5 eating disorders

Question 1

What is the origin of eating disorders?

Answer 1

Anorexia nervosa - Charles Lasegue (1873) + William Gull (1874)

emaciation, inadequate and unhealthy patterns of eating
excessive concern with control of body weight and shape

Gerard Russell (1979) - bulimia nervosa
separate condition

Question 2

What are defining behaviours in eating disorders?

Answer 2

restrictive eating, low calorific intake, thin or emaciated, vomiting, using diuretics and laxatives, or excessive exercising
self-destructive behaviours, self-punishments

Question 3

What are perceptive features of eating disorders?

Answer 3

distortion of body image, low interoception (difficulty interpreting internal gastrointestinal and emotional stimuli)

Question 4

What are cognitive features of eating disorders?

Answer 4

preoccupation with food, low self-esteem, low self-efficacy
worthless, powerless
perfectionistic tendencies
rigidity and inflexibility in thinking style and a gradual reduction in the capacity to concentrate
dependence and maturity

Question 5

What are emotional features of eating disorders?

Answer 5

intense fear of fatness and depressed or irritable mood
sense of failure
suicide attempts occur 20% of patients with anorexia and 25% of patients with bulimia

Question 6

What are features of social adjustment in eating disorders?

Answer 6

withdrawal from peer relationships, deterioration in family relationships, and poor educational and vocational performance

Question 7

What are physical health attributes of eating disorders?

Answer 7

endocrine disorder
hypothalamic-pituitary-gonadal axis
amenorrhea -
starvation symptomatology
reduced metabolic rate, bradycardia, hypotension, hypothermia, and anaemia; lanugo hair on the back; delayed gastric emptying; electrolyte abnormalities; renal dysfunction; and zinc deficiency.

In bulimia, erosion of dental enamel may occur due to vomiting.

Lesions on the back of the dominant hand may develop if the hand is used to initiate vomiting.

With both anorexia and bulimia a particularly serious concern is that the client may develop electrolyte abnormalities that may lead to a fatal arrhythmia.

Question 8

What are the DSM-5 diagnostic criteria for bulimia nervosa?

Answer 8

A. recurrent episodes of binge eating
1. eating a larger amount in a specific time than most ppl would
2. sense of lack of control

B. reccurent inappropriate compensatory behaviours

C. a+b occurs on average once a week for at least three months

D. self-evaluation is unduly influences by body shape and weight

E. not better explained by anorexia nervose

Question 9

How does the ICD-10 classification of bulimia nervosa differ to the DSM-5 ?

Answer 9

A + B are the same

C. morbid dread of fatness
-> overly concerned with weight

Question 10

What are the diagnostic criteria of the DSM-5 for anorexia nervosa?

Answer 10

A. Restriction of energy intake relative to requirements
-> significant low body weight

B. intense fear of gaining weight

C. body image distortion

Question 11

How does bulimia nervosa differ from binge-eating disorder?

Answer 11

BED - no compensatory behaviours and body weight maintained

BN - compensatory behaviours

Question 12

What is the onset of AN?

Answer 12

commonly during adolescence or young adulthood
rarely after

often associated with stressful life event

Question 13

What is the onset of BN?

Answer 13

during adolescence or adulthood (peak age of onset is later than AN)

often associated with stressful life event and frequently begins during or after an episode of dieting or binge eating

Question 14

What is the typical course of AN?

Answer 14

highly variable

after 2.5y -> 29% remission

most individuals (50%+) within 5 years

mortality rate 2.8%
most transition to BN or unspecified eating disorder

For anorexia nervosa about half of all cases have a good outcome, a third have moderate outcome and a fifth have a poor outcome.

Question 15

What is the typical course of BN?

Answer 15

may be chronic or intermittent, with periods of remission alternating with recurrences of binge eating

after 1y -> 27% remission

after 10y -> 70%

mortality rate 0.4%

Question 16

What are prevalences of AN and BN?

Answer 16

1-2% of fa and yw suffer from eating disorders

anorexia is less common than bulimia

The average prevalence rates for anorexia nervosa and bulimia nervosa among young females are about 0.3– 0.5% and 1– 4%, respectively.

The lifetime prevalence rate of anorexia nervosa is 0.16– 0.3% and of bulimia nervosa 0.1– 0.5%.

Eating disorders are relatively rare in men.

The male to female ratio of lifetime prevalence rates is 1:3– 1:12 for anorexia and 1:3– 1:18 for bulimia (Raevuori et al., 2014).

Question 17

What are common commorbidities?

Answer 17

comorbid mood disorders and OCD are common cases of anorexia

comorbid drug misue and borderline personality disorder are relatively common

Question 18

What are risk factors for both AN and BN?

Answer 18

• female
• adolescent
• genetic factors
• pregnancy complications
• child sexual abuse
• physical neglect
• gastrointestinal problems
• childhood GAD
• stressful life events
• dieting
• low social support
• low self-esteem
• ineffectiveness
• low interception
• avoidant coping

Question 19

What are risk factors unique to AN?

Answer 19

• preterm birth or birth trauma
• infant feeding and sleep problems
• high concern parenting in early childhood
• OCD + perfectionism
• neuroticism
• weight subculture (dancer, model, athlete)
• acculturation

Question 20

What are risk factors unique to bulimia nervosa?

Answer 20

• childhood obesity
• social phobia
• parental criticism
• parental obesity
• parental depression and substance abuse

Question 21

What are genetic factors contributing to eating disorders?

Answer 21

genetic predisposing factors contribute moderately to the eatiology
50-83% heritable
serotonin, dopamine and other neurotransmitter systems
genes involved in body weight regulation
appetit and satiety dysregulation
might be polygenetically determined

Question 22

What are temperamental dispositions that underpin the development of personality traits associated with eating disorders?

Answer 22

restrictive-anorexia like disorders
disinhibited-bulimic-like disorders
perfectionism, harm avoidance, depression
compulsivity and inflexibility - anorexia
impulsivity and novelty-seeking - bulimia

Question 23

What are sociocultural risk factors?

Answer 23

availability of food, thinness value, dieting is promoted
greater social pressure
modernisation
mass media
precipitating factors contribute to that tho

Question 24

What are life stresses and personality risk factors for eating disorders?

Answer 24

absence of social support, negative affectivity, internalisation of thin-ideal body image
Serpell and Troup (2003) propose that four background predisposing personality factors render people vulnerable to developing eating disorders:
(1) childhood helplessness;
(2) childhood adversity;
(3) low self-esteem; and
(4) rigid perfectionism.

In response to sociocultural pressures for thinness, these four factors give rise to four intermediate predisposing factors: (1) dietary restraint;
(2) low shapeand weight-based self-esteem; (3) disgust of food and food-related body stimuli; and
(4) bodily shame.

Question 25

What are biomedical factors of eating disorders?

Answer 25

neuroendocrine abnormalities and changes in gastric functioning arising from experimentally induced starvation are similar to those observed in clients with eating disorders
more pronounced changes in bulimia
reproductive functioning
mood, appetite, arousal and other vegetative functions
reduced cortical mass and altered functioning of the tast and reward processing regions of the brain
hightended sense of being full

Question 26

What are CB maintaining factors?

Answer 26

all-or-nothing thinking

catstrophising

magnification and minimisation

selective attention

overgeneralisation

personalisation

emotional reasoning

mental filtering

mind-reading

double standards

Question 27

What are interpersonal maintaining factors?

Answer 27

grief
role disputes
role transitions
interpersonal benefits

Question 28

What are psychodynamic maintaining factors?

Answer 28

early childhood experiences

-> individual psychodynamic model

Question 29

What is the primary focus of IPT for eating disorders?

Answer 29

primary focus on “here and now” - issues outside of the therapy room
does not contain systematic approaches to change problematic thoughts or beliefs or homework for practice and rehersal of new skills

-> enables modulating emotional states that perpetuate eating-disordered behaviour

conflict avoidance, difficult with role expectations, confusion regarding needs for closeness and distance, and deficits in social problem solving, affect regulation

Question 30

What is a common structure of IPT for eating disorders?

Answer 30

• first phase: history-taking and assessment, last between three and five sessions
  identifying the primary problem areas to be addressed
  review of current relationships
  establish associations between onset and exacerbation of the symptons over time
  significant life events, mood and self-esteem, interpersonal relationships, changes in weight
  based on that one of four approaches is focussed on:
  role transition, interpersonal role disputes, grief, and interpersonal deficits
• middle phase: therapist “steering from behind”
  exploring the meaning of moving from one role to another
  encouraged to avoud detailed discussion of eating behaviours
• final phase: summarising and consolidating gains, anticipating future problem areas, and thinking through solutions

Question 31

How does CBT for eating disorders look like?

Answer 31

• Stage 1: Rationale for CBT treatment of bulimia and addressing binge eating
  
  • collaborative formulation
  • psychoeducation
  • treatment contract
  • self-monitoring
  • session format
  • prescribing a regular eating pattern
  • stimulus control
  • planning alternatives to bingeing and vomiting
  • managing laxative and diuretic use
  • excessive exercise
  • involving significant others
• Stage 2: Tacking stock, reformulating, and planning
• Stage 3: Reducing dieting, improving problem solving and challenging cognitive distortions
  
  • over-evaluation of weight/shape/dieting and its consequences
  • enhancing the importance of other areas of self-evaluation
  • problem solving
  • mood intolerance
  • shape and weight checking and avoidance
  • adressing “feeling fat”
  • controlling the eating disorder mindset: cognitive restructuring
  • exploring the origins of overevaluation
  • reducing dieting
• Stage 4: Relapse prevention
  
  • addressing underweight and undereating

Question 32

Give an overview of general treatment options for BN.

Answer 32

Psychotherapy:

Cognitive-Behavioral Therapy (CBT): CBT is considered the gold standard in bulimia nervosa treatment. It helps patients challenge and change unhealthy thought patterns and behaviors related to eating, body image, and self-esteem.

Interpersonal Psychotherapy (IPT): This therapy focuses on improving interpersonal issues which can contribute to the eating disorder’s development and maintenance.

Dialectical Behavior Therapy (DBT): Although less commonly used than CBT, DBT can help patients develop coping skills to tolerate stress, regulate emotions, and improve relationships, which can indirectly address the triggers of bulimic behavior.

Pharmacotherapy:

Antidepressants: SSRIs, particularly fluoxetine, are FDA-approved for treating bulimia nervosa and can reduce binge-purge cycles and improve mood.
The effectiveness of pharmacotherapy is generally considered to be enhanced when combined with psychotherapy.

Question 33

Give an overview of the treatments of AN.

Answer 33

Psychotherapy:

Cognitive-Behavioral Therapy (CBT): This is a key psychotherapeutic approach that addresses distorted thoughts and behaviors related to food, body image, and self-worth.

Family-Based Therapy (FBT): Particularly effective in adolescents, this therapy involves family members in the treatment process, helping the patient regain control over their eating in a supportive home environment.

Other Therapies: Depending on individual needs, other psychotherapeutic approaches like psychodynamic therapy or interpersonal therapy might be beneficial.

Pharmacotherapy:

There’s no specific medication for treating anorexia, but medications might be used to address co-occurring disorders like depression or anxiety.
Antidepressants or antipsychotics can sometimes be prescribed to manage symptoms that are secondary to anorexia but are not primary treatments for the eating disorder itself.