Eating Disorders Anorexia Nervosa and Bulimia Nervosa

1
Eating Disorders???????? ?? ???? ?????(Anorexia
Nervosa and Bulimia Nervosa)( ????? ???? ??????
?????? ? ??? ?????? ??????)

• ACHC. Dubai 2008
• Dr. Alya Al Merri
• Canadian Board in Psychiatry

2
Objectives??????? ????????

• -Epidemiology
• -Diagnosis and the clinical picture
• -Pathogenesis and Risk Factors
• -Treatment
• -Summary

• -??? ???? ????????
• ? ???????
• ????? ?????
• ? ?????? ????????
• -????(????) ?????? ?
• ???????(??????) ???????? ?? ?????
• -??????
• -???????

3
Epidemiology??? ???? ???????? ? ???????

• Anorexia Nervosa
• (????? ???? ?????? ?????? )
• -0.5 prevalence
• 0?5 ???? ??????? ?? ???????
• -Onset in mid to late adolescences (age 14-18)
• ???? ????? ?? ????? ???????? ???????? ? ????????
  ??? ?? 14-18
• -Mainly affects females (90)
• 90 ??????? ??? ??????
• -Debate whether the incidence is increasing
• ???? ?? ??? ???????? ?????? ?? ???? ??????

4
Epidemiology??? ???? ???????? ? ???????

• Bulimia Nervosa
• -1-2 prevalence
• 1-2 ???? ??????? ?? ???????
• -Onset in late adolescence/early twenties
• ???? ????? ?? ????? ???????? ???????? ? ?????
  ?????????
• -Mainly affects females (90)
• 90 ??????? ??? ??????
• -Incidence has been growing
• ??? ???????? ?? ??????

5
Diagnosis and the clinical picture(DSM-IV
Criteria)????? ????? ? ?????? ????????
????? ???? ?????? ?????? -??? ???? ???????? ???
????? ??? ???? ?????? ??????? ??? ?????? ?? ????
? ????? ???????. -????? ?????? ?? ????? ????? ??
??????. -??????? ?????? ??? ?????? ? ????? ? ?
????? ???? ???? (????) ????? ?? ????? ??? ?????
????? ????? ??????. -?????? ?????? ???????
?????? ????? ???????

• Anorexia Nervosa
• -REFUSAL to maintain body weight at or above a
  minimally normal weight for age and height.
• INTENSE FEAR of gaining weight or becoming FAT.
• Increased emphasis on weight/shape, body image
  distortion, OR denial of the seriousness of the
  current low body weight
• Amenrrohea at least for three consecutive
  menstrual cycle

6

• Subtypes
• Restricting Type
• Binge-Eating/Purging Type
• ???????
• -????? ??????? ?? ???????? ?????? ??????
• -????? ?????? ?? ??????? ???????? ?? ?????? ?????
  ??????

7
The clinical picture of Anorexia Nervosa??????
?????? ???????? ?????? ???? ??????

• Anorexia Nervosa
• Food restriction
• ?????? ?????? ??????
• Excessive exercise
• ??????? ?? ???????? ????????
• Preoccupations with food, eating, and calories
• ??????? ?????? ??????? ? ??????? ? ???????
  ????????
• Social Isolation
• ?????? ??????????
• Mood irritability, Depression, Obsessive-compulsiv
  e behavior
• ????? ?????? ? ???????? ? ?????? ??????? ??????

8
The clinical picture of Anorexia Nervosa??????
?????? ???????? ?????? ???? ??????

• Cold intolerance
• ??? ?????? ??? ???? ?????
• Lanugo hair and hair loss
• ????? ??? ????? ?? ????? ??? ?????
• Poor sleep (early morning wakening)
• ???????? ?????
• Dizziness, fainting
• ?????? ? ???????? ???????
• Gastrointestinal symptoms, constipation, bloating
• ?????? ?????? ?????? ?? ????? ? ?????? ???????
  ?????

9
Clinical picture of AN?????? ???????? ????????

• ?Anorexia Nervosa
• -5-18 die
• 5-18 ????? ???????
• -10-20 have an intractable
• Course
• 10-20 ????? ??????
• -Risk of death increases 5
• every decade
• ????? ???? ?????? 5 ?? ?? ??? ?? ?????
  
• -Many develop bulimic
• symptoms (40-50)
• ???? ??? ?????? ???? ????? ??????
  
• -Death is due to suicide in
• 24-50 of cases, and medical
• complication in 50
• ???? ?????? ????? ???????? ?? 24-50 ? ?????????
  ?????? ?? 50

10
Medical Complications????????? ??????

• ?Anorexia Nervosa
• -Heart rhythm abnormalities, Heart
• failure, slow heart rate.
• ???????? ?? ????? ????? ????? ?
• ?????? ?? ??? ????? ? ??? ?? ????? ?????
• -Osteoporosis
• ???? ??????
• -Dehydration
• ??????
• -Brain shrinkage
  
• ??????/???? ??????
• -Impaired fertility
• ??? ???????
• -Death from starvation and
• Suicide
• ?????? ????? ??????? ?? ??????? ?? ????????

11
Diagnosis and the clinical picture (DSM-IV
Criteria) ????? ????? ? ?????? ????????
??? ?????? ?????? -?????? ?? ????? ???? ????? ?
???? ?????? ?????? ?? ??????? ???????? -???
?????? ?????? ????? ????? ??????? ? ???? ?????
???? -???????? ?????? ?????? ? ????? ??????? -??
??????? ???????? ? ?????? -???? ??????? ????????
? ??????

• Bulimia Nervosa
• Binge eating (large amount of food in short
  period of time AND loss of control) AND
  compensatory behavior (eliminating calories)
• Binge eating AND compensatory behaviors occur
  twice weekly or three months
• Increased importance of weight and shape
• Do not meet criteria for AN (weight is in normal
  range)
• Subtypes
• Purging Type
• Nonpurging Type

12
Clinical picture of BN?????? ???????? ????????
??????

• Bulimia Nervosa
• Vomiting, laxatives, diet pills, excessive
  exercise
• ?????? ?????? ? ??????? ???????? ? ??????
  ???????? ? ??????? ??????? ???????
• Secretiveness, and shame
• ?????? ?????? ? ?????? ??????
• Social isolation
• ?????? ??????????
• Mood lability
• ????? ?????? ???? ????? ?????
• Preoccupations with food, eating, calories
• ??????? ?????? ??????? ? ??????? ? ???????
  ????????
• Russells sign- abrasion on hand from
  self-induced vomiting
• ????? ???? ??? ? ?????? ?? ???? ????? ?????
  ?????? ?????
• Enlarged salivary glands
• ???? ????? ????????

13
Clinical picture of BN?????? ???????? ????????
??????

• ?Bulimia Nervosa
• -Patients go untreated
• for many years
• ??? ?????? ?????? ? ???????? ?????? ?????
• -Mortality in BN (5-10 year studies)
• 6-7 x more than normal population
• ???? ?????? 6-7???? ???? ??????? ???????
  ?????????
• -With treatment 50-70 improve,
• 30 have a poor outcome
• ?? ?????? 50-70 ??????? ? 30 ???? ??????? ?????
• -30-50 relapse
• ???? ????????? 30-50
• -Generally better prognosis than AN
• ???? ??? ???? ????? ? ??????? ?????? ???? ??
  ?????? ????? ???? ?????? ??????

14
Medical Complications????????? ??????

• ?Bulimia Nervosa
• -Electrolyte abnormalities
• ??? ????? ??????? (??? ???????? ? ??????????)
• -Heart rhythm abnormalities
• ???????? ?? ????? ????? ?????
• -Dental Damage
• ???? ???????
• -Tears to the esophagus
• ???? ? ???? ?? ??????

15
Pathogenesis and Risk Factors ????(????) ??????
? ???????(??????) ????????

• Vulnerability((??????? ??????? ??????? ??????
• ?Female Gender
• ??????
• ?Family History (genetics)
• ??????? ?????? ? ??????? ????????
• ?Family Dynamics
• ??????? ??????? ???? ???????
• ?Childhood obesity and parental obesity
• ?????? ??? ????? ??????? ? ???? ????????
• ?Sexual and physical abuse
• ?Adolescence
• ?? ????????
• ?Other Biological Factors
• Serotonin abnormalities time precedence not
  determined
• ??? ??????? ?????????? ????????? ?? ?????
  ???????? ???????
• ???????? ?????? ? ??????

16
Pathogenesis and Risk Factors ????(????) ??????
? ???????(??????) ????????

• Precipitating Factors (??????? ??????? ??? ????
  ?????)
• ?Adolescence
• ?? ????????
• ?Western Culture/Media
• ??????? ?????? ?????? ???????
• ?Stresses
• ?????? ???????
• ?DIETING, DIETING, DIETING!!! (?????? ????????)
• Dieting is often reported as preceding the onset
  of the eating disorder
• ?????? ???? ?? ???? ???????? ?? ???? ?????
• ?Profession Related weight control
• ??? ????? ???? ????? ? ???? ??????? ? ???????
  

17
Pathogenesis and Risk Factors ????(????) ??????
? ???????(??????) ????????

• Maintaining Factors ??????? ???? ? ???? ?????))
• ?Long History
• ????? ????? ????
• ?Severe weight loss
• ????? ????? ??????
• ?Family Dynamics
• ??????? ??????? ???? ???????
• ?Psychological Problems (Depression, anxiety)
• ?????????? ??????? ?????????? ? ?????
• ?ThinnessSuccess, and Beauty
• Personality disorder
• ?????? ?? ???????
• ?Substance abuse
• ??????? ?????? ?????? ??????

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Treatment??????

• ?Inpatient/Outpatient
• ?Multidisciplinary Approach
• ???? ???? ???
• ?Psychotherapy and Nutrition Rehabilitation
• ?????? ?????? ?? ????? ??????? ???????
• ?Psychotherapy
• ?Family Therapy
• ?????? ?????? ???????
• ?CBT
• ?????? ?????? ???????
• ?Biological Treatment

19
Summary???????

• ?Eating Disorder exists in our culture and is a
  disabling disease
• ???????? ???? ????? ??? ???? ?? ??????? ?????? ?
  ???? ?????? ?? ?????? ???
• Need of awareness
• ?????? ??? ??????? ??????/ ???????

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