1. Eating disorders Katalin Tolvay MD. DEOEC English Program

2. Epidemiology Prevalence of obesity is at least 40% Prevalence of AN: 1% Prevalence of BN: 3% Prevalence of subclinical eating disorders among students is up to 50%! Mortality of AN: 6-8% Frequency increasing Changing clinical picture, new types

3. Aethiology Psychosomatic disorders – bio-psycho- social approach Predisposing, precipitating and maintaining factors

4. Aethiology Predisposing factors – individual, family- related and society-related Precipitating factors – stress, life events Maintaining factors – environmental reinforcement, consequences

5. Theories 1.Biological 2.Psychoanalytic 3.Family dynamic 4.Cognitive – behavioral 5.Feminism 6.Sociocultural 7.Depression 8.Addiction 9.OCD 10.Stress-reduction 11.Dissociative hypothesis

6. 1.Biological hypothesis Glucostatic model (insulin, glucagon) Lipostatic model (leptin) Orexigenic and anorexigenic agents 2. Psychoanalytic hypothesis Oral and anal regression Sexual trauma 3. Family dynamic Pathological balance in the family structure and communication

7. 4. CBT hypothesis Cognitive dystorsions, attitudes, pathological learning, environmental reinforcement 5. Feminist hypothesis Change in the gender roles 6. Socio-cultural hypothesis Beauty-ideal in the media Risk groups

8. 7. Depression hypothesis High comorbidity, positive family history AD-s may be effective Increased suicudal rate, seasonal changes 8. Addiction model High comorbidity, positive family history Controll-loss 9. OCD hypothesis High comorbidity, positive family history Obsessive features

9. 10. Stress-reduction High anxiety rate Vomiting as anxiety reducing technique in BN 11. Dissociative hypothesis Trans-state MPD, dissociative symptoms

10. Anorexia nervosa Body weight less than 85% of that expected Intense fear of gaining weight (weight phobia) Pathological self-experience of body (body dysmorphia) Amenorrhea 1.Restricting type 2.Purging type

11. Bulimia nervosa Recurrent episodes of binge-eating Compensatory behavior in order to prevent weight gain At least twice a week for 3 months. Increased involvement in body shape and weight

12. Treatment options Complex, integrative approach Somatic treatments Pharmacotherapies Psychoanalitycally oriented therapies CBT Family therapy Group therapy Hypnosis