EATING DISORDERS

KAVYA P R
MOT 1ST YEAR
SANTHOSH PARAMEDICAL COLLEGE
What are Eating Disorders?
• Eating disorders involve a serious disturbance in eating behaviour -
either eating too much or too little - in addition to great concern over
body size and shape
• Eating disorders are not a function of will but are, rather, unhealthy
eating patterns that “take on a life of their own.” The voluntary eating
of smaller or larger portions of food than usual is common, but for
some people this develops into a compulsion and the eating
behaviours become extreme.
• We all worry about food sometimes, overeat at holidays or skip a
meal. In some people, the worry becomes extreme and they live in
constant fear of food and fat, often struggling to hide eating patterns
they cannot control. When this occurs, an Eating Disorder may result.
Eating Disorders are extreme expressions of a range of weight and
food issues experienced by both men and women. They include
anorexia nervosa, bulimia nervosa, and compulsive overeating. All are
serious emotional problems that can have life-threatening
consequences.
• Technically speaking, the "eating" in eating disorder refers to a set of
eating habits, weight management practices and attitudes about
weight and body shape. The "disorder" means that the eating-related
attitudes and behaviors result in (a) loss of self-control and other
forms of behavioral inefficiency, (b) obsession, anxiety, guilt, and
other forms of misery, (c) alienation from self and others, and (d)
physiological imbalances which are potentially life-threatening.
Symptoms of eating disorder
• These are some of the early signs and symptoms of eating disorders:
you are afraid of putting on weight, or you weigh yourself all the time
 you think about food all the time, or you feel anxious at meal times
 you’ve started restricting how much food you eat
 you overeat uncontrollably
 you feel out of control around food
 you hoard food to binge on later
 you make yourself vomit after eating
 you take laxatives to make you lose weight
 you worry too much about how you look
 you check yourself in the mirror constantly
 you don’t like eating around other people
 you have started to lie about what you eat or
 how much you eat
 you exercise too much
you feel cold all the time, weak or light headed
 for girls and women, your periods have stopped, or have not begun
by age 16
Anorexia Nervosa
• The defining features of this disorder are
(a) an intense and irrational fear of body fat and weight gain
(b) an iron determination to become thinner and thinner
(c) a misperception of bodyweight and shape to the extent that the
person may feel or see "fat" even when emaciation is clear to others.
These psychological characteristics contribute to drastic weight loss and
defiant refusal to maintain a healthy weight for height and age. Food,
calories, weight, and weight management dominate the person's life,
and woe to anyone who tries to disrupt this private system.
• The symptoms of anorexia nervosa include:
Refusal to maintain weight at or above a minimally normal weight for
height and age
Intense fear of gaining weight or becoming fat
Distorted body image
In females, loss of three consecutive menstrual periods
Extreme concern with body weight and shape
• Anorexia nervosa most often starts at around age 15–19 years but it
can occur at any age, including in childhood. About 1% of women and
less than 0.5% of men will experience anorexia nervosa during their
life.
Bulimia Nervosa
• This disorder is characterized by self-perpetuating and self-defeating
cycles of binge-eating and purging. During a "binge," the person
consumes a large amount of food in a rapid, automatic, and helpless
fashion. This may anesthetize hunger, anger, and other feelings, but it
eventually creates physical discomfort and anxiety about weight gain.
Thus, the person "purges" the food eaten, usually by inducing
vomiting and by resorting to some combination of restrictive dieting,
excessive exercising, laxatives, and diuretics.
• The term nervosa reminds us that people suffering from bulimia are
similar to those with anorexia nervosa. Both may have a distorted
body image, an intense fear of fat, and the conviction that a slender
body shape is absolutely crucial for self-acceptance.
The symptoms of bulimia nervosa include:
Repeated episodes of bingeing and purging
Feeling out of control during a binge
Purging after a binge (vomiting, use of laxatives, diet pills, diuretics,
excessive exercise, fasting)
Frequent dieting
Extreme concern with body weight and shape
• Bulimia nervosa usually starts in the late teenage years or young
adulthood. About 2% of women and 0.5% of men will experience
bulimia nervosa during their life.
Binge Eating Disorder
• A diagnosis of binge eating disorder (BED) is made if the binge eating
is not followed by some compensatory behaviour, such as vomiting,
excessive exercise or laxative abuse. This disorder is often associated
with obesity.
• People with binge eating disorder do not display these behaviours
regularly, so they can either have a normal weight or be overweight,
even obese. Binging and purging can be a symptom of both bulimia
nervosa and anorexia nervosa. However, people with bulimia nervosa
are not extremely underweight like people with anorexia nervosa
• Binge eating disorder usually starts in the late teenage years or young
adulthood. People in mid-life are more likely to develop binge eating
disorder than other eating disorders. Around 3.5% of women and 2%
of men will experience the condition during their life
Other Eating Disorders
• A significant number of people with "eating problems" do not quite fit
the criteria for anorexia nervosa and bulimia nervosa. However, there
is substantial disagreement about the nature and labeling of these
"other" eating disorders. Clearly there are some people who abuse
vomiting and/or exercise without bingeing as forms of weight
management, while there are others who indulge in repetitive
episodes of bingeing without purging. Compulsive overeating is
characterized primarily by periods of impulsive gorging or continuous
eating. While there is no purging, there may be sporadic fasts or
repetitive diets. Body weight may vary from normal to mild,
moderate, or severe obesity
What Causes Eating Disorders?
• Eating disorders arise from a combination of long-standing
psychological, interpersonal, and social conditions. Feelings of
inadequacy, depression, anxiety, and loneliness, as well as troubled
family and personal relationships, may contribute the development of
an eating disorder. Our culture, with its unrelenting idealization of
thinness and the "perfect body," is often a contributing factor.
• Once started, eating disorders may become self-perpetuating. Dieting,
bingeing, and purging help some people to cope with painful
emotions and to feel as if they are in control of their lives. Yet, at the
same time, these behaviors undermine physical health, self-esteem,
and a sense of competence and control.
What are the Warning Signs?
• A marked increase or decrease in weight not related to a medical
condition
• The development of abnormal eating habits such as severe dieting,
preference for strange foods, withdrawn or ritualized behavior at
mealtime, or secretive bingeing
• An intense preoccupation with weight and body image
• Compulsive or excessive exercising
• Self-induced vomiting, periods of fasting, or laxative, diet pill, or diuretic
abuse
• Feelings of isolation, depression, or irritability
Psychological treatment
• family therapy (family members work together as a team to directly
manage a child’s behaviour)
• cognitive behavioural therapy (works by teaching you to recognise
your negative thoughts and beliefs and to challenge them, so that you
can change your behaviour)
• interpersonal psychotherapy (focuses on the link between when and
how your symptoms started and on problems you have relating to
other people)
• psychodynamic psychotherapy (focuses on uncovering what’s on your
mind that you are notnormally aware of).
OT MANAGEMET FOR EATING
DISORDER
• ASSESSMENT
• EDDS [eating disorder diagnostic scale]
• INTERVENTION
• Family therapy
• Cognitive behavioral therapy
• Psycho therapy
• Teaching behavioral strategies
• Video therapy
• Shopping for clothes
EATING DISORDER DIAGNOSTIC
SCALE[EDDS]
✓ 22 questions to screen for eating disorders. Self report scale for adolescent and
adults[13-65]
1. Over the past 3months have you felt fat? o Not at all/ between not at all and slightly/
slightly/between slightly and moderately/moderately/between moderately and
extremely/extremely.
2. Over the past 3 months have you had a definite fear that you might gain weight or
become fat?
• Not at all/ between not at all and slightly/slightly/ between slightly and
moderately/moderately/between moderately and extremely/ extremely
3.Over the past 3months has your weight influenced how you think about [judge] yourself
as a person?
• Not at all/ between not at all and slightly/slightly/between slightly and
moderately/moderately/between moderately and extremely/extremely
4.Over the past 3month has your shape influenced how you think about[judge]
yourself as a person?
• Not at all/ between not at all and slightly/slightly/ between slightly and
moderately/ moderately/between moderately and extremely/ extremely
5.During the past 6 moth have there been times when you felt you have eaten
what other people would regard as a unusually large amount of food given the
circumstances?
• Yes/no
6.During the time when you ate an usually large amount of food did you
experience a loss of control? ◦
• Yes/no
7. How many days per week on average over the past 6 months have you eaten an
unusually large amount of food and experienced a loss of control? Number 0-7days
◦
• Unanswered/days
8.How many times per week on average over the past 3months have
you eaten an unusually large amount of food and experienced a loss of
control?
• Unanswered/times
9. During these episodes of overeating and loss of control did you eat
much more rapidly than normal?
• Yes/no
10. During these episodes of overeating and loss of control did you eat
until you felt uncomfortably?
• Yes/no
11.During these episode of overeating and loss of control and did you
eat large amount food when you didn’t fell physically hungry?
• Yes/no
12.During these episode of overeating and loss of control did you eat
alone because you were embarrassed by how much you were eating?
• Yes/no
13. During these episodes of overeating and loss of control did you feel
disgusted with yourself, depressed, or very guilty after overeating?
Yes/no
14. During these episode of overeating and loss of control did you feel
very upset about uncontrollable overeating or resulting weight gain?
• Yes/no
15. How many times per week on average over the past 3 months have
you made yourself vomit to prevent weight gain or counteract the effects
of eating?
• Unanswered /times
16. How many times per week on average over the past 3months have
you used laxatives or diuretics to prevent weight gain or counteract the
effects of eating?
• Unanswered /times
17. How many times per week on average over the past 3months have
you fasted to prevent weight gain or counteract the effects of eating?
• Unanswered/times
18. How many times per week on average over the past 3months have
you engaged in excessive exercise specifically to counteract the effects of
overeating episode?
• Unanswered/times
19. How much do you weight?
• Unanswered/ kilogram
20. How tall are you?
• Unanswered/ centimeters
21. Over the past 3months how many menstrual periods have you
missed?
• Unanswered/times
22. Have you been taking birth control pills during the past 3 months?
• Yes/no
PSYCHOLOGICAL THERAPY
• Normalize your eating patterns and achieve a healthy weight
• Exchange unhealthy habits for healthy ones
• Learn how to monitor your eating and your moods.
• Develop problem solving skills.
• Explore healthy ways to cope with stressful situations.
• Improve your relationships
• Improve your mood
COGNITIVE BEHAVIOURAL THERAPY
• It focuses o behaviors, thoughts, and feelings related to your eating
disorder
• It helps to learn recognize and change distorted thoughts
• Focuses on questioning society standard for physical attractiveness,
challenging beliefs
• That encourage severe food restriction and developing normal eating
pattern.
• Self monitoring [food diaries, regular weight]
• Cognitive restructuring dysfunctional thoughts to functional thoughts
FAMILY THERAPY
• Engage the entire family to known about eating disorder. It is
especially useful for parents learning.
• Control over food.
• The decision is gradually handed back to child/adolescent.
• Help patient and his or her family navigate a return to normal
trajectory of adolescent development
• ASSERTIVENESS SKILLS :
➢ Patient with bulimia nervosa are also taught assertiveness skills to help
them cope with unreasonable demands placed on them other.

PSYCHOEDUCATIONAL APPROACH :
➢ The focus is on educating children and adolescents about eating disorder
to prevent them from developing the symptom.

COPING SKILLS :
➢ Distraction- taking your mid off the problem for a while RELAXATION

TECHNIQUE
: ➢ To control the urge to induce vomiting.
THANK YOU