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23 Cards in this Set

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___ of adolescents and college students have a severe ED
3-10%
Typical Characteristics of a Person with an ED
Weak Sense of Self
Holds Neg. Beliefs/Cognitive Distortions
Self-Critical/Cannot Accept Flaws
Strives for Perfection/Demands High Achievement of Self
Needs to be in control/O/C tendencies
Dissatisfied with Body
Unsatisfying Social Relationships
People Pleasing/Overly Sensitive to Rejection/Criticism
Difficulty Tolerating Emotions/Doesn’t Cope Well w/ Disappointment or Failure
Feels Powerless
Experiences Dep. Or Anxiety
Intense Narcissistic Qualities/Needs
Fears Growing Up (AN)
Becomes Impulsive (BN)
Risk Factors for ED
Age 13-18
Female (although # of males increasing)
Obesity Avoidance/Fear of Gaining Weight
Early Puberty and Maturation
Restrained Eating
Unhealthy Weight Control Measures
Difficulty Identifying and Expressing Emotions
History of Depression
Need for Perfection
Low Self-Esteem
Lack of Adequate Coping Skills
Alcohol/Substance Abuse
Sexual or Physical Abuse History
Early Dating/Confusion about Appropriate Behavior
Ill Health or Early Pregnancy
Sociocultural Factors in development of an ED
Standard of Beauty
Media/Advertising
Diet Industry/Fast Food Industry
Sports
Peers
Familial Factors in development of an ED
Family Environment

Trauma
Family Environment Factors in development of ED
Expectation of Success/Achievement Orientation
Push to be Perfect in Attitude and Appearance
Chronically Criticize Children and/or Each Other
Many Conflicts with Inability to Resolve Them
Expression of Painful or “Negative” Emotions Discouraged
Disconnected from one or both parents
Overinvolvement/ Underinvolvement
Parents who are Controlling
Emphasis on Weight and Thinness
Family History of ED
Food Used to Soothe Feelings
Physical/Emotional/Sexual Abuse
Family Environment Factors in AN
Limited Ability to Tolerate Psychological Tension or Disharmony
Emphasis on Propriety and Rule-Mindedness
Overdirection of Child/Discouragement of Autonomy
Poor Conflict Resolution Skills
Family Environment Factors in BN
Substance Abuse (Parents use to deal with problems)

Obesity and/or Migraines

Affective Disorders (Depression etc.)
Trauma etiological factors in ED
Includes Family, Authority Figures, Peers, Strangers
Psychological Growth Delay
Sexual Abuse and Body-Hate
Emotional Abuse Most Clearly Influences Eating Behaviors/Pathology (Kent et al., 1999)
Biogenetic Factors in AN
Increased Risk of AN in 1rst Biological Degree Relatives
May Have Increased Levels of Serotonin and May Diet in an Attempt to Decrease Anxiety, Obsessiveness and Perfectionism
Starving enduces Endorphins/Cortisol
Biogenetic Factors in BN
Higher Frequency of BN, mood disorders and substance abuse in 1rst degree relatives of those with BN
43% of sisters/26% mothers of women with BN had an ED Diagnosis
Lowered Serotonin Levels
Inheritable Genetic Traits
Depression
Anxiety
Obsessiveness
Compulsiveness
Inhibitedness/Shyness
Asocial Behavior/Schizoid
Lability/Emotional Disregulation
Narcissism
Pessimism
Worrying
Perfectionism
Low Frustration Tolerance
Sociopathy
Intrapsychic Factors in AN
Childhood Anxiety Disorder
Perfectionism (Over Compliance, O/C, Exacting, Self-Controlled)
Harm Avoidance (Worrier, Pessimistic, Shy)
Easily Fatigued
Low Level of Novelty Seeking
Negative Affect
Intrapsychic Factors in BN
Childhood Anxiety Disorder
High Level of Novelty Seeking
Negative Affect
Affective Instability
Low Self-Esteem/Interpersonal Sensitivity
3 Layers of an Eating Disorder
1) deficits in self concept
2) body image disturbances
3) eating and biologic symptoms/disturbances
Common Presenting Complaints and Medical Conditions of AN
Hair Loss
Dry Skin/Facial Hair Growth
Pain Around Heart/Down Left Arm
Heart Palpitations
Low Blood Pressure
Loss of Menstrual Cycle
Catches Colds/Infections Easily
Anemia
Osteopenia/Osteoporosis
Gets Chills/ Can’t Warm Up
Stomach Aches after Eating
Food Sits in Stomach Fainting
Alternating Energy Level btwn High Energy and Extreme Fatigue
Attn./Concentration/Retention Difficulties
what AD is contraindicated in AN
fluoxitine (appitite depressant)
What AD is contraindicated with BN
buprophin (wellbutrin)
Common Presenting Complaints and Medical Conditions of BN
Dental Erosion
Blisters in Mouth
Blood in Vomit
Pain around Heart/Down Left Arm
Heart Palpitations
Low Blood Pressure
Fatigue
Irregular Menstrual Cycles
Esophageal Burning
Constipation/Diarrhea
Hypoglycemia
Kidney Problems
Dehydration
Diminished Cognitive
Function
Dizziness
Inpatient Hospitalization indicated if:
AN and/or BN symptoms so severe and entrenched that meeting 1 to 2 times per week would have no impact
Weight is 25-30% below healthy body weight at start and little gain is likely to be achieved in outpatient
Health is medically compromised
Debilitating anxiety/depression/suicidality
Symptoms worsen during therapy and remain worse for over one month
No improvement over a 3 to 4 month period
Intensive Outpatient Programs indicated if:
patient will need more than traditional outpatient treatment but would benefit from continuing with work, school etc. and are able to do so without regressing into eating disordered behaviors or experience refeeding syndrome.
Overall Aims of Treatment for AN
Weight gain of .5 to 2lbs per week
Restoration of normal weight
Restoration of normal menstruation
Overall Aims of Treatment for BN
For BN:
Eliminate binge and purging

For Binge Eating:
Eliminate bingeing
Natural weight loss created by healthy eating