World Digestive Health Day WDHD – May 29, 2016 EATING DISORDERS AND THE GI TRACT: DEFINITION, RECOGNITION, THE ROLE OF THE PSYCHOLOGIST IN CARE SIMON R. KNOWLES, MPSYC (CLINICAL), PHD Clinical Psychologist and Senior Lecturer in Psychology Department of Psychology, Faculty Health, Arts, and Design, Swinburne University of Technology Department of Medicine, The University of Melbourne Department of Psychiatry, St Vincent’s Hospital Department of Gastroenterology and Hepatology, Royal Melbourne Hospital Melbourne, VIC, Australia GEOFF HEBBARD, MBBS, BMEDSCI, PHD Gastroenterologist and Director of Gastroenterology at Royal Melbourne Hospital Department of Medicine, The University of Melbourne Department of Gastroenterology and Hepatology, Royal Melbourne Hospital Melbourne, VIC, Australia DAVID CASTLE, MBCHB, MSC, MD Consultant Psychiatrist and Chair of Psychiatry at St Vincent’s Hospital Department of Medicine, The University of Melbourne Department of Psychiatry, St Vincent’s Hospital Melbourne, VIC, Australia INTRODUCTION Eating disorders (EDs) represent a group of psychiatric disorders which commonly have significant concurrent gastrointestinal (GI) symptoms, creating significant management challenges for gastroenterologists, psychologists, and other health professionals involved in their care. Further, diagnosis is made more challenging due to the cyclical patterns associated brain-gut interactions associated with EDs (e.g., psychopathology and behaviors associated with EDs can influence GI function and in turn GI function can influence psychopathology and behaviors). At the core of all EDs are abnormalities of eating or eating-related behaviors resulting in altered consumption and/or absorption leading to significant impairment in health and/or psychosocial functioning.1 The most common EDs which may present to an adult gastrointestinal (GI) practice are Anorexia Nervosa (AN; Restricting type or Binge-eating/purging type), Bulimia Nervosa (BN), Binge-Eating Disorder (BED), and Avoidant/Restrictive Food Intake Disorder (ARFID). It should be noted that several other EDs, such as Other Specified Feeding or Eating Disorder, Unspecified Feeding or Eating Disorder, and atypical conditions associated with mental health problems (e.g., muscle dysmorphia), may also present at an adult GI practice, but are beyond the scope of this chapter. DEFINITION AND PREVALENCE OF EDS AN and BN share a common focus on an individual’s selfevaluation being strongly influenced by their body shape or weight. In AN, an individual is of a significantly lower weight than would be expected. Despite this low weight, there is a strong fear of gaining weight that is accompanied by restrictions of energy intake to prevent weight gain. Individuals with AN may belong to a subtype that is restrictive and achieves weight loss through low food intake or high exercise or to a binge-eating/purging subtype that eat large quantities of food and use compensatory methods to control weight (e.g., vomiting, laxatives, or exercise). AN has a 12-month prevalence of 0.4% and is more common in young females. In contrast, individuals with BN, although also engaging in binge-eating and purging to control weight, are not significantly underweight World Digestive Health Day WDHD May 29, 2016 WGO Handbook on DIET AND THE GUT 41
WGO Handbook on Diet and the Gut_2016_Final
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