1b// Eating Disorders Flashcards
What are eating disorders?
- Mental disorders
- A persistent disturbance of eating behaviour or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning’
- Driven by fear of fatness or extreme distress about eating
What are the disturbances of eating behaviour?
- Binge eating
- Restricted eating
– Quantity
– Range
What are behaviours intended to control weight?
Restricted eating (fasting)
Self induced vomiting
Excessive exercise
Laxative, diuretic and other energy burning or appetite suppressing medications (e.g. caffeine, smoking)
How do eating disorders impair physical health?
impacts growth and development
stops periods
effects on the brain
results in osteoporosis
high mortality
How do eating disorders impair psychosocial function?
functional impairment
- impacts work
- relationships (family, peers, intimate)
- daily living
distress
What are the DSM-5 and ICD-11 feeding and eating disorders? (7)
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder
- Other Specified Feeding and Eating Disorders (OSFED)
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Rumination Disorder/Syndrome
- Pica
What is anorexia nervosa?
A. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health.
- B. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain.
- C. Disturbance in experience of weight/shape, undue influence of wt/shape on self-evaluation, or persistent lack of recognition of seriousness of low body weight
What are the subtypes of anorexia nervosa?
restricting vs binge-eating/ purge
What about anorexia nervosa is not in DSM-5?
amenorrhoea
What is bulimia nervosa?
- Over eating episodes
– large amount of food in discrete time period
– sense of lack of control - Inappropriate compensatory mechanisms
- Body image disturbance
- Occur at least 1x week for 3x weeks
What is binge eating disorder?
episodes of over eating
no or minimal compensation
hence, frequently overweight
Compare anorexia nervosa, bulimia nervosa and binge eating disorder.
- weight, binge eating, dietary restriction, self induced vomiting, excessive exercise, guilt and shame
What is an atypical anorexia nervosa in DSM-5?
anorexia nervosa in ICD-11
purging disorder
What is purging disorder?
Defined by recurrent purging behaviour to influence weight or shape (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications including insulin) in the absence of binge eating.
- Weight is in the normal range
OSFED are atypical AN, purging disorder, atypical BN and night eating syndrome
What is ARFID?
Avoidant restrictive food intake disorder
- Replaces and extends Feeding Disorders of Infancy and Early Childhood (FdoIEC)
- Feeding/Eating disturbance
– significant weight loss
– significant nutritional deficiency
– dependance on enteral feeding/nutritional supplements
– marked interference with psychosocial functioning - No weight/ shape concerns
What are the 3 main subtypes of ARFID?
Avoidant restrictive food intake disorder
- individuals who do not eat enough/ show little interest in feeding;
- individuals who only accept a limited diet in relation to sensory features;
- and individuals whose food refusal is related to aversive experience
Compare AN, BN, BED, PD, and ARFID.
Describe the epidemiology of EDs.
ED are relatively common in childhood and adolescence
– Around 40% of adolescent girls show ED behaviours by age 16, 11% diagnosable
- Incidence of AN and BN are stable
- Incidence of OSFED & BED may be increasing
- AN is still most common disorder in ED clinics
- Not much research on ARFID
What is prevalence?
existing cases at a time point or over a time period
What are eating disorders classified as?
serious mental illnesses (like psychoses)
Are eating disorders less common than psychosis?
no
Who do EDs affect?
everyone, of all ages, genders and ethnicities
What are key messages about EDs.
Do these make sense.
Does thia make sense.
Do you remember these.
What are the possible triggers and maintaining factors for EDs?
Reasons for EDs individual and genetics?
Do eating disorders run in families?
Yes
Why is acknowledging EDs imporant?
- Reduces stigma and blame
- Might help identify important gene environment interactions
- Might inform treatment decisions
- Might help us develop interventions
What are children with AN more likely to have?
Children with AN more likely to have had early feeding & GI problems, picky eating and mealtime conflict
What were children with BN more likely to be?
Children with BN were less picky and ate faster and more likely to overeat
Genetics linked with what condition drives eating behaviour and with what gene?
obesity
FTO gene
What are psychological risk factors for Eds? (5)
Temperament/personality
Neurocognition
Self-esteem
Psychopathology
Behaviour
What are sociocultural risk factors for EDs? (3)
family
school/ peers
wider social influences
What are risk factors that are both psychological and sociocultural?
life events
trauma
What are psychological things about EDs?
perfectionism (especially fasting and purging)
high self esteem- protective for AN; low self esteem- risk factor for bulimic and compulsive eating
What can cause an increased risk of AN?
Anxiety disorders e.g., OCD
What disorders increases the risk of BN?
Externalising disorders, e.g., ADHD, hx depression
What trauma/ life events increases risk of EDs?
sexual abuse (binge-purge type disorders)
life events (non-specific)
What is the evidence about family influences for risk factors of EDs?
No evidence for family interaction or ‘type’
Some evidence that maternal emotional wellbeing and protective parenting
style important
Maternal dieting and paternal comments about weight influence girls but not boys
What is evidence for socio-cultural factors affecting EDS?
Some evidence of increase in developing countries of incidence/prevalence (mass media exposure)
Bullying, teasing by peers, social pressure to be thin
Exposure to social network media
Y/ N
What is the etiology of AN?
What is the perpetual cycle of EDs?
What is the triad of evidence based practice?
What are the best scientific evidence in EDs?
Evidence for effectiveness of existing treatments is weak across the age range
– e.g. Few large scale randomised controlled drug trials for AN
Where we do now have randomized controlled treatment trials for eating disorders, there are few replication studies
Many RCTs show no differences, or differences that diminish over time, between treatment arms
Clinical guidelines (e.g. NICE) mostly based on consensus views rather than strong research
What do the 9 published guidelines for treatment of ED consider?
What is the scope of the NICE guidelines (NG69, 2017) for EDs?
Children, young people and adults with an eating disorder (anorexia nervosa, bulimia nervosa, binge eating disorder or atypical eating disorder), or a suspected eating disorder
What is not covered in the NICE guidelines (NG69, 2017) for EDs?
– People with disordered eating because of a physical health problem or another primary mental health problem of which a disorder of eating is a symptom (for example, depression).
– People with feeding disorders, such as pica or Avoidant Restrictive Food Intake Disorders (for example, food avoidance emotional disorder or picky/selective eating).
– People with obesity without an eating disorder.
What are psychological interventions for children and young people for EDs?
ED focussed Family Therapy
CBT
Adolescent focussed therapy (AN only)
** Common : psychoeducation on effects of starvation on the body and mind, regulating body weight, dieting; the adverse effects of attempting to control weight with self-induced vomiting, laxatives or other compensatory behaviours
* Ultimate goal of increasing persons confidence in making positive decisions when coping with stress that do not include food or eating
What are psychological interventions for adults for EDs?
MANTRA (AN only)
SSCM (AN only)
CBT
** Common : psychoeducation on effects of starvation on the body and mind, regulating body weight, dieting; the adverse effects of attempting to control weight with self-induced vomiting, laxatives or other compensatory behaviours
* Ultimate goal of increasing persons confidence in making positive decisions when coping with stress that do not include food or eating
What are the most commonly used medications for EDs and why?
SSRIs for anxiety or depression
olanzapine or aripiprazole to reduce emotional dysregulation during refeeding
How would you manage medication for EDs?
Never use on its own
Tends to be used to manage comorbidities or support symptoms control in short term
What is the triangle of care?
What is the tree of care?
What are the long term complications of EDs?
death
growth stunting (if pre-pubertal onset)
osteoporosis
pregnancy complications
dental erosion
mental health comorbidities including substance misuse
What are outcomes of EDs?
Most young people go into remission (`80%)
Some relapse in adulthood
Later onset and certain personality traits increase likelihood of persistence
