Eating Disorders By: Amanda Sensabaugh Hayley Fennessy By: Amanda Sensabaugh Hayley Fennessy

Eating DisordersEating Disorders

By: Amanda Sensabaugh

Hayley Fennessy

By: Amanda Sensabaugh

Hayley Fennessy

Anorexia NervosaAnorexia Nervosa

Psychiatric disorder Characterized by low body weight Body image distortion Obsessive fear of gaining weight Depression Weight loss viewed as a sign of achievement Control Weight by:

Voluntary starvation Purging Excessive exercise Diet pills or diuretic drugs

Psychiatric disorder Characterized by low body weight Body image distortion Obsessive fear of gaining weight Depression Weight loss viewed as a sign of achievement Control Weight by:

Voluntary starvation Purging Excessive exercise Diet pills or diuretic drugs

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Bulimia NervosaBulimia Nervosa

Recurrent binge eating followed by feelings of guilt, depression, and intentional purging to prevent weight gain from occurring.

Purging may consist of: Vomiting Fasting Use of laxatives, enemas, diuretics, or other medication Excessive exercise

Recurrent binge eating followed by feelings of guilt, depression, and intentional purging to prevent weight gain from occurring.

Purging may consist of: Vomiting Fasting Use of laxatives, enemas, diuretics, or other medication Excessive exercise



Bulimia NervosaBulimia Nervosa

Typically within normal weight range, underwt. or overwt.

More open to treatment that AN (tire of binge/purge cycle)

Typically within normal weight range, underwt. or overwt.

More open to treatment that AN (tire of binge/purge cycle)

Binge Eating DisordersBinge Eating Disorders

Binge without the purge Psychiatric disorder Eats a large amount of food at one time-more than

what a normal person would eat at the same time. Eats until physically uncomfortably full Feels depressed or guilty after a binge Eats large amounts of food even if there not really

hungry

Binge without the purge Psychiatric disorder Eats a large amount of food at one time-more than

what a normal person would eat at the same time. Eats until physically uncomfortably full Feels depressed or guilty after a binge Eats large amounts of food even if there not really

hungry



Variations of Eating DisordersVariations of Eating Disorders

Binging/purging AN Restrictive AN Purging BN Non-purging BN EDNOS (eating disorder

Not otherwise specified)

Binging/purging AN Restrictive AN Purging BN Non-purging BN EDNOS (eating disorder

Not otherwise specified)



Purging vs. Non Purging BulimiaPurging vs. Non Purging Bulimia

Purging: over consumption of calories then using laxatives/edemas/excessive exercise to rid calories

Non-Purging: over consumption of calories without ridding them from the body

Purging: over consumption of calories then using laxatives/edemas/excessive exercise to rid calories

Non-Purging: over consumption of calories without ridding them from the body

Medical Consequences of Anorexia Nervosa


Dizziness, confusion Dry, brittle hair Lanugo-type hair Low blood pressure, pulse, ECG voltage Orthostasis Cachexia Biochemical changes

Decreased WBC Decreased glucose Increased cholesterol Increased carotene

Dizziness, confusion Dry, brittle hair Lanugo-type hair Low blood pressure, pulse, ECG voltage Orthostasis Cachexia Biochemical changes

Decreased WBC Decreased glucose Increased cholesterol Increased carotene





Loss of menses Muscle wasting Diminishing DTRs Osteoporosis Dry skin Edema Growth retardation Hypothermia

Loss of menses Muscle wasting Diminishing DTRs Osteoporosis Dry skin Edema Growth retardation Hypothermia





Medical Consequences of Bulimia Nervosa


Salivary gland enlargement Enamel erosion Esophagitis Arrhythmias Normal weight or underweight or overweight Calluses on hands Edema Diarrhea

Salivary gland enlargement Enamel erosion Esophagitis Arrhythmias Normal weight or underweight or overweight Calluses on hands Edema Diarrhea





Biochemical changes Decreased potassium Increased carbon dioxide Increased amylase

Biochemical changes Decreased potassium Increased carbon dioxide Increased amylase



Role of treatmentRole of treatment

Multidisciplinary team Physicians

Check wt. other physical signs/symptoms Electrolyte imbalances Heart arrhythmias May prescribe antidepressants

Multidisciplinary team Physicians

Check wt. other physical signs/symptoms Electrolyte imbalances Heart arrhythmias May prescribe antidepressants



Role of TreatmentRole of Treatment

Registered Dietitians Discuss food intake Exercise and weight related behaviors

Registered Dietitians Discuss food intake Exercise and weight related behaviors



Role of TreatmentRole of Treatment

Psychotherapists Discuss issues leading to disordered eating

patterns.

Psychiatrist Physician that specializes in treating mental

disorders.

Psychotherapists Discuss issues leading to disordered eating

patterns.

Psychiatrist Physician that specializes in treating mental

disorders.

Goals of Treating Disordered EatingGoals of Treating Disordered Eating

Normal eating Eating based on physical signs that is free from fear,

guilt, anxiety, obsessive thinking or behaviors or compensatory behavior.

Improved body image Weight normalization Discontinue extreme behaviors such as bingeing,

purging, starvation Often client exchange one coping tool for another

equally destructive coping tool.

Normal eating Eating based on physical signs that is free from fear,

guilt, anxiety, obsessive thinking or behaviors or compensatory behavior.

Improved body image Weight normalization Discontinue extreme behaviors such as bingeing,

purging, starvation Often client exchange one coping tool for another

equally destructive coping tool.

Prevention Strategies to Reduce Risk of Disordered Eating

Prevention Strategies to Reduce Risk of Disordered Eating

Practice intuitive eating concepts by accepting your body type.

Healthy at every size.

Practice intuitive eating concepts by accepting your body type.

Healthy at every size.





Paris’ DescriptionParis’ Description

34 year old female attorney She experiences a high amount of stress Spent lots of hours at the recreation center

in high school Swam for 1 hr. before classes Walked 3 miles on the indoor track after lunch She did aerobics in the afternoon for 1 hr.

34 year old female attorney She experiences a high amount of stress Spent lots of hours at the recreation center

in high school Swam for 1 hr. before classes Walked 3 miles on the indoor track after lunch She did aerobics in the afternoon for 1 hr.


She learned how to purge using her toothbrush She took OTC laxatives every other day She hasn’t had a menstrual period in over two

years Tried to maintain her weight below 120 lbs. Smokes 1 pack of cigarettes a day Multiple food allergies: all meats, dairy foods,

most desserts

She learned how to purge using her toothbrush She took OTC laxatives every other day She hasn’t had a menstrual period in over two

years Tried to maintain her weight below 120 lbs. Smokes 1 pack of cigarettes a day Multiple food allergies: all meats, dairy foods,

most desserts




She tried to stop restricting her intake of food and purging on her own but once she experienced stress she reverted back to her old coping mechanisms.

She was hospitalized while in law school for a weekend because of severe dehydration but released after 24 hrs.

She tried to stop restricting her intake of food and purging on her own but once she experienced stress she reverted back to her old coping mechanisms.

She was hospitalized while in law school for a weekend because of severe dehydration but released after 24 hrs.


She appears emaciated She appears tired and older than age 34 She loves to cook but gives most of the

food away She admitted that she knows she has a

problem dealing with food and eating

She appears emaciated She appears tired and older than age 34 She loves to cook but gives most of the

food away She admitted that she knows she has a

problem dealing with food and eating

Paris’ AnthropometricsParis’ Anthropometrics

Height: 5’8 Weight: 115 lbs. BMI: 17.48 Interpretation: underweight

Height: 5’8 Weight: 115 lbs. BMI: 17.48 Interpretation: underweight

Basal Energy MetabolismBasal Energy Metabolism

Harris Benedict:655 + (9.6 x 52.8) + (1.8 x 172.72) – (4.7 x 34)=

1313 x activity factor(1.3)= 1707 KCALS

Harris Benedict:655 + (9.6 x 52.8) + (1.8 x 172.72) – (4.7 x 34)=

1313 x activity factor(1.3)= 1707 KCALS

Paris’ 24 Hr. RecallParis’ 24 Hr. Recall

AM: ¼ whole wheat bagel, 4 oz. calcium fortified orange juice, 6 oz black coffee

Lunch: Black coffee 2-3 c Afternoon snack: 12 oz can Diet Coke Dinner: 6 green peas, 18 oz water Snack: 12 oz Diet Coke

AM: ¼ whole wheat bagel, 4 oz. calcium fortified orange juice, 6 oz black coffee

Lunch: Black coffee 2-3 c Afternoon snack: 12 oz can Diet Coke Dinner: 6 green peas, 18 oz water Snack: 12 oz Diet Coke

Nutrition ProblemsNutrition Problems

Rough dry skin with lanugo Bruising Brittle finger/toenails Erosion of dental enamel Multiple food allergies Gastric/abdominal problems Easy Bleeding/anemia

Rough dry skin with lanugo Bruising Brittle finger/toenails Erosion of dental enamel Multiple food allergies Gastric/abdominal problems Easy Bleeding/anemia

Paris’ Lab Value ResultsParis’ Lab Value Results

Low albumin of 3.0 L Low pre-albumin of 14.5 L Low potassium of 3.0 L Low magnesium of 1.7 L High glucose of 115 H High CPK of 146 H High HDL of 60 H Low WBC of 4.6 L

Low albumin of 3.0 L Low pre-albumin of 14.5 L Low potassium of 3.0 L Low magnesium of 1.7 L High glucose of 115 H High CPK of 146 H High HDL of 60 H Low WBC of 4.6 L

Characteristics of Refeeding Syndrome

Characteristics of Refeeding Syndrome

Increases BMR May lead to confusion, coma, convulsions

and death. Caused by introducing food to quickly to a

malnourished person. Prevent refeeding syndrome by slowly

introducing foods in small amounts and advancing as tolerated.

Increases BMR May lead to confusion, coma, convulsions

and death. Caused by introducing food to quickly to a

malnourished person. Prevent refeeding syndrome by slowly

introducing foods in small amounts and advancing as tolerated.

Questions regarding Paris’ purging behaviors

Questions regarding Paris’ purging behaviors

1. What types of food trigger your bingeing/purging episodes?

2. What food rituals do you have?

3. What foods do you consider fear foods?

4. What other behavior could you do when you feel a bingeing/purging episode about to occur?

5. What weight would you consider healthy for yourself?

1. What types of food trigger your bingeing/purging episodes?

2. What food rituals do you have?

3. What foods do you consider fear foods?

4. What other behavior could you do when you feel a bingeing/purging episode about to occur?

5. What weight would you consider healthy for yourself?

DiagnosisDiagnosis

Inadequate energy intake(NI-1.4) related to restricting food and purging as evidenced by her underweight BMI of 17.48.

Inadequate energy intake(NI-1.4) related to restricting food and purging as evidenced by her underweight BMI of 17.48.

InterventionIntervention

Nutrition-Related Behavior Modification Therapy C-1 A supportive process to set priorities, establish goals

and create individualized action plans that acknowledge and foster responsibility for self-care by setting goals for Paris

From Paris’ description and 24 hr. food recall we determined that Paris has anorexia nervosa with binge/purge tendencies.

Nutrition-Related Behavior Modification Therapy C-1 A supportive process to set priorities, establish goals

and create individualized action plans that acknowledge and foster responsibility for self-care by setting goals for Paris

From Paris’ description and 24 hr. food recall we determined that Paris has anorexia nervosa with binge/purge tendencies.

Education InterventionEducation Intervention

Teach Paris the hunger/fullness scale Learn not to classify foods as good versus bad Discuss physical activity in terms of health rather than using it to

control her weight Discuss with her the idea about trusting her body to fluctuate between

a goal range weight for her Gradually increase her caloric intake to prevent refeeding syndrome Teach her to add foods that she considers “safe” into her diet. She

stated she felt “safe foods” were all vegetables and salads.

Although we intend to attempt to try these intervention techniques with Paris, we realize that this may be an extremely slow process and take a very long time depending on how she reacts to treatment.

Teach Paris the hunger/fullness scale Learn not to classify foods as good versus bad Discuss physical activity in terms of health rather than using it to

control her weight Discuss with her the idea about trusting her body to fluctuate between

a goal range weight for her Gradually increase her caloric intake to prevent refeeding syndrome Teach her to add foods that she considers “safe” into her diet. She

stated she felt “safe foods” were all vegetables and salads.

Although we intend to attempt to try these intervention techniques with Paris, we realize that this may be an extremely slow process and take a very long time depending on how she reacts to treatment.

Sample DietSample Diet

2 eggs, 1 C granola, 1 C skim milk 1/2 C grapes 2 oz turkey on 2 slices whole wheat bread, light

mayo, mustard, 2 slices tomato, lettuce 1 C apple juice 2 cups mixed green salad, 2 oz tuna, 4 slices

cucumber, tomato, carrots, balsamic dressing

This diet is low in calories and not meant for the long term, but it can be a good place to start.

2 eggs, 1 C granola, 1 C skim milk 1/2 C grapes 2 oz turkey on 2 slices whole wheat bread, light

mayo, mustard, 2 slices tomato, lettuce 1 C apple juice 2 cups mixed green salad, 2 oz tuna, 4 slices

cucumber, tomato, carrots, balsamic dressing

This diet is low in calories and not meant for the long term, but it can be a good place to start.

Action GoalsAction Goals

1. Have Paris choose one food item of her choice at every meal. This can be a vegetable, fruit, or anything she wants.

2. To better understand intuitive eating, have her read a chapter a week from Intuitive Eating (Tribole, Resch, 1995) and focus her behavior change on that particular chapter.

3. Have Paris keep a journal of her feelings prior and post eating.

1. Have Paris choose one food item of her choice at every meal. This can be a vegetable, fruit, or anything she wants.

2. To better understand intuitive eating, have her read a chapter a week from Intuitive Eating (Tribole, Resch, 1995) and focus her behavior change on that particular chapter.

3. Have Paris keep a journal of her feelings prior and post eating.

Outcome Goals: Goal WeightsOutcome Goals: Goal Weights

Paris should aim to gain about 1 lb. per week, however this may be unrealistic at first, and that is alright in the beginning, as long as she does not lose any more weight.

Goal: 140 lbs. based upon Hamwi 1 Month Goal: 119 lbs. 3 Month Goal: 131 lbs. 1 Year Goal: 126-154 lbs. Insure a slow and steady weight gain to prevent

refeeding syndrome.

Paris should aim to gain about 1 lb. per week, however this may be unrealistic at first, and that is alright in the beginning, as long as she does not lose any more weight.

Goal: 140 lbs. based upon Hamwi 1 Month Goal: 119 lbs. 3 Month Goal: 131 lbs. 1 Year Goal: 126-154 lbs. Insure a slow and steady weight gain to prevent

refeeding syndrome.

Follow-UpFollow-Up

Follow up with Paris in one week due to being in the beginning stages of treatment.

Then follow-ups may occur every two weeks.

Have weekly talks/meetings with the other healthcare professionals on the team (physician, psychologist, etc)

Follow up with Paris in one week due to being in the beginning stages of treatment.

Then follow-ups may occur every two weeks.

Have weekly talks/meetings with the other healthcare professionals on the team (physician, psychologist, etc)

Parameters to measureParameters to measure

Weight Coping mechanisms Monitor purging behavior Continual discussion with the other

members of the treatment team for Paris

Weight Coping mechanisms Monitor purging behavior Continual discussion with the other

members of the treatment team for Paris

ReferencesReferences Scarano M.G., Kalodner-Martin R.C. A description of the continuum of eating

disorders: Implications for intervention and research. Journal of Counseling & Development. Vol. 72, 1994.

Williams L.R., Schaefer A.C., Shisslak M.C., Gronwaldt H.V., Comerci D.G. Eating Attidtudes & Behaviors in Adolescent Women: Discrimination of Normals, Dieters, & Suspected Bulimics Using the Eating Attitudes Test & Eating Disorder Inventory. International Journal of Eating Disorders. Vol. 5, 1986

Kitsantas A., Gilligan D.T., Kamata A. College Women With Eating Disorders: Self-Regulation, Life Satisfaction, & Positive/Negative Affect. The Journal of Psychology. Vol. 137, 2003.

Garner M.D., Garner V.M., Rosen W.L. Anorexia Nervosa “Restricters” Who Purge: Implications for subtyping Anorexia Nervosa. International Journal of Eating Disorders. Vol. 13, 1993.

Robinson H.P. Review article: recognition and treatment of eating disorders in primary and secondary care. Alliment Pharmacol Ther. Vol. 14, 2000.

http://encyclopedia.thefreedictionary.com/anorexia+nervosa Tribole E., Resch E. Intuitive Eating. St. Martin’s Press, 1995.

Scarano M.G., Kalodner-Martin R.C. A description of the continuum of eating disorders: Implications for intervention and research. Journal of Counseling & Development. Vol. 72, 1994.

Williams L.R., Schaefer A.C., Shisslak M.C., Gronwaldt H.V., Comerci D.G. Eating Attidtudes & Behaviors in Adolescent Women: Discrimination of Normals, Dieters, & Suspected Bulimics Using the Eating Attitudes Test & Eating Disorder Inventory. International Journal of Eating Disorders. Vol. 5, 1986

Kitsantas A., Gilligan D.T., Kamata A. College Women With Eating Disorders: Self-Regulation, Life Satisfaction, & Positive/Negative Affect. The Journal of Psychology. Vol. 137, 2003.

Garner M.D., Garner V.M., Rosen W.L. Anorexia Nervosa “Restricters” Who Purge: Implications for subtyping Anorexia Nervosa. International Journal of Eating Disorders. Vol. 13, 1993.

Robinson H.P. Review article: recognition and treatment of eating disorders in primary and secondary care. Alliment Pharmacol Ther. Vol. 14, 2000.

http://encyclopedia.thefreedictionary.com/anorexia+nervosa Tribole E., Resch E. Intuitive Eating. St. Martin’s Press, 1995.

http://encyclopedia.thefreedictionary.com/anorexia+nervosa

http://encyclopedia.thefreedictionary.com/anorexia+nervosa

Documents

Eating Disorders By: Amanda Sensabaugh Hayley Fennessy By: Amanda Sensabaugh Hayley Fennessy