Transcript NFSC 470 eating disorders

Eating Disorders
By: Amanda Sensabaugh
Hayley Fennessy
Anorexia Nervosa
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Psychiatric disorder
Characterized by low body weight
Body image distortion
Obsessive fear of gaining weight
Depression
Weight loss viewed as a sign of achievement
Control Weight by:
 Voluntary starvation
 Purging
 Excessive exercise
 Diet pills or diuretic drugs
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Bulimia Nervosa
 Recurrent binge eating followed by feelings of guilt,
depression, and intentional purging to prevent weight gain
from occurring.
 Purging may consist of:
 Vomiting
 Fasting
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 Excessive exercise
Bulimia Nervosa
 Typically within normal weight range, underwt. or
overwt.
 More open to treatment that AN (tire of
binge/purge cycle)
Binge Eating Disorders
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 Binge without the purge
 Psychiatric disorder
 Eats a large amount of food at one time-more than
what a normal person would eat at the same time.
 Eats until physically uncomfortably full
 Feels depressed or guilty after a binge
 Eats large amounts of food even if there not really
hungry
Variations of Eating Disorders
 Binging/purging AN
 Restrictive AN
 Purging BN
 Non-purging BN
 EDNOS (eating disorder
Not otherwise specified)
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Purging vs. Non Purging Bulimia
 Purging: over consumption of calories then
using laxatives/edemas/excessive exercise
to rid calories
 Non-Purging: over consumption of calories
without ridding them from the body
Medical Consequences of Anorexia
Nervosa
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Dizziness, confusion
Dry, brittle hair
Lanugo-type hair
Low blood pressure, pulse, ECG voltage
Orthostasis
Cachexia
Biochemical changes
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Decreased WBC
Decreased glucose
Increased cholesterol
Increased carotene
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Medical Consequences of Anorexia
Nervosa
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Loss of menses
Muscle wasting
Diminishing DTRs
Osteoporosis
Dry skin
Edema
Growth retardation
Hypothermia
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Medical Consequences of Bulimia
Nervosa
 Salivary gland enlargement
 Enamel erosion
 Esophagitis
 Arrhythmias
 Normal weight or underweight
or overweight
 Calluses on hands
 Edema
 Diarrhea
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Medical Consequences of Bulimia
Nervosa
 Biochemical changes
 Decreased potassium
 Increased carbon dioxide
 Increased amylase
Role of treatment
 Multidisciplinary team
 Physicians
 Check wt. other physical signs/symptoms
 Electrolyte imbalances
 Heart arrhythmias
 May prescribe antidepressants
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Role of Treatment
 Registered Dietitians
 Discuss food intake
 Exercise and weight related behaviors
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Role of Treatment
 Psychotherapists
 Discuss issues leading to disordered eating
patterns.
 Psychiatrist
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 Physician that specializes in treating mental
disorders.
Goals of Treating Disordered Eating
 Normal eating
 Eating based on physical signs that is free from fear,
guilt, anxiety, obsessive thinking or behaviors or
compensatory behavior.
 Improved body image
 Weight normalization
 Discontinue extreme behaviors such as bingeing,
purging, starvation
 Often client exchange one coping tool for another
equally destructive coping tool.
Prevention Strategies to Reduce Risk
of Disordered Eating
 Practice intuitive eating concepts by
accepting your body type.
 Healthy at every size.
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Paris’ Description
 34 year old female attorney
 She experiences a high amount of stress
 Spent lots of hours at the recreation center
in high school
 Swam for 1 hr. before classes
 Walked 3 miles on the indoor track after lunch
 She did aerobics in the afternoon for 1 hr.
Paris’ Description
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 She learned how to purge using her toothbrush
 She took OTC laxatives every other day
 She hasn’t had a menstrual period in over two
years
 Tried to maintain her weight below 120 lbs.
 Smokes 1 pack of cigarettes a day
 Multiple food allergies: all meats, dairy foods,
most desserts
Paris’ Description
 She tried to stop restricting her intake of
food and purging on her own but once she
experienced stress she reverted back to her
old coping mechanisms.
 She was hospitalized while in law school
for a weekend because of severe
dehydration but released after 24 hrs.
Paris’ Description
 She appears emaciated
 She appears tired and older than age 34
 She loves to cook but gives most of the food
away
 She admitted that she knows she has a
problem dealing with food and eating
Paris’ Anthropometrics
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Height: 5’8
Weight: 115 lbs.
BMI: 17.48
Interpretation: underweight
Basal Energy Metabolism
 Harris Benedict:
655 + (9.6 x 52.8) + (1.8 x 172.72) – (4.7 x 34)=
1313 x activity factor(1.3)= 1707 KCALS
Paris’ 24 Hr. Recall
 AM: ¼ whole wheat bagel, 4 oz. calcium
fortified orange juice, 6 oz black coffee
 Lunch: Black coffee 2-3 c
 Afternoon snack: 12 oz can Diet Coke
 Dinner: 6 green peas, 18 oz water
 Snack: 12 oz Diet Coke
Nutrition Problems
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Rough dry skin with lanugo
Bruising
Brittle finger/toenails
Erosion of dental enamel
Multiple food allergies
Gastric/abdominal problems
Easy Bleeding/anemia
Paris’ Lab Value Results
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Low albumin of 3.0 L
Low pre-albumin of 14.5 L
Low potassium of 3.0 L
Low magnesium of 1.7 L
High glucose of 115 H
High CPK of 146 H
High HDL of 60 H
Low WBC of 4.6 L
Characteristics of Refeeding
Syndrome
 Increases BMR
 May lead to confusion, coma, convulsions
and death.
 Caused by introducing food to quickly to a
malnourished person.
 Prevent refeeding syndrome by slowly
introducing foods in small amounts and
advancing as tolerated.
Questions regarding Paris’ purging
behaviors
1. What types of food trigger your bingeing/purging
episodes?
2. What food rituals do you have?
3. What foods do you consider fear foods?
4. What other behavior could you do when you feel a
bingeing/purging episode about to occur?
5. What weight would you consider healthy for
yourself?
Diagnosis
 Inadequate energy intake(NI-1.4) related to
restricting food and purging as evidenced by
her underweight BMI of 17.48.
Intervention
 Nutrition-Related Behavior Modification
Therapy C-1
 A supportive process to set priorities, establish goals
and create individualized action plans that acknowledge
and foster responsibility for self-care by setting goals
for Paris
 From Paris’ description and 24 hr. food recall we
determined that Paris has anorexia nervosa with
binge/purge tendencies.
Education Intervention
 Teach Paris the hunger/fullness scale
 Learn not to classify foods as good versus bad
 Discuss physical activity in terms of health rather than using it to
control her weight
 Discuss with her the idea about trusting her body to fluctuate between
a goal range weight for her
 Gradually increase her caloric intake to prevent refeeding syndrome
 Teach her to add foods that she considers “safe” into her diet. She
stated she felt “safe foods” were all vegetables and salads.
 Although we intend to attempt to try these intervention techniques with
Paris, we realize that this may be an extremely slow process and take a
very long time depending on how she reacts to treatment.
Sample Diet
 2 eggs, 1 C granola, 1 C skim milk
 1/2 C grapes
 2 oz turkey on 2 slices whole wheat bread, light
mayo, mustard, 2 slices tomato, lettuce
 1 C apple juice
 2 cups mixed green salad, 2 oz tuna, 4 slices
cucumber, tomato, carrots, balsamic dressing
 This diet is low in calories and not meant for the
long term, but it can be a good place to start.
Action Goals
1. Have Paris choose one food item of her choice at
every meal. This can be a vegetable, fruit, or
anything she wants.
2. To better understand intuitive eating, have her read
a chapter a week from Intuitive Eating (Tribole,
Resch, 1995) and focus her behavior change on
that particular chapter.
3. Have Paris keep a journal of her feelings prior and
post eating.
Outcome Goals: Goal Weights
 Paris should aim to gain about 1 lb. per week,
however this may be unrealistic at first, and that is
alright in the beginning, as long as she does not
lose any more weight.
 Goal: 140 lbs. based upon Hamwi
 1 Month Goal: 119 lbs.
 3 Month Goal: 131 lbs.
 1 Year Goal: 126-154 lbs.
 Insure a slow and steady weight gain to prevent
refeeding syndrome.
Follow-Up
 Follow up with Paris in one week due to
being in the beginning stages of treatment.
 Then follow-ups may occur every two
weeks.
 Have weekly talks/meetings with the other
healthcare professionals on the team
(physician, psychologist, etc)
Parameters to measure
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Weight
Coping mechanisms
Monitor purging behavior
Continual discussion with the other
members of the treatment team for Paris
References
 Scarano M.G., Kalodner-Martin R.C. A description of the continuum
of eating disorders: Implications for intervention and research. Journal
of Counseling & Development. Vol. 72, 1994.
 Williams L.R., Schaefer A.C., Shisslak M.C., Gronwaldt H.V.,
Comerci D.G. Eating Attidtudes & Behaviors in Adolescent Women:
Discrimination of Normals, Dieters, & Suspected Bulimics Using the
Eating Attitudes Test & Eating Disorder Inventory. International
Journal of Eating Disorders. Vol. 5, 1986
 Kitsantas A., Gilligan D.T., Kamata A. College Women With Eating
Disorders: Self-Regulation, Life Satisfaction, & Positive/Negative
Affect. The Journal of Psychology. Vol. 137, 2003.
 Garner M.D., Garner V.M., Rosen W.L. Anorexia Nervosa
“Restricters” Who Purge: Implications for subtyping Anorexia
Nervosa. International Journal of Eating Disorders. Vol. 13, 1993.
 Robinson H.P. Review article: recognition and treatment of eating
disorders in primary and secondary care. Alliment Pharmacol Ther.
Vol. 14, 2000.
 http://encyclopedia.thefreedictionary.com/anorexia+nervosa
 Tribole E., Resch E. Intuitive Eating. St. Martin’s Press, 1995.