1. Module Nine EATING DISORDERS Lesson 1: Anorexia Nervosa (2 training hours) Lesson 2: Bulimia Nervosa (1 training hour) TOTAL TIME: 3 TRAINING HOURS OF 45 MINUTES

2. Lesson 1 ANOREXIA NERVOSA TIME : 90 minutes (2 training hours of 45 minutes)

3. Step 1: Brainstorming (10΄) What do you know about Anorexia Nervosa?

4. Step 2: Theory presentation (10΄) In reality Anorexia Nervosa is not an eating disorder. It is a chronic disorder mainly manifested to young women (10 women to 1 man). It is manifested in 15 women over 100.000 people.. It is usually manifested in wealthy people. In some groups, like fitness instructors, dancers etc. is manifested more often. Many people with this disorder, manifest during their life other mental disorders as well, mainly Depression. It is estimated that 15% of these cases end up to death.

5. Step 3: Slide projection (10΄) Slide 9.1.1: Causal factors of Anorexia Nervosa Psychological Avoidant personality characteristics. Perfectionist personality characteristics (“child’s image”) Disorder in figure’s perception Equalize the slim figure with emotion of value or possibility to control oneself. Retrogression for fear of adult sexuality.

6. Step 3 (continued) Family High percentages of mental disorders in the family. Dominating mother, passive and ineffective father, inflexible family with over involved members and avoidance of conflicts.

7. Step 3 (continued) Cultural Society which considers important being fit Conflict and fluid expectations regarding woman’s role Use of food as communication mean

8. Step 3 (continued) Biological Connection with Depression, as it appears from the manifestation in the same families. Neurochemical disorders (serotonin decrease, hypothalamus abnormalities etc.) which might also be a result of starvation

9. Step 4: Slide projection (15΄) Slide 9.1.2: Clinical manifestation of Anorexia Nervosa The person denies to maintain the appropriate weight regarding its age and height. Is afraid of putting on weight. Cause vomiting after eating. Takes too much exercise. Uses diuretics. Has distorted body image. Absence of menstruation. Might manifest depressive symptoms. In advanced progress states manifest hypothermia, ankle oedema, low heart rate, hypotension, thin and soft hair as a newborn’s, coma, death.

10. Step 5: Exercise (20΄) Leaflet 9.1.1: Exercise Look carefully the therapeutical interventions mentioned used for treating Anorexia Nervosa and point out the specific clinical manifestations for which each one is used.

11. Step 6: Slide projection (15΄) Slide 9.1.3: Therapeutical interventions for Anorexia Nervosa Diagnosis and treatment of physical disturbances Gain of normal weight Eating training Psychotherapy Pharmacotherapy

12. Step 7: Questions and comments (5΄)

13. Step 8: Lesson’s evaluation (5΄)

14. Lesson 2 BULIMIA NERVOSA TIME : 45 minutes (1 training hour of 45 minutes)

15. Step 1: Introduction (5΄)  Bulimia Nervosa, characterized also as “dietetic chaos syndrome”, is a disorder manifested in young girls during adolescence or early adulthood.  About 4% of girls in this age are attacked.  These girls usually have long history of eating difficulties and about one third of these has manifested Anorexia Nervosa in the past.

16. Step 2: Slide projection (10΄) Slide 9.2.1: Clinical manifestations of Bulimia Nervosa Continuous occupation with food Normal weight Recurrent episodes of overeating Causing vomiting after eating Alternative periods of starvation Use of diuretics Intense fear of weight gain

17. Step 3: Discussion (10΄) Which must be the therapeutical interventions in Bulimia Nervosa in your opinion?

18. Step 4: Slide projection (10΄) Slide 9.2.2: Similarities and differences between Anorexia Nervosa and Bulimia Nervosa Similarities Gender: mainly women Age: adolescence or early adulthood History: long lasting eating problems Clinical image: fear of weight gain, causing vomiting, use of diuretics Etiology: multifactor (psychological, family, cultural, biological factors) Therapeutical treatment: versatile (Cognitive, Behavioral, Family therapy, Eating training, Antidepressants)

19. Step 4 (continued) Differences Age: BN later than AN Rate of incidence: BN more frequent than AN Clinical image: AN : distorted image of oneself, AN : many physical distortions, BN: normal weight, BN: overeating episodes Therapeutical treatment: AN: hospitalization often required, AN: Chlorpromazine Expectations (prognosis) : AN: 15% death from complications BN: much better, but often subsides

20. Step 5: Questions and comments (5΄)

21. Step 6: Lesson’s evaluation (5΄)