Jacqueline Corcoran, Ph.D.http://www.jacquelinecorcoran.com/

From: Mental Health in Social Work (Pearson, 2014, DSM 5 Update)

Eating Disorders

Eating Disorders and Feeding DisordersFeeding Disorders

Pica

Rumination

Restrictive Food Intake

Eating DisordersAnorexia Nervosa (AN)

Bulimia Nervosa (BN)

Binge Eating D/O

Anorexia NervosaUnderweight

Distortions of weight and 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

Bulimia Nervosapathological fear of becoming overweight

Bingeing

Purging behaviorsself-induced vomiting

misuse of medications

Nonpurging type also:fasting or excessive exercise

Binge eating & compensatory behaviors at least 1 per wk for 3 mos.

Binge Eating D/Ochronic, episodic overeating

Despite its recent inclusion, binge eating disorder is more common than either AN or BN

Prevalence

Recent Australian study of 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 diagnosesBulimia has increased 2nd half of 20th century

Prevalence

bulimia nervosa 1.5% of the U.S. female population.5% of the male populationlife-time prevalence of bulimia nervosa is 1% of the

population.

Anorexia nervosa.9% of females and .3% of men

lifetime prevalence is .6% of the U.S. population

Comorbidity

three or more 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 disordersMood disordersPersonality disorders are often present

low to 58% of the time

AssessmentA standard clinical interview Questionnaires eating disorders, body image, etc.A medical evaluationroutine checkupassessment of risk due to weight loss and amenorrhea,

laboratory tests of electrolyte imbalancesbulimia, possible referral to a dentist for problems related

to enamel erosion Assessment of comorbid disorders

Risk factorsBiological

Heritability

Obstetrical complications

Early disordered eatingPicky eating

Obesity

Dieting

Adolescent stage

Risk Factors: PsychologicalBody dissatisfaction and distortion

Low self-esteem

Perfectionism

Other psychiatric disorders

Risk Factors: Social Family factors

Heritability

Family transactions

Emphasis on weight

Abuse

Poor bonding

Over-protectiveness

Other social risksPoor social support

social isolation

social anxiety

public self-consciousness

Involvement in activities that promote thinness and low body weight

SocietalMid to high SES

Exposure to media

Goals1) Reduce body image 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

Goals, cont. 7) Providing education 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

Goals, cont. Addressing themes 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

Hospitalization indicationsSerious physical 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

Hospitalization, cont.Comorbid disorders that interfere with outpatient treatment (e.g., severe depression, obsessive-compulsive disorder)

A need to be separated from the current living situation

Problems with

InterventionTypically outpatientFor AN, family interventions more effective than individualFor BN

CBT (self-monitoring, social skills training, assertiveness training, problem solving, and cognitive restructuring)

interpersonal therapy medication