anorexia Flashcards
features of anorexia
restrictive type
- show weight loss through dieting
- excessive exercise
- extreme periods of fasting
binge eating and purging type
- recurrent bouts of binge eating
- followed by bouts of purging
- self induced vomiting
- misuse of laxatives
- people with AN usually have high anorexia levels
- all must occur for 3 consecutive months
symptoms of anorexia
Criteria A - (all about losing weight)
- restriction of energy intake and weight significantly below expected
- BMI of 18.5kg/m2 and below
Criteria B - (all about maintaining weight)
- intense fear of gaining weight (body weight already low)
- persistent exercise that interrupts gaining weight
Criteria C
- distortion of body image where weight is overestimated
- unable to accept severity of low body weight
- poor self image
biological explanation for anorexia
Genetics:
- If genetics then frequency of anorexia in relatives of someone with it should be higher than population
- identical twins should be more concurrent
zeeland et al 2013: specific gene linked to disorder
- he compared 152 different genes in women with and without anorexia and found significant differences between EPHX2 gene
EPHX2 = enzyme that metabolises cholesterol suggesting that the disorder may be caused by a disruption in how the body processes cholesterol
difference between concordance rates and heritability estimate
concordance rates is the probability that individuals will both have certain characteristics given that one has it
heritability estimate is the similarity between family members or twins that is due to genes
family studies
Kipman et al 1999
- increased risk of AN on female relatives of someone who has the disorder than controls which supports genetic theory
- however, this could be that they share the same environment
- although, one relatives do no share the same environment e.g. aunt
twin studies
Kipman 1999
- 46.2% MZ twins concordance for disorder
- 7.1% DZ twins
- 71% heritability estimate when it comes to anorexia
biological explanation evaluation
pros
- supporting evidence from Kipmann
cons
- research is still new and little known
- difficult to separate biological explanation as a cause as opposed to being a result. Poor diet can cause a biological change making it hard to determine if genes are explanation
non- biological theory
sociocultural theory = contributions society makes to individual development. Suggests that learning is a social process
Garner and Garfinkel 1980 - ‘slim is beautiful’ they found AN more common in dancer and model students because the social setting reflects in them having AN (slimmer physique required to do well)
Rackoff and Hoing 2006 - female athlete triad. Female may attempt to enhance performance by altering diet/ over exercising which can lead to amenorrhea, low bone density, disordered eating
Thompson and Johnson - looked at miss americas beauty across 20 years and found the average weight of contestants were decreasing but average weight of normal women were increasing. Suggests that the body type being celebrated as ideal was far from reality which makes women see themselves as fat
Garner et al 1980 - 10 year span and found that diet articles in magazines were increasing which suggests that society and culture has predisposition to the idea that slim is beautiful
evaluation of the non-biological explanation of anorexia
Pros
- supporting evidence from the studies
- more males have anorexia which links with the changes in mens magazines to include more diet
Cons
- if theory is 100% then all dancers should have AN
- theory may only influence people with predisposition to develop the disorder
- reductionism as it doesn’t take into account other causes of AN
- cultural images and influences are something we are all exposed to but we all don’t have anorexia
treatments of anorexia (intro CBT)
enhanced cognitive behavioural therapy
- tracks thoughts and behaviours linked to disordered eating
- ‘enhanced’ has developed so can be used to treat changing patterns linked to AN and targets multiple aspect
- one to one basis
- 20 sessions, very low weight 40
- life impacts highlighted and if severe they may be refused treatment
stages of CBT
Stage 1: 4 weeks, 2 per week
- to encourage rapid change of behaviour
- weekly weigh in and regular eating
- patients briefed about disorder and treatment
- need positive mindset to see progress
Stage 2: 2 appointments, 1 week apart
- discuss progress being made in stage 1 and talk about how patient is currently doing
Good progress = praise to increase motivation
Bad progress = identify things that aren’t going well
Stage 3: 8 appointments, once a week
- tackle factors involved in the maintenance of E.D
- Body image = behaviours and triggers that make them feel fat
- Dietry rules = consider the impact of rules on life and foods being avoided gradually add to diet
- external events = that impact major changes in eating tackled
Stage 4: 3 appointments 2 weeks apart
- look into future and factors they need to manage to prevent relapse
- plan made together and personalise for specific circumstances
- post treatment review made after 5 months and they look at setbacks and issues
evaluation for CBT
pros
- pike et al 2003: out of 33 patients the relapse rate of those receiving CBT-E was lower than nutritional counselling
cons
- client has to be motivated to change so this form of therapy does not cater to everyone
- for patients who live at home family therapy is better as CBT-E is most suited to older patients
treatments for anorexia (drug therapy)
SSRI’s
- form of antidepressant
- block reuptake of serotonin in presynaptic neurones making more serotonin available in synapse. More serotonin can now be passed to post synaptic neurone and increase serotonin levels
Olanzapine
- atypical anti-psychotic drug, also used for anxiety
- block absorption of dopamine and serotonin in certain pathways
evaluation for drug therapy
Pros
- good for comorbid conditions as medication enables patients to benefit more readily than psychological therapies
- 3 patients treated with olanzapine and found positive effects to patients body which suggests that antipsychotic effect makes patients body image more realistic
Cons
- AN patients are malnourished and may have serious heart issues and drugs have cardia side effects
- drugs can make patients gain weight
- there is little evidence that drugs are useful
- not to be used as a primary treatment
