1. CHAPTER 7 EATING DISORDERS *Etiology 1.Biologic factors: -There is a connection b/w eating disorders & depression. -A biological tendency to be overweight may increase the likelihood of body dissatisfaction & dieting behavior, which along with other factors may trigger eating disorder to develop 2.Socio-cultural factors: -Diet &fitness industry -Fashion industry -Women’s movement -Developmental peer pressure

2. 3. Psychological factors: Personality traits common among those with eating disorders include the following: -Perfectionism -Social insecurity -Affective instability rapidly fluctuating moods -Interceptive deficits inability to correctly identify a respond to bodily sensations -Immaturity -Compliance -A sense of ineffectiveness in dealing with the world -Low self-esteem

3. 4-Familial factors -Enmeshment -Poor conflict resolution -Separation / individuation issues -Some incidence of alcoholism or physical or sexual abuse

4. *Epidemiology for Eating Disorder -Average age(s) of onset is 14-18 years for anorexia nervosa, 18 years for bulimia nervosa. -95%-99% of clients are female -Mortality rates for bulimia nervosa are from 0%-19%, for anorexia nervosa, from 6%-20 % -Eating disorders are very rare in undeveloped countries

5. 1. Anorexia Nervosa *Clinical Sx 1.Behavioral Sx -Self-starvation (reported intake restriction & refusal to eat). -Ritual or compulsive behaviors regarding food, eating, & / or wt. loss. -May engage in self-induced vomiting, laxatives, diuretics, or excessive exercise to lose wt.

6. 2.Physical symptoms -Wt. loss 15 % below ideal wt. -Amenorrhea–Absence of 3 or > menstrual cycles when expected to occur -Slow pulse, decreased body temp -Cachexia (L), sunken eyes, protruding bones, dry skin -Growth of lanugo on face -Constipation

7. 3.Psychological sx -Denial of seriousness of current low wt. -Body image disturbance, claiming to see self as fat when emaciated or to experience parts of body such as stomach, buttocks, hips & thighs as unrealistically large. -Intense & irrational fear of wt. gain that does not diminish as wt. is lost. -Constant striving for “perfect” body. -Self-concept unduly influenced by shape & wt. -Preoccupation with food, cooking, nutritional in formation, feeding others. -May exhibit delayed psychosexual development or lack age-appropriate interest in sex relations.

8. Rx -Complete physical examination especially in critical conditions. -Rx aims to correct nutritional condition as normal as possible because of danger of death. -Admissionin moderate-severe conditions which gives appropriate environment to gain wt. 1-Drugs: -No drugs given unless there is a need to as pt. is depressed will be given anti-depression & if psychotic sx appear anti-psychotic will be given.

9. 2-Psychotherapy: -Pt. is encouraged to express his anger & fear (It is noticed that pt. is using defense mechanism: denial so therapist should move him to condition of insight to continue Rx). 3-Family psychotherapy: -Pt.’s family should recognize that this disorder includes all family members & every one should be aware of nature of communication among family members & their participation in helping other members. 4-ECT: -Especially when there is depression ECT has quick effect to decrease it & to improve condition of pt.’s condition.

10. **When performing Rx the following should be noticed: -Usually pt. vomits after eating so it is important to make him away from bathroom for 2 hour after eating. -Weigh pt. daily–weekly according to his condition & some measures should be taken into consideration when weighing pt.: -Empty bladder. -Do not give him food or drink much water. -Be sure he has no heavy thing in his pockets or wearing heavy clothes. -If pt. continues loosing wt. therapist should discuss that clearly with him & tells him that if he doesn0’t gain wt. about 1½ Kg weekly therapist will feed him by nasogastric tube. -About 75% of pts. improve by Rx but the rest either having another episodes or die or suicide.

11. 2. Bulimia Nervosa *Clinical sx 1.Behavioral sx -Recurrent episodes of binge eating rapid consumption of a large amount of food in a discrete period of time. -Engages in purging behavior such as self- induced vomiting, use of laxatives, diuretics, diet pills, enemas, excessive exercise or periods of fasting to compensate for the binge.

12. 2.Physical sx -May experience fluid electrolyte imbalance as from purging. -Hypokalemia, alkalosis, dehydration. -Cardiovascular: Hypotension, dysrhythmia, cardiomyopathy. -Endocrine: May experience menstrual dysfunction. -Gastrointestinal: Constipation, diarrhea, gastroparesis (delayed gastric emptying), esophageal reflux, esophagitis. -Dental: Enamel erosion -Parotid gland enlargement

13. 3.Psychological sx -Body image disturbance, seeing self as unrealistically fat when at or near ideal wt. or experiencing parts of body as unrealistically fat or out of proportion. -Persistent over concern with wt., shape, proportions. -Constant striving “perfect” body. -Self-concept unduly influenced by body wt. shape.

14. Rx -Long-term psychotherapy is used to get good results with modifying behavior by positive support for eating & extinction binge behavior.