EATING DISORDERS

ANDREW P. LEVIN, MD

SAINT VINCENT’S

WESTCHESTER

HARRISON, NY

Essential Features of Eating Disorders

• Disturbance in perception of body weight, size, or shape

• Behavioral efforts to control or lose weight in response to perceptions of body.

Associated Features of Eating Disorders

• Mood and anxiety symptoms

• Distorted Cognitions

• Emotional and physical developmental delays

• Physical complications

• Relationship to trauma

Mechanisms of Appetite and Satiety

• Cephalic phase

• Central control areas

• Termination of eating

• Eating disorder – Uncoupling of eating behavior and motivation.– Uncoupling of eating behavior and plasma

• Endogenous opiate system

• Serotonin system

Eating Disorder History

• Weight history

• Daily eating pattern

• Self-appraisal

• Loss of control

• Use of eating/binging/purging diary

Anorexia Nervosa in DSM-IV

• Refusal to maintain weight at 85% of minimum for height and age.

• Intense fear of gaining weight or becoming fat, even though underweight.

• Disturbance in body perception

• Amenorrhea in postmenarchy

Anorexia Nervosa in DSM-IV(con’t)

• Subtypes:– Restricting (low intake only)– Binge-Eating/Purging Type (these new in

DSM-IV)

Associated features of Anorexia Nervosa

• Epidemiology

• Associated psychiatric conditions– Perfectionistic style– Major depressive disorder– Obsessive-compulsive disorder– Starvation syndrome

Associated features of Anorexia Nervosa (con’t)

• Family Dynamics– Enmeshment– Overprotection– Conflict avoidance– Rigidity– Conflict Detouring

Associated features of Anorexia Nervosa (con’t)

• Medical Complications– Gasterointestinal– Cardiovascular– Renal– Endocrine– Systemic

• Longterm outcome--mortality rate approximately 10%

Principles of Treatment in Anorexia Nervosa

• Medical evaluation and stabilization

• Laboratory evaluation

• Physical exam with focus on hydration

• Rehydrate and correct electrolytes

Principles of Treatment in Anorexia Nervosa (con’t)

• Refeeding-- “food is the best medicine”– Inpatient--controlled eating environment– Outpatient--difficulty in maintaining eating– Try to minimize cues

• Individual and family therapies

• Psychopharmacologic interventions– Appetite stimulants– Antidepressants– Benzodiazepines and neuroleptics

Bulimia Nervosa in DSM-IV• Recurrent episodes of binge eating

• Recurrent inappropriate compensatory behavior (maintain wt. above 85% IBW)

• Binge/compensation cycle at least twice per week

• Self-evaluation by body weight and shape

• Types:– Purging--vomiting, laxative, diuretics, enemas.– Non-purging--exercise or fasting

Associated features of Bulimia Nervosa

• Epidemiology– Onset--late adolescence or early adulthood,

learned from peers.– Premorbid obesity– Industrialized countries– Female:Male 9:1

Associated features of Bulimia Nervosa (con’t)

• Psychiatric Complications– Incidence of Major depressive disorder– Substance abuse 20-30%.– Labile, low frustration tolerance, poor self-

soothing, high anxiety

Associated features of Bulimia Nervosa (con’t)

• Medical complications– Gastrointestinal– Dental– Electrolyte abnormalities– Endocrine

Principles of treatment in Bulimia Nervosa

• Similar to Anorexia Nervosa in terms of medical evaluation.

• Dietary normalization stresses control of intake

• Cognitive behavioral therapy is guiding principle

• Individual and family therapy

Principles of treatment in Bulimia Nervosa (con’t)

• Careful attention to substance abuse issues.

• 12-step groups such as Over Eaters Anonymous

• Pharmacotherapy

Eating Disorder NOS

• Features of Eating Disorder without full criteria

• Binge Eating Disorder

• Trauma related eating disorder

• Obesity