Understanding Eating Disorders in Children and Adolescents: Insights from Dr. Irene Yi

 
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Oct 2014
 
 
Dr Irene Yi
Specialist EDS for Children and
Adolescents
 
Types of Eating Disorders
 
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Developmental Perspective
 
Lack of reserve in children and young people
Rapid rate of weight loss
Medical compromises
Pulse rate / blood pressure / dehydration
Re-feeding syndrome
Growth
 
Manifestations
Assessment
Stages of Change
Management
  
psychological
  
medical
 
 
Overview
 
NICE Guidelines
 
The majority should be managed on an OP basis by a service with
expertise in both the psychological aspects and in assessing the
physical risk associated with ED
Assessment and treatment should be provided at the earliest
opportunity
When IP tr is required this should be provided in a unit with specific
skills in treating ED
For BN as a first step encourage pts to follow an evidence-based self-
help programme
BN pts may be treated with CBT adapted as needed to suit age and
specific circumstances and include the family as appropriate
 
Anorexia Nervosa
 
Characterized by:
 
Self starvation
Excessive weight loss
Intense fear of fatness
Unrelenting pursuit of thinness
 
Anorexia Nervosa
 
Excessive weight loss (15%)
Severe diets – odd food behaviours and rituals
Hyperactivity
Investment in perfectionism
Denial of hunger
Preoccupation with food, weight  and/or body image
thoughts
 
 
Emotional Manifestation of AN
 
Inability to express or cope with emotional situations
Increasingly diminished social and inter-personal
functioning – isolation
Feelings of inadequacy, low or no self-esteem
Extreme moodiness
Intense remorse and shame regarding eating behaviours
and their body
 
Physical Manifestations of AN
 
Inability to express or cope with emotional situations
Increasingly diminished social and inter-personal
functioning – isolation
Feelings of inadequacy, low or no self-esteem
Extreme moodiness
Intense remorse and shame regarding eating behaviours
and their body
 
Bulimia Nervosa
 
Characterized by:
A secretive cycle of binge eating and self – induced
purging
Rapid consumption of large amounts of food
A sense of loss of control
Compensatory purging to get rid of food or calories consumed
 
Behavioural Manifestations of BN
 
Secretive and impulsive behaviours
Purging
Large weight variations
Food hoarding, stealing
Often associated behaviours
Preoccupation with food, weight and body image thoughts
Aware of hunger, but eating behaviour not connected to
hunger cues
 
Emotional Manifestations of BN
 
Frequent sense of shame and guilt connected to
behaviours
Intense fear of fatness
Suicide thoughts and attempts
Frequent mood swings
Low self esteem, ongoing feelings of unworthiness
 
Physical Manifestations of BN
 
Digestive problems
Electrolyte imbalance
Muscle Spasms
Cardiac arrhythmias
Fatigue
Menstrual irregularities
Swollen parotid glands
 
 
Hypokalemia
Russell’s sign
Dehydration
Dental problems
Loss of enamel
Receding gums
Esophageal tears
Anemia
 
Early Manifestations
 
The SCOFF Questions
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A score of >2 indicates a likely case of AN or BN
 
Assessment
 
Physical
Medical compromise
Psychiatric
Psychopathology
Depression
Obsession/compulsion
Motivation
Family
Questionnaires / EDE
 
 
Stages of Change
 
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
 
Management
 
Psychoeducation
Medical
Meal planning
Weight Monitoring
Psychological
Individual / group (MET / CBT / IPT / CRT)
Family
Individual / multifamily
 
Medical Management
 
Criteria for admission to Paediatric Ward
Weight 4 Height <67 – 70% (BMI <13)
Cardiac abnormalities Sys <80, Dias <60, P <40)
Electrolyte abnormalities (K <3, Na <130, Mg <0.5, PO4 < 0.5,
Urea > 10)
Severe hypothermia (<36)
Hypoglycaemia (< 2.5)
 
Estimated Energy Requirement
 
Age
    
Energy (F)
   
Energy (M)
 
15-18 
    
2110 kcal/day
  
2755 kcal/day
11-14
    
1845 kcal/day
  
2220 kcal/day
7-10
    
1740 kcal/day
  
1970 kcal/day
 
What Works
 
Working with parents
Collaboration
Consistency
Compassion
Containing Anxiety
Dispelling Myths
Engagement
Empowerment
Psycho-education
Support
 
 
Research Evidence
Family based treatments
Current Interest in Neuropsychology
 
 
 
What works
 
Dispelling Myths
Engagement
Empowerment
Psycho-education
Support
Research Evidence
Family based treatments
Current Interest in Neuropsychology
 
 
 
 
Competence
 
 
Fraser (Gillick) Competence
 
Capacity to consent
 
Helping People with Anorexia
 
Assume mixed feelings (not antagonism)
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Few people want to be anorexic
Provide ladders not cranes
Traps
Battling
Colluding
Scare tactics
Most adolescents get better
 
My Friend
 
In a way you have made my life much easier. Instead of
having lots of thoughts and worries I just concentrate on
you. You determine whether I am happy or sad and you
make everything less complicated. You’ve made me much
happier about the way I look and you make most of my
decisions for me. I wish people would understand how you
feel and what you’re thinking.
 
My Enemy
 
I wish you wouldn’t hurt my friends and family, they don’t
deserve this. I don’t want you to prevent me from doing
things I enjoy. You are deceitful in that you don’t show me
what I really look like. I know this because I’m starting to
believe some of the things people tell me. It hurts most
when I see people I love suffer because of you.
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This comprehensive presentation by Dr. Irene Yi delves into eating disorders, including Anorexia Nervosa and Bulimia, in children and adolescents. The content covers types of eating disorders, developmental perspectives, assessment stages, and management strategies. NICE guidelines for managing eating disorders are outlined, emphasizing psychological and physical risk assessments. Detailed insights into Anorexia Nervosa, its manifestations, physical and emotional aspects, are also provided.


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  1. Eating Disorders Oct 2014 Dr Irene Yi Specialist EDS for Children and Adolescents

  2. Types of Eating Disorders Anorexia Bulimia EDNOS Selective Eating Food avoidance emotional disorder Restrictive Eating

  3. Developmental Perspective Lack of reserve in children and young people Rapid rate of weight loss Medical compromises Pulse rate / blood pressure / dehydration Re-feeding syndrome Growth

  4. Overview Manifestations Assessment Stages of Change Management psychological medical

  5. NICE Guidelines The majority should be managed on an OP basis by a service with expertise in both the psychological aspects and in assessing the physical risk associated with ED Assessment and treatment should be provided at the earliest opportunity When IP tr is required this should be provided in a unit with specific skills in treating ED For BN as a first step encourage pts to follow an evidence-based self- help programme BN pts may be treated with CBT adapted as needed to suit age and specific circumstances and include the family as appropriate

  6. Anorexia Nervosa Characterized by: Self starvation Excessive weight loss Intense fear of fatness Unrelenting pursuit of thinness

  7. Anorexia Nervosa Excessive weight loss (15%) Severe diets odd food behaviours and rituals Hyperactivity Investment in perfectionism Denial of hunger Preoccupation with food, weight and/or body image thoughts

  8. Emotional Manifestation of AN Inability to express or cope with emotional situations Increasingly diminished social and inter-personal functioning isolation Feelings of inadequacy, low or no self-esteem Extreme moodiness Intense remorse and shame regarding eating behaviours and their body

  9. Physical Manifestations of AN Inability to express or cope with emotional situations Increasingly diminished social and inter-personal functioning isolation Feelings of inadequacy, low or no self-esteem Extreme moodiness Intense remorse and shame regarding eating behaviours and their body

  10. Bulimia Nervosa Characterized by: A secretive cycle of binge eating and self induced purging Rapid consumption of large amounts of food A sense of loss of control Compensatory purging to get rid of food or calories consumed

  11. Behavioural Manifestations of BN Secretive and impulsive behaviours Purging Large weight variations Food hoarding, stealing Often associated behaviours Preoccupation with food, weight and body image thoughts Aware of hunger, but eating behaviour not connected to hunger cues

  12. Emotional Manifestations of BN Frequent sense of shame and guilt connected to behaviours Intense fear of fatness Suicide thoughts and attempts Frequent mood swings Low self esteem, ongoing feelings of unworthiness

  13. Physical Manifestations of BN Digestive problems Electrolyte imbalance Hypokalemia Russell s sign Dehydration Dental problems Muscle Spasms Cardiac arrhythmias Fatigue Menstrual irregularities Swollen parotid glands Loss of enamel Receding gums Esophageal tears Anemia

  14. Early Manifestations The SCOFF Questions S sick C control O one stone F fat F food A score of >2 indicates a likely case of AN or BN

  15. Assessment Physical Medical compromise Psychiatric Psychopathology Depression Obsession/compulsion Motivation Family Questionnaires / EDE

  16. Stages of Change Precontemplation Contemplation Preparation Action Maintenance Termination

  17. Management Psychoeducation Medical Meal planning Weight Monitoring Psychological Individual / group (MET / CBT / IPT / CRT) Family Individual / multifamily

  18. Medical Management Criteria for admission to Paediatric Ward Weight 4 Height <67 70% (BMI <13) Cardiac abnormalities Sys <80, Dias <60, P <40) Electrolyte abnormalities (K <3, Na <130, Mg <0.5, PO4 < 0.5, Urea > 10) Severe hypothermia (<36) Hypoglycaemia (< 2.5)

  19. Estimated Energy Requirement Age Energy (F) Energy (M) 15-18 2110 kcal/day 2755 kcal/day 11-14 1845 kcal/day 2220 kcal/day 7-10 1740 kcal/day 1970 kcal/day

  20. What Works Working with parents Collaboration Consistency Compassion Containing Anxiety Dispelling Myths Engagement Empowerment Psycho-education Support

  21. What works Dispelling Myths Engagement Empowerment Psycho-education Support Research Evidence Family based treatments Current Interest in Neuropsychology

  22. Competence Fraser (Gillick) Competence Capacity to consent

  23. Helping People with Anorexia Assume mixed feelings (not antagonism) Fear of changing and fear of staying the same Few people want to be anorexic Provide ladders not cranes Traps Battling Colluding Scare tactics Most adolescents get better

  24. My Friend In a way you have made my life much easier. Instead of having lots of thoughts and worries I just concentrate on you. You determine whether I am happy or sad and you make everything less complicated. You ve made me much happier about the way I look and you make most of my decisions for me. I wish people would understand how you feel and what you re thinking.

  25. My Enemy I wish you wouldn t hurt my friends and family, they don t deserve this. I don t want you to prevent me from doing things I enjoy. You are deceitful in that you don t show me what I really look like. I know this because I m starting to believe some of the things people tell me. It hurts most when I see people I love suffer because of you.

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