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How to recognise an eating How to recognise an eating disorder?disorder?
Eating DisordersEating Disorders
““Eating disorders are complex illnesses, Eating disorders are complex illnesses, rooted in psychological and emotional rooted in psychological and emotional distress, where people use food and distress, where people use food and
eating as a means of coping with eating as a means of coping with seemingly insurmountable problems. seemingly insurmountable problems. They offer a mechanism for control in They offer a mechanism for control in
a life that seems out of control.”a life that seems out of control.”Eating Disorders Association (now b-eat)Eating Disorders Association (now b-eat)
BMI SCALESBMI SCALES
17.5 - 2017.5 - 20 Irregular or absent ovulationIrregular or absent ovulation
Osteoporosis risk increasedOsteoporosis risk increased
15 – 17.515 – 17.5 Anorexia nervosa. Amenorrhoea, Anorexia nervosa. Amenorrhoea, loss of substance of all organs loss of substance of all organs and structures,and structures,
Osteoporosis high riskOsteoporosis high risk
13.5 - 1513.5 - 15 Severe Anorexia nervosa. Severe Anorexia nervosa. Compromised bone, heart and Compromised bone, heart and brain. Metabolism reduced 50%brain. Metabolism reduced 50%
12 – 13.512 – 13.5 Organs begin failing muscle, Organs begin failing muscle, heart, bone marrow. Life heart, bone marrow. Life threateningthreatening
< 12< 12 Sudden DeathSudden Death
Effects of excessive weight loss Effects of excessive weight loss or food restrictionor food restriction
• Decreased heart rateDecreased heart rate• Digestive system slows down – gastro Digestive system slows down – gastro
intestinal discomfortintestinal discomfort• Decreased tolerance for cold temperature Decreased tolerance for cold temperature
– extremities become purple/blue– extremities become purple/blue• To conserve heat, fine hair may grow on To conserve heat, fine hair may grow on
the bodythe body• Decrease in body temperaDecrease in body tempera• Decrease in metabolic rateDecrease in metabolic rate
Cont’dCont’d
• Reduced strengthReduced strength• Dizziness, headachesDizziness, headaches• Decreased need for sleepDecreased need for sleep• Skin and hair become dry/hair falls outSkin and hair become dry/hair falls out• Females may notice that periods become Females may notice that periods become
irregularirregular• Hormone imbalance and poor diet can lead to Hormone imbalance and poor diet can lead to
osteoporosisosteoporosis• Hurts to sit downHurts to sit down• Long-term muscle loss can damage the heart, Long-term muscle loss can damage the heart,
kidney and other organskidney and other organs• Collapse and even deathCollapse and even death
Psychological effectsPsychological effects
• Food becomes the principle topic of Food becomes the principle topic of conversationconversation
• Pre occupation with reading cook books and Pre occupation with reading cook books and collecting recipescollecting recipes
• There may be signs of hoardingThere may be signs of hoarding
• Much of day spent planning allotted foodMuch of day spent planning allotted food
• Unusual concoctionsUnusual concoctions
• Increased use of salt and spicesIncreased use of salt and spices
• Often increased consumption of tea and coffeeOften increased consumption of tea and coffee
Cont’dCont’d
• Emotionally there may be periods of depression Emotionally there may be periods of depression and low mood. and low mood.
• Anxiety high with outbursts of anger and Anxiety high with outbursts of anger and irritabilityirritability
• Socially withdrawnSocially withdrawn• Loss of sexual interestLoss of sexual interest• Feeling of social inadequacyFeeling of social inadequacy• Humour seems to disappearHumour seems to disappear• Concentration becomes increasingly difficultConcentration becomes increasingly difficult• Decision making almost impossibleDecision making almost impossible• Forgetfulness commonForgetfulness common
SCOFF questionnaireSCOFF questionnaire
Do you ever make yourself sick Do you ever make yourself sick because you feel uncomfortably because you feel uncomfortably full?full?Do you worry you have lost Do you worry you have lost control over how much you eat?control over how much you eat?Have you recently lost more than Have you recently lost more than one stone in a three month one stone in a three month period?period?Do you believe yourself to be fat Do you believe yourself to be fat when others say you are too thin?when others say you are too thin?Would you say that food Would you say that food dominates your life?dominates your life?
What to do?What to do?
• Complete referral to CMHT Complete referral to CMHT
• If monitoring risk, use King’s College If monitoring risk, use King’s College GuidelinesGuidelines
Case study 1Case study 1
Patient presents feeling cold all the Patient presents feeling cold all the time, lack of motivation, tired, time, lack of motivation, tired, eating very little, feeling sickeating very little, feeling sick
Recent weight - 41kgRecent weight - 41kg
Height – 1.54mHeight – 1.54m
What next?What next?
Case Study 2Case Study 2
Patient presented with restricted food Patient presented with restricted food intake, vomiting, regular alcohol intake, vomiting, regular alcohol intake and exercising every day but intake and exercising every day but looks normal weightlooks normal weight
What next?What next?
Case Study 3Case Study 3
Patient presents with weight loss, Patient presents with weight loss, anxiety, insomnia, increased alcohol anxiety, insomnia, increased alcohol intake, exercising every day, chest intake, exercising every day, chest pains – recently moved to the area pains – recently moved to the area after brief recent admission to after brief recent admission to psychiatric unit for suicidal ideation.psychiatric unit for suicidal ideation.
Weight 43kg, Height - 1.75m, BMI 14Weight 43kg, Height - 1.75m, BMI 14 What next?What next?