1. Eating Disorders Maciej Pilecki MD PhD
Division of Child and Adolescent Psychiatry, Queens University

2. Weight Preoccupation % women in general population

3. Epidemiology Anorexia Nervosa: Prevalence 0.5-1%
Bulimia Nervosa: Prevalence 1-4%
95% FEMALES (10:1)
Most common age of onset: year
Commoner in Developed countries
Cuts across all social classes

4. Anorexia Nervosa: Diagnostic Criteria
Refusal to maintain body weight at or above minimally normal weight for age and height leading to body weight less than 85% of expected (or failure to make expected weight gain at period of growth)
Intense fear of gaining weight or becoming fat, even though underweight
Disturbance in the way in which one’s body weight of shape is experienced, undue influence of body weight shape on self evaluation
In postmenarcheal females, amenorrhoea - at least 3 consecutive cycles

5. BODY MASS INDEX BMI = Weight (kilograms)/ Height 2 (meters)
BMI of < 17.5 = Severely Underweight
BMI of 18.5–17.5 = Underweight BMI of = Normal BMI of = Overweight BMI of = Obese BMI of > 37.0 = Severely Obese

6. Specific subtypes
Restricting type: During present episode not binging or purging (self-induced vomiting ,laxatives, diuretics enemas)
Binging and Purging type: During present episode of AN regularly engaged in binge eating or purging, patients alternate between severe restriction and B/P(unlike in Bulimia)

7. Bulimia: Diagnostic Criteria
Recurrent episodes of binge eating (eating in a discrete period of time, amount of food larger than most people would eat during same period)
Sense of lack of control over eating during this period
Recurrent inappropriate compensatory behavior to prevent weight gain e.g. vomiting and purging
Binging and compensatory behavior both occur at least twice a week for 3mths
Self evaluation unduly based on body shape
Disturbance does not occur exclusively during episodes of AN

8. Eating Disorder not Otherwise Specified
All of the criteria for Anorexia Nervosa are met except the individual has regular menses.
All of the criteria for Anorexia Nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range.
All of the criteria for Bulimia Nervosa are met except binges occur at a frequency of less than twice a week or for a duration of less than 3 months.
An individual of normal body weight who regularly engages in inappropriate compensatory behavior after eating small amounts of food (eg, self-induced vomiting after the consumption of two cookies).
An individual who repeatedly chews and spits out, but does not swallow, large amounts of food.
Binge eating disorder; recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.

11. Girls (and boys) with eating disorders are very different
In therapy we are not looking for etiology of syndromes

14. First time consults in KPDiM, Krakow, Poland

15. In childhood, middle and upper class girls (and boys) are consistently fatter than poorer girls;
At around the time of puberty, the relative level of fatness in the two groups switches; and in adulthood, lower class women are consistently fatter than middle and upper class women.
- Brown Konner 2006

16. Over the course of the twentieth century, when the proportion of American women working as professionals or graduating from college has increased, the standard of bodily attractiveness for women has become less curvaceous and that college women who report that their fathers did not believe them to be very intelligent tend to want to be slim.
- Silverstein 2006

17. Culture
Personality
Biology
Family Relations

18. Autonomy and separation concerns
Maturation fear
Difficulty communicating negative emotions
Perfectionist Personality,
Poor conflict resolution

19. AN: Individual risk factors
Autonomy and separation concerns
Maturation fear
Difficulty communicating negative emotions
Perfectionist Personality,
Poor conflict resolution

20. AN: family predisposing factors
We do not talk about our emotions and - relations
Its difficult to separate from my family because:
I am loyal,
we keep together,
world is a danger place,
they need me,
I do not know how.

21. In bulimic families differences and problems are being expressed in the stormy and opened way

22. AN: treatment Force Feeding can save live but is not a treatment
Family therapy is a treatment of choice in a case of children, adolescents and young adults living with their families

23. BN: Treatment CBT is a treatment of choice
Pharmacological treatment is sometimes useful

24. AN: Prognosis Full Recovery 30-40%
Improved but continue to restrict 25%
Mortality rate % will die within 20 years
The mortality rate 12 times higher than the death rate of ALL causes of death for females 15 – 24 years old.

25. Symptoms are the chance to change