Ed 2014

Ed 2014

• 1.
  Jacqueline Corcoran, Ph.D. http://www.jacquelinecorcoran.com/ From:Mental Health in Social Work (Pearson, 2014, DSM 5 Update) Eating Disorders
• 2.
  Feeding Disorders Pica Rumination Restrictive FoodIntake Eating Disorders Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge Eating D/O
• 3.
  Underweight Distortions of weightand shape Achieved through: Restrictive Eating Over-exercise Binge-eating and purging 2 subtypes Restricting Binge-eating/purging Relax criteria by dropping cessation of menstruation requirement
• 4.
  pathological fear ofbecoming overweight Bingeing Purging behaviors self-induced vomiting misuse of medications Nonpurging type also: fasting or excessive exercise Binge eating & compensatory behaviors at least 1 per wk for 3 mos.
• 5.
  chronic, episodic overeating Despiteits recent inclusion, binge eating disorder is more common than either AN or BN
• 6.
  Prevalence Recent Australian studyof adolescents with DSM 5: Eating Disorder prevalence at different points: age 14 was 8.2% 17 had risen to 15.8% Binge eating and bulimia most common diagnoses Bulimia has increased 2nd half of 20th century Prevalence
• 7.
  1.5% of theU.S. female population .5% of the male population life-time prevalence of bulimia nervosa is 1% of the population.
• 8.
  .9% of femalesand .3% of men lifetime prevalence is .6% of the U.S. population
• 9.
  Comorbidity  three ormore diagnoses is the most common co-morbidity pattern among both anorexia (33.8%) and bulimia (64.4%)  most common co-morbid diagnoses are (in order of occurrence) anxiety disorders,; impulse control disorders (ODD, CD, ADHD, intermittent explosive disorder), and substance use disorders Mood disorders Personality disorders are often present low to 58% of the time
• 10.
  Assessment  A standardclinical interview  Questionnaires eating disorders, body image, etc.  A medical evaluation  routine checkup  assessment of risk due to weight loss and amenorrhea, laboratory  tests of electrolyte imbalances  bulimia, possible referral to a dentist for problems related to enamel erosion  Assessment of comorbid disorders
• 11.
  Biological Heritability Obstetrical complications Early disorderedeating Picky eating Obesity Dieting Adolescent stage
• 12.
  Body dissatisfaction anddistortion Low self-esteem Perfectionism Other psychiatric disorders
• 13.
  Heritability Family transactions Emphasis onweight Abuse Poor bonding Over-protectiveness
• 14.
  Poor social support socialisolation social anxiety public self-consciousness Involvement in activities that promote thinness and low body weight
• 15.
  Mid to highSES Exposure to media
• 16.
  Goals 1) Reduce bodyimage dissatisfaction and distorted attitudes about food, shape, and weight 2) Reduction or elimination of binge-eating and purging behaviors 3) Healthy weight 4) Treating physical complications 5) Enhancing clients’ motivation to participate in treatment and cooperate in the restoration of healthy eating patterns
• 17.
  Goals, cont. 7) Providingeducation on nutrition and healthy eating patterns, including minimization of food restriction and increasing the variety of foods eaten 8) Encouraging healthy but not excessive exercise patterns 9) Correcting core maladaptive thoughts, attitudes, and feelings related to the eating disorder 10) Treating comorbid disorders
• 18.
  Goals, cont.  Addressingthemes that may underlie eating disorder behaviors, such as developmental conflicts, identity formation, body image concerns, self-esteem in areas unrelated to weight and shape, sexual and aggressive difficulties, mood regulation, gender role expectations, family dysfunction, coping styles, and problem solving  Enlisting family support and providing family counseling and therapy where appropriate  Improving interpersonal and social functioning  Preventing relapse
• 19.
  Hospitalization indications  Seriousphysical complications, including malnutrition, dehydration, electrolyte disturbances, cardiac dysrhythmia, arrested growth  Extremely low body weight  Suicide risk  Lack of response to outpatient treatment  Lack of available outpatient treatment
• 20.
  Hospitalization, cont.  Comorbiddisorders that interfere with outpatient treatment (e.g., severe depression, obsessive-compulsive disorder)  A need to be separated from the current living situation  Problems with
• 21.
  Intervention  Typically outpatient For AN, family interventions more effective than individual  For BN  CBT (self-monitoring, social skills training, assertiveness training, problem solving, and cognitive restructuring)  interpersonal therapy  medication