1. Eating Disorders

2. Prevalence Individuals with eating disorders are often in severe psychic pain which can result in hospitalization or death Estimated lifetime prevalence of anorexia nervosa among women ranged from 0.5 to 3.7% Lifetime prevalence among women for bulimia nervosa ranged from 1.1 to 4.2%

3. Prevalence Disorder is more common in females and estimates of male female ratios range from 1:6 to 1:10. –Within the younger population 19 to 30% are males African American women were found overall to have the same incidence of eating disordered behaviour as Caucasian women (pattern related to fasting or abusing diuretics or laxatives)

4. Prevalence Overall worldwide increase in eating disorders, especially within cultures where it was previously rarely seen (i.e. Chinese women in Hong Kong & Australia and adolescents in Iran. Female athletes especially those in sports that emphasize thinness such as gymnastics, ballet dancing, figure sakting, and running have demonstrated and increase in eating disorders There is a high rate of anorexia nervosa among male body builders

5. Comorbidity Incidence of comorbid psychiatric illness is high in eating disorder patients who seek treatment. Major depressive disorder or dysthymia is diagnosed in 50-75% of patients with anorexia nervosa and bulimia nervosa Bipolar disorder is found in 4-6%, some report as high as 13%

6. Comorbidity Incidence of OCD reported as high as 25% and is common among patients with bulimia nervosa Anxiety disorders especially social phobia are common Substance abuse found in as many as 30- 37% of those with bulimia and 12-18% of those with anorexia

7. Comorbidity Pattern of comorbidity for psychiatric illness was noted to be the same in men as in women Homosexuality/bisexuality was notes as a specific risk factor for males especially those diagnosed with bulimia Sexual abuse has been reported in 20- 50% of people with bulimia and anorexia

8. Comorbidity Anorexia nervosa carries a significant risk of death and suicide Features associated with a fatal outcome are longer duration of illness, binge eating & purging, comorbid substance abuse, and affective disorders

9. Theories Neurobiological / Neuroendocrine interactions Psychological Interactions Sociocultural models Biopsychosocial models –Important in this theory is the experienced event of dieting. The perception of being overweight is the most immidiate cause for dieting that predisposed and individual to an eating disorder

10. Assessment Anorexia and bulimia nervosa are two separate syndromes and present two clinical pictures on assessment (table 17.1, page 415)

11. DSM-IV-TR criteria for eating disorders (page 419) Criteria for hospital admission for clients with an eating disorder (page 417)

12. Fundamental to all care for individuals with eating disorders is the establishment of a caring and trusting relationship

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