2.a. Anorexia Nervosa Flashcards
Anorexia nervosa
Extreme fear of weight gain paired with obsessive, dangerous behaviours to lose extreme amounts of weight
Amenorrhea
stopping menstruating due to eating habits
- No longer a requirement to be diagnosed with anorexia
- Same psychologically with or without
- Cannot be used to diagnose men
Weight loss
- Satisfaction at weight loss
- However, may try to mask their low weight from others e.g. baggy clothing
- Denial that there is a problem
DSM-5 Criteria
A. Restriction of energy intake resulting in significantly low weight (comparative to norm group e.g. sex, physical health etc.)
B. Intense fear of weight gain
Doing everything to not gain weight, even when extremely thin
C. Distorted body image
Self-image is defined by weight
Lack of recognition that there is a problem
Two types of anorexia
Restricting type
Binge-purge type
Restrictive anorexia
- All possible efforts are made to limit eating
- High caloric control
- Eating in front of others: avoided or eating very slowly, cutting things up tiny & secretly disposing (Cassie, Skins) in order to keep controlling intake
- Often celebrated within eating disorder communities
Binge-purge anorexia
- Binging - out-of-control eating of an abnormal quantity of food over an abnormally short amount of time
- Purging - vomiting, laxatives, enemas
Effects of Malnutrition
Thinning, brittle hair
Brittle nails
Dry skin
Lanugo
- Downy hair growing on face, neck, arms, backs & legs
Yellowish tinge to skin
- Particularly on hands and bottoms of feetDifficulties coping with cold temperatures
Purple-blue tinge to hands and feet
- Lack of temperature regulation
- Lack of oxygen
Low blood pressure
- Tired, weak, dizzy & faint
Vitamin B deficiency
- B1 affects mood
Lanugo
Downy hair growing on face, neck, arms, backs & legs
Dangers
Brittle, fragile bones
- Can persist throughout life
Heart arrhythmias
- Often leading to death
- Heartbeat irregularities
Kidney damage & renal failure (kidney failure)
- Result of chronically low levels of potassium
Laxative abuse
- Makes all health problems worse
- Dehydration
- Electrolyte imbalances
- Kidney disease
- Damage to bowels & gastrointestinal tract
Mortality
Mortality rate 12x higher than general population (females aged 15-24)
Highest mortality rate of any psychiatric disorder (2%)
Prevalence
Less than 1% of population
Ages 15-18 (when brain is developing, affected by environment)
Girls with higher socioeconomic backgrounds are more predominantly affected by eating disorders
Comorbidity
Personality disorders
e.g. borderline personality disorder (intense fear of abandonment
50% with depression
OCD
>1/3 self harm
Could be that the malnutrition just enhances problems that were already there
Gender
3:1 ratio girls:boys
Men may be misdiagnosed because they overexercise rather than diet
Gay men are more susceptible - beauty ideals
Genetic factors
- Genes on chromosome 1
- May be linked to anorexia nervosa (restrictive type)
- Weak evidence
Brain abnormalities
- Damage to frontal & temporal cortex
- Temporal cortex - body image
- Frontal cortex - monitoring pleasantness of stimuli e.g. smell & taste
Lateral hypothalamus
- Food intake regulation (integrating relevant info.
- Receives information from the amygdala (emotional regulation)
- Environmental cues leading to overeating & suppressing eating in response to fear
Set points
Innate ‘set point’ of weight which our bodies try to ‘defend’
Our body uses feelings of hunger to regulate this
Could explain binging due to intense hunger
Anorexia - constantly thinking about food
Serotonin
Implicated in obsession, mood disorders & impulsivity
- Also manages appetite & feeding behaviour
Suggests that EDs cause disruption to the serotonergic system
Anorexia - low levels of 5-HIAA (component of serotonin)
*Tryptophan
Converted chemically into serotonin
Obtained from food
Sociocultural influences
Impact of media & Western ideals
Fiji study - dieting and body dissatisfaction only seen after introduction of Western TV
Family influences
> 1/3 of anorexia patients said development of anorexia was linked to family dysfunction
- Parents also tend to have perfectionist tendencies
View families as more rigid & less communicative
Family therapy is the most effective of the treatments
Individual risk factors
Gender
Internalization of thin ideal
Perfectionism
Negative body image
Dieting
Negative emotionality
Childhood sexual abuse
Perfectionism
Pursuit of the ‘perfect’ body
Scored higher on perfectionism tests
Often predates the disorder
Seen more in girls than boys
Twin study
- High levels of perfectionism found in anorexic twins
- However, also found in non-anorexic twins
Negative body image
Intrusive & pervasive perceptions regarding what is ‘fat’
- Feeling evaluated by other women
- Desired weight loss is not possible for most people
Completely influenced by media and culture (not seen in Amish people)
- Body dissatisfaction is a crucial risk factor
- Biggest predictor
Dieting
Almost all EDs start with ‘normal’ dieting
The majority of adolescent girls with anorexia had been dieters
Bidirectional?
Negative body image when the diet fails
Could be people who diet are already struggling with body image & weight
Negative emotionality
Negative effect - feeling bad
Risk factor for body dissatisfaction
Leads to being self-critical
Similar to depression - distorted thinking & information processing
- Binging as a distraction from negative feelings
- Resulting in feeling worse about self
Childhood sexual abuse
Higher rates of EDs in abused children but evidence is a little weak
Could be the result of negative body image or negative effect
Medication
Antidepressants - target serotonin, not especially effective
Antipsychotics - helps treat distorted views of body and weight gain
- Weight gain side effect
51% recovery
Family therapy
- Best treatment for adolescents
- Neither child or parent is blamed
Most complete therapy
More effective than individual therapy (but this still helped)
49% recovered a year later
Family therapy stages
- Re-feeding phase -
- Parents learn to help child eat healthily
- Family meals are observed
- Parents learn to guide child
- Child begins to gain weight - Relationship phase
- Family issues are addressed
- Termination phase
- Focus on developing a health relationship between parents & child
CBT
Changing behaviours & maladaptive thinking styles
Focuses on modifying distorted beliefs about body image, food & the self
1-2 years, recommended length of treatment
Only 17% recovered
