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Eating Disorders


anorexia nervosa
bulemia
I notice that compulsive overeating is not in her list

INCIDENCE
5-10% of postpubertal females have an eating disorder
25-35% of college female athletes practice binging & purging
10-20% of combined male & female

pts may not see it as a problem
mothers bring in daughters to clinic
rule out possible etiologies: OCD, GI etio, addiction
anxiety re: germs, texture, food touching stuff, people touching food, dead animals
etio: lack of meaningful ritual

how many of us are happy with our bodies as we are?
the problem is partly cultural
we learn via media that we are not good enough
Dr Frances says, "When you have a spare moment, cultivate vanity. Say 'Man I'm good lookin'."

TREATMENT
meet pt where they are, do not attempt to change entrenched views
general health support
psych support
counseling
1st tx in general: add foods
beware of adding restrictions to pt tx plans before assess for eating disorders
watch for relapses
eval re: over-exercising (high cort), self injury (incr cort), addiction

ANOREXIA NERVOSA
most in age 14-18 age group
book: addiction to perfection
females 9:1
usu type A, overachievers, rigid thinking, smart, mb: manipulative, evasive
sig correlation with hx of abuse
highest mort rate of any pscyh dx, est 10% within 10yrs of dx
Sullivan, P book: Eating Disorders and obesity, 2002
no pharm helps, drugs disappointing
pts loose bone mass in teens, get osteoporosis so are given bisphosphonates (fosamax)
refeeding resistance = ?
many pts are determined to fool the doc and remain skinny:
http://anaregzig.blogspot.com/
http://en.wikipedia.org/wiki/Pro-ana
http://www.houseofthin.com/

VEGANISM
as a type of eating disorder
caution with children of parents with strict diets

BULEMIA
recurrent binge eating, purging and non
2x/wk x3mo
in 1-3% of women in developed countries
pts are given SSRIs and tricyclic antidepressants
w meds pts show reduced binging/purging but rare for pts to attain abstinence
tx: whole person, avoid food sensit, introduce good foods

ADDICTIONS IN GENERAL has these things in common with EATING DISORDERS
lie about actions
chose behavior over relationships
withdrawal when unable to indulge

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