ARION PROJECT INTERNATIONAL MEETING GROTTAMMARE 2007,21-25th MAY

EATING DISORDERS (ED): HOW TO INFORM AND TO TRAIN TEACHERS, IN ORDER TO DETECT AND PREVENT TEEN AGERS DISCOMFORT Emilio Franzoni Child Neurology and Psychiatry Regional Center for Eating Disorders in child and adolescence S. Orsola-Malpighi Hospital Bologna University Italy

Tell me how you eat and I’ll tell you who are you I am nervous, anxious, so I don’t eat (my stomach is closed) I am nervous, anxious, so I eat continuosly

Eating Disorders (ED) are mainly classified as : Anorexia Nervosa (AN) Bulimia Nervosa (BN) Obesity Others ED ED are a complex pathology charactherized by psychological, biological and social components

The real estimate of the of the phenomenon diffusion is not clear, but we know that the more frequent age of onset is between years. AN starts mainly between 13-17, whilst BN is Any adolescent, sooner or later, may shows anorexic behaviour. However this is not always illness.

The distribution over population involves 90% of females and 10% of males. Recently the percentage, in males, has increased from 5 to 10%. However, ED also involve children and pre-adolescents with different mechanisms and clinical features. In particular 25% of children with normal mental and motor development and 35% of children with developmental problems, may present an eating difficulty. A genetic predisposition facilitated by environmental factors can lead to the true illness.

Statistics About Anorexia Nervosa : Between 0.5-1% of American women suffer from anorexia nervosa. Anorexia nervosa is one of the most common psychiatric diagnoses in young women (Hsu, 1996). Between 5-20% of individuals struggling with anorexia nervosa will die. The probabilities of death increases within that range depending on the length of the condition (Zerbe, 1995). Anorexia nervosa has one of the highest death rates of any mental health condition. Anorexia nervosa typically appears in early to mid- adolescence.

Eating Disorders Anorexia Nervosa (AN) is a severe, life-threatening disorder in which the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant distortion in the perception of the shape or size of his body, as well as dissatisfaction with his body shape and size. Bulimia nervosa (BN) is a severe, life-threatening disorder characterized by recurrent episodes of binge eating followed by self- induced vomiting or other purging methods (e.g. laxatives, diuretics, excessive exercise, fasting) in an attempt to avoid weight gain. Binge Eating (BE) disorder is a severe, life-threatening disorder characterized by recurrent episodes of compulsive overeating or binge eating. In binge eating disorder without purging

Warning Signs of Anorexia Nervosa: Dramatic weight loss. Preoccupation with weight, food, calories, fat grams, and dieting. Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.). Frequent comments about feeling “fat” or overweight despite weight loss. Anxiety about gaining weight or being “fat.” Denial of hunger. Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).

Consistent excuses to avoid mealtimes or situations involving food. Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury--the need to “burn off” calories taken in. Withdrawal from usual friends and activities. In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns. Anorexia nervosa involves self-starvation. The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences.

Bulimia Nervosa has three primary symptoms: Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior. Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise. Extreme concern with body weight and shape. Eating disorder specialists believe that the chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Health Consequences of ED: Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower. Reduction of bone density (osteoporosis), which results in dry, brittle bones. Muscle loss and weakness. Severe dehydration, which can result in kidney failure. Fainting, fatigue, and overall weakness. Dry hair and skin, hair loss is common. Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

The treatment of ED is based on medical and psychological intervention. We know that, at the beginning of the illness, it is very difficult to convince a person who suffers from ED, to realise that he needs a help. On the other hand, we also know that the sooner we intervene the better is the prognosis after the treatment.

Sometimes, in particular when a profound depression and/or psychotic symptoms are associated, a pharmachologycal therapy can be useful. In addition a nutritional approach must be done that becames necessary when the Body Max Index (BMI) is too low or too high (normal values 18-24)

ED represent just a part of a wider discomfort that, to day, is evident not only in teen agers, but also in adults. We really don’t know why in the last 20 years a large diffusion of such a disorder has been happened. Drugs, addiction, ED, depression (and suicides), bullyng, delinquency(even murders) are the most frequent behaviours. We cannot produce a specific solution to each type of discomfort and we must find a common strategy to connect the whole world of young people.

What is Eating Disorders Prevention? Prevention is any systematic attempt to change the circumstances that promote, initiate, sustain, or intensify problems like eating disorders. Primary prevention refers to programs or efforts that are designed to prevent the occurrence of eating disorders before they begin. Primary prevention is intended to help promote healthy development. Secondary prevention (sometimes called "targeted prevention") refers to programs or efforts that are designed to promote the early identification of an eating disorder---to recognize and treat an eating disorder before it spirals out of control. The earlier an eating disorder is discovered and addressed, the better the chance for recovery.

Basic Principles for the Prevention of Eating Disorders Eating disorders are serious and complex problems. We need to be careful to avoid thinking of them in simplistic terms, like "anorexia is just a plea for attention," or "bulimia is just an addiction to food." Eating disorders arise from a variety of physical, emotional, social, and familial issues, all of which need to be addressed for effective prevention and treatment. Eating disorders are not just a "woman`s problem" or "something for the girls." Males who are preoccupied with shape and weight can also develop eating disorders as well as dangerous shape control practices like steroid use. In addition, males play an important role in prevention. The objectification and other forms of mistreatment of women by others contribute directly to two underlying features of an eating disorder: obsession with appearance and shame about one`s body. disorders, and, when appropriate, receive referrals to sources of competent, specialized care.

Prevention efforts will fail, or worse, inadvertently encourage disordered eating, if they concentrate solely on warning the public about the signs, symptoms, and dangers of eating disorders. Effective prevention programs must also address: Our cultural obsession with slenderness as a physical, psychological, and moral issue. The roles of men and women in our society. The development of people`s self-esteem and self- respect in a variety of areas (school, work, community service, hobbies) that transcend physical appearance. Whenever possible, prevention programs for schools, community organizations, etc., should be coordinated with opportunities for participants to speak confidentially with a trained professional with expertise in the field of eating

Attention and prevention take back the responsability; First of all the educational institutions (family and school) must reflecton the opportunities to rebuilt its educational skills The families delegate too frequently the education of their children to school. School, on its own, is not often prepared to give instruction and education toghether. Which strategies can be used to approach these complexes problems?

At the same time we cannot forget adults who need often help and training either parents (or future) or teachers, in dealing with ED. We must know and we must live as we speake. It is very important for young people to see that you do what you say.

On the other hand we must remember the different educational target of family and school. Family look after the relationship between single person School look after the relationship among the social community

In conclusion: Have we usefull advises? Self-esteeme Listening Respect for the Person (I would like to underline that would only exist the Person and not the Person categories

THANK YOU FOR ATTENTION