Disturbi dell'alimentazione (DA) Informazioni generali - Dr ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Disturbi dell’alimentazione (DA)
Informazioni generali
Dr. Riccardo Dalle Grave
Responsabile Unità di Riabilitazione Nutrizionale
Casa di Cura Villa Garda
www.dallegrave.it
Argomenti
Descrizione generale
Decorso
Distribuzione
Cause
Aree danneggiate
Trattamento
1Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Argomenti
Descrizione generale
Decorso
Distribuzione
Cause
Aree danneggiate
Trattamento
Disturbi dell’alimentazione
Definizione
I disturbi dell'alimentazione sono condizioni caratterizzati da un persistente
disturbo dell’alimentazione che danneggia significativamente il
funzionamento psicosociale e la salute fisica
La maggior parte dei disturbi dell’alimentazione ha caratteristiche cliniche
distintive e criteri diagnostici positivi
2Chapter 4 C
3. Eating disorders and their The course of AN varies greatly. It may be s
may require some form of intervention; or
management treatment-resistant and persist for many ye
Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
life-threatening. For those with longstandin
becomes increasingly poor over time, altho
3.1 Clinical features still occur.10 In the early years, it is common
Figure 4.1 shows the typical distribution of the four eating into BN or an OED.
disorder diagnoses among adult outpatients.4 The OEDs
are the most common diagnosis, followed by BN and then 3.3 Bulimia nervosa
AN. Eating disorder services see relatively few cases of BED. BN generally starts in late adolescence or e
Among adolescents, the diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
Disturbi dell’alimentazione about one in ten patients is male.3 In contrast, men constitute
about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
in which large amounts of food are consum
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
Distribuzione negli Adolescenti
shown here (Figure 4.1). attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
• Anoressia nervosa on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Bulimia nervosa BED
BED
with binge eating,11 and it is easy for them
BN
AN problem secret as their weight is generally
• Altri disturbi dell’alimentazione (ADA)
3.4 Other eating disorders
• Disturbo da binge-eating (BED) Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
• Disturbo evitante/restrittivo ADA
OEDs same tendency to engage in persistent and
AN
BN and other forms of weight-control behavio
dell’assunzione di cibo (ARFID?) OEDs are mixed states in which the feature
are combined in such a way that it is not p
either diagnosis. Body weight may be low i
restriction is marked.
Many people with an OED have a history o
Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford
both, reflecting the diagnostic migration th
among the eating disorders9,14 (see Figure 4
Chapter 4 Fairburn and Harrison15).The OEDs are as imC
3.2 Anorexia nervosa the level of eating disorder features is the s
AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
of dieting that gets out of control and becomes persistent,
3. Eating disorders and their
inflexible and extreme.3 Progressive weight loss results and is
accompanied by over-concern about body shape and weight,
The
One course
may requirein
specialising
of AN varies
small subgroup
some
alsogreatly. It may be s
merits mentioning
form of intervention;
the treatment of young child or
management
although this may not be acknowledged and may be absent treatment-resistant
adolescents with eating
life-threatening.
restrict
and persist
Forbut
their eating
problems
those
notwith
for see
many
in anlongstandin
attempt t
ye
some
at the outset. There is a fear of weight gain and fatness, and
this drives further dieting. The dieting may be accompanied becomes
shape increasingly
or weight. Thesepoor overvary
states time, altho
in natur
3.1other
by Clinical
forms features
of weight-control behaviour including still occur.
been
10
In the early years,
well characterised. They ithave
is common
recently
over-exercising,
Figure 4.1 showsself-induced vomiting and
the typical distribution oflaxative
the fourmisuse.
eating into BN or an OED. food intake disorder’.3
‘avoidant/restrictive
Typically, sufferers do
disorder diagnoses not acknowledge
among adult outpatients.having4 a problem;
The OEDs prevalence in specialist clinics for children r
theirthe
are lowmost
weight and extreme
common diagnosis,weight-control
followed by behaviour
BN and then are 3.3 16,
14%. Bulimia
17
In our nervosa
experience, they are rarely
consistent
AN. Eatingwith theirservices
disorder desire toseemaintain
relativelystrict
fewcontrol
cases of over
BED. BN generally starts in late adolescence or e
their eating,
Among shape and
adolescents, theweight.
diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
Disturbi dell’alimentazione about one in ten patients is male.3 In contrast, men constitute
about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
in which large amounts of food are consum
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
Distribuzione negli Adulti
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: Women
shown here (Figure 4.1). attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
• Anoressia nervosa on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Bulimia nervosa BED with binge eating,11 and it is easy for them
BED AN problem secret as their weight is generally
AN
• Altri disturbi dell’alimentazione (ADA)
3.4 Other eating disorders
• Disturbo da binge-eating (BED) Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
• (ARFID) ADA
OEDs same tendency to engage in persistent and
BN
BN and other forms of weight-control behavio
OEDs are mixed states in which the feature
are combined in such a way that it is not p
either diagnosis. Body weight may be low i
restriction is marked.
Many people with an OED have a history o
Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford
both, reflecting the diagnostic migration th
among the eating disorders9,14 (see Figure 4
Fairburn and Harrison15).The OEDs are as im
3.2 Anorexia nervosa the level of eating disorder features is the s
AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
of dieting that gets out of control and becomes persistent,
inflexible and extreme.3 Progressive weight loss results and is One small subgroup also merits mentioning
accompanied by over-concern about body shape and weight, specialising in the treatment of young child
although this may not be acknowledged and may be absent adolescents with eating problems see some
at the outset. There is a fear of weight gain and fatness, and restrict their eating but not in an attempt t
this drives further dieting. The dieting may be accompanied shape or weight. These states vary in natur
by other forms of weight-control behaviour including been well characterised. They have recently
over-exercising, self-induced vomiting and laxative misuse. ‘avoidant/restrictive food intake disorder’.3
Typically, sufferers do not acknowledge having a problem; prevalence in specialist clinics for children r
their low weight and extreme weight-control behaviour are 14%.16, 17 In our experience, they are rarely
consistent with their desire to maintain strict control over
their eating, shape and weight.
3
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: WomenChapter 4 C
3. Eating disorders and their The course of AN varies greatly. It may be s
may require some form of intervention; or
management treatment-resistant and persist for many ye
Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
life-threatening. For those with longstandin
becomes increasingly poor over time, altho
3.1 Clinical features still occur.10 In the early years, it is common
Figure 4.1 shows the typical distribution of the four eating into BN or an OED.
disorder diagnoses among adult outpatients.4 The OEDs
are the most common diagnosis, followed by BN and then 3.3 Bulimia nervosa
AN. Eating disorder services see relatively few cases of BED. BN generally starts in late adolescence or e
Among adolescents, the diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
about one in ten patients is male.3 In contrast, men constitute in which large amounts of food are consum
Disturbi dell’alimentazione about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
shown here (Figure 4.1).
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
• Anoressia nervosa on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Bulimia nervosa with binge eating,11 and it is easy for them
BED
BED AN
AN problem secret as their weight is generally
• Altri disturbi dell’alimentazione (ADA)
3.4 Other eating disorders
• Disturbo da binge-eating (BED) Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
• (ARFID) ADA
OEDs same tendency to engage in persistent and
BN
BN and other forms of weight-control behavio
OEDs are mixed states in which the feature
Anoressia nervosa are combined in such a way that it is not p
either diagnosis. Body weight may be low i
• Restrizione dietetica calorica persistente, restriction is marked.
rigida ed estrema Many people with an OED have a history o
• Basso peso Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford
both, reflecting the diagnostic migration th
among the eating disorders9,14 (see Figure 4
• Eccessiva valutazione del peso e della forma
Chapter 4 Fairburn and Harrison15).The OEDs are as imC
3.2 Anorexia nervosa
del corpo the level of eating disorder features is the s
AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
• Soprattutto adolescenti of dieting that gets out of control and becomes persistent,
3. Eating disorders and their
inflexible and extreme.3 Progressive weight loss results and is
accompanied by over-concern about body shape and weight,
The
One course
may requirein
specialising
of AN varies
small subgroup
some
alsogreatly. It may be s
merits mentioning
form of intervention;
the treatment of young child or
management
although this may not be acknowledged and may be absent treatment-resistant
adolescents with eating
life-threatening.
restrict
and persist
Forbut
their eating
problems
those
notwith
for see
many
in anlongstandin
attempt t
ye
some
at the outset. There is a fear of weight gain and fatness, and
this drives further dieting. The dieting may be accompanied becomes
shape increasingly
or weight. Thesepoor overvary
states time, altho
in natur
3.1other
by Clinical
forms features
of weight-control behaviour including still occur.
been
10
In the early years,
well characterised. They ithave
is common
recently
over-exercising,
Figure 4.1 showsself-induced vomiting and
the typical distribution oflaxative
the fourmisuse.
eating into BN or an OED. food intake disorder’.3
‘avoidant/restrictive
Typically, sufferers do
disorder diagnoses not acknowledge
among adult outpatients.having4 a problem;
The OEDs prevalence in specialist clinics for children r
theirthe
are lowmost
weight and extreme
common diagnosis,weight-control
followed by behaviour
BN and then are 3.3 16,
14%. Bulimia
17
In our nervosa
experience, they are rarely
consistent
AN. Eatingwith theirservices
disorder desire toseemaintain
relativelystrict
fewcontrol
cases of over
BED. BN generally starts in late adolescence or e
their eating,
Among shape and
adolescents, theweight.
diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
about one in ten patients is male.3 In contrast, men constitute in which large amounts of food are consum
Disturbi dell’alimentazione about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: Women
shown here (Figure 4.1).
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
• Anoressia nervosa on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Bulimia nervosa with binge eating,11 and it is easy for them
BED
BED AN
AN problem secret as their weight is generally
• Disturbo da binge-eating (BED)
3.4 Other eating disorders
• Altri disturbi dell’alimentazione (ADA) Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
• (ARFID) ADA
OEDs same tendency to engage in persistent and
BN
BN and other forms of weight-control behavio
OEDs are mixed states in which the feature
Bulimia nervosa are combined in such a way that it is not p
either diagnosis. Body weight may be low i
• Restrizione dietetica calorica persistente, restriction is marked.
rigida ed estrema Many people with an OED have a history o
• Episodi di abbuffate ricorrenti seguiti da Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford
both, reflecting the diagnostic migration th
among the eating disorders9,14 (see Figure 4
comportamenti di compenso Fairburn and Harrison15).The OEDs are as im
3.2 Anorexia nervosa
• Non sottopeso the level of eating disorder features is the s
AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
• Eccessiva valutazione del peso e della forma
of dieting that gets out of control and becomes persistent,
One small subgroup also merits mentioning
del corpo inflexible and extreme. Progressive weight loss results and is
3
accompanied by over-concern about body shape and weight, specialising in the treatment of young child
• Soprattutto giovani donne although this may not be acknowledged and may be absent adolescents with eating problems see some
at the outset. There is a fear of weight gain and fatness, and restrict their eating but not in an attempt t
this drives further dieting. The dieting may be accompanied shape or weight. These states vary in natur
by other forms of weight-control behaviour including been well characterised. They have recently
over-exercising, self-induced vomiting and laxative misuse. ‘avoidant/restrictive food intake disorder’.3
Typically, sufferers do not acknowledge having a problem; prevalence in specialist clinics for children r
their low weight and extreme weight-control behaviour are 14%.16, 17 In our experience, they are rarely
consistent with their desire to maintain strict control over
their eating, shape and weight.
4
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: WomenChapter 4 C
3. Eating disorders and their The course of AN varies greatly. It may be s
may require some form of intervention; or
management treatment-resistant and persist for many ye
Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
life-threatening. For those with longstandin
becomes increasingly poor over time, altho
3.1 Clinical features still occur.10 In the early years, it is common
Figure 4.1 shows the typical distribution of the four eating into BN or an OED.
disorder diagnoses among adult outpatients.4 The OEDs
are the most common diagnosis, followed by BN and then 3.3 Bulimia nervosa
AN. Eating disorder services see relatively few cases of BED. BN generally starts in late adolescence or e
Among adolescents, the diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
about one in ten patients is male.3 In contrast, men constitute in which large amounts of food are consum
Disturbi dell’alimentazione about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
shown here (Figure 4.1).
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
• Anoressia nervosa on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Bulimia nervosa with binge eating,11 and it is easy for them
BED
BED AN
AN problem secret as their weight is generally
• Altri disturbi dell’alimentazione (ADA)
3.4 Other eating disorders
• Disturbo da binge-eating (BED) Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
• (ARFID) ADA
OEDs same tendency to engage in persistent and
BN
BN and other forms of weight-control behavio
OEDs are mixed states in which the feature
Altri disturbi dell’alimentazione are combined in such a way that it is not p
either diagnosis. Body weight may be low i
• Soprattutto disturbi sottosoglia o misti restriction is marked.
• La stessa psicopatologia dell’AN e BN Many people with an OED have a history o
• Un sottogruppo sottopeso Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford
both, reflecting the diagnostic migration th
among the eating disorders9,14 (see Figure 4
• Soprattutto giovani donne Chapter 4 Fairburn and Harrison15).The OEDs are as imC
3.2 Anorexia nervosa the level of eating disorder features is the s
AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
of dieting that gets out of control and becomes persistent,
3. Eating disorders and their
inflexible and extreme.3 Progressive weight loss results and is
accompanied by over-concern about body shape and weight,
The
One course
may requirein
specialising
of AN varies
small subgroup
some
alsogreatly. It may be s
merits mentioning
form of intervention;
the treatment of young child or
management
although this may not be acknowledged and may be absent treatment-resistant
adolescents with eating
life-threatening.
restrict
and persist
Forbut
their eating
problems
those
notwith
for see
many
in anlongstandin
attempt t
ye
some
at the outset. There is a fear of weight gain and fatness, and
this drives further dieting. The dieting may be accompanied becomes
shape increasingly
or weight. Thesepoor overvary
states time, altho
in natur
3.1other
by Clinical
forms features
of weight-control behaviour including still occur.
been
10
In the early years,
well characterised. They ithave
is common
recently
over-exercising,
Figure 4.1 showsself-induced vomiting and
the typical distribution oflaxative
the fourmisuse.
eating into BN or an OED. food intake disorder’.3
‘avoidant/restrictive
Typically, sufferers do
disorder diagnoses not acknowledge
among adult outpatients.having4 a problem;
The OEDs prevalence in specialist clinics for children r
theirthe
are lowmost
weight and extreme
common diagnosis,weight-control
followed by behaviour
BN and then are 3.3 16,
14%. Bulimia
17
In our nervosa
experience, they are rarely
consistent
AN. Eatingwith theirservices
disorder desire toseemaintain
relativelystrict
fewcontrol
cases of over
BED. BN generally starts in late adolescence or e
their eating,
Among shape and
adolescents, theweight.
diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
about one in ten patients is male.3 In contrast, men constitute in which large amounts of food are consum
Disturbi dell’alimentazione about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: Women
shown here (Figure 4.1).
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
• Anoressia nervosa on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Bulimia nervosa with binge eating,11 and it is easy for them
BED
BED AN
AN problem secret as their weight is generally
• Altri disturbi dell’alimentazione (ADA)
3.4 Other eating disorders
• Disturbo da binge-eating (BED) Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
• (ARFID) ADA
OEDs same tendency to engage in persistent and
BN
BN and other forms of weight-control behavio
OEDs are mixed states in which the feature
Disturbo da binge-eating are combined in such a way that it is not p
either diagnosis. Body weight may be low i
• Episodi di abbuffata ricorrenti non seguiti da restriction is marked.
comportamenti di compenso Many people with an OED have a history o
• Tendenza generale a mangiare in eccesso Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford
both, reflecting the diagnostic migration th
among the eating disorders9,14 (see Figure 4
• Spesso coesiste con l’obesità Fairburn and Harrison15).The OEDs are as im
• Ampia fascia di età, un terzo sono maschi3.2 Anorexia nervosa the level of eating disorder features is the s
AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
of dieting that gets out of control and becomes persistent,
inflexible and extreme.3 Progressive weight loss results and is One small subgroup also merits mentioning
accompanied by over-concern about body shape and weight, specialising in the treatment of young child
although this may not be acknowledged and may be absent adolescents with eating problems see some
at the outset. There is a fear of weight gain and fatness, and restrict their eating but not in an attempt t
this drives further dieting. The dieting may be accompanied shape or weight. These states vary in natur
by other forms of weight-control behaviour including been well characterised. They have recently
over-exercising, self-induced vomiting and laxative misuse. ‘avoidant/restrictive food intake disorder’.3
Typically, sufferers do not acknowledge having a problem; prevalence in specialist clinics for children r
their low weight and extreme weight-control behaviour are 14%.16, 17 In our experience, they are rarely
consistent with their desire to maintain strict control over
their eating, shape and weight.
5
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: WomenChapter 4 C
3. Eating disorders and their The course of AN varies greatly. It may be s
may require some form of intervention; or
management treatment-resistant and persist for many ye
Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
life-threatening. For those with longstandin
becomes increasingly poor over time, altho
3.1 Clinical features still occur.10 In the early years, it is common
Figure 4.1 shows the typical distribution of the four eating into BN or an OED.
disorder diagnoses among adult outpatients.4 The OEDs
are the most common diagnosis, followed by BN and then 3.3 Bulimia nervosa
AN. Eating disorder services see relatively few cases of BED. BN generally starts in late adolescence or e
Among adolescents, the diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
about one in ten patients is male.3 In contrast, men constitute in which large amounts of food are consum
Disturbi dell’alimentazione about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
shown here (Figure 4.1).
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
• Anoressia nervosa on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Bulimia nervosa with binge eating,11 and it is easy for them
BED
BED AN
AN problem secret as their weight is generally
• Altri disturbi dell’alimentazione (ADA)
3.4 Other eating disorders
• Disturbo da binge-eating (BED) Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
• ARFID ADA
OEDs same tendency to engage in persistent and
BN
BN and other forms of weight-control behavio
OEDs are mixed states in which the feature
ARFID are combined in such a way that it is not p
either diagnosis. Body weight may be low i
• Restrizione alimentare selettiva persistente restriction is marked.
- apparente mancanza d’interesse per il mangiare
Many people with an OED have a history o
- evitamento basato sulle caratteristiche Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford both, reflecting the diagnostic migration th
sensoriali del cibo among the eating disorders9,14 (see Figure 4
Chapter 4 Fairburn and Harrison15).The OEDs are as imC
- preoccupazioni relativa alle conseguenze 3.2 Anorexia nervosa the level of eating disorder features is the s
negative del mangiare AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
of dieting that gets out of control and becomes persistent,
• Malnutrizione
3. Eating disorders and their
inflexible and extreme.3 Progressive weight loss results and is The
One course of AN varies
small subgroup alsogreatly. It may be s
merits mentioning
• Soprattutto nell’infanzia accompanied by over-concern about body shape and weight, may requirein
specialising some form of intervention;
the treatment of young child or
management
although this may not be acknowledged and may be absent treatment-resistant
adolescents with eating
life-threatening.
restrict
and persist
Forbut
their eating
problems
those
notwith
for see
many
in anlongstandin
attempt t
ye
some
at the outset. There is a fear of weight gain and fatness, and
this drives further dieting. The dieting may be accompanied becomes
shape increasingly
or weight. Thesepoor overvary
states time, altho
in natur
3.1other
by Clinical
forms features
of weight-control behaviour including still occur.
been
10
In the early years,
well characterised. They ithave
is common
recently
over-exercising,
Figure 4.1 showsself-induced vomiting and
the typical distribution oflaxative
the fourmisuse.
eating into BN or an OED. food intake disorder’.3
‘avoidant/restrictive
Typically, sufferers do
disorder diagnoses not acknowledge
among adult outpatients.having4 a problem;
The OEDs prevalence in specialist clinics for children r
theirthe
are lowmost
weight and extreme
common diagnosis,weight-control
followed by behaviour
BN and then are 3.3 16,
14%. Bulimia
17
In our nervosa
experience, they are rarely
consistent
AN. Eatingwith theirservices
disorder desire toseemaintain
relativelystrict
fewcontrol
cases of over
BED. BN generally starts in late adolescence or e
their eating,
Among shape and
adolescents, theweight.
diagnostic distribution differs (ie that It begins in much the same way as AN, but
AN is more common than BN), but the OEDs remain the most months or years the dieting becomes punc
common diagnosis.5 BED is not often seen in this age group.5 episodes of binge eating with the result tha
AN, BN and the OEDs mainly affect girls or young women: lost tends to be regained. (‘Binges’ are epis
about one in ten patients is male.3 In contrast, men constitute in which large amounts of food are consum
Disturbi dell’alimentazione about a third of patients with BED. A typical distribution of
the eating disorder diagnoses among adult outpatients6 is
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: Women
shown here (Figure 4.1).
a sense of loss of control at the time.) The
followed by self-induced vomiting or laxativ
attempt to minimise the amount of food ab
Figure 4.1 Typical distribution of the eating disorder Once fully developed, BN tends to be self-p
diagnoses among adult outpatients in England may persist for years or even decades with
Disturbi tradizionali on self-esteem, career and relationships. It
sufferers to delay seeking help due to the s
• Anoressia nervosa with binge eating,11 and it is easy for them
BED
BED AN
AN problem secret as their weight is generally
• Bulimia nervosa
3.4 Other eating disorders
• Altri disturbi dell’alimentazione Most OEDs are very similar to AN and BN.12
same over-concern about eating, shape an
(sottosoglia o condizioni miste) ADA
OEDs same tendency to engage in persistent and
BN
BN and other forms of weight-control behavio
Altre condizioni OEDs are mixed states in which the feature
are combined in such a way that it is not p
• Disturbo da binge-eating (BED) either diagnosis. Body weight may be low i
restriction is marked.
• ARFID Many people with an OED have a history o
Source Christopher G. Fairburn, Professor of Psychiatry, University of Oxford
both, reflecting the diagnostic migration th
among the eating disorders9,14 (see Figure 4
Fairburn and Harrison15).The OEDs are as im
3.2 Anorexia nervosa the level of eating disorder features is the s
AN typically starts in early to mid-adolescence with a period duration and their impact on everyday func
of dieting that gets out of control and becomes persistent,
inflexible and extreme.3 Progressive weight loss results and is One small subgroup also merits mentioning
accompanied by over-concern about body shape and weight, specialising in the treatment of young child
although this may not be acknowledged and may be absent adolescents with eating problems see some
at the outset. There is a fear of weight gain and fatness, and restrict their eating but not in an attempt t
this drives further dieting. The dieting may be accompanied shape or weight. These states vary in natur
by other forms of weight-control behaviour including been well characterised. They have recently
over-exercising, self-induced vomiting and laxative misuse. ‘avoidant/restrictive food intake disorder’.3
Typically, sufferers do not acknowledge having a problem; prevalence in specialist clinics for children r
their low weight and extreme weight-control behaviour are 14%.16, 17 In our experience, they are rarely
consistent with their desire to maintain strict control over
their eating, shape and weight.
6
Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: WomenCopyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Argomenti
Descrizione generale
Decorso
Distribuzione
Cause
Aree danneggiate
Trattamento
Decorso
Anoressia nervosa
• Inizia nell’adolescenza, spesso breve durata ed auto-limitata
• Se persiste, frequentemente evolve nella BN o in ADA
• La minoranza rimane come AN, il disturbo diventa grave di lunga durata.
Bulimia nervosa
• Inizia nella tarda adolescenza o nella giovane età adulta
• Frequentemente preceduta da AN o condizioni simil-AN
• Può persistere come BN o ADA
Altri disturbi dell’alimentazione
• Decorso non ben caratterizzato
• Iniziano nell’adolescenza o nella giovane età adulta
• Spesso preceduti da AN o BN
7Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Decorso
Migrazione diagnostica
AN
ADA BN
Argomenti
Descrizione generale
Decorso
Distribuzione
Cause
Aree danneggiate
Trattamento
8Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Distribuzione
Punti generali
• La distribuzione non è stabile – Modificazioni secolari
• Emergenza della BN negli anni 70 (nord Europa e America, poi
Italia del Nord)
• Emergenza dei DA nei Paesi asiatici negli anni 90
• Distribuzione globale irregolare
Distribuzione
Anoressia nervosa Bulimia nervosa BED
Distribuzione mondiale Società occidentali Società occidentali Non conosciuta
Principalmente razza Principalmente razza
Origine etnica Distribuzione irregolare
bianca bianca
Adolescenza (alcuni Giovani adulti (alcuni
Età Età adulta
giovani adulti) adolescenti)
Sesso 90% femmine 90% femmine 2/3 femmine
Prevalenza 0,1-0,5% 1,0-2.0% 3%
Modificazioni secolari Possibile incremento Possibile incremento Non conosciuto
9Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Argomenti
Descrizione generale
Decorso
Distribuzione
Cause
Aree danneggiate
Trattamento
Cause
Punti generali
Le cause non sono conosciute
Molte sfide metodologiche
• I DA non sono comuni
• I DA sono difficili da individuare
• I campioni clinici non sono rappresentativi
• I DA sono difficili da diagnosticare, sono usate delle definizioni inconsistenti
• Non vi sono dei fenotipi ovvi da studiare
– Per es. AN o AN persistente
• Problema della comorbilità
– Molto ignorata, anche se appare esista una relazione tra DA e depressione
10Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Cause
Punti generali (cont.)
Familiarità indubbia
• Rischio aumentato di 10 volte nei familiari di primo grado
• Trasmissione crociata tra i DA tradizionali
Gli studi sui gemelli suggeriscono un importante contributo genetico
• I fattori genetici sembrano contribuire al 40-60% della predisposizione
Cause
Punti generali (cont.)
Studi di associazione genome-wide (GWAS)
• Risultati negativi nel primo studio (1000 partecipanti)
• Studio con 3495 AN e 10982 controlli (Duncan et al, 2017)
– Identificato un locus genome-wide significativo per l’anoressia nervosa
sul cromosoma 12
• (index variant rs4622308, p=4.3x10-9) nella regione
(chr12:56,372,585-56,482,185) che include 6 geni.
– Correlazioni positive con schizofrenia, neuroticismo, livello di istruzione
e HDL colesterolo
– Correlazioni negative con alcuni fenotipi (BMI, insulina, glucosio e lipidi)
• Un nuovo studio è in corso (obiettivo N = 25000)
11Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Cause
Punti generali (cont.)
Le modificazioni secolari suggeriscono il contributo di processi sociali
Alcuni fattori di rischio potenziali sono stati individuati
AN BN BED Psych
Esperienze avverse nell’infanzia ++ +++ ++ ++
Depressione nei genitori + ++ + +
Abuso di sostanze nei genitori - ++ - -
Fattori di vulnerabilità alla dieta + +++ + -
- Obesità nell’infanzia - +++ + -
- Obesità nei genitori - +++ - -
Menarca precoce - ++ - -
Perfezionismo +++ ++ - -
Bassa autostima +++ +++ + ++
Argomenti
Classificazione DSM-5
Distribuzione
Decorso
Cause
Aree danneggiate
Trattamento
12Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Aree danneggiate
Relazioni interpersonali
• Trascurare le amicizie per perseguire il controllo del peso
• Isolamento sociale e attività solitarie che richiedono consumo di energia
• Riduzione degli interessi
• Difficoltà nella relazione di coppia
Profitto scolastico/lavorativo
• Organizzazione della giornata secondo rituali precisi e stereotipati
• Difficoltà di concentrazione, di attenzione e comprensione
• Interruzione del lavoro/scuola
• Eccessivo impegno scolastico
Aree danneggiate
Funzionamento psicologico
• Ansia
• Apatia
• Senso di colpa
• Prolungati episodi di irritabilità
• Scoppi di rabbia
• Depressione, demoralizzazione
• Sbalzi d’umore
• Bassa autostima e pensieri suicidari
• Presenza di atti impulsivi abuso di alcool o di droghe, autolesionismo
13Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Aree danneggiate
Aree danneggiate (cont)
Salute fisica
Complicanze mediche Conseguenti a
• Elettrolitiche • dieta ipocalorica
• Cardiache • perdita di peso
• Endocrine • vomito auto-indotto
• Orali • uso improprio di lassativi, diuretici
• Gastrointestinali • attività fisica eccessiva
• Renali Il recupero del peso e la sospensione dei
• Polmonari comportamenti non salutari di controllo
• Neurologiche del peso risolve la gran parte delle
• Ossee complicanze mediche
• Cutanee
• Ematologiche e immunologiche
• Funzione mestruale e riproduttiva
Argomenti
Classificazione DSM-5
Distribuzione
Decorso
Cause
Aree danneggiate
Trattamento
14Copyright dr. Riccardo Dalle Grave (2017). Solo per uso personale
Terapie farmacologiche
Anoressia nervosa
Nessun trattamento farmacologico
Bulimia nervosa
Antidepressivi – effetto a breve termine sulla frequenza delle abbuffate
Altri disturbi dell’alimentazione
Nessuno studio
Binge-eating disorder
Lisdexamfetamina – effetto a breve termine sulla frequenza delle abbuffate
Trattamenti psicologici evidence-based
(NICE guideline May 2017 – NG69)
Bulimia Binge Eating Anoressia OSFED
Nervosa Disorder Nervosa
Adulti GSH GSH CBT-E o “Mantra” Trattamento del
Se inefficace Se inefficace o SSCM DA che più gli
CBT-ED CBT-ED Se inefficace FPT assomiglia
Adolescenti FT-BN GSH FT-AN Trattamento del
Se inefficace Se inefficace Se inefficace DA che più gli
CBT-ED CBT-ED CBT-ED o ANFT assomiglia
AFP-AN = Adolescent- Focused Psychotherapy for Anorexia Nervosa; CBT-ED = Cognitive
Behaviour Therapy for Eating Disorders; GSH = Guided Self-Help; FPT= Focal psychodynamic
therapy: MANTRA = Maudsley Anorexia Nervosa Treatment for Adults; OSFED = other specied
feeding and eating disorders; SSCN = Specialist Supportive Clinical Management
N.B. La CBT-ED per gli adolescenti è stata sviluppata e valutata a Villa Garda in tre studi di coorte
15You can also read
