1. EATING DISORDERS BULIMIA ANOREXIA NERVOSA

2. EPIDEMIOLOGY Up to 4% of adolescent & young adults Most common age of onset bet. 14 & 18 yrs 0.5% to 1 % of adolescent girls 20X more common in females Professions requiring thinness COMORBIDITY Depression 65%;social phobia 34% OCD 26% ANOREXIA NERVOSA

3. BIOLOGICAL opiods- deny hunger hypercortisolemia Non suppression on DST Thyroid fxn-supressed Amenorrhea- low LH, FSH, GRH Enlarged ventricles Higher caudate metabolism Dysfunction in DA, S, NE Delayed release of insulin SOCIAL Close but troubled relationship with parents High levels of chaos, hostility, isolation Low levels of nurturance and empathy ANOREXIA NERVOSA ETIOLOGY

4. A. REFUSAL TO MAINTAIN BODY WEIGHT AT OR ABOVE A MINIMALLY NORMAL WEIGHT FOR AGE & HEIGHT(e.g. weight loss leading to maintenance of body weight less than 85% of that expected; failure to make expected weight gain during period of growth, leading to body weight less than 85% that expected). DSM CRITERIA FOR ANOREXIA NERVOSA

5. B. INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT EVEN THOUGH UNDERWEIGHT C. DISTURBANCE IN THE WAY WHICH ONE’S BODY WEIGHT OR SHAPE IS EXPERIENCED, UNDUE INFLUENCE OF BODY WEIGHT OR SHAPE ON SELF- EVALUATION,OR DENIAL OF THE SERIOUSNESS OF THE CURRENT LOW BODY WEIGHT DSM CRITERIA FOR ANOREXIA NERVOSA

6. D. IN POSTMENARCHEAL FEMALES, AMENORRHEA,(ABSENCE OF AT LEAST 3 CONSECUTIVE MENSTRUAL CYCLES) TYPES 1. RESTRICTING- DURING THE CURRENT EPISODE OF ANOREXIA NERVOSA, THE PERSON HAS NOT REGULARLY ENGAGED IN BINGE EATING OR PURGING BEHAVIOR 2. BINGE EATING/PURGING TYPE- SELF- INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR ENEMAS) DSM CRITERIA FOR ANOREXIA NERVOSA

7. Onset between 10 and 30 years Behavior and psychopathology present for at least 3 months; HALF WILL HAVE BULIMIA WITHIN ONE YEAR Peculiar behavior about food Comorbidity with obsessive compulsive behavior, depression and anxiety Delayed psychosocial sexual development PE- hypothermia, dependent edema, hypotension, lanugo hair Laboratory- hypokalemia, ECG changes CLINICAL FEATURES

8. CLINICAL FEATURESMORTALITY 5 TO 18% RESTRICTING TYPE BINGE EATING/PURGING TYPE OBSESSIVE COMPULSIVE TRAITS LOWER SUICIDE LOWER RECOVERY SUBSTANCE ABUSE,IMPULSE CONTROL &PERSONALITY DISORDER HIGHER SUICIDE HIGHER RECOVERY

9. VERSUS DEPRESSION NORMAL APPETITE HYPERACTIVITY PLANNED & RITUALISTIC FEAR OF OBESITY VERSUS SCHIZOPHRENIA INVOLVE CALORIC INTAKE HYPERACTIVE DIFFERENTIAL DIAGNOSIS

10. MORE PREVALENT LATER ONSET MAINTAIN NORMAL WEIGHT FEMALES>MALES 10:1 BULIMIA NERVOSA

11. BIOLOGICAL FACTORS NE & SEROTONIN RAISED ENDORPHINS SOCIAL FACTORS DEPRESSED AND MORE CONFLICTUAL FAMILIES Describe parents as NEGLECTFUL & REJECTING PSYCHOLOGICAL FACTORS MORE ANGRY, OUTGOING AND IMPULSIVE EGO DYSTONIC LACK OF TRANSITIONAL OBJECT , struggle with separation Ambivalent attitude BULIMIA-ETIOLOGY

12. 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(WITHIN ANY 2 HOUR PERIOD) , AN AMOUNT OF FOOD THAT IS DEFINITELY LARGER THAN MOST PEOPLE WOULD EAT DURING A SIMILAR PERIOD OF TIME AND CIRCUMSTANCES (2) A SENSE OF LACK OF CONTROL OVER EATING DURING THE EPISODE DSM CRITERIA FOR BINGE EATING DISORDER AND BULIMIA

13. B. RECURRENT INAPPROPRIATE COMPENSATORY BEHAVIOR IN ORDER TO PREVENT WEIGHT GAIN C. THE BINGE EATING AND INAPPROPRIATE COMPENSATORY BEHAVIOR BOTH OCCUR ON AVERAGE,AT LEAST TWICE A WEEK FOR 3 MONTHS D. SELF EVALUATION IS UNDULY INFLUENCED BY BODY SHAPE AND WEIGHT DSM CRITERIA FOR BULIMIA

14. E. THE DISTURBANCE DOES NOT OCCUR EXCLUSIVELY DURING EPISODES OF ANOREXIA NERVOSA TYPE: 1. PURGING TYPE: ENGAGED IN SELF INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR ENEMAS 2. NON PURGING TYPE- EXCESSIVE EXERCISE OR FASTING DSM CRITERIA FOR BULIMIA

15. MOST HAVE NORMAL WEIGHT SEXUALLY ACTIVE HIGH RATES OF MOOD AND IMPULSE CONTROL DISORDER (15%) HIGHER RECOVERY THAN ANOREXIA NERVOSA CLINICAL FEATURES

16. B. THE BINGE EATING EPISODES ARE ASSOCIATED WITH 3 OR MORE OF THE FOLLOWING: 1. EATING MUCH MORE RAPIDLY THAN NORMAL 2. EATING UNTIL UNCOMFORTABLY FULL 3. EATING LARGE AMOUNTS OF FOOD WHEN NOT PHYSICALLY HUNGRY 4. EATING ALONE BECAUSE OF BEING EMBARRASSED BY HOW MUCH ONE IS EATING 5. FEELING DISGUSTED WITH ONESELF, DEPRESSED, OR VERY GUILTY AFTER OVEREATING DSM CRITERIA FOR BINGE EATING DISORDER

17. C. MARKED DISTRESS REGARDING BINGE EATING IS PRESENT D. THE BINGE EATING OCCURS, ON AVERAGE, AT LEAST 2 DAYS A WEEK FOR 6 MONTHS E. THE BINGE EATING IS NOT ASSOCIATED WITH THE REGULAR USE OF INAPPROPRIATE COMPENSATORY BEHAVIORS, AND DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF ANOREXIA NERVOSA OR BULIMIA NERVOSA CRITERIA FOR BINGE EATING DISORDER