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Eating Disorders Anorexia and Bulimia: Symptoms, Sequelae, Causes and Strategies Presented by Christopher Haymaker, Ph.D. Northeast Iowa Family Medicine Residency Program October 15, 2014

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Eating Disorder Facts Begins in adolescence Approximately 1% of female adolescents; Lifetime prevalence approaches 5% More common on college campuses More women than men Mortality rate greater than 10%

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Anorexia Criteria (DSM-V) Restriction of energy intake relative to requirements Intense fear of gaining weight or becoming fat Disturbance in body image or self- evaluation based on body image Restricting versus Binge/Purge Severity Specifiers tied to BMI

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Bulimia Criteria (DSM-V) Recurrent episodes of binge eating Inappropriate compensatory behavior Binge/compensatory behavior occurs frequently Self evaluation unduly shaped by bod image and weight Severity specifier based on frequency

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Anorexia Symptoms/Sequelae Depression Anxiety Irritability Obsession with food Low Energy Slower thinking

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Anorexia Sequelae (2) Low Hormone Levels Amenorrhea Protein Loss Dehydration Decrease in Liver Function Heart Problems

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Anorexia Sequelae (3) Electrolyte Imbalance Damaged Hair Thick Body Hair Hematology: Leukopenia, Anemia, thrombocytopenia

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Anorexia Sequelae (4) Heart Damage Failure to Accumulate Bone Mass Osteoporosis Death

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Bulimia Symptoms/Sequelae Electrolyte Abnormalities (Which may have cognitive and physical affects) Scarring of the hand Menstrual Irregularity/Amenorrhea Metabolic Alkalosis Cardiac and Skeletal Myopathy (Ipecac)

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Bulimia Sequelae Metabolic Acidosis (Laxatives) Erosion of Upper GI Laxative Dependence Osteoporosis Potentially Fatal Complications

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The Cycle of Escape Fear of Fat Dieting behavior Result: Escape from Fear (Momentarily) Escape increases fear

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The Cycle of Addictive Brain Chemistry Guilty Feelings about Purging Bad Feelings Eating Activation of Parasympathetic Improved Mood Guilty Feelings about Eating Purging Release of Endorphins

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Inpatient hospitalization from Society for Adolescent Medicine One or more of the following: Sever malnutrition (