An Introduction To Eating Disorders

Transcription

1 An Introduction To Eating Disorders Presented by Hilary Smith, NEDC. Supported By OTA. The presenter retains all rights to the intellectual property contained within this presentation.

2 An Introduction to Eating Disorders Presented by the National Eating Disorders Collaboration (NEDC)

3 Introducing the NEDC Resources Evidence based Downloadable Membership Free monthly e-bulletin Current research, training and networking Key stakeholders = Any professional providing health, social, education and welfare support to people in the community.

4 Eating disorders are Diverse Common Serious Complex Treatable mental health issues that have a significant impact on every aspect of life, particularly physical, psychological, and social wellbeing.

5 COMMON MYTHS & MISCONCEPTIONS Why don t they just eat?

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7 FACTS ABOUT EATING DISORDERS I never get clients with eating disorders. Only teenage girls get eating disorders. Is obesity an eating disorder?

8 FACT # 1 EATING DISORDERS ARE DIVERSE 4 specified eating disorders All genders, ages, sizes, shapes & cultural backgrounds Disordered eating behaviours Variance over time

9 Trans-diagnostic view: Core psychopathology Over evaluation of shape, weight & their control Considerable psychological impairment and distress Wide-ranging, serious medical complications can affect every organ in the body

10 ANOREXIA NERVOSA (AN) - Restriction of energy intake - Intense fear of weight - Disturbance in view of shape - Low weight BULIMIA NERVOSA (BN) - Binging and compensation - Self-evaluation unduly influenced by weight and shape - Separate to anorexia nervosa

11 BINGE EATING DISORDER (BED) - Binging without compensation - Distress and lack of control around binge eating - Feelings of guilt and shame OTHER SPECIFIED FEEDING & EATING DISORDERS (OSFED) - Symptoms but not full criteria - Significant distress or impairment

12 LIVING A NIGHTMARE Eating disorders are characterised by: Hopelessness Anxiety and depression Intense feelings of self-hatred Harsh inner critic

13 Starvation Impact of poor nutrition on brain Stress Impact of stress and anxiety on brain, perception and choices Inner Critic Harsh, demanding inner voice Habit Repeatedly reinforced behaviour becomes automatic Personal Traits Perfectionism, anxiety, obsessive or impulsive traits Personal Values Value placed on the ED; pride in self discipline (AN); value placed on related activities (e.g. Sport, modelling) Life Experience Lessons from past experience including experience of treatment Hard Work Effort required to maintain or hide the ED; effort required to recover; effort required to regain the ED self Loss of Alternatives Lack of alternative goals, identities, coping strategies and supportive relationships Social Pressures Impact of social environment and relationships

14 There is a tyrant in my head screaming abuse at me 24/7. After a binge/purge episode I feel like I have been hit by a truck. There were numerous times when ending it all crossed my mind because I was just so tired. I was recently asked to sum up my experience of anorexia nervosa in one sentence actually, I can do it in just one word isolation...you feel completely alone.

15 FACT # 2 EATING DISORDERS ARE COMMON Approx. 9% of the population Increasing over last 30 years 15% of females in their lifetime Males approx. 25% of people with AN & BN and 40% people with BED

16 1 in 11 Australians will experience an eating disorder in their lifetime

17 FACT # 3 EATING DISORDERS ARE SERIOUS - Total Social and Economic cost $70 billion/year - Individual cost of care is substantial

18 ALL Eating Disorders: Significant physical & mental health consequences Severe medical complications Increased mortality rates Main causes of mortality: Suicide (200 x more likely than general population) Gastrointestinal complaints Infection Severe emaciation

19 MEDICAL SIGNS, SYMPTOMS & COMPLICATIONS Source: Academy for Eating Disorders' (AED) Medical Care Standards - and

20 FACT # 4 EATING DISORDERS ARE COMPLEX All ages, genders, economic and ethnic backgrounds Psychiatric comorbidity Genetic, psychological and environmental factors Continuum of healthy to severely disordered

21 HIGH RISK POPULATIONS Adolescents Competitive occupations that emphasise body shape Women, particularly during transition periods Low self esteem, anxiety, depression or substance misuse Illness - Diabetes or Polycystic Ovary Syndrome People with perfectionist or compulsive personality traits Families with a history of eating disorders Those who are seeking weight loss treatment or dieting

22 PSYCHIATRIC COMORBIDITY 20-40% of people with EDs have with comorbidities: Depression Anxiety Personality disorders Substance abuse Obsessive compulsive disorder Comorbid conditions can persist after treatment for ED Integrated approaches required

23 FACT # 5 EATING DISORDERS NEED ACTION Prevention Early Identification and Intervention Recovery is possible

24 PREVENTION Prevention programs should focus on: 1. Reducing modifiable risk factors, such as - Body dissatisfaction - Peer pressure, bullying & fat talk - Dieting behaviour - Perfectionism

25 PREVENTION Prevention programs should focus on: 2. Increasing protective factors, such as - Self esteem - Social support - Non competitive physical activity - Healthy eating behaviours & attitudes - Respect for diversity

26 FACT # 6 EATING DISORDERS ARE TREATABLE FULL RECOVERY is POSSIBLE Recovery is a unique, personal journey Listen and help to find a treatment program that suits the person Best treatment is long-term and focussed on the needs of the person and their family or circle of support 90% of patients given an effective treatment within 3 years of illness onset have a positive outcome at 5years

27 EARLY IDENTIFICATION & INTERVENTION When should I be concerned? Should I say something?

28 DETECTION OBSERVE Physical, psychological and behavioural warning signs LISTEN Listen to concerns e.g. family, friends, colleagues ASK Opportunistically screen high risk populations

29 OBSERVE WARNING SIGNS Psychological: o Preoccupation with eating, food, body shape & weight o Feeling out of control around food o Distorted body image o Black & white thinking o Using food for emotional regulation o Changes in emotional state Physical: o Weight loss, gain or fluctuations o Gastro-intestinal problems o Overexercising injuries o Infertility issues o Feeling cold despite weather o Fatigue o Calluses on knuckles, damage to teeth, swelling of jaw & bad breath (signs of vomiting) o Fainting or dizziness

30 OBSERVE WARNING SIGNS Behavioural: Dieting or binge eating Frequent trips to the bathroom during or shortly after meals Vomiting, using laxatives or other compensatory behaviours Changes in clothing style Compulsive or excessive exercising Obsessive rituals around food preparation or eating Sensitivity to comments about body, eating or exercise habits Secretive behaviour around food

31 ASK: SCREENING FOR EDs Many people have concerns about food and weight. Do you have any concerns or worry about these things? Many people have trouble with eating too much. Has this ever been a problem for you? Are you satisfied with your eating patterns? Do you eat in secret? If the response is yes to any of these, screen further.

32 SCREENING SCOFF To assess the possible presence of an ED S: Do you make yourself Sick because you feel uncomfortably full? C: Do you worry you have lost Control over how much you eat? O: Have you recently lost Over 6.35kg in a three-month period? F: Do you believe yourself to be Fat when others say you are too thin? F: Would you say Food dominates your life? Yes to 2 or more indicates further assessment is required.

33 OTHER TOOLS FOR DIAGNOSTIC ASSESSMENT Eating Disorders Examination or Questionnaire (EDE; EDE-Q) Eating Disorders Inventory (EDI-3) Readiness and Motivation Interview (RMI) HEADSS Psychosocial Assessment Home Education, Employment, Eating, Exercise Activities, Hobbies & Peer Relationships Drug Use Sexuality& Sexual Activity Suicide, Depression & Mental Health; Safety & Risk

34 ASSESSING RISK Multidisciplinary assessment: psychological, nutritional and medical Consider all results in combination and in context Psychological Medical Behavioural Self harm and suicidality RANZCP Admission Guidelines Co-morbid conditions GP Assessment (e.g. full blood count, ECG) Diagnostic Tools Weight, height & temperature Severity and frequency of behaviours Current food intake Refusal of treatment

35 ESSENTIAL ELEMENTS OF CARE What is involved in treatment?

36 REFLECTION THE PATIENT S POSITION I am a clinician who specialises in the detection and prevention of unhealthy relationships between parents and children. After careful assessment of your family, I am convinced that it was a terrible mistake for you to have your child. You may feel quite attached to her at the moment, but in the long run it simply won t work out. Whatever pleasure you may think you are getting out of this relationship, a detached and objective observer can see that you are losing a great deal too. You are tired and rundown, you lack sufficient energy for many of the activities you used to find rewarding, you spend less time with your friends, and sometimes your work has suffered. You have become so preoccupied with this child that you are unable to make a realistic assessment of how she has actually affected your life. Therefore, I have decided to take your child away. I can appreciate you feel angry with me just now, and may not believe it is my right to interfere but eventually you will come to understand that I have acted in your own best interest. With your child gone, you will be able to return to the life you had before you became a parent.

37 IMPACT OF STARVATION Food, eating and bingeing: Overwhelming preoccupation with food Hoarding of food and food-related items Ritualistic eating Loss of control of appetite during refeeding Emotion and personality Depression, mood swings, anxiety for most Social effects Withdrawal and isolation Libido decreased and slow to return Cognitive effects Impaired problem solving and decision making Poor concentration, alertness, comprehension, judgment

38 STEPPED CARE Prevention and EI General Outpatient Intensive Outpatient Day Program Inpatient Care Entry level may be at intensive end of continuum Flexible step up/down pathways meet individual need Integration and transition support between treatment

39 STAGES OF CHANGE MODEL 1. Pre-contemplation: denial that there is a problem 2. Contemplation: ambivalence about wanting to change and wanting to maintain disordered habits 3. Preparation/determination: preparing to make changes 4. Action: need support to help them on first steps to recovery 5. Maintenance: focusing on maintaining their new, healthier habits while learning to live without an eating disorder. NB. It is still possible for a person to relapse at this stage

40 COMMUNICATION Communication about EDs should: Be about Recognition, Resilience, Help Seeking Help the person to feel safe and listened to Be non-judgemental Encourage the person to seek help Not motivate through fear or stigma Avoid using details on ED behaviours or anthropomorphic measurements unless necessary Neutral language food, weight, shape Not normalise, glamorise or stigmatise ED behaviours

41 THE ROAD TO RECOVERY

42 EATING DISORDERS RECOVERY Given high rate of relapse and recurrence, recovery may be achieved episodically before sustainable recovery is achieved Criteria for Recovery (Bardone-Cone, et al., 2010) Diagnosis no longer meeting diagnostic criteria Behaviour no longer engaging in eating disorder behaviours Physical health weight within healthy BMI range Psychological positive attitudes to one s self, food, the body, expression of emotions and social interaction Practical quality of life including capacity for engagement in work or education, and leisure

43 BASIC BUILDING BLOCKS FOR RECOVERY Hope the belief that recovery is personally achievable and worthwhile Choice opportunities to make decisions about treatment and support, working towards a personally meaningful life Connection supportive relationships and valued community roles Knowledge and skill functional skills and coping strategies to enable healthy responses to adversity

44 SUPPORT THE PERSON Motivational Interviewing Strengths based approaches Peer support Recovery education Counselling for emotional support Mindfulness therapy Alternative activities, e.g. Yoga, art, music Functional skill development e.g. Meal planning, cooking, social eating TREAT THE ILLNESS Medical stabilisation Weight normalisation Psychotherapy that specifically addresses the behaviours and cognitions of ED

45 New resource for OTs What and how to: Know Observe Ask Listen Act

46 Know, Observe, Ask, Listen Signs and symptoms High risk groups Your organisation s protocols If you see something, say something Warning signs - Behavioural - Physical - Psychological Immediate risk indicators - Mental health - Physical health S.C.O.F.F.

47 Act Call for assistance immediately Follow your org s protocols for medical emergency. Once the person is stabilised and crisis response is no longer required Refer to GP or CMT Multidisciplinary case meeting Care Plan: Medical, Nutritional, Psychological, Functional, Family Work towards recovery If the person does not give any indications of a current problem with food, eating or body image Give information. Continue to monitor. Ask again if you suspect again.

48 NEDC RESOURCES Posters/Infographics Printed Resources GPs, Allied Health, Counselling & Nursing Midwives and Perinatal Teachers and Schools Sporting professionals/coaches Pharmacists & Dentists Caring for Someone with an Eating disorder

49 HELP FOR YOU & YOUR CLIENTS Butterfly National Helpline: 1800 ED HOPE ( ) 8am-12am AEST, 7 days a week (except public holidays) support@thebutterflyfoundation.org.au Webchat: Online support groups Online carer psychoeducation

50 NATIONAL INFORMATION & FURTHER TRAINING The Australian and New Zealand Academy for Eating Disorders: Journal of Eating Disorders The Butterfly Foundation InsideOut Institute Centre for Excellence in Eating Disorders (Victoria) Centre for Clinical Interventions (WA) Mental Health First Aid Australia

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