Transcript Eating Disorders in Teens: Anorexia/Bulimia

Eating Disorders in Teens:
Anorexia/Bulimia
Michelle Stauffer, SPT
Amber Stanback, RN
Alison Baumann, RN
Eating Disorders: Anorexia Nervosa
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Potentially life threatening
eating disorder characterized by
self-starvation and excessive
weight loss
90-95% with this disorder are
women
Highest death rates of any
mental health condition
Typically appears in early to
mid-adolescence
Affects many minorities but
exact stats are not available
Photo: http://www.clinicaladvisor.com/anorexia-and-bulimia-warning-signs/slideshow/705/#3
Warning Signs: Anorexia Nervosa
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Warning Signs:
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Dramatic weight loss
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Preoccupation with weight, food, calories,
fat grams, and dieting
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Refusal to eat certain foods to even cutting
out entire food groups
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Comments/anxiety of being overweight
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Denial of hunger
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Development of food rituals
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Consistent excuses to avoid mealtime
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Excessive, rigid exercise program despite
the weather, fatigue, illness, or injury
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Withdrawal from usual activities and
friends
Health Consequences/Physical Findings:
Anorexia Nervosa
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The body is denied of essential nutrients
that it needs to function normally and it is
forced to slow down and conserve energy
Abnormally slow heart rate and low blood
pressure results which increases the risk
for heart failure
Reduction in bone density leads to brittle
bones
Muscle loss and weakness
Severe dehydration which can lead to
kidney failure
Fainting and fatigue are common
Dry skin and hair along with hair loss
Growth of lanugo all over body in attempts
to keep body in body heat
Eating Disorders: Bulimia
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Psychological and life threatening eating disorder characterized by
ingestion of an abnormally large amount of food, followed by purging of
food so weight isn’t gained.
o Purging is to prevent weight gain, establish a sense of control, or to
cope with difficult circumstances
Causes are unknown but may be attributed to genetics, environmental,
physiological, and cultural influences.
80% of patients are female; affects 1-2% of adolescent-young women
Frequently associated with depression and changes in social adjustment
Most appear of average body weight and recognize their behaviors as
abnormal
May not appear as struggling because eating disorder behaviors are hidden
Warning Signs: Bulimia
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Warning Signs
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Disappearance of large amounts of food in
short periods of time
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Finding wrappers and containers
indicating consumption of large amounts
of food
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Followed by frequent trips to the
bathroom, signs or smells of vomiting,
presence of laxatives or diuretics
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Excessive, rigid exercise
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Unusual swelling of cheeks or jaws
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Discoloration of teeth
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Withdrawal from friends and usual
activities
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Calluses on back of hand (Russell’s sign)
Health Consequences/Physical Findings:
Bulimia
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Binge-and-purge can damage the entire
digestive system
Purging can lead to electrolyte and
chemical imbalances in the body that can
affect the heart and other major organ
functions
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Irregular heartbeats, heart failure,
and even death
Tooth decay and staining from stomach
acids being released when vomiting
Chronic irregular bowel movements and
constipation as a result of laxative abuse
Photo: http://commons.wikimedia.org/wiki/File:Oral_manifestation_of_Bulimia..jpg
Tests for Anorexia and Bulimia
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The Practice Guideline for the Treatment of Patients With Eating Disorders, Third Edition, does not recommend specific
test for diagnosis. Laboratory blood tests will likely be abnormal, but will normalize as the patient condition begins to
improve.3
The following are recommended for overall health screening:
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Blood chemistry studies (including electrolytes, BUN, creatinine, TSH)
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CBC with differential
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Erythrocyte sedimentation rate
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UA
For severely malnourished or symptomatic patients:
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Blood chemistry (Ca, Mg, Phos, ferritin)
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ECG
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24-hour urine for creatinine clearance
For amenorrheic for >6 months
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Dual-energy x-ray absorptiometry
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Serum estradiol in female patients
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Serum testosterone in male patients
DSM-IV Diagnostic Criteria for Anorexia Nervosa and
Bulimia Nervosa6
ANOREXIA NERVOSA (307.1)
BULIMIA NERVOSA (307.51)
1. Refusal to maintain body weight at or above a minimally normal weight
1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both
for age and height (e.g., weight loss leading to maintenance of body
weight less than 85% of that expected; or failure to make expected
weight gain during period of growth, leading to body weight less than
85% of that expected).
2. Intense fear of gaining weight or becoming fat, even though
underweight.
3. Disturbance in the way in which one's body weight or shape is
experienced, undue influence of body weight or shape on selfevaluation, or denial of the seriousness of the current low body weight.
4. In postmenarcheal females, amenorrhea (i.e., the absence of at least
three consecutive menstrual cycles).
Specific Type:
Restricting Type: During the current episode of anorexia nervosa,the
person has not regularly engaged in binge-eating or purging behavior
(i.e., self-induced vomiting or the misuse of laxatives,diuretics, or
enemas).
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)
(Massey-Stokes, 2000)
of the following:( A) eating, in a discrete period of time (e.g., within any two-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;and (B) 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).
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such
as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting;
or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at
least twice a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight. 5. The disturbance does
not occur during episodes of anorexia nervosa.
Specific Type:
Purging Type: During The current episode of bulimia nervosa, the person has regularly
engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Non Purging Type: During The current episode of bulimia nervosa, the person has used
other compensatory behaviors, such as fasting or excessive exercise, but has not
engaged in self-induced vomiting or the misuse of laxatives,diuretics,or enemas.
Treatment
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Bulimia:
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Anorexia:
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Therapy needs to be integrated because
these individual have a negative body
image and poor self esteem
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Underlying psychological, interpersonal,
and cultural forces that are contributing
need to be addressed
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Addressing the underlying issues related to
bulimia along with psychotherapy methods
can dramatically improve recovery
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Psychologist, psychiatrist, social worker,
nutritionist, and medical doctor all need to
work together in providing care.
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Need to break the binge-purge cycle and
restore normal eating
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Physical therapy to improve de-conditioned
state
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Change irrational beliefs about weight,
body shape, and dieting
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Need to heal from emotional issues that
may have caused the eating disorder
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Dental treatment to repair/restore damage
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Physical therapy to improve deconditioned state
Referral & Follow up
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For eating disorders patient should be referred to psychotherapy or
psychological counseling, coupled with careful attention to medical and
nutrition needs as soon as possible for best outcomes.
Dental referral is indicated for bulimia patients.
Physical therapy for deconditioned patients
Patient must be continually monitored by family and health care
professional throughout treatment for relapse or issues that would hinder
further progression.
Other resources that may be beneficial for patients with eating disorders
are group therapy sessions along with antidepressants.
Who is Affect by Eating Disorders?
There is NO Discrimination:
Eating Disorders affect every
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Age
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Anorexia average age of onset: 19 years5
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Age 20-59 have higher rates of bulimia than those >60
Race
Rates are similar across all racial groups
Gender
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Bulimia average age of onset: 20 years5
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No statistically significant lifetime rates for all age groups
An estimated 10-15% of people with anorexia or bulimia are male5
Socio-economic Status
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It has been found that more accultured women have higher eating disorder patterns
Photo: www.examiner.com
Why Teenagers and Young Adults?
According to the Healthy People 2020 adolescents are in a “developmental
transition”.
● Adolescents are very sensitive to environmental influences
○ Family
○ Peer group
○ School
○ Neighborhood
○ Societal cues
“Adolescence is a critical transitional period that includes the biological changes of puberty and
the need to negotiate key developmental tasks, such as increasing independence and normative
experimentation” (Healthy People 2020)
Physical Cues Health Professionals should be
aware of in patients with eating disorders
During an assessment potential Warning Signs are:
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Malnutrition
Interference with pubertal development
Fatigue and dizziness
Inability to concentrate
Unhealthy hair, skin, nails
Less of tooth enamel
Stomach problems
Lowered metabolic rate
Amenorrhea
Undeveloped bones and bone loss
Damage to the esophagus, heart, kidneys, digestive system, colon, and reproductive system
Important Issues for Screening
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There is no laboratory test or imaging study that determines diagnosis.
Screening and diagnosis is based upon behaviors, feelings toward weight and eating, and
physical symptoms.
Families need to be aware that anorexia and bulimia patients work very hard at, and can be very
good at, hiding their illness.
Photos: www.medscape.com
Education is the Key
Education is considered one of the primary vehicles
for prevention 6
Resources
Books:
Agras WS, Apple RF: Overcoming Eating Disorders: A CognitiveBehavioral Treatment for Bulimia Nervosa and Binge-Eating
Disorder. New York, Oxford University Press, 1997
Cash TF: The Body Image Workbook: An 8-Step Program for Learning
to Like Your Looks. Oakland, CA, New Harbinger, 1997
Internet resources for healthcare
professionals:
Academy for Eating Disorders (http://www.aedweb.org)
Goodman LJ, Villapiano M: Eating Disorders: The Journey to Recovery
Workbook.New York, Brunner-Routledge, 2001 (client workbook)
Internet resources for patients, families, and
professionals:
Goodman LJ, Villapiano M: Eating Disorders: Time for Change. Plans,
Strategies, and Worksheets. New York, Brunner-Routledge, 2001
(therapist workbook)
National Eating Disorders Association
(http://www.nationaleatingdisorders.org)
Bulik CM, Taylor N: Runaway Eating: The 8-Point Plan to Conquer
Adult Food and Weight Obsessions. New York, Rodale Books, 2005
Goodman LJ, Villapiano M: Eating Disorders: The Journey to Recovery
Workbook.New York, Brunner-Routledge, 2001 (client workbook)
Lock J, le Grange D: Help Your Teenager Beat an Eating Disorder.
New York, Guilford, 2005
Walsh BT, Cameron VL: If Your Child Has an Eating Disorder: An
Essential Resource for Parents. New York, Guilford, 2005
National Association of Anorexia Nervosa and Associated
Disorders (http://www.anad.org/site/anadweb/)
Eating Disorder Referral and Information Center
(http://www.edreferral.com)
Something Fishy (http://www.something-fishy.org; a wellmonitored advocacy site)
References
1.
Jacquelyn Ekern, MS, LPC. Bulimia nervosa: causes, symptoms, signs, and treatment. Eating Disorder Education and Awareness. 2014.
Available at: http://www.eatingdisorderhope.com/information/bulimia. Accessed February 2014.
2.
National Eating Disorder Association.Anorexia nervosa. Information on Eating Disorders. 2011. Available at:
http://www.nationaleatingdisorders.org/anorexia-nervosa. Accessed February 2014.
Yager, Joel, Michael Devlin, Katherine Halmi, David Herzog, James Mitchell, Pauline Powers, Kathryn Zerbe. “Practice Guidelines for
the Treatment of Eating Disorders, Third Edition”. 2013 Available at:
http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1671334. Accessed February 2014
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Herpertz S, Hagenah U, Vocks S, von Wietersheim, Cuntz U, Zeeck A. The Diagnosis and Treatment of Eating Disorders. Deutsches
Aerzteblatt International [serial online]. October 6, 2011;108(40):678-685. Available from: CINAHL Plus with Full Text, Ipswich, MA.
Accessed February 14, 2014.
5.
National Institutes of Mental Health. Eating Disorders. 2007. Available at: http://www.nimh.nih.gov/health/publications/eatingdisorders/index.shtml. Accessed February 2014
6.
Massey-Stokes, M. S. (2000, Jul.-Aug.). Prevention of Disordered Eating among Adolescents. TheClearingHouse,73(6),335-340.
I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as
cheating or plagiarism. I am aware that as a mamber of the academic community it is my responsibility to turn in all suspected violators of the
Honor Code. I will report to a hearing if summond.
Alison Baumann
Michelle Stauffer
Amber Stanback
February 15, 2014