18 Anorexia Nervosa

Question 1

What are the crude mortality rates for:

Anorexia

Bulimia

EDNOS?

Answer 1

4% for AN patients; 20% with no treatment

3. 9% for BN patients
4. 2% for EDNOS patients.

Question 2

What percentage of the population has an eating disorder? And what percentage suffer from symptoms?

Answer 2

1-2% has eating disorder

20% suffer from ED symptoms

Question 3

What’s the gender split for AN?

Answer 3

90% female; 10% male

Question 4

What’s the BMI cut-off for anorexia nervosa?

Answer 4

BMI must be less than 18.5

Question 5

What is the A criterion for Anorexia Nervosa in DSM-5?

Answer 5

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

Question 6

What becomes the criterion for AN if individual has naturally low BMI?

Answer 6

Weight loss.

Question 7

What is the B criterion for AN in DSM-5?

Answer 7

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

Question 8

Have most anorexics ever been overweight?

Answer 8

No.

Question 9

What is the C criterion for Anorexia Nervosa in the DSM-5?

Answer 9

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Question 10

What makes it hard to recover once the body is in starvation mode?

Answer 10

Once your body is in starvation mode, you need around 3000 calories a day in order to gain weight.

Question 11

What is the Restricting Type of AN?

Answer 11

The person does not regularly engage in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Question 12

What is the binge-eating/purging type of AN?

Answer 12

During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Question 13

What are some of the physical effects of AN?

Answer 13

• Thin brittle hair
• Low blood pressure, heart palpitations, heart failure
• Anemia
• Weak muscles
• Bone fractures
• Kidney stones, kidney failure
• Constipation, bloating
• Amenorrhea
• Yellow skin
• Growth of fine hair all over body

Question 14

What are 3 cognitive effects of AN?

Answer 14

1. Cognitive effects comparable to those of prefrontal lesions (but recover when starvation ends)
2. Depression
3. Memory deficits

Question 15

What 6 psychological factors predict AN?

Answer 15

1. Low self-esteem
2. Negative affect
3. Dysfunctional thinking – i.e. judging self in terms of eating/weight
4. Low executive function
5. Perfectionism
6. Need for control

Question 16

How are the serotonin levels of ANs?

Answer 16

Abnormally high. Probably because of starvation –also the case in starved rats.

Question 17

In a cognitive model of AN, in what 2 ways might the weight loss be reinforcing? (Garner and Bemis, 1986)

Answer 17

1. Reduction in distress about being overweight

2. Feeling great about the achieved self-control.

Question 18

What 4 kind of cognitive distortions might be present in ANs? (Garner and Bemis, 1986)

Answer 18

1. Selective abstraction –focus on the negative
2. Dichotomous thinking
3. Magnification of events – positive results of actions are smaller than in reaiity; negative are larger than in reality
4. Assessing self-worth in terms of weight and self-control

Question 19

What is a weight schemata?

Answer 19

A specific cognitive representation of the self as a certain weight.

Question 20

Schema theory hypothesises that individuals with eating disorders have an attentional bias towards what 3 things?

Answer 20

1. Weight
2. Shape
3. Food stimuli

Question 21

How might body dissatisfaction and body-related stimuli form a feedback loop?

Answer 21

Body dissatisfaction increases with body-related stimuli (e.g. word ‘flabby’, pics of thin people). More body dissatisfaction leads to more attention towards body-related stimuli.

Question 22

What percentage of people with AN are actually working toward recovery?

Answer 22

20%

Question 23

What is the number one therapy for adolescents with AN?

Answer 23

Maudsley Therapy

Question 24

What are the three stages in Maudsley Therapy?

Answer 24

0 stage –refeeding
1 - parents must take control of the behaviour, take leave from work, eat every single meal with the child. Blame must be externalised, no one’s fault.
2 - adolescent takes back control of eating
3 - development of personality of adolescent

Question 25

What is cognitive remediation therapy?

Answer 25

Mental exercises aimed at improving cognitive skills, particularly metacognition. Used in tandem with CBT.

Question 26

What are the three phases of CBT for AN?

Answer 26

Phase 1 - therapeutic alliance and refeeding (usually inpatient)
Phase 2 - cognitive restructuring (usually outpatient)
Phase 3 - relapse prevention

Question 27

Is Muscle Dysmorphia an eating disorder?

Answer 27

No, it’s a type of body dysmorphic disorder.