1. Rebecca Sposato MS, RN

2. Eating Disorders A collection of psychiatric conditions that manifest psychological illness through abnormal eating habits and body image Includes anorexia nervosa, bulimia nervosa, binge eating, orthorexia nervosa, pica and selective eating disorder (www.nationaleating disorder.org, 2011) http://vimeo.com/user638254/videos /sort:date

3. Statistics Eating disorders are grossly under diagnosed due to the surrounding secretive and resistant habits 90% of cases are female: U.S. prevalence 10 million women and 1 million men 40% of new diagnoses occur in females 15-19 years old Only 1/3 of people with anorexia nervosa and 6% of people with bulimia receive mental health services (www.nationaleating disorder.org, 2011)

4. Eating Disorders Comorbid Diagnoses Borderline Personality Disorder Obsessive Compulsive Disorder and Obsessive Personality Disorder Depression Anxiety Body Dysmorphic Disorder Narcissistic Personality Disorder Addiction and Substance abuse Victim of Abuse or trauma

5. Methods of Eating Disorders Persons with eating disorders may utilize different methods as their illness evolves Calorie reduction Excessive exercise Induced vomiting (mechanical or chemical) Misuse of laxatives, dieting pills, enemas, diuretics Insulin misuse

6. What does 300 calories look like?

7. Anorexia Nervosa Seek to maintain a BMI <18, most often with calorie reduction Ritualistic /analytical eating habits Preoccupation with weight/size and anxiety with weight gain Lifetime prevalence of 1% in women, 90% of cases are female Anorexia nervosa has a mortality rate of 20%, giving it the highest mortality rate of all psychiatric disorders 10% die within 10 years of diagnosis 35% fully recover ( www.state.sc.us/dmh/anorexia/statistics.htm, 2011 )

8. Body Mass index

10. Bulimia Nervosa Engage in compulsory consumption of high calorie foods during binge episodes often followed by purging Cyclic pattern of calorie restraint, excessive intake and purging Binge on high calorie, high sugar and high fat foods Binge-purge twice/week x 3 months per DSM 4 Episodes occur in private, beyond volitional control Usually have a BMI >18 Episodes are often triggered by stressful events and changes (www.womenshealth.gov/faq/bulimia-nervosa.cfm#a, 2011)

12. Pro-Ana, Pro-Mia and Pro-Ed A n eating disorder community who collectively deny the pathology of their habits, defend their condition as a lifestyle choice and maintain extreme thinness as a form of beauty Thinspiration pictures http://www.bukisa.com/articles/381852_45-pro-ana- tips-and-tricks

13. Assessment What would you include in your assessment? Questions? Measurements? Labs? Diagnostics?

14. Medical Treatments Standard: History: height/weight, eating/dieting habits, body image, menstrual habits, stressors/coping Labs: CBC, chem panel, thyroid levels, estrogen, albumin/prealbumin, urinanalysis, ABG Diagnostics: VS, EKG >20% below BMI: chest x-ray, 24hr creatinine clearance, bone density scan, echocardiogram (mitral valve prolapse) EEG, brain imaging (www.nationaleatingdisorders.org/uploads/file/Screening%20for%20Eating%20Disorders%20by%20Pri mary%20Care%20Physicians-2.pdf, 2011)

15. Recovery Team Medical MD, psychiatrist Clinical psychologist/therapist, expressive therapist Social worker, case manager Nurse Dietician Teachers/School Liaison

16. Recovery Environments Hospital Inpatient: Acute physical problems Mental Health Inpatient Facility: unstable psychiatric problems, suicidal Residential Facility: structured living environment Intensive Outpatient: several hours on most weekdays Outpatient: weekly sessions Telehealth: technology and telephone resources (www.eatingdisorderrecovery.com. 2011)

17. Recovery Interventions Tube Feeding – with consent Treat the compounding psychiatric condition Individual counseling, psychotherapy Group Therapy Family Therapy Support Groups Art/Expression Therapy, Culinary/Nutrition Sessions (www.eatingdisorderrecovery.com. 2011)

18. References Eating Disorder Recovery (2011). Retrieved from www.eatingdisorderrecovery.com. National Eating Disorders Association (2011). Retrieved from www.nationaleating disorder.org Women’s Health Information Center (2011) Retrieved from www.womenshealth.gov