eating disorders and disordered eating - werry workforce · 2020-04-07 · eating disorders and...
TRANSCRIPT
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Eating Disorders and
Disordered EatingRachel Lawson, Louise Bennett and Heidi Brace, South Island Eating Disorders
Service, Canterbury District Heath Board
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We are here to help
Four specialist eating disorders services
SIEDs, CREDs, Midland Region Eating Disorders Expert Hub and Waikato Specialist Eating Disorders Service, Tupu Ora Eating Disorders Service
Talk to the Eating Disorder liaison person
We need referral from a GP
Provide assessment, treatment of eating disorders and residential or inpatient facilities
Consultation, supervision and training from a Multidisciplinary team
Please call us
SIEDS: 03 3377707 CREDS: 04 461 6528 Waikato: 07 834 6902 Tupu Ora 09 623 4650
EDANZ
provides hope, information, support and resources to people supporting a loved one with an eating disorder
www.ed.org.nz
http://www.ed.org.nz/
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Overview of the morning
0900 – 9.45 Understanding eating disorders and disordered eating
15 minutes for questions
10 minute break
10.10 – 10.55 Thinking about eating- sorting out fact from fiction
15 minutes for questions
10 minute break
11.20 – 12.05 Working with family/whanau- treatment options
15 minutes for questions
12. 20 CLOSING
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Understanding Eating Disorders and
Disordered eating
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Other Specified Feeding & Eating Disorders - OSFEDMixed behaviours / presentation, but serious illness:
→Atypical AN (AAN) – ‘normal’ weight AN→Sub-threshold BN→Sub-threshold BED→Purging Disorder→Night Eating Syndrome
Anorexia Nervosa
─ Restriction of Energy intake
→ significantly low body weight
→ less than minimally expected wt
─ Intense fear of weight gain / fatness→ behaviour that interferes with wt
gain, despite low wt
─ Disturbance in body image→ self evaluation unduly influencedby body weight / shape
→ persistent lack of recognition ofseriousness of low wt
Binge Eating Disorder
• Recurrent Binge-eating
• Abnormal eating behaviour with marked distress / guilt
→ Frequency ≥ 1 / week for 3 months
• Absence of:→ compensatory behaviours→ Anorexia Nervosa→ Bulimia Nervosa
Bulimia Nervosa
• Recurrent Binge-eating
• Inappropriate compensatory weight control behaviours → Frequency ≥ 1 / week for 3 months
• Self-evaluation unduly influenced by body weight / shape
• Absence of Anorexia Nervosa
Eating Disorders
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Detection
Few young people will volunteer they have an eating problem
Their friends may know and tell the school counsellor
Parents/ family whanau
Warning signs can be physical, behavioural or psychological
Weight loss, stress fractures, narrowing of food choices, Increasing absences from family meals, Excessive exercise that is solitary, distorted body image, anxiety around meal times
See Appendix
Co-morbidity is common
For any young person presenting with anxiety or depression please ask questions about eating
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Screening
“Many people have concerns about food and weight. Do you have any concerns or worries about these things?”
Yes – Follow up with the SCOFF questionnaire
S –Do you make yourself Sick because you feel uncomfortably full?
C- Do you worry you have lost Control over how much you eat?
O- Have you recently lost more than One stone (6.35kg)
F- Do you believe yourself to be Fat when others say you are too thin?
F – Would you say Food dominates your life?
* One point for every “yes”; a score of 2 or more indicates further questioning is warranted
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What causes an Eating Disorder?
Multi-factorial and complex
No single cause of eating disorders has been identified; however, known contributing risk factors include:
Genetic vulnerability
edgi.nz
Psychological factors
E.g. perfectionism, low self-esteem
Socio-cultural influences
Media exposure and pressure for thinness
“In year seven they weighed me and then put all our weights up on the board. That was when I started thinking about seriously losing weight. Suddenly I was comparing myself to others”
The message “Some how I was less because I was bigger”
9
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Central Cognitive Elements
Judging oneself largely, or exclusively, in terms of shape, weight, eating and the ability to control them
For Example
If I eat carbohydrates I will get fat
If I am fat I will be unacceptable
If I am thin I will be happy
If I am thin I am in control
What do I do?
Restrict, binge, purge, exercise etc...
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Central Cognitive Elements
Self-Evaluation I am now going to ask you a rather hard question –you may not have thought
about this before. Over the past four weeks has your weight/shape been important in influencing how you feel about/ think about yourself as a person?
For example, friend who loves their job
Take a moment to think about yourself?
What influences how you feel about/ think about yourself as a person?
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Self-Evaluation
Client's Current Self-Evaluation
Pie ChartRelationship
Family
Friends
School
Weight and
Shape
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Client's Ideal Self-evaluation Pie
Chart
Family
Friends
Relationship
School
Wgt/Shape
Hobbies
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Eating Disorders – A range of different
presentations
Anorexia Nervosa-Restricting subtype
Obsessive compulsive personality traits
Like order and are highly organised
focus on detail,
perfectionist,
value mental and interpersonal control
Anxious
Social anxiety
GAD
OCD
Anorexia nervosa –Binge purge subtype
More impulsive, less introvert
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Eating Disorders – A range of
presentations
Trauma group with or without PTSD
disordered eating , e.g. don’t eat when anxious, low mood
Some adolescents
Binge and purge for affect regulation as part of a picture of self harm
E.g. overdosing, self-cutting
Tend to fast
Some drive for thinness
DBT program
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Eating Disorders and sexual trauma
Causes of eating disorders are multidimensional
May add to a person’s risk of developing an ED
About 40% will report sexual abuse
Higher in those with Bulimia nervosa, BED and AN-BP subtype than AN restricting subtype
DSM-5 CSA and CPA increase the risk of developing BN in adolescence
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Eating Disorders and sexual trauma
Negative perception of the body
Shame
Restrict eating, vomiting and laxatives as a form of punishment
“It was my fault I do not deserve to live”
Aversion to sexual activity
With low weight comes reduced sexual interest
Fear of future sexual trauma
Defensive strategy is “become unattractive”
- become bigger to be intimidating
- underweight to lose signs of sexual maturity
Way to cope with psychological difficulties
Need for control
Regulation of emotion
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Physical Risk
All clients with eating disorders are at medical risk to some degree
BED – longer term risks associated with obesity
Weight or BMI is only one aspect of this
e.g., A patient with a BMI of 15 but who is losing weight at a kilo a week is likely to
be more at risk than someone who has kept a stable BMI of 14 over many years
Frequent use of purging (vomiting, laxatives) greatly increases physical risk,
especially if patient underweight
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What to do?
All patients should have had a physical examination by their GP to establish their level of physical risk
If on-going risk the GP needs to continue to be involved (or medical staff in DHBs)
Speciality services offer advice on medical monitoring
Your part
Provide education about risks to adolescent and family
www.cci.health.wa.gov.au
Monitor risk during treatment
purging increases or weight is dropping ; patient reports fainting dizziness, blackouts
Contract at start of treatment
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Disordered Eating and
Body Dissatisfaction
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What is disordered eating?
A disturbed and unhealthy eating pattern that can include restrictive
dieting, compulsive eating or skipping meals
Implications
For some can be the entry point to an eating disorder
Dieting implicated in weight gain and obesity
Psychological impact
Feelings of guilt and a sense of failure
Diets fail people; People don’t fail diets
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What’s happening out there?
High rates of body image concerns
• Adolescent body dissatisfaction in Australia:
50% adolescent boys
75% adolescent girls
• Of adolescents in a healthy weight range
33% boys believe they’re overweight
50% girls believe they’re overweight
High and increasing rates of disordered eating
• National sample of adolescent girls:
Year 2000: 10% showed disordered eating behaviour
Year 2006: 18% showed disordered eating behaviour
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What’s happening out there?
Unhealthy weight control behaviours among NZ adolescents are common
More than one third of males and two thirds of females had attempted
weight loss
A high proportion had used unhealthy and potentially dangerous methods
to try an loose weight
Fasted, skipped meals, smoked cigarettes, vomited, diet pills
Female, reported Maori or Pacific ethnicity
And/or had a BMI in the overweight or obese range
Media exposure and poor dietary behaviour predicted DE
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Who is at risk?
Over 30 factors identified by research as eating disorder risk factors
Media exposure
Risk factor target
Media Internalisation
When an individual invests in societal ideas of size and appearance to the point they become rigid guiding principles
Girls and women – thin ideal
Men – Muscular ideal
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What can we do about this?
Media Literacy
Encourage students to adopt a critical approach so they can identify, analyse
and challenge ideal body image seen in the media
Through evidenced based prevention programs
Media Smart
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Media Smart
8 lessons media literacy program taught in school
Developed by Dr Simon Wilksch and Prof Tracey Wade
For intermediate and early high school students
Topics covered include:
techniques used by the media to manipulate images (e.g., airbrushing);
ideas on how to analyse and challenge media messages,
tips for handling pressure placed on young people
planning for how to move through adolescence and beyond as a skilful and
confident person
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Media Smart
Been researched with over > 3000 participants
MS significantly reduced risk factors related to eating disorders and obesity
Reductions in dieting, depression, body dissatisfaction, shape and weight
concerns and over-evaluation of shape and weight
96% of boys and rated the program as both being valuable and enjoyable
“I used to get upset all the time because I couldn’t look perfect (no one knew
how I felt)
“Even though I sometimes feel jealous of people, I think about the lessons and
feel better about myself”
“I never knew how much the media changed the pictures before they went in
the magazine
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Media Smart coming to NZ
Research trial in 2020 for Year 7and Year 8 pupils
Efficacy vs Effectiveness
Media smart program delivered by researchers or psychologists
Effectiveness trials examine whether interventions produce effects when
delivered by non-specialists presenters and under real world conditions in
natural settings
Canterbury and Nelson Marlborough
Range of non-specialists presenters
Funding ? Roll out to rest of NZ
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Researchers are investigating two versions of Media Smart Online. This program has been found to reduce a range of eating disorder risk factors and symptoms, and prevent the onset of related problems (e.g., depressive symptoms).
Want to feel better about your body?
Worry less about your eating? Exercise?
Be able to think about other things without getting stuck on worries about your shape or weight?
You will be compensated with a $30 voucher for completing the study. Participation is fully confidential.
The study is open to 13–25 year-olds of any gender across Australia/NZ and is starting soon.
Register your interest now by email [email protected]
mailto:[email protected]
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What can help?
For yourself and your family whanau
For children, adolescents and their family whanau
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What can help? Work toward acceptance rather than satisfaction
Focusing away from looks and towards function
What does my body enable me to do? Allow me to enjoy?
E.g. Legs for walking, my eyes allow me to see beautiful colours
The Role of genetics
Helping the individual see how their body shape (or parts of) have been inherited
My favourite aunt
Comparison
exploration of whether this is useful
Comparison is the thief of joy
who does the young person tend to compare herself against, and is this adaptive?
What else could you look at?
Positive and accurate body language
No such thing as a ‘”cankle”
List five positive things about my body and five about my self
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What can help?
Remember those life pies
Complimenting non-appearance attributes
Emphasize positive qualities and talents
Act as a positive role model
Eat regular meals and snacks
No complaining about your own body
No weight related compliments
Have you lost weight?
Be aware of how “health” is being taught in your school
check anti-obesity message not being delivered “too strongly”
The pizza example
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What can help?
Understanding what social media young people are using
Encourage a healthy skepticism of media messages
What are the family rules around access to sites? Parental control
Send parents to netsafe.org.nz
Protective
Eating with the family
Family connectedness
Our next presentation is going to step you through these factors
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Questions
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Appendix
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NINE TRUTHS ABOUT EATING DISORDERS
Truth #1: Many people with eating disorders look healthy, yet may be extremely ill.
Truth #2: Families are not to blame, and can be the patients’ and providers’ best allies in treatment.
Truth #3: An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.
Truth #4: Eating disorders are not choices, but serious biologically influenced illnesses.
Truth #5: Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.
Truth #6: Eating disorders carry an increased risk for both suicide and medical complications.
Truth #7: Genes and environment play important roles in the development of eating disorders.
Truth #8: Genes alone do not predict who will develop eating disorders.
Truth #9: Full recovery from an eating disorder is possible. Early detection and intervention are important.
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Produced in collaboration with Dr. Cynthia Bulik, PhD, FAED, who serves as distinguished Professor of Eating Disorders in the School of Medicine at the University of North Carolina at Chapel Hill, “Nine Truths” is based on Dr. Bulik’s 2014 “9 Eating Disorders Myths Busted” talk at the National Institute of Mental Health.
Leading associations in the field of eating disorders also contributed their valuable input.
The Academy for Eating Disorders along with other major eating disorder organizations (Families Empowered and Supporting Treatment of Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders, National Eating Disorders Association, The International Association of Eating Disorders Professionals Foundation, Residential Eating Disorders Consortium, Eating Disorders Coalition for Research, Policy & Action, Multi-Service Eating Disorders Association, Binge Eating Disorder Association, Eating Disorder Parent Support Group, International Eating Disorder Action, Project HEAL, and Trans Folx Fighting Eating Disorders) will be disseminating this document.
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Impact of Eating Disorders
Psychological Poor sense of identity; inadequacy & ineffectiveness; guilt; anxiety; rumination; compulsive behaviour; poor problem
solving; poor emotional coping; poor emotional regulation;
unsatisfactory relationships
•Depression, anxiety
•PD, DSH, suicidality
•Substance use
Medical •Malnutrition & growth delay
•Acute medical instability / problems
•Health problems 20 to malnutrition: osteoporosis, impaired
fertility, G/I problems
Psycho-social,
life stage,
quality of life
•Incomplete / disrupted education
•Work / school issues / skills
•Social isolation, restricted life experience
•Self neglect, personal austerity
•Burden of ED symptoms on personal time
•Housing, financial & legal issues
Family •High Burden of care
•Unhelpful Beliefs about illness & response to illness
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Physical Warning Signs
❖Sudden weight loss/gain/fluctuation
❖Dehydration
❖Dry hair or skin
❖Sensitivity to the cold
❖Feeling faint, cold or tired
❖Injuries relating to over-exercising
❖Stress fractures
❖Muscle cramps
❖Dental problems
❖Gastrointestinal
problems e.g.
Feeling full or
bloated
❖Knuckle calluses
❖Abdominal pain
❖Sores on hand
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Psychological Warning Signs
❖Obsessive pre-occupation with foods
❖Negative body image
❖Distorted body image
❖Negative comparisons with others
❖ Low self esteem
❖ Feelings of lack of control
❖Depression
❖Anxiety
❖Perfectionism
❖Guilt – especially around food
❖Not enjoying normal activities
❖Heightened anxiety around meal times
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Behavioural Warning Signs
❖Restricted/rigid diet
❖Fussy eater/banned foods
❖Throws away food
❖Social isolation
❖Frequent weighing
❖Constantly talks about food and diets
❖Wears baggy clothing
❖Constant preoccupation with food or exercise
❖Makes excuses not to eat
❖Calorie counting
❖Excessive use of the toilet
❖Excessive exercise
❖Use of diet pills, supplements and laxatives
❖Wrappers/food
disappearing
❖Denies problem
❖Trains through injury
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Detection
Families get it right
Gradual changes in behaviour and appearance occurring over months or years
A narrowing of food choices
Increasing absences from family meals
Prolonged visits to the toilet
Excessive exercise that is solitary
Gradual withdrawal from social activities, particularly involving eating or drinking
For AN persistent and noticeable weight loss (may attempt to conceal)
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Excellent Teacher Resource.
www.nedc.com
http://www.nedc.com/