Dr Aseni Wickramatillake

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1 Dr Aseni Wickramatillake

2 An illness that causes serious disturbances to your everyday diet Issue is a morbid fear of weight gain Eating extremely small amounts or overeating The urge to eat more or less spirals out of control.

3 Severe distress on body weight or shape may also characterize an eating disorder Commonly appear during teens or young adulthood Affect both men and women Coexist with other illnesses such as depression, substance abuse, or anxiety disorders.

5 Modern societal view : thin is healthy and beautiful A gradual rise in eating disorders

6 Sociocultural conditions (societal and family pressures) Annual beauty pageant contestants are weighing lesser Models, actors, dancers are pressured to be thin 1/5 th of surveyed gymnasts have eating disorders Women in higher SES are concerned more on weight Psychological problems (ego, cognitive, and mood disturbances) Disturbed parent child interactions lead to serious ego deficiencies and severe cognitive disturbances in the child Sufferers of eating disorders also suffer from mood disorders Biological factors Relatives of sufferers are more likely to develop the disorder

9 1. Anorexia nervosa 2. Bulimia nervosa 3. Binge-eating disorder - eating disorders not otherwise specified (EDNOS) EDNOS is the most common diagnosis among people who seek treatment

self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of

10 Characteristics Emaciation A relentless pursuit of thinness Unwillingness to maintain a normal or healthy weight (<85% of normal weight) Intense fear of gaining weight Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight Lack of menstruation among girls and women Extremely restricted eating

by extreme dieting, excessive exercise, self-induced

11 Eating, food, and weight control is an preoccupation and obsession May also engage in binge-eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or enemas

12 May display psychologal problems Depression (usually mild) Anxiety Low self-esteem Insomnia or other sleep disturbances Substance abuse Obsessive-compulsive patterns Perfectionism

13 Escalation to anorexia nervosa may follow a stressful event Separation of parents Move or life transition Experience of personal failure Some may recover with treatment following a single episode, some may relapse, some may have a chronic condition

14 Osteopenia or osteoporosis Brittle hair and nails Dry and yellowish skin Lanugo Mild anemia Muscle wasting Weakness Lethargy Sluggishness Feeling tired all the time Severe constipation Low blood pressure Slowed breathing Slow pulse Damage to the structure and function of the heart Brain damage Multi organ failure Drop in internal body temperature, causing a person to feel cold all the time Infertility

15 Restricting type anorexia Lose weight by restricting foods Binge-eating/purging type anorexia Lose weight by vomiting after binge eating, abusing laxatives or diuretics, or engaging in excessive exercise

16 Majority of cases occur in females Onset peaks in adolescent and young adults

followed by forced vomiting, excessive use of laxatives or diuretics

17 Characteristics Recurrent and frequent episodes of eating unusually large amounts of food Feeling a lack of control over these episodes Binge-eating is followed by forced vomiting, excessive use of laxatives or diuretics (purging), fasting, excessive exercise (nonpurging), or a combination of these behaviors.

18 Sufferers maintain a healthy or normal weight, while some are slightly overweight. Often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape Bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame

19 Binge-eating and purging cycle happens anywhere from many times a day to several times a week Majority incidences are in women Common in adolescents and young adults May last for several years

20 Chronically inflamed and sore throat Swollen salivary glands in the neck and jaw area Worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid Acid reflux disorder and other gastrointestinal problems

21 Intestinal distress and irritation from laxative abuse Severe dehydration from purging of fluids Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack

24 Anorexia Nervosa Bulimia Nervosa Onset after a period of dieting Fear of becoming obese Drive to become thin Preoccupation with food, weight, appearance Elevated risk of self-harm or attempts at suicide Feelings of anxiety, depression, perfectionism Substance abuse Disturbed attitudes toward eating

25 Anorexia Nervosa Bulimia Nervosa more worried about pleasing others, being attractive to others, and having intimate relationships tend to be more sexually experienced display fewer of the obsessive qualities that drive restricting-type anorexia more likely to have histories of mood swings, low frustration tolerance, and poor coping almost all women have amenorrhea tend to be controlled by emotion may change friendships easily more likely to display characteristics of a personality disorder half of women have amenorrhea suffer damage caused by purging, especially from vomiting and laxatives

Characteristics A person loses control over his or her eating Periods of binge-eating are not followed by purging, excessive exercise, or fasting.

26 Characteristics A person loses control over his or her eating Periods of binge-eating are not followed by purging, excessive exercise, or fasting. People with binge-eating disorder often are overweight or obese. People who are obese are at higher risk for developing cardiovascular disease and high blood pressure. They experience guilt, shame, and distress about their habit, which can lead to more binge-eating.

29 1. Individual, group, and/or family psychotherapy 2. Medical care and monitoring (hospitalization if required) 3. Nutritional counseling 4. Medications

30 The initial aims of treatment for anorexia nervosa are to: Restore proper weight Recover from malnourishment Restore proper eating

Anorexia Nervosa Restoring the person to a healthy weight Treating the psychological issues related to the eating disorder Reducing or eliminating behaviors or thoughts that lead to insufficient

31 Anorexia Nervosa Restoring the person to a healthy weight Treating the psychological issues related to the eating disorder Reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse. Force tube and intravenous feedings on the patient Use of supportive nursing care and high-calorie diets Bulimia Nervosa To reduce or eliminate binge-eating and purging behaviors- a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication. Binge-eating Disorder Antidepressants may reduce binge eating

While we sleep our body is inactive and brain very active Sleep is important for our

33 More sleep would make most people happier, healthier and safer. 60 percent of adults report having sleep problems a few nights a week or more. While we sleep our body is inactive and brain very active Sleep is important for our physical and mental functioning and daily functioning Sleep deprivation effects badly on the immune and nervous system

34 Classified into 4 stages Stage 1 The sleeper is in a very light sleep It is a transitional phase between waking and sleeping If woken at this stage the volunteer may claim that he has not even been asleep In early sleep we pass through about 10 minutes of stage 1 before moving to deeper stage 2 Stage 2 In early sleep we spend about 20 minutes in stage 2 before moving on to the deeper stage 3 and 4 About 50% of a normal sleep is spent in stage 2

Stages 3 and 4 a. The brain is semi-active emitting long slow waves measured by EEG tracings and thus commonly referred to as slow wave or orthodox sleep b. The eyes are still behind the eyelids c.

36 Stages 3 and 4 a. The brain is semi-active emitting long slow waves measured by EEG tracings and thus commonly referred to as slow wave or orthodox sleep b. The eyes are still behind the eyelids c. Muscles are relaxed d. Choking or crushing dreams Function of slow wave sleep (orthodox sleep) Slow wave sleep refreshes the body and is necessary for tissue restoration After strenuous physical activity the body will require more slow wave sleep

37 Superimposed on the above 4 stages is REM (sometimes referred to as Paradoxical sleep) which is quite different to orthodox sleep a. The brain is active and the EEG trace is similar to that of an individual who is fully awake whilst the other measurements show the person to be sleep b. Rapid eye movement behind the eyelids are detected c. Muscles twitch d. Complex bizarre and emotionally- coloured dreams

38 Function of REM Sleep REM sleep refreshes the brain It strengthens and organizes the memory After a period of learning new tasks of procedures REM sleep will increase

During normal night s sleep the pattern operates on an approximately 90 minutes cycle Towards the end of the first 90 minutes of falling asleep the first REM stage occurs but this

39 During normal night s sleep the pattern operates on an approximately 90 minutes cycle Towards the end of the first 90 minutes of falling asleep the first REM stage occurs but this first REM experience lasts only minutes before the person passes back into slow wave sleep At the end of the second cycle of 90 minutes the duration of REM sleep periods increases

41 Typical sleep night is seen in the diagram Individual stages vary depending on the activities prior to sleep Following great strenuous activities stage 3 and 4 will be extended If a lot of mental stress is undertaken (learning new information, procedures) then REM sleep will be increased

Infants Birth 2 months need 12 18 hours 3 11 months need 14

years old need 11 13 hours 5 10 years old need 10 11 hours

43 Infants Birth 2 months need hours 3 11 months need hours Toddlers/Children 1 3 years need hours 3 5 years old need hours 5 10 years old need hours Adolescents years need hours Adults need 7 9 hours

44 Insomnia an inability to fall or stay asleep that can result in functional impairment throughout the day. Narcolepsy excessive daytime sleepiness combined with sudden muscle weakness; episodes of narcolepsy are sometimes called "sleep attacks" and may occur in unusual circumstances.

45 Restless Legs Syndrome (RLS) an unpleasant "creeping" sensation associated with aches and pains throughout the legs that can make it difficult to fall asleep. Sleep Apnea interrupted sleep caused by periodic gasping or "snorting" noises or momentarily suspension of breathing.

with good sleep Alcohol and smoking will reduce the REM sleep, causing

46 Short term insomnia is common Treated with sleeping pills Sleeping pills are ineffective after a few weeks and long term use interferes with good sleep Alcohol and smoking will reduce the REM sleep, causing only light sleep Mild insomnia can be helped with practicing good sleep habits

Interruption of breathing during sleep Linked to obesity and decreased muscle tone due to aging wind pipe collapse when muscles relax during sleep

47 Interruption of breathing during sleep Linked to obesity and decreased muscle tone due to aging wind pipe collapse when muscles relax during sleep obstructive sleep apnea causing loud snoring Lack of blood flow to the brain wakes person up momentarily and goes back to sleep May occur hundreds of times a night

48 Oxygen deprivation in sleep apnea may cause Morning headaches Loss of interest in sex Reduced mental functioning High blood pressure Irregular heart rate Increase risk of heart attack or stroke

49 People with symptoms such as loud snoring, day time sleepiness, obesity should see a sleep specialist Polysomnography records brain waves, heart beat and breathing during the sleep period at night Mild sleep apnea: Reducing weight Avoiding sleeping on the back Devices or surgery to correct obstruction

50 Treatment Continuous positive air pressure (CPAP) to keep airway open

51 Hereditary Disorder Unpleasant crawling, prickling or tingling sensation in the legs and feet Urge to move the legs Common among older people May be linked with anaemia, pregnancy and diabetes

52 Sudden period of sleep in the middle of being awake Brain s inability to regulate sleep-awake cycles Lasts from several seconds to over 30 minutes

53 Two main symptoms: 1. you feel sleepy in the daytime, with sudden uncontrollable attacks of sleepiness 2. cataplexy - you suddenly lose control of your muscles and collapse during emotional conditions may also have Inability to speak or move when falling asleep or waking up (sleep paralysis) Hallucinations Wake with hot flushes during the night

54 Mainly hereditary, but also can occur following neurological disease or head injury Treatment Anti depressants Stimulants :Modafinil which makes you more awake in the day-time Naps

55 Sleep and wake up at regular times daily Exercise Avoid caffeine, alcohol, nicotine Relax prior to bedtime

57 Intentional death a self-inflicted death One makes an intentional, direct, and conscious effort to end one s life

58 Suicide is a leading cause of death in the world It is significantly high in Sri Lanka There are more unsuccessful attempts of suicide Rates are highest for people between the ages of 45 60

59 People who are single, divorced or widowed are 2-3 times as likely to commit suicide as married people Theorists believe that suicide results from depression and from anger at others that is redirected toward oneself Common among relatives

60 Women have a higher attempt rate (x3 grater than men) Men have a higher completion rate(x3 greater than women) People with less social support tends to suicide more

61 current condition and stressful events in life (Occupational problems, Relationship problems) mood and thought changes alcohol, substance abuse mental disorders Depression Schizophrenia Some of the personality disorders

62 loss of a loved one the loss of a job natural disaster long-term stressors Serious illness Abusive environment Occupational stress Psychiatrists and psychologists, physicians, nurses, dentists, lawyers, farmers, and unskilled laborers have particularly high suicide rates

63 1. Cognitions (beliefs, imagery, thought processes, etc.) is key for development of psychological disorders 2. The loss of a loved person may result in great despair and hopelessness 3. 2/3 of all suicide attempts are estimated to be actually attempts to communicate something to others 4. The intention to kill oneself is not a constant condition for the individual. It comes and goes. 5. The motivation to commit suicide is largely a social phenomenon

64 Individuals may become preoccupied, lose perspective, and see suicide as their only option Studies indicate that as many as 70% of the people who attempt suicide drink alcohol just before the act It is not unusual for people, particularly teens, to commit suicide after observing or reading about someone who has done so Serotonin levels have been found to be low in people who commit suicide

65 The person s ability and opportunity to cope How confident they are in their ability to resolve problems and bring about a change in their life Availability of good support from parents, friends, carers and professionals.

67 Shneidman s characterizations : 1. Death seekers clearly intend to end their lives 2. Death initiators intend to end their lives because they believe that the process of death is already underway 3. Death ignorers do not believe that their selfinflicted death will mean the end of their existence 4. Death darers have ambivalent feelings about death and show this in the act itself

68 Durkheim: probability of suicide is determined by how attached a person is to such social groups as the family, religious institutions, and community The more thoroughly a person belongs, the lower the risk of suicide categories of suicide Egoistic suicide Altruistic suicide Anomic suicide

69 Egoistic suicides are committed by people over whom society has little or no control Altruistic suicides are committed by people who are so well integrated into their society that they intentionally sacrifice their lives for its well-being Anomic suicides are those committed by people whose social environment fails to provide stable structures that support and give meaning to life A change in an individual s immediate surroundings can also lead to this type of suicide

70 Suicidal actions become much more common after the age of 14 than at any earlier age About half of teen suicides have been linked to depression, low self-esteem, and feelings of hopelessness

71 Thank you

Eating Disorders. About more than Food Teena

Eating Disorders. About more than Food Teena Eating Disorders About more than Food Teena Eating Disorders: About More than Food What are eating disorders? The eating disorders anorexia nervosa, bulimia nervosa, and binge-eating disorder, and their