NUTRITION NOTES

2nd Semester Sy 2015-2016

Types of Eating Disorders

Overview of Eating Disorders

DISORDERED EATING
Includes irregular eating, consistent
under eating, &/or consistent
overeating
Response to stress, illness,
dissatisfaction with personal
appearance

EATING DISORDERS
Anorexia Nervosa
(AN)

Extreme disturbances in eating behaviors that

can result in medical, psychological
consequences, and dangerous weight loss
Arise from physical, psychological, & social
issues

Bulimia Nervosa
(BN)
Binge Eating
Disorder (BED)

Can progress to clinical eating

disorder

Anorexia Nervosa (AN)

Characterized by irrational fear
of gaining weight
Disturbance in body weight or
shape
Significantly low body weight
due to restriction of energy
intake.

Level 2 Section 1

American Psychiatric Association, DSM-5 2013

No One Knows
What Causes
Anorexia Nervosa

Central to its
diagnosis is a
distorted body image
that overestimates
body fatness

The more body sizes

are overestimated the
greater the resistance
to treatment
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Level 2 Section 1

During the episode of anorexia nervosa, the person

does not engage in binge eating or purging behavior.

Two Types of Anorexia Nervosa

Restricting type

Pursuit of Thinness

Restricting Type
of Anorexia
Nervosa
Bingeeating/purging
type

During the episode of anorexia nervosa, the person

regularly engages in binge eating or purging behavior

Binge-eating/Purging
Type of
Anorexia Nervosa

Signs and Symptoms of Anorexia

Nervosa
Rigid dieting/food restriction

Perfectionism

Complains about feeling bloated

Food rituals
when eating

Maintains rigid schedule

Dramatic weight loss
Complains of feeling cold
Complains of being fat when thin
Weighs frequently

Irregular or cessation of
menstruation

Exercises obsessively

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Level 2 Section 1

Health Concerns Associated with

Anorexia Nervosa

Strict
Daily
Monitoring

Dry skin & hair

Loss of menstrual cycle

Hair thinning & loss

Loss of bone mass

Impaired iron status & immune

system

Stress fractures

Fainting, fatigue, weakness

Significant loss of fat & lean mass
Lanugo (a coat of delicate, downy
hairs)

Anorexia Nervosa Treatment Goals

Electrolyte imbalance
Irregular heartbeat
Slow heart rate
Low blood pressure

Ultimate Treatment Goals for Anorexia Nervosa

Restoration of lost weight

Stopping weight loss is the first goal

May require inpatient stays

Resolving psychological issues

Establishing regular eating patterns is the next goal

Progress will be slow at first due to an increase in metabolic rate and
an increase in thermic response to food

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NUTRITION NOTES

Bulimia Nervosa (BN)

2nd Semester Sy 2015-2016

American Psychiatric Association, DSM-5 2013

Recurrent episodes of binge eating

**Bingeing is compulsive consumption of large amounts of food
Recurrent compensatory behavior
Both occur, on average, at least once/week for 3 months
Self-evaluation is influenced by body shape & weight

Level 2 Section 1

Two Types of Compensatory Behaviors

PURGING

NON-PURGING TYPE

Self-induced vomiting &/or

misuse of laxatives, diuretics,
&/or enemas

Excessively exercises or fasts to

compensate for bingeing

Disturbance does not occur exclusively during episodes of anorexia nervosa

Characteristics of Bulimia Nervosa

Much more prevalent then anorexia nervosa
True incidence is difficult to establish
People often suffer in secret and may deny the existence of a
problem

The Binge
Food is not consumed for its
nutritional value
During a binge, eating is accelerated
by hunger from previous caloric
restriction
During a binge, nearly 1,000 extra
calories are consumed
There may be several binges in a day

Typical binge foods

Easy-to-eat foods
Low-fiber
Smooth-texture
High-fat
High-carbohydrate

More men suffer from bulimia nervosa than from anorexia nervosa
Bulimia nervosa is still most common in women

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The Binge Is a Compulsion and Usually

Occurs in Several Stages
Anticipation and planning
Anxiety

Level 2 Section 1

Signs & Symptoms of Bulimia Nervosa

Repeated attempts at food restriction

& dieting

Frequent use of bathroom during &

after meals

Responds to stress by overeating

Swollen or puffy face

Urgency to begin

Feels out of control

Odor of vomit on breath

Rapid and uncontrollable consumption of food

Moodiness & depression

Disappearance of food

Relief and relaxation

Feels guilt or shame after eating

Disappointment

Obsessive about weight

Fluctuation in body weight (at or
slightly above normal weight)

Shame or disgust

Health Concerns Associated with Bulimia

Nervosa
Erosion of tooth enamel & tooth Dehydration
decay
Irregular bowel functions
Inflammation of salivary glands

Electrolyte imbalances
Irregular heart beat
Sudden cardiac death

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Irritation & inflammation of

esophagus
Hemorrhaging & bleeding
during vomiting

Treatment Goals for Bulimia Nervosa

Unlike anorexics, bulimics are aware that their behavior is abnormal, and
they are ashamed of it
Bulimics are less likely to be in

and more likely to recover

50% of females diagnosed with bulimia recover completely after 5 - 10 years with or
without treatment
Treatment probably speeds the recovery
Antidepressant medication may be of benefit

Prepared By: Ms. April Anne D. Balanon-Bocato

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Treatment Goals for Bulimia Nervosa

Reduction & eventual elimination
of binging & purging

Address nutritional, medical, &

psychological issues

To regain control over food and

establish regular eating patterns
requires adherence to a
structured eating plan
Restrictive dieting is forbidden
Almost always precedes and may
trigger binges

Binge Eating Disorder

Level 2 Section 1

American Psychiatric Association, DSM-5 2013

At least one binge/week for at least 3 months accompanied by:

Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone out of embarrassment
Feeling disgusted with oneself

Regular exercise may be of

benefit

Signs and Symptoms of Binge Eating

Disorder

Triggers for Binges

Recurring episodes of binging within a short period of time

Clinical depression

Not followed by purging

Anger

Puts individuals at risk for weight-related health problems

Type 2 diabetes, gallstones, CVD

Sadness
Anxiety
Other types of emotional distress

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Level 2 Section 1

Signs and Symptoms of Diabulimia

Diabulimia
Term started to surface 2007

A1c inconsistent with meter readings

Secrecy about diabetes management

Eating disorder in which individuals with Type I Diabetes give

themselves less insulin than they need for the purpose of losing weight.

Unexplained weight loss

Fatigue/lethargy

Constant bouts of nausea

Extreme increase/decrease in diet

Individuals with diabulimiaa manipulate insulin as an inappropriate

behavior to prevent weight gain resulting in the loss of glucose in the
urine.

May episodes of diabetic ketoacidosis or

near episodes
Irregular or lack of menses

Low sodium or potassium

Not yet recognized medical term

Who Has Eating Disorders?

Causes of Eating Disorders

Common among adolescent girls & young women

8 million females in U.S.
Anorexia Nervosa
8/100,000/year
Males ~10% of cases
Bulimia Nervosa
12/100,000/year
Males ~ 15% of cases

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Sociocultural
characteristics

Family
dynamics

Personality
traits

Biological
factors

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Level 2 Section 1

Sociocultural Factors
Food abundance
Slimness is valued
Celebrity role models
Peer influences
puberty
Media
Perfect body = tall, lean & well-defined muscles

Family Dynamics

Personality Traits & Emotional Triggers

Enmeshment

PERSONALITY TRAITS

EMOTIONAL TRIGGERS

Disengaged families

Low self-esteem

Ridiculed about weight as child

Over protectiveness

Lack of self-confidence
Obsessive
Food preoccupied

Puberty

Rigidity
Conflict avoidance
Abusiveness

Having a mother with an eating disorder

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Feelings of helplessness
Anxiety

Family dysfunction
Starting a new school
Rape or incest

Depression

Prepared By: Ms. April Anne D. Balanon-Bocato

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Level 2 Section 1

Biological Factors

Athletes and Dancers are at Increased

Risk for Eating Disorders?

May predispose an individual to eating disorders

Considered at risk group (15-60%)

Brain chemicals may play a role in development of eating disorders

Weight dictates physical performance &/or appearance

Questions remain about whether depression leads to eating disorder

or vice versa

Twin studies
Implications that eating disorders are inherited

Athletes Who
Compete with
Revealing
Clothing may
Feel Internal or
External
Pressures to
Meet Body
Image
Expectations

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Female Athlete Triad

Osteoporosis

Disordered
eating

Amenorrhea

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NUTRITION NOTES

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Side Bar: Causes of Osteoporosis/Osteopenia in

Female Athlete Triad

Sports With Highest Number of Athletes with

Eating Disorders
FEMALES

Low levels
of body
fat
Stress fractures can
result

Leads to
amenorrhea

Wrestling

Gymnastics

Cross-country

Swimming

Body Building

Dancing

Estrogen
levels
diminish

MALES

Cross-country

Track & field

Bones
become
weak

Level 2 Section 1

Body Building

Males: disordered
eating brings on
many of the same
physical problems
affecting female
counterparts

How Can We All Help Prevent Eating Disorders

Treatment of Eating Disorders

Need programs & educational curricula that focus on encouraging

healthy attitudes toward :
Eating
Dieting
Body image

Interdisciplinary approach
Physicians, nurses, social workers, mental health therapists,
dietitians
Involve family members

Focus on self-esteem

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Friends and Family

Level 2 Section 1

General Treatment Goals

Talk with concern and without judgment

Learn how to enjoy food without fear & guilt

Act now: Early intervention is paramount

Rely on physiological cues of hunger & satiety to regulate food intake

Essential To Life

Nutrition

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