![31
Clinical picture of bulimia nervosa
pathophysiology Bulimia nervosa
Recurrent vomiting washes mouth with
acid and stomach enzymes; mineral
deficiencies
Dental enamel erosions and gum disease
Laxative abuse, hypo-proteinuria,
electrolyte imbalances
Edema
Gastric acid and enzymes from vomiting
cause parotid inflammation
Parotid gland enlargement
Self-induced vomiting Scars or calluses on fingers or hands
(Russell sign [knuckle calluses])
Alternating between bingeing and purging Weight fluctuations; not underweight](https://image.slidesharecdn.com/4-241228141303-77b8d91d/85/4-Body-image-and-womens-eating-disorders-pptx-31-320.jpg)
More Related Content
Similar to 4. Body image and womens eating disorders.pptx (20)
Recently uploaded (20)
4. Body image and womens eating disorders.pptx
- 1. 1 Body image and Eating Disorders (Womens Health)
- 2. 2 Lecture Outline The concept of body image Definition and clinical presentation of Body Dysmorphic Disorder Management of Body Dysmorphic Disorder Classification of eating disorders Screening for eating disorders Definition and clinical presentation of anorexia nervosa Management and prognosis of anorexia nervosa Definition and clinical presentation of bulimia nervosa Management and prognosis of bulimia nervosa
- 3. 3 Body image Body image refers to how people see themselves when they look in a mirror
- 4. 4 Positive and negative body image: A positive body image is when people accept themselves regardless of body weight or shape A negative body image is when people feel that they need to improve their bodies because they are unhappy with the way their bodies look.
- 5. 5 Body dysmorphic disorder Body dysmorphic disorder diagnosed if someone has a strong obsession with one or more perceived defects or flaws in physical appearance that are not visible or appear minor to others. These perceived flaws can cause the individual to feel ugly and abnormal as well as dreadful or monster-like. Any body area can be the focus of concern, but individuals commonly worry about their skin, hair, or nose.
- 6. 6 Diagnostic Criteria for Body Dysmorphic Disorder (DSM-5) There are a few pieces of criterion that the DSM-5 have defined in order for one to be diagnosed with body dysmorphic disorder: 1. Appearance preoccupations: The individual obsesses over one or more apparent flaws in his or her physical appearance that are not visible or a big deal to others. 2. Repetitive behaviors: At some point, the individual has performed recurrent behaviors like frequently looking in the mirror, excessively grooming, or comparing his or her appearance to anothers Cont .
- 7. 7 Diagnostic Criteria for Body Dysmorphic Disorder DSM-5 3. Clinical significance: This obsession causes clinically significant distress or impairment in his or her social or work life. 4. Differentiation from an eating disorder: The individuals preoccupation with his or her appearance cannot be explained by concerns with body fat or weight, which may be symptomatic of an eating disorder.
- 8. 8 Risk factors for developing Body Dysmorphic Disorder: Body dysmorphic disorder has been associated with a couple environmental and genetic factors including: Childhood abuse and bullying Unrealistic societal standards and expectations (media & fashion industry effect ) Poor self-esteem. Fear of being alone or isolated Perfectionism or competing with others Genetics Depression, anxiety or OCD Neurotransmitters imbalance
- 9. 9 The Effect of media & fashion industry on Body Image Thin/muscular ideal : The media promotes builds that are impossible and unhealthy for most people There is no single cause of body dissatisfaction or disordered eating. Yet, research is increasingly clear that media does indeed contribute. A small 2018 study found a correlation between time spent on social media, negative body image, and disordered eating. http://www2.psy.unsw.edu.au/Users/lvartanian/Publications/Fardouly%20&%20Vartanian%20(2016).pdf
- 10. 10 Influence of parents and peer comparison Study showed that peer comparison and competition among girls has more of a negative effect on body image than the media Study found that a moms concerns about weight are actually the third leading cause of body image problems in adolescents Girls who believed their mothers wanted them to be thin were 2-3 times more likely to worry about their weight
- 11. 11 Rates of body dysmorphic disorder in selected populations: prevalence rate % populations 39 Anorexia nervosa 14 to 42 Atypical depression 8 to 37 Obsessive-compulsive disorder 11 to 13 Social anxiety 6 to 15 Dermatology and cosmetic surgery patients 2 to 5 Female college students
- 12. 12 Gender Predominance of Specific Symptoms in Body Dysmorphic Disorder: Female male symptom Breasts Buttocks Excessive hair Nose Skin Stomach Teeth Thighs Weight Body build Genitalia Thinning hair Body part focus Camouflaging techniques (e.g., baggy clothing, hats, wigs, makeup) Eating disorder Skin picking Substance use disorder Weight lifting Behavior
- 13. 13 Treatment for Body Dysmorphic Disorder 1. Cognitive Behavioral Therapy. 2. Medications: SSRIs.
- 15. 15 Classification of Eating Disorders: Anorexia nervosa Starve, underweight. Bulimia nervosa Binge and purge (vomit; laxative/ diuretic abuse/ excessive exercise). Binge eating disorder (BED) Overeat/ binge; no purge Almost all are obese
- 16. 16 Anorexia Nervosa Excessive concern to control body weight and shape along with inadequate and unhealthy pattern of eating .
- 17. 17 Epidemiology Approximately 95% of persons with an eating disorder are 12 to 25 years of age. About 90-95% of those affected by anorexia nervosa are females. It is more common in middle and upper socioeconomic groups.
- 18. 18 Diagnostic Criteria for Anorexia Nervosa (DSM-5) : A. Restriction of energy intake relative to requirements, leading to a significantly low body weight. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which ones body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
- 19. 19 Subtypes of anorexia nervosa: Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
- 20. 20 Levels of Severity: Mild: BMI 17 kg/m2 Moderate: BMI 16-16.99 kg/m2 Severe: BMI 15-15.99 kg/m2 Extreme: BMI < 15 kg/m2
- 21. 21 Clinical Signs of anorexia nervosa Underlying pathophysiology Anorexia nervosa Hypothalamic dysfunction, low fat stores, malnutrition Amenorrhea Electrolyte disorders, heart failure, prolonged corrected QT interval Arrhythmia Heart muscle wasting, associated with arrhythmias and sudden death Bradycardia Malnutrition Brittle hair and nails Malnutrition, vitamin and mineral deficiencies Hyperkeratosis
- 22. 22 Clinical Signs of anorexia nervosa Heart muscle wasting, associated with arrhythmias and sudden death Edema Malnutrition, dehydration Hypotension Thermoregulatory dysfunction, hypoglycemia, reduced fat tissue Hypothermia Response to fat loss and hypothermia Lanugo (fine, white hairs on the body) Self starvation, low caloric intake Marked weight loss Malnutrition Osteoporosis at a young age
- 23. 23 Management: A. Inpatient hospitalization: to correct medical derangement. B. Outpatient management - psychotherapy (CBT). - Medication (SSRIs, Zyprexa). - Support Groups. - Family therapy. - Nutritional education. - Stress management.
- 24. 24 Criteria for Inpatient Hospitalization AN Heart rate < 50 beats/min daytime; < 45 beats/min nighttime Systolic blood pressure < 90 mm Hg Orthostatic changes in pulse (> 20 beats/min) or blood pressure (> 10 mm Hg) Arrhythmia Temperature < (35.6 属C) < 75% ideal body weight or ongoing weight loss despite intensive management Body fat < 10% Refusal to eat Failure to respond to outpatient treatment
- 25. 25 Medications: Overall, disappointing results. SSRIs : Effective only for treating co-morbid conditions such as depression. Atypical antipsychotics such as olanzapine (Zyprexa), may be beneficial in controlling anorexia nervosa( understudy). Anxiolytics may be helpful before meals to suppress the anxiety associated with eating.
- 26. 26 Prognosis of Anorexia Nervosa Approximately one-half of patients with anorexia nervosa fully recover. about 30% achieve only partial recovery. 20% remain chronically ill. Anorexia nervosa has the highest mortality rate of any mental health disorder, with an estimated all-cause standardized mortality ratio of 1.7 to 5.9.
- 27. 27 Bulimia Nervosa Bulimia nervosa involves the uncontrolled eating of an abnormally large amount of food in a short period, followed by compensatory behaviors, such as self- induced vomiting, laxative abuse, or excessive exercise
- 28. 28 Diagnostic criteria of bulimia nervosa (DSM-5): A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- 29. 29 Diagnostic criteria of bulimia nervosa B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
- 30. 30 Level of severity of BN: Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week. Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week. Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week. Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.
- 31. 31 Clinical picture of bulimia nervosa pathophysiology Bulimia nervosa Recurrent vomiting washes mouth with acid and stomach enzymes; mineral deficiencies Dental enamel erosions and gum disease Laxative abuse, hypo-proteinuria, electrolyte imbalances Edema Gastric acid and enzymes from vomiting cause parotid inflammation Parotid gland enlargement Self-induced vomiting Scars or calluses on fingers or hands (Russell sign [knuckle calluses]) Alternating between bingeing and purging Weight fluctuations; not underweight
- 32. 32 Treatment of bulimia nervosa Inpatient treatment: to correct medical derangement Outpatient treatment - Psychotherapy - SSRIs may be beneficial in decreasing the frequency of binge eating and purging.
- 33. 33 Criteria for Inpatient Hospitalization BN Syncope Serum potassium < 3.2 mmol/L Serum chloride < 88 mmol/L Esophageal tears Cardiac arrhythmias including prolonged QTc Hypothermia Suicide risk Intractable vomiting Hematemesis Failure to respond to outpatient treatment
- 34. 34 Prognosis for bulimia nervosa The prognosis for bulimia nervosa is more favorable, compared to that of anorexia nervosa. up to 80% of patients achieving remission with treatment. the 20% relapse rate represents a significant clinical challenge, and the disorder is associated with an elevated all-cause standardized mortality ratio of 1.6 to 1.9.
- 35. 35 The SCOFF Questionnaire: Screening for Eating Disorders in Adults Do you make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than one stone (7 kg) in a three-month period? Do you believe yourself to be fat when others say you are too thin? Would you say that food dominates your life? NOTE: One point is given for every yes answer; a score of 2 indicates the patient likely has anorexia nervosa or bulimia nervosa.
- 36. 36 Binge eating disorders:(DSM 5) 1. Recurrent episodes of binge eating, usually associated with obesity and all related morbidities. An episode of binge eating is characterized by both of the following: a. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. b. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- 37. 37 2. The binge-eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of feeling embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or very guilty afterwards
- 38. 38 3. Marked distress regarding binge eating is present 4. The binge eating occurs, on average, at least once a week for three months. 5. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder. It is extremely important to note that weight or appearance is not part of the diagnostic criteria for binge eating disorder.
- 39. 39
- 40. 40 References https://www.aafp.org/afp/2008/0715/p217.html https://www.aafp.org/afp/2015/0101/p46.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035811/