5 eating disorders Flashcards
What is the origin of eating disorders?
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
What are defining behaviours in eating disorders?
restrictive eating, low calorific intake, thin or emaciated, vomiting, using diuretics and laxatives, or excessive exercising
self-destructive behaviours, self-punishments
What are perceptive features of eating disorders?
distortion of body image, low interoception (difficulty interpreting internal gastrointestinal and emotional stimuli)
What are cognitive features of eating disorders?
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
What are emotional features of eating disorders?
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
What are features of social adjustment in eating disorders?
withdrawal from peer relationships, deterioration in family relationships, and poor educational and vocational performance
What are physical health attributes of eating disorders?
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.
What are the DSM-5 diagnostic criteria for bulimia nervosa?
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
How does the ICD-10 classification of bulimia nervosa differ to the DSM-5 ?
A + B are the same
C. morbid dread of fatness
-> overly concerned with weight
What are the diagnostic criteria of the DSM-5 for anorexia nervosa?
A. Restriction of energy intake relative to requirements
-> significant low body weight
B. intense fear of gaining weight
C. body image distortion
How does bulimia nervosa differ from binge-eating disorder?
BED - no compensatory behaviours and body weight maintained
BN - compensatory behaviours
What is the onset of AN?
commonly during adolescence or young adulthood
rarely after
often associated with stressful life event
What is the onset of BN?
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
What is the typical course of AN?
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.
What is the typical course of BN?
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%
What are prevalences of AN and BN?
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).
What are common commorbidities?
comorbid mood disorders and OCD are common cases of anorexia
comorbid drug misue and borderline personality disorder are relatively common
What are risk factors for both AN and BN?
- 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
What are risk factors unique to AN?
- 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
What are risk factors unique to bulimia nervosa?
- childhood obesity
- social phobia
- parental criticism
- parental obesity
- parental depression and substance abuse
What are genetic factors contributing to eating disorders?
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
What are temperamental dispositions that underpin the development of personality traits associated with eating disorders?
restrictive-anorexia like disorders
disinhibited-bulimic-like disorders
perfectionism, harm avoidance, depression
compulsivity and inflexibility - anorexia
impulsivity and novelty-seeking - bulimia
What are sociocultural risk factors?
availability of food, thinness value, dieting is promoted
greater social pressure
modernisation
mass media
precipitating factors contribute to that tho
What are life stresses and personality risk factors for eating disorders?
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.
What are biomedical factors of eating disorders?
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
What are CB maintaining factors?
all-or-nothing thinking
catstrophising
magnification and minimisation
selective attention
overgeneralisation
personalisation
emotional reasoning
mental filtering
mind-reading
double standards
What are interpersonal maintaining factors?
grief
role disputes
role transitions
interpersonal benefits
What are psychodynamic maintaining factors?
early childhood experiences
-> individual psychodynamic model
What is the primary focus of IPT for eating disorders?
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
What is a common structure of IPT for eating disorders?
- 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
How does CBT for eating disorders look like?
- 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
Give an overview of general treatment options for BN.
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.
Give an overview of the treatments of AN.
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.
