Anorexia Nervosa

Question 1

Depression and anxiety were the cornerstones for the development of CBT, what therapy did Anorexia Nervosa help develop?

Answer 1

Family Therapy.

Question 2

Why is it important to hear the stories of people who suffer from certain disorders?

Answer 2

Because the lived experience is lost when we just look at numbers. Stories are an important form of evidence.

Question 3

What ratio is Anorexia Nervosa diagnosed in men vs. women?

Answer 3

10:1.

Question 4

What are some common precursor traits of women who go on to develop Anorexia?

Answer 4

Being compliant, perfectionistic, driven, empathetic, people-pleaser.

Question 5

What kind of institutions are a ‘breeding ground’ for Anorexia?

Answer 5

All-girls private schools, because it has a destructive culture whereby the girls are expected to be perfect and compliant, achieve ATAR’s of 99 (without even knowing why they are striving for that).

Question 6

People with severe Anorexia can develop symptoms from other disorders, which one’s? And why does this happen?

Answer 6

They can seem OCD, anxious, depressed, autistic. It is because their brains are shrinking from lack of nutrients (sometimes up to 20%).

Question 7

For those who are diagnosed with Anorexia Nervosa, what percentage will die?
What causes most of the deaths?

Answer 7

15% will die.

50% of those deaths are due to suicide.

Question 8

The DSM-5 criteria for Anorexia Nervosa contains 3 features, what are they?

Answer 8

• persistent restriction of energy intake leading to significantly low body weight.
• either intense fear of gaining weight, or behaviour that interferes with needed weight gain.
• disturbance in the way one’s body weight or shape is experienced, negative evaluation of self based on body shape, or cannot understand seriousness of low body weight.

Question 9

In the DSM-5 criteria for Anorexia Nervosa, what are the two specifiers?

Answer 9

• Restrictive type: during the last three months, individual has not engaged in binge eating or purging. Low weight is accomplished through dieting, fasting and/or excessive exercise.
• Binge-eating/purging type: during the last three months, the individual has engaged in recurrent episodes of binge eating or purging behaviours.

Question 10

Out of the two specifiers for Anorexia Nervosa in the DSM-5, which is more common? And what specific behaviours does it involve.

Answer 10

The ‘restrictive type’.
Involves eating less, eating rigidly, having rigid food behaviours (not mixing certain foods) & obsessional exercise.

Question 11

What are some strategies Anorexia Nervosa sufferers will perform in a hospital setting when they want to appear to have gained weight, while maintaining weight loss behaviours?

Answer 11

To appear heavier:
- wearing baggy clothes to hide body.
- eat Vegemite/salty foods to retain water.
- sew weights into underwear for weigh-ins. 
Weight loss behaviours:
- hiding food in clothes/bed.
- throwing food out the window.
- exercise in the shower.
- exercise in the middle of the night.

Question 12

Why might group-therapies in hospitals be a bad idea for the maintenance of Anorexia Nervosa?

Answer 12

Because they can learn weight loss tricks from one another, as well as compared themselves to each other.

Question 13

In the less common Anorexia Nervosa specifier, what are some behaviours involved to maintain the illness?

Answer 13

Self-induced vomiting, the misuse of laxatives, enemas and diuretics - so that food is not properly processed in the body.

Question 14

An alternative way to conceptualise Anorexia Nervosa is through ‘embodiment’, what does this entail?

Answer 14

To understand that we ARE our bodies & there is no mind/body dualism. If a woman hates her body and loathes being in it, she experiences a dissociation from her body and herself. The mind/body relationship is disturbed and the sufferer will attempt to punish their body.

Question 15

How does the bio-psycho-social paradigm define and categorise Anorexia Nervosa?

Answer 15

As a ‘disturbance in the way in which one’s body weight or shape is experienced’.

Question 16

Understanding that Anorexia Nervosa is culturally-bound to a patriarchal system (as highlighted in feminist theories), why is it problematic to have an influx of male clinicians in the field of Anorexia Nervosa?

Answer 16

Because the societal framing of how a female body should be, often comes from a male perspective. Having too many male clinicians is problematic, as they may continue the male gaze and the patriarchal body-ownership of women’s bodies.

Question 17

‘Embodiment’ theory shifts the perspective of Anorexia Nervosa to a view different tot that of the DSM-5. What is this shift is perspective?

Answer 17

It changes how the illness is understood by not looking AT the patient (behaviour, symptoms, etc.), but understanding the subjective experience of the patient. Figuring out what it’s like to look OUTSIDE at the world, from within one’s own body.

Question 18

Psychology as a field normally stays neutral on issues within politics, even spirituality - as it wants to only deal with ‘science’. Why is this an issue?

Answer 18

Because any disorder listed in the DSM (or suffering in general) must be understood by looking at the society that created them (and the political/spiritual issues within that society).

Question 19

How have feminist theories of Anorexia Nervosa sought to understand the illness?

Answer 19

By looking at the illness in relation to the wider social expectations on Western femininity.

Question 20

Feminist theories of Anorexia Nervosa see the illness as bound to what?

Answer 20

A culture-bound syndrome.

Question 21

The feminist understanding of Anorexia Nervosa, is that it is a cultural metaphor for what?

Answer 21

It is a cultural metaphor for issues of control (power), compliance and body ownership in a patriarchal system.

Question 22

Feminist theories explore the idea that Anorexia Nervosa is an illness bound to ‘body ownership’ within a patriarchal society. From this perspective, how might recovery be achieved?

Answer 22

Recovery is about taking ownership of one’s body back from the patriarchal system women are bound to.

Question 23

What are the medical risks associated with Anorexia Nervosa? (list the 9 body-systems and some examples)

Answer 23

• Neurological (atrophy of the brain).
• metabolic (hypothermia, dehydration).
• cardiovascular (arrhythmia).
• haematological (iron deficiency).
• renal (kidney failure).
• endocrine (amenorrhea, problems having children).
• musculoskeletal (osteoporosis, stress fractures).
• gastroenterological (delay gastric emptying, severe constipation).
• immunological (severe bacterial infections).

Question 24

What are 4 indications that someone needs to be hospitalised because of their Anorexia Nervosa?

Answer 24

1. Physiological Instability: e.g., slow heart beat (bradycardia), hypotension, hypothermia, changes in pulse or blood pressure.
2. Cardiac Arrhythmia (irregular heartbeat).
3. Electrolyte Disturbance.
4. Severe Malnutrition (weight is less that 75-80% of IBW).

Question 25

What is the average duration for most sufferers of Anorexia Nervosa?

Answer 25

7 years.

Question 26

What is the most effective therapeutic treatment for adolescents who suffer from Anorexia Nervosa? What does it entail?

Answer 26

Family Therapy.
Gets the parents to take control. They may have to take leave from work to sit with patient at every meal, make sure they eat, don’t let them exercise. Have firm boundaries. Be kind, don’t blame them. No force feeding, shouting or nagging, bring food EVERYWHERE.

Question 27

What is one of the biggest barriers to the successful treatment of Anorexia Nervosa?

Answer 27

The patient not accepting treatment. Without their compliance, the treatment is doomed to fail and resources will be wasted.

Question 28

Why are psychological interventions not the first mode of action to fight Anorexia Nervosa?

Answer 28

Because psychological interventions do not subsequently cause weight gain, and when the illness is critical, behavioural interventions must happen first to save the person. It is also understood that if the patient gains weight, they will often feel psychologically better.

Question 29

In Family-Based Therapy, what is the duration and course of the therapy?

Answer 29

About a year, 6 months of feeding phase, 3 months of giving the control back to the patient and then 3 months of therapy.

Question 30

When starting Family-Based Therapy, how long does it take before the clinicians will know it’s not working?

Answer 30

If weight gain doesn’t start within 2 months, then it is unlikely to work at all.

Question 31

Chronic Anorexia usually entails the illness enduring for 10-20 years (or longer). Recovery can come, but what does it usually involve?

Answer 31

By reaching a crises point, or tipping point in life, whereby many factors come together:

• person is worn out by the illness.
• begin to externalise the illness and see it as the enemy.
• gain insight to how it developed.
• have people who understand and are willing to help.

Question 32

How can people who have never gotten better be helped? These are the gaunt older people who have struggled with the disease for decades.

Answer 32

Society ignores these people because we do not like pain, death, horror and crave heroes journey-type stories. Instead, we must get rid of that myth and help the sufferers live meaningful lives that, regardless of Anorexia, are still valued.

Question 33

Family-based therapies tend to only work for adolescents, why is that?

Answer 33

Because they are still under the control of the parents. After 17-18 years, they are more self-determining and in order to get better must admit themselves.

Question 34

Anorexia Nervosa can be seen as similar to OCD (there is a strong comorbidity), but in what ways does it differ?

Answer 34

Anorexia has different obsessions and compulsions.

Question 35

If there is a comorbidity of Anorexia Nervosa and OCD, what are the differences in outcome for some who has both, compared to someone with just Anorexia?

Answer 35

It is more difficult to get a positive outcome because the person’s rigidity is so strong.

Question 36

Why is suicide so common among Anorexia sufferers?

Answer 36

Because of the suffering, the illness is hard to deal with. The person may feel hopeless when they can’t get better.

Question 37

The risk of suicide in Anorexia Nervosa sufferers is high. What is it compared to those suffering Major Depression?

Answer 37

AN: 32 x more than the norm.
MD: 21 x more than the norm.