1. EatingEating
DisordersDisorders

2. What Influences Your FoodWhat Influences Your Food
Choices?Choices?
Food & Emotions: Eating inFood & Emotions: Eating in
response to an emotional need.response to an emotional need.
- Stressed.- Stressed.
- Frustration.- Frustration.
- Tension.- Tension.
- Lonely.- Lonely.
- Boredom.- Boredom.
Can also lose appetite if upset.Can also lose appetite if upset.

3. Eating DisordersEating Disorders
Pica.Pica.
Rumination Disorder.Rumination Disorder.
Failure to Thrive.Failure to Thrive.
Anorexia Nervosa.Anorexia Nervosa.
Bulimia Nervosa.Bulimia Nervosa.
Binge Eating Disorder.Binge Eating Disorder.

4. PicaPica
Symptoms:Symptoms:
– Persistent eating of nonnutritive substancesPersistent eating of nonnutritive substances
for at least 1 monthfor at least 1 month
Typically paint, plaster, sand, hair or cloth.Typically paint, plaster, sand, hair or cloth.
Course:Course:
– Onset in infancy.Onset in infancy.
– Usually last several months.Usually last several months.
– Usually remits on its own.Usually remits on its own.
Often concurrent with mental retardation.Often concurrent with mental retardation.

5. Rumination DisorderRumination Disorder
Symptoms:Symptoms:
– Repeated regurgitation & re-chewing of food.Repeated regurgitation & re-chewing of food.
Behavior occurs for at least one month.Behavior occurs for at least one month.
– Not due to GI problems.Not due to GI problems.
Course:Course:
– Onset between 3 & 12 months.Onset between 3 & 12 months.
– Often remits spontaneously.Often remits spontaneously.
Uncommon.Uncommon.
Occurs more in males.Occurs more in males.

6. Feeding Disorder of InfancyFeeding Disorder of Infancy
or Early Childhoodor Early Childhood
Failure to eat enough.Failure to eat enough.
Failure to gain weight or significant lossFailure to gain weight or significant loss
of weight.of weight.
Not due to GI problems or reflux.Not due to GI problems or reflux.
Occurs in 1 - 5% of pediatric admissions.Occurs in 1 - 5% of pediatric admissions.
Equally common in males & females.Equally common in males & females.
Onset before age 6 years.Onset before age 6 years.
Formerly called Failure to Thrive.Formerly called Failure to Thrive.

7. Anorexia NervosaAnorexia Nervosa
Weight <85% standard.Weight <85% standard.
Intense fear weight gain although underweight.Intense fear weight gain although underweight.
Distorted body image.Distorted body image.
Amenorrhea in females.Amenorrhea in females.
Restricting type:Restricting type:
– Not regularly engaged in binge eating-purgingNot regularly engaged in binge eating-purging
behavior.behavior.
Binge eating/ purging type:Binge eating/ purging type:
– Regularly engaged in binge eating & purgingRegularly engaged in binge eating & purging
behavior.behavior.

8. Psych Disorders in ANPsych Disorders in AN
Depression.Depression.
Obsessive-Compulsive Disorder.Obsessive-Compulsive Disorder.
Comorbid Personality Disorders.Comorbid Personality Disorders.
Impulse Control Disorders.Impulse Control Disorders.
Substance Abuse Disorders.Substance Abuse Disorders.
Bipolar Mood Disorders.Bipolar Mood Disorders.
Suicide Tendencies.Suicide Tendencies.
Sleep Disorders.Sleep Disorders.

9. Common Medical ComplicationsCommon Medical Complications
of Anorexia Nervosaof Anorexia Nervosa
Cardiovascular Complications.Cardiovascular Complications.
Metabolic Complications.Metabolic Complications.
Fluid & Electrolyte Complications.Fluid & Electrolyte Complications.
Hematological Complications.Hematological Complications.
Dental Problems.Dental Problems.
Endocrine Complications.Endocrine Complications.
Gastrointestinal Complications.Gastrointestinal Complications.

10. Nutritional Care in ANNutritional Care in AN
Hospitalization to begin re-feeding.Hospitalization to begin re-feeding.
Some require parenteral feeding but mostSome require parenteral feeding but most
can be rehabbed with oral feeding.can be rehabbed with oral feeding.
Prevent further weight loss.Prevent further weight loss.
Goal is increase in energy intake withGoal is increase in energy intake with
weight gain.weight gain.
Some weight restoration & treatment ofSome weight restoration & treatment of
malnutrition may make psychotherapymalnutrition may make psychotherapy
more effective.more effective.

11. Bulimia NervosaBulimia Nervosa
An illness characterized by repeatedAn illness characterized by repeated
episodes of binge eating followed byepisodes of binge eating followed by
inappropriate compensatory methods:inappropriate compensatory methods:
– Purging:Purging: including self-induced vomiting orincluding self-induced vomiting or
misuse of laxatives, diuretics or enemas.misuse of laxatives, diuretics or enemas.
– Non-purging:Non-purging: including fasting or engaging inincluding fasting or engaging in
excessive exercise.excessive exercise.
Binge Eating:Binge Eating:
Eating, in a discrete period of time a huge amount ofEating, in a discrete period of time a huge amount of
food.food.
A sense of lack of control over eating during theA sense of lack of control over eating during the

12. Medical Complications ofMedical Complications of
Bulimia NervosaBulimia Nervosa
Renal Complications.Renal Complications.
Gastrointestinal Complications.Gastrointestinal Complications.
Electrolyte Complications.Electrolyte Complications.
Dental Problems.Dental Problems.
Laxative Abuse Complications.Laxative Abuse Complications.
Other Abnormalities &Other Abnormalities &
Complications.Complications.

13. PrevalencePrevalence
0
0.5
1
1.5
2
2.5
3
Anorexia Bulimia
Gen Population

14. PrevalencePrevalence
0
10
20
30
40
50
60
70
80
90
100
Anorexia Bulimia
females
male

15. CourseCourse
Anorexia:Anorexia:
– Onset 17 years.Onset 17 years.
– Rarely have onsetRarely have onset
after age 40.after age 40.
– Onset usuallyOnset usually
associated withassociated with
stressful life event.stressful life event.
– Chronic.Chronic.
BulimiaBulimia
– Late adolescence orLate adolescence or
early adulthood.early adulthood.
– Onset frequentlyOnset frequently
begins with a diet.begins with a diet.
– Tend to be chronic.Tend to be chronic.

16. ConsequencesConsequences
Anorexia N:Anorexia N:
– Heart attack.Heart attack.
– Dry & cracking skin.Dry & cracking skin.
– Constipation.Constipation.
– Low bodyLow body
Temperature.Temperature.
– Weakness.Weakness.
– Amenorrhea.Amenorrhea.
– Baby fine body hair.Baby fine body hair.
Bulimia N:Bulimia N:
– Sore throats.Sore throats.
– Swollen glands.Swollen glands.
– Tooth decay.Tooth decay.
– Intestinal damage.Intestinal damage.
– Dehydration.Dehydration.
– menstrualmenstrual
irregularities.irregularities.
– Others.Others.

17. Binge Eating DisorderBinge Eating Disorder
Large quantities of food in a shortLarge quantities of food in a short
period of time, two or more timesperiod of time, two or more times
per week.per week.
Eat until uncomfortably full.Eat until uncomfortably full.
Eating large amounts when notEating large amounts when not
hungry.hungry.
Eating alone.Eating alone.
Feeling disgusted with one’s self.Feeling disgusted with one’s self.

18. Binge-Eating DisorderBinge-Eating Disorder
(Compulsive Overeating)(Compulsive Overeating)
Eat more rapidly than usual.Eat more rapidly than usual.
Eat until uncomfortable.Eat until uncomfortable.
Eat when not hungry.Eat when not hungry.
Cannot control binges.Cannot control binges.
Embarrassed, guilty after binge.Embarrassed, guilty after binge.

19. Treatment for Binge-EatingTreatment for Binge-Eating
Learn to eat inLearn to eat in
response to hunger.response to hunger.
Learn to eat inLearn to eat in
moderation.moderation.
Avoid restrictiveAvoid restrictive
diets which candiets which can
intensify problems.intensify problems.
Increase activity.Increase activity.

20. Risk Factors ofRisk Factors of
Eating DisorderEating Disorder
Depression.Depression.
Anxiety disorder.Anxiety disorder.
Substance abuse.Substance abuse.
Obesity:Obesity:
– Arteriosclerosis.Arteriosclerosis.
– Type 2 Diabetes.Type 2 Diabetes.
– Hypertension.Hypertension.
– Hyperlipidemia.Hyperlipidemia.

21. Psychiatric ComplicationsPsychiatric Complications
Many people with eating disorders alsoMany people with eating disorders also
have depression, anxiety & substancehave depression, anxiety & substance
abuse.abuse.
Bulimia may also be associated withBulimia may also be associated with
posttraumatic stress disorder.posttraumatic stress disorder.
People with antisocial personalityPeople with antisocial personality
disorders are more likely to havedisorders are more likely to have
bulimia.bulimia.
Borderline personality disorder.Borderline personality disorder.

22. Management of EatingManagement of Eating
DisordersDisorders
Multidisciplinary team includingMultidisciplinary team including
physicians, nutritionists,physicians, nutritionists,
psychotherapists.psychotherapists.
May include inpatient medical orMay include inpatient medical or
psychiatric hospitalization, partialpsychiatric hospitalization, partial
hospitalization and residentialhospitalization and residential
treatment, intensive outpatient ortreatment, intensive outpatient or
outpatient programs.outpatient programs.