.
• She perceived herself as ‘fat’. She also experienced low self-esteem as she believed that she was
not pretty and was not happy with her self-image.
• She described her father as a strict and over-protective parent, thus felt that she was not able to
be her real self.
• Her parents described her as someone who was rather perfectionist and obsessive in cleanliness
and punctuality.
 Prevalence and Development
• Prevalence of anorexia nervosa and bulimia among
adolescents is 0.3% and 0.9%, respectively
• Persons with anorexia are 15% or more below normal
weight and engage in binge eating only occasionally
• Those with bulimia are within 10% of normal weight
and binge frequently; then purge to control their
weight
 Prevalence and Development

• Eating disorders among boys

• More common than originally believed
• Young men place emphasis being muscular
• Sexual orientation and eating disorders
• Gay men are at greater risk for behavioral symptoms of
eating disorders compared to heterosexual men
 Cross-Cultural Considerations

• Anorexia occurs around the world, although it may

manifest differently
• Bulimia is a culture-bound syndrome
• Predominately in Western regions of the world
• Higher SES for women was considered a risk factor in
the past,
 Developmental Course
• Onset of anorexia is usually between ages 14 and 18
• Often begins with dieting - gradually leads to life-
threatening starvation (5% mortality rate).
• Fewer than one-half show full recovery; one-third show fair
improvement, and one-fifth continue on a chronic course.

• Worse outcomes are correlated with:

• Longer illness duration; bingeing and purging; and
comorbid affective or anxiety disorders
 Biopsychosocial Disorders
• Biological • Psychological • Social Factors:
Factors: Factors: • Cultural norms that
• Family history • Low self esteem overvalue
• Relationship appearance
• History of
dieting with self • Body dissatisfaction
– Drive for perceived
• Type One • Feelings of
ideal body type
(Insulin- inadequacy – Historical trauma
dependent) • Depression, – Weight
Diabetes anxiety, fear, or stigma/bullying
• Genetic loneliness.
predispositio
n
 Causes

• Neurobiological factors
• Imbalances of serotonin, which regulates hunger and
appetite, may be implicated
• Biochemical similarities have been found between people
with eating disorders and those with OCD.
• Sociocultural factors
• Self-worth, happiness, and success are determined primarily by physical
appearance.

• Teenage girls - weight loss and being skinny are more important than
sexual issues, alcohol and drug abuse, mental health, disease, and
environmental issues.

• Mass media influences perceptions of body dissatisfaction

• Family influences
• Teen’s eating disorder may be functional
• Directing attention away from basic family conflicts

• Family processes may contribute to an overemphasis on

weight and dietary control.

• Child sexual abuse may be a risk factor for eating disorders,

especially bulimia.
• Psychological dimension
• Hilda Bruch stated that eating disorders are related to
struggle for autonomy, competence, control, and self-
respect.

• Arthur Crisp considers anorexia to be a type of phobic

avoidance disorder, in which the phobic objects are normal
adult body weight and shape.

• Mood disorder is often comorbid with anorexia

 Common Warning Signs
EMOTIONAL/BEHAVIORAL PHYSICAL
• Weight loss, dieting, and • Noticeable weight fluctuations
control of food are primary • Gastrointestinal complaints
concerns • Dizziness upon standing
• Food rituals • Difficulty concentrating, sleeping
• Issues with skin, hair, and nail health
• Social withdrawal
• Menstrual irregularities
• Frequent dieting, body • Fertility problems
checking • Unexplained seizures
• Extreme mood swings • Chronic fatigue
• Loss of dental enamel
 DSM-5 Diagnoses

• Anorexia Nervosa (AN) • Other Specified Feeding or

Eating Disorder (OSFED)
• Bulimia Nervosa (BN)
• Eating disorders are complex and
some eating issues will not meet
• Binge Eating Disorder (BED) diagnostic criteria. All must be taken
seriously.
• Avoidant-Restrictive Food Intake
Disorder (ARFID)
 Anorexia Nervosa

• Characterized primarily by self-starvation and excessive weight loss

• Symptoms include:

• Inadequate food intake leading to a weight that is clearly too low

• Disturbance in the experience of body weight or shape
• Intense fear of weight gain, obsession with weight, and persistent behavior to prevent
weight gain
• Inability to appreciate the severity of the situation
 Bulimia Nervosa
• Characterized by binge eating and compensatory
behaviors, such as self-induced vomiting, in an attempt
to undo the effects of binge eating.
• Symptoms include:

• Frequent episodes of consuming very large amounts of food

followed by behaviors to prevent weight gain, such as
vomiting, laxative abuse, and excessive exercise
• Feeling of being out of control during the binge-eating
episodes
• Extreme concern with body weight and shape
• Most people are of a normal weight
 Binge Eating Disorder
• Characterized by recurrent binge eating without the regular use of
compensatory measures to counter the binge eating.
• Symptoms include:

• Indications that the binge eating is out of control

• eating when not hungry,
• eating to the point of discomfort,
• eating alone because of shame about the behavior.

• Feelings of strong shame or guilt regarding the binge eating

 Avoidant-Restrictive Food Intake Disorder

• Characterized by lack of interest in food, fears of negative consequences of

eating, and selective or picky eating.
• Symptoms include:

• Reduced food intake and frequent complaints of bodily discomfort with no apparent
cause
• Lack of appetite or interest in food, with a range of preferred foods narrowing over time
Comorbid Disorders

• Most common comorbidities:

• Mood disorders
• Anxiety disorders
• Substance abuse
• Treatment should address co-existing conditions and eating disorders
 Health Consequences

• Cardiovascular (muscle loss, low or irregular heartbeat)

• Gastrointestinal (bloating, nausea, constipation)
• Neurological (difficulty concentrating, sleep apnea)
• Endocrine (hormonal changes – estrogen, testosterone, thyroid)
 Investigation of Physical Conditions and
Psychological Symptoms
• Growth charts
• Food diaries
• Psychiatric assessment
• Observation of family meal
• Height and weight
• Physical investigations
• Routine blood tests: glucose, thyroid, electrolytes, liver
function tests, pregnancy, complete blood count
• Electrocardiogram
• Bone density
 Treatment
• Initial phase - restoring weight and monitoring of any
medical complications.
• Psychological interventions: individual and/or family-
based psychotherapy, sometimes accompanied by
medical interventions.

• Effectiveness is weak, especially for anorexia nervosa

• Efficacy of cognitive-behavioral approaches focusing on

modifying abnormal eating behaviors underlying bulimia

• Most can be managed as outpatients

• Hospitalization (usually brief) is necessary for those
who:
• Have serious complications due to comorbid diagnosis or
• Are at high physical and/or psychiatric risk

• Pharmacological antidepressants (not for initial

treatment) and SSRIs may be helpful for bulimia, but
not anorexia
• Should be used in conjunction with CBT, not just
medication by itself
• Psychosocial interventions
• Comprehensive treatment plans with
• an internist,
• a psychotherapist,
• a nutritionist, and
• a psychopharmacologist are more effective than medications
alone

• Resolution of family and interpersonal problems are crucial

to recovery from an eating disorder
 Pica

• Ingestion of inedible, nonnutritive substances (e.g.,

hair, insects, and paint) for a period of at least one
month
• Affects mostly very young children and those with
intellectual disability
Prevalence and Development
• Pica is more prevalent among institutionalized
children and adults
• Especially those with severe impairments and mental
retardation
• Affects 0.3-14.4% of children and adults with
intellectual disabilities
• 9-25% of those in institutions
Causes and Treatment
• Specific causes have not been isolated
• Vitamin or mineral deficiency
• No evidence of genetic factors
• Can be a serious and substantial problem
• Risk of lead poisoning or intestinal obstruction
• Treatments are based on operant conditioning
procedures and teaching caregivers to keep the child’s
environment tidy and removing dangerous substances
THANK YOU