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![Pica diagnostic criteria
A. Persistent eating of nonnutritive, nonfood substances over a period of at least
1 month.
B. The eating of nonnutritive, nonfood substances is inappropriate to the
developmental level of the individual.
C. The eating behavior is not part of a culturally supported or socially
normative practice.
D. If the eating behavior occurs in the context of another mental disorder
(e.g., intellectual developmental disorder [intellectual disability], autism
spectrum disorder, schizophrenia) or medical condition (including
pregnancy), it is sufficiently severe to warrant additional clinical attention.](https://image.slidesharecdn.com/eatingandfeedingdisorders-220801101009-2c80452c/75/EATING-AND-FEEDING-DISORDERS-pptx-28-2048.jpg)
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Similar to EATING AND FEEDING DISORDERS.pptx
EATING AND FEEDING DISORDERS.pptx
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- 3. General warning signs Preoccupied with food, eating and dieting Compulsive exercising Negative thoughts about self esp. body image Social withdrawal Difficult in tolerating cold Weight leading to cessation of menses in women
- 4. Anorexia nervosa Anorexiameans prolonged loss of appetite. Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. The distortion in body image is manifested by the individual’s perception of being “fat” when he or she is obviously underweight or even emaciated (excessively thin). Weight loss is usually accomplished by reduction in food intake and often extensive exercising. Self-induced vomiting and the abuse of laxatives or diuretics also may occur. Age at onset is usually early to late adolescence(14-18 years) and psychosexual development is often delayed. Feeling of depression and anxiety often accompany the disorder.
- 5. continued Weight lossis excessive. For example, the individual may present for healthcare services weighing less than 85 percent of expected weight. Other symptoms include hypothermia, bradycardia, hypotension, edema, lanugo, and a variety of metabolic changes. Amenorrhea (absence of menstruation) usually follows weight loss, but sometimes it happens early on in the disorder, even before severe weight loss has occurred. Individuals with anorexia nervosa may be obsessed with food. For example, they may hoard or conceal food, talk about food and recipes at great length, or prepare elaborate meals for others, only to restrict themselves to a limited amount of low-calorie food intake. Compulsive behaviors, such as hand washing, may also be present.
- 6. Types Restrictive: Nobinge eating or purging behavior Binge eating/purging: binge eating or purging(induce-vomiting, use laxative, diuretics or enemas).
- 7. Clinical presentation Extremewt loss: BMI ≤ 17.5 or ≤ 85% of expected wt for children Bradycardia, reduced basal metabolic rate, anaemia, hypothermia, hypotension Suppressed immunity, electrolyte imbalance, Lanugo hair, damage to teeth/esophagus Cardiac arrhythmias due to potassium loss low threshold to cold Personality traits: Inflexible, rigid and stubborn
- 8. Diagnostic Criteria forAnorexia Nervosa A. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
- 9. Management- biopsychosocial model Severe cases: hospitalization to focus on malnutrition and electrolyte balance for ≤ 75 % body weight. Pharmacotherapy: SSRIs, Anxiolytics for accompanying depressive, anxiety symptoms. Psychological interventions: Individual therapy, CBT, group therapy, CBT: cognitive distortions of body image Social interventions: Family and friends social support
- 10. Bulimia Nervosa Bulimiameans Excessive, insatiable appetite. Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (binging), followed by inappropriate compensatory behaviors to rid the body of the excess calories. The food consumed during a binge often has a high caloric content, a sweet taste, and a soft or smooth texture that can be eaten rapidly, sometimes even without being chewed. The binging episodes often occur in secret and are usually only terminated by abdominal discomfort, sleep, social interruption, or self-induced vomiting. Although the eating binges may bring pleasure while they are occurring, self- degradation and depressed mood commonly follow.
- 11. To ridthe body of the excessive calories, the individual may engage in purging behaviors (self-induced vomiting, or the misuse of laxatives, diuretics, or enemas) or other inappropriate compensatory behaviors, such as fasting or excessive exercise. Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. Gastric acid in the vomitus also contributes to the erosion of tooth enamel. In rare instances, the individual may experience tears in the gastric or esophageal mucosa. Some people with this disorder are subject to mood disorders, anxiety disorders, or substance abuse, most frequently involving central nervous central (CNS) stimulants or alcohol.
- 12. Begins inadolescence/early adult usually in females (15-24yrs) Persons often hide their behaviour/illness Women seek healthcare for GIT or menstrual problems 3 Patterns Binge eating vs normal eating Normal eating vs fasting Binging and fasting Key features are Binge eating within less than 2 hours, Compensate through purging, exercise or use laxative and Secretive about their binging e.g. hide food.
- 13. Types Purging: vomiting, use laxative to ‘remove food’ Non-purging: excessive exercise or fasting to cope with binging Bulimic maintain normal body weight while anorexics are characterized by extreme weight loss.
- 14. Diagnostic Criteria forBulimia Nervosa A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely larger than most individuals would eat during a similar period of time and under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
- 15. Management Biological interventions-If in-patient, restrict available food, Treat any health-related problem such as dental due to vomiting or electrolyte imbalance, Pharmacotherapy such as SSRIs Psychological interventions- Group therapy for social support CBT to boost r self-esteem, modify body image distortions and controlling negative feelings such as anxiety Self-monitoring for precipitating factors Psychoeducation Social interventions- Family therapy for support
- 16. Predisposing Factors Associatedwith Anorexia Nervosa and Bulimia Nervosa Biological Influences- such as genetics, neuroendocrine abnormalities and neurochemical influences. Genetics A hereditary predisposition to eating disorders has been hypothesized on the basis of family histories and an apparent association with other disorders for which the likelihood of genetic influences exists. Neuroendocrine Abnormalities Some speculation has occurred regarding a primary hypothalamic dysfunction in anorexia nervosa. Studies consistent with this theory have revealed elevated cerebrospinal fluid cortisol levels and a possible impairment of dopaminergic regulation in individuals with anorexia nervosa. Neurochemical Influences. Neurochemical influences in bulimia nervosa may be associated with the neurotransmitters serotonin and norepinephrine. This hypothesis has been supported by the positive response these individuals have shown to therapy with the selective serotonin reuptake inhibitors (SSRIs). Some studies have found high levels of endogenous opioids in the spinal fluid of clients with anorexia nervosa, promoting the speculation that these chemicals may contribute to denial of hunger.
- 17. Psychodynamic Influences Psychodynamictheories suggest that eating disorders result from very early and profound disturbances in mother-infant interactions The result is delayed ego development in the child and an unfulfilled sense of separation-individuation.
- 18. Family Influences ConflictAvoidance - In the theory of the family as a system, psychosomatic symptoms, including anorexia nervosa, are reinforced in an effort to avoid spousal conflict. Parents are able to deny marital conflict by defining the sick child as the family problem.
- 19. obesity Obesity isnot classified as a psychiatric disorder in the DSM-5, but because of the strong emotional factors and the potential serious health consequences associated with the condition, it may be considered under “Psychological Factors Affecting Medical Condition.”
- 20. Binge-eating disorder (BED) Obesity is a factor in BED because the individual binges on large amounts of food (as in bulimia nervosa) but does not engage in behaviors to rid the body of the excess calories.
- 21. Diagnostic Criteria forBinge-Eating Disorder A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) B. The binge-eating episodes are associated with 3 (or more) of the following: 1. Eating much more rapidly than normal 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not feeling physically hungry 4. Eating alone because of feeling embarrassed by how much one is eating 5. Feeling disgusted with oneself, depressed, or very guilty after overeating
- 22. C. Marked distressregarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
- 23. Based oncriteria of the World Health Organization, obesity is defined as a BMI of 30.0 or greater. Individuals who are obese often present with hypertension and hyperlipidemia, particularly elevated triglyceride and cholesterol levels. They commonly have hyperglycemia and are at risk for developing diabetes mellitus. Osteoarthritis may be evident because of trauma to weight-bearing joints. Workload on the heart and lungs is increased, often leading to symptoms of angina or respiratory insufficiency.
- 24. Predisposing Factors AssociatedWith Obesity Biological Influences Genetics- heredity is a predisposing factor to obesity. Physiological Factors - Lesions in the appetite and satiety centers in the hypothalamus may contribute to overeating and lead to obesity. Hypothyroidism is a problem that interferes with basal metabolism and may lead to weight gain. Weight gain can also occur in response to the decreased insulin production of diabetes mellitus and the increased cortisone production of Cushing’s disease. Lifestyle Factors On a more basic level, obesity can be viewed as the ingestion of a greater number of calories than are expended. Weight gain occurs when caloric intake exceeds caloric output in terms of basal metabolism and physical activity. Many overweight individuals lead sedentary lifestyles, making it very difficult to burn off calories.
- 25. Psychosocial Influences Thepsychoanalytic view of obesity proposes that obese individuals have unresolved dependency needs and are fixed in the oral stage of psychosexual development. The symptoms of obesity are viewed as depressive equivalents, attempts to regain “lost” or frustrated nurturance and caring. Depression and binge eating are strongly linked.
- 26. Binge-Eating Disorder diagnosticcriteria A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward.
- 27. C. Marked distressregarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
- 28. Pica diagnostic criteria A.Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month. B. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. C. The eating behavior is not part of a culturally supported or socially normative practice. D. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.