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Signs, Symptoms, & Supports for
Eating Disorders
Presenter:
Cynthia Galloway, MEd (Couns Psych), RD, CCC
Nutrition Therapist / Psychotherapist
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Continuum of Disordered Eating
Unrestrained Eating Milder Forms of Disturbed Eating Clinical Eating
Disorders
Normal Self-conscious Conscientious Obsessive Dieter Binge Bulimic Anorexic
Eater Eater Eater Eater Eater
eats when counts calories rigidly compensatory
hungry expresses body begins follows swings mechanisms refuses
dissatisfaction eliminates eating meal between to eat
stops fats patterns restricting
when full blames good if & bingeing may
problems on begins on diet, B/P
fatness exercising bad if
toU body off diet
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Criteria for Anorexia Nervosa
(DSM-IV)
A. Refusal to maintain a minimally normal body
weight for age and height (body weight less than
85% of that expected)B. Intense fear of gaining weight or becoming fat,
even though underweight
C. Disturbance in perception of body shape & weight
D. Absence of at least three consecutive menstrual
cycles in postmenarcheal females
From the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision. 2000 American Psychiatric Association
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Anorexia Nervosa
Specify type:
Restricting Type: the person has not regularly
engaged in binge-eating or purging behaviorBinge-Eating/Purging Type: the person has
regularly engaged in binge-eating or purging
behavior (i.e., self-induced vomiting or the
misuse of laxatives, diuretics, or enemas)
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Criteria for Bulimia Nervosa
(DSM-IV)
Recurrent episodes of binge eating.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 most people would eat
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)
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Eating Disorder
Not Otherwise Specified
EDNOS category is for disorders of eating that donot meet the criteria for any specific ED
1. For females, all of the criteria forAN are metexcept that the individual has regular menses
2. All of the criteria forAN are met except that,despite significant weight loss, the individual's
current weight is in the normal range3. All of the criteria for BN are met except that the
bingeing and compensatory mechanisms occurless than twice a week or for a duration of lessthan 3 months
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ED NOS
4. The regular use of inappropriate compensatorybehavior by an individual of normal body weightafter eating small amounts of food (e.g. self-
induced vomiting after the consumption of twocookies).
5. Repeatedly chewing and spitting out, but notswallowing, large amounts of food.
6. Binge-eating disorder: recurrent episodes ofbinge eating in the absence of the regular use ofinappropriate compensatory behaviorscharacteristic of Bulimia Nervosa
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Why?
Social and Cultural Pressures
History ofAbuse or Neglect
Mental Illness
Genetic Vulnerabilities
Family pressures
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Family Pressures
Families where there is excessive concern
with weight and appearance
Family conflict
Close family member moving out or dying
Parents have a mental illness or substance
abuse problem
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Social Pressures
Fat prejudice
Being bullied or teased
Early pubertal development
Peer group focused on dieting & body image
Participation in activities that focus on body
weight and sizePressure to be strong, independent, not have needs
Very thin body ideals
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Warning Signs
Significant or unexpected weight loss OR
repeated, large weight fluctuations
Backbone, ribs, collarbones or cheekbones
are sticking out
Stop in growth (25% of adult height gain
occurs during puberty)
Loss of or irregular menstrual periods
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Other Signs
Yellow or orange-tinged skin
Thinning or brittle hair
Downy hair on back, stomach, or face
Conjunctival hemorrhages
Swollen parotid glands (chipmunk cheeks)
Calluses on the back of the hand
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Eating Behaviours
Dieting
Skipping meals
Changes in types of food eaten
Eating only low-fat or non-fat foods
Eating significantly fewer caloriesCounting calories or fat grams,measuring portions
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Eating Behaviours
Unusual eating practices
E.g. pushing food around the plate
cutting food into very small pieces
hiding food
Preoccupation with food-related activitiesEating alone
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Eating Behaviours
Disappearing to the washroom
immediately after meals
Claiming to have eaten already or not
being hungry
Food missing from the kitchen, ornumerous empty food containers in the
garbage or persons bedroom
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Behavioural Changes
Weighing self daily or more than once
per day
Extreme concern with appearance
Distorted body image
Low self-esteemInflexibility and resistance to change
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Behavioural Changes
Excessive exercise
Standing during activities usually donesitting or constantly moving legs whilesitting
Anxiety if misses routine exercise
Irritability, personality change
Change in school performance
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Medical Complications
Extremely low body weight
Very low heart rate
Low blood pressure
Low body temperature
Irregular heart rhythms
Electrolyte abnormalities (qK, o orq Na,qCa, qP)
Fainting, seizures
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Medical Complications
Arrested growth and development
Low bone density
Changes in brain function and structure
Slowing of the digestive system
Heart failure
Kidney failure
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Why dont you just eat?
Not a conscious choiceunconscious
protection from emotional pain
Eating disorder behaviours are the
symptoms, not the problem
Safer to be angry with your body than
someone you care about
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Are eating disorders addictions?
12 Steps ofAA have been modified to fit eatingdisorders, resulting in Overeaters Anonymous
Addictive substances = sugar &/or refined flourSubstances alter mood, help one manage feelings
The bodys response to the substance results in
eating disorder behavioursGet rid of the substance, you get rid of theaddiction
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Amandas Story
Family expected her to act & feel certain
ways & punished if she did not
Perfectionist, always trying to please others
Left home for college & gained the
freshman 15
Boyfriend with whom she had had her firstsexual experience rejected her
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Amanda
Decided her life would be better if she
lost weight
Started by restricting intake, then
began purging when she ate more than
planned
Lost 25 lbs in 4 months
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Amanda
Initially received positive feedback for
her weight loss
Preoccupation with food & weight
enabled her not to think about her
actual troubles
Physiological stress protected her from
feeling
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Amanda
Concern of possible pregnancy due
to missed periods led her to see adoctor
Physician suspected an ED and
referred her to a specialist
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Amandas Treatment
Specialist helped her to
Feel safe enough to work on emotional
issues
Understand how emotional issues and
eating behaviours are connected
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Emotions
Specialist helped Amanda identify: Thoughts & feelings never validated as a
child Learned to equate parental approval with
love
Never learned how to express feelings orresolve conflicts in a healthy way
Learn how to express intense emotions & askfor support
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Nutrition Therapy: Normalization
of Eating &Weight
Establish collaborative relationship
Collect relevant information
Separate eating behaviours from emotional
issues
Determine setpoint or ideal body weight
Provide nutrition education
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Nutrition Therapy
Nutrition education about
symptoms of starvation
metabolic rate
hunger & fullness cues
healthy weight range
minimum food intake to stabilize weight
optimal food intake for health
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Nutrition Therapy
Challenge distorted beliefs re: food, weight
& body image
Devise experiments that help the person todemonstrate to herself the truth or falseness
of her beliefs
Gradually restore weight to healthy levelResolve the social eating dilemma
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Refeeding Syndrome
Generalized fluid & electrolyte imbalance
in patients refed after severe weight loss
Severe q P, q K, q Mg
Glucose intolerance & fluid intolerance
Result in complications in variety of organ
systems including cardiac, gastrointestinal,neuromuscular, renal & pulmonary
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Preventing Refeeding Syndrome
Start slowly, e.g. 50% of calculated needs
Restrict total glucose to 150-200 g/d
Restrict fluid & Na, e.g. net fluid not to
exceed 800 ml/d during the 1st week
Weight gain should not exceed 1 kg/wk
Daily monitoring of serum electrolytes with
supplementation as needed
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Recovery
Therapy needs to continue beyond cessation
of eating disorder behaviours to:
prevent resumption of behaviours
address any remain psychological issues
Recovery = cessation of behaviours +
development of life skills
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Myth
Once you have an eating disorder,you always have an eating disorder
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Family & Friends
Focus on behaviours that you have witnessed &express your resulting feelings
Be prepared for the person to deny she itAvoid talking about weight & appearance, even ifyou think they are compliments
Dont try to force the person to eatlet her make
her own decisions about when & what to eatTalk about things other than the eating disorder,e.g. the days happenings, special interests, oraccomplishments
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Where to go for help?
No publicly funded treatment programs for
adults > 18 y.o. in London, Ontario
Extended healthcare benefits may cover
residential treatment at Homewood Health
Centre in Guelph
Eating Disorders Program at Victoria Hospital
for adolescents
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Hospital-Sponsored Eating
Disorder Programs in Ontario
Toronto Toronto General Hospital
Waterloo Grand River Hospital
Ottawa Childrens Hospital ofEastern Ontario
Newmarket Southlake Regional Health
Centre
Port Colborne Niagara Eating DisorderOutpatient Program
Sudbury Sudbury General Hospital
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379 Dundas St, Suite 210 Ph: 434-7721
Support & resource centre for people witheating disorders and their loved ones
Non-clinical programs offered in a safe,
non-threatening environment
Opened in November 2002, modelled after
Sheenas Place in Toronto
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NEDIC is a Toronto-based, non-profitorganization, established in 1985 to
provide information and resources oneating disorders and weight preoccupation
The National Eating Disorder Information CentreES 7-421, 200 Elizabeth Street, M5G 2C4
Telephone 416-340-4156 Fax 416-340-4736
Toll-Free 1-866-NEDIC-20 (1-866-63342-20)
Email: nedic@uhn.on.ca
The National Eating Disorder
Information Centre
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Questions?
Email questions to:
cynthiagalloway@yahoo.ca
Or call Cynthia Galloway
777-1906
Or visit website coming soonwww.hopecounsellingcentre.ca
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