Recurrent episodes of overeating large amounts of food in a short period of time with either purging, use of laxatives or diuretics

or counteracting the negative effects of the extreme caloric intake with excessive exercise or fasting. The ICD-10: compulsion DSM IV TR: lack of control Even if the person does not make use of purgatives, but binge eats and then fasts, crash diets or over-exercises in order to stave off the anxiety over weight gain, the criteria for Bulimia Nervosa are still met.

Strict Dieting

Shame & Disgust

Tension & Cravings

Purging to Avoid Weight Gain

BingeEating

 Callouses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting. Puffy chipmunk cheeks near salivary glands, caused by repeated vomiting. Discoloured teeth from exposure to stomach acid when throwing up. Teeth may look yellow, ragged, or clear. Not usually underweight: men and women with bulimia are usually normal weight or slightly overweight. Frequent fluctuations in weight: weight may fluctuate by up to 5kg or more due to alternating episodes of bingeing and purging.

 Epileptic-equivalent seizures Central nervous system tumours Patients with BN and concurrent Seasonal Affective Disorder and depression, may show seasonal worsening Being underweight whilst purging might indicate a purging type of Anorexia Nervosa, rather than Bulimia Nervosa. Binge-eating Disorder, currently under Eating Disorders Not Otherwise Specified

 Cognitive-behavioural therapy
Manual-guided, 18-20 sessions over about 6 months More effective long-term, when self-forgiveness is learnt

Dynamic psychotherapy Pharmacotherapy

Antidepressant (Fluoxetine (Prozac)

 The incidence of BN tends to be similar in most industrialised countries Mostly found in young, white, better-educated, middle-class females, but other groups are also at risk In African cultures, treatment of ailments often involves restoring harmony within the body, as well as between the body and the cosmos In order of popularity, the treatment methods normally employed include: induction of vomiting, enemas, inhalation, and incisions in the skin with the rubbing of medicines into the incisions. Certain cultures (such as Xhoza and Zulu cultures) drink seawater which causes vomiting, in order to expel evil spirits.

 Obesity is not an official DSM IV TR or ICD-10 disorder. Obesity was ultimately rejected for the DSM 5 as both an eating disorder and an addiction disorder

Limitations to the use of BMI as a measure of overweight in obesity:

Athletes or bodybuilders who have a muscular build. May underestimate the body fat in elderly people or those who have muscle-loss for any of a number of reasons.

The most important consideration when overweight is the reason for seeking therapy is whether there is an underlying medical condition responsible for the weight gain.

This could include such causes as hormone problems, an underactive thyroid, Cushings syndrome, Polycystic Ovarian Syndrome as well as medication such as corticosteroids, antidepressants and some seizure medications.

calories in

> calories out

African countries have the steepest rise in overweight and obesity rates, with the figures in 2010 nearly double those in 1990 Overweight children are more likely to become overweight adults: health risks! Low self-esteem, depression, anxiety, social isolation, discrimination.

 Obesity rates continue to grow especially in industrialised nations- serious public health threat to millions of people. Skinny = HIV/AIDS Fat = Wealth

Sensitivity!!
Most common form of therapeutic intervention for obesity includes using CBT. Standardised Obesity Family Therapy (SOFT). The SOFT program focuses on family interactions as integral in implementing and maintaining lifestyle changes with the help of a multidisciplinary team and a restricted number of sessions (only 3 to 4 per year).

I remember the first moment I thought I was fat. I was a child I stood on the first step up to the back yard, looking down at my legs. Im fat. Disgusting I thought. Since that instant, my every waking moment has been consumed with thoughts of being fat, ugly, unworthy, unlovable, undeserving. Where did this come from? How can I get rid of it? Ive exhausted every avenue of enquiry, undergone hours of therapy and introspection all in the quest for some kind of answer, some kind of resolution, some kind of absolution. There has been none. I still spend every day counting calories, mentally working out how many Ive consumed, how many I can still consume, how many Ive burned off, how many I need to burn off. Ive lied to everyone I love, Ive hidden this monster from those closest to me. Ive tried to explain it to some of them no-one understands this terrible demon. This thing that took over my life, sucks every ounce of joy from it, feeds my insecurities, whispers its taunts, tells me Im not good enough, that Ill never be good enough, thin enough, beautiful enough, perfect enough.

Ill never be enough.

Onset between the ages of 10 and 30 years. Intense fear of gaining weight and becoming obese present in all patients.

Most patients with Anorexia do not voluntarily seek psychotherapy, but are usually convinced to see a therapist by a parent or other loved one. As a result, they are often reluctant, resistant clients.

Other psychiatric symptoms of anorexia nervosa most frequently noted in the literature: Obsessive-compulsive behaviour Depression and Anxiety Patients tend to be rigid and perfectionist and somatic complaints, especially epigastric discomfort, are usual.

Clinicians must ascertain that a patient does not have a medical illness that can account for the weight loss (e.g.: a brain tumour or cancer). Weight loss, peculiar eating behaviours, and vomiting can occur in several mental disorders:
o o o o o Depressive disorders Somatization disorder Schizophrenia Anorexia nervosa must be differentiated from Bulimia Nervosa:
the two conditions frequently co-exist
Patients with bulimia nervosa seldom lose 15 percent of their weight, but the two conditions frequently coexist.

 spontaneous recovery without treatment, recovery after a variety of treatments, a fluctuating course of weight gains followed by relapses, and a gradually deteriorating course resulting in death caused by complications of starvation.
Restricting-type anorectic patients seem less likely to recover the binge eating-purging type.
Indicators of a favourable outcome are: Admission of hunger, lessening of denial and immaturity, and improved self-esteem. Indicators of a poor outcome include: childhood neuroticism, parental conflict, bulimia nervosa, vomiting, laxative abuse, and various behavioural manifestations, for example, obsessive-compulsive, hysterical, depressive, psychosomatic, neurotic, and denial symptoms In general, the prognosis is not good. Studies have shown a range of mortality rates from 5 to 18 percent.

First priority: Restore patients' nutritional state; dehydration, starvation, and electrolyte imbalances can seriously compromise health and, in some cases, lead to death. Patients with anorexia nervosa who are 20 percent below the expected weight for their height are recommended for inpatient programs Patients who are 30 percent below their expected weight require psychiatric hospitalization for 2 to 6 months.

Inpatient psychiatric programs: Combine behavioural management approach, individual psychotherapy, family education and therapy, and, in some cases, psychotropic medications.

Patients must become willing participants for treatment to succeed in the long run.

Cognitive-behavioural Therapy Dynamic Psychotherapy Family Therapy

A study conducted in 2009 by Kaye, Fudge and Paulus found new evidence linking Anorexia Nervosa with ventral and dorsal neural circuit dysfunction, possibly related to altered serotonin and dopamine metabolism. The article discusses in quite technical detail how the reward circuits relating to food are dysfunctional in patients with Anorexia Nervosa. Normal people experience mild euphoria after consuming a carbohydrate-rich meal (which contributes to the production of serotonin), whereas the consumption of large amounts of carbohydrates leads to increased anxiety levels in patients with Anorexia Nervosa.

Whats the nutritional information for the chocolate laxatives? If anyone knows, please let me know. I cant believe Im obsessing over the calorie and carb content of a laxative.