Ch 11-Eating disorders Flashcards by Emmy Griesmer

Anorexia

In control

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Restrictive type anorexia

Restricts eating and/or over-exercise

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Binging/purging type anorexia

-Person still significantly underweight

<85% of recommended healthy body weight

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Previous DSM-4 specifiers

-Missed 3 consecutive menstrual cycles

–>”manorexia”

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“Manorexia”

10-15% anorexics are male

Higher mortality rates

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Characteristics of anorexia

perfectionism
depression
obsessed with food
lower self-esteem
distorted body image

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Background of individuals with anorexia

enmeshed families (intrusive/invasive)
high expectations
middle or upper class

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Ages of anorexia & prevalence

Peak ages: 14 & 18 years (bimodal)

Peak range: 15-19 yrs

*on increase in Japan, Europe, China

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Treatment of anorexia

Main focus: weight gain!

CBT
Operant
Family Therapy

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CBT for anorexia

frequently used

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Operant techniques for anorexia

Positive & negative reinforcement to modify maladaptive behaviors

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Maudsely Approach family therapy

engages entire family

encourages anorexic to re-feed
adjust family dynamics

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Irony of recovery from anorexia

can increase health risks

- heart tissue becomes lost/weakened

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Restrictive type comorbid disorders/characteristics

Introversion
Conformity
perfectionism
rigidity

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Binging/Purging type comorbid disorders/characteristics

Extraversion
Histrionic PD
impulse control
substance use/abuse

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Bulimia

Out of control

*may be normal or overweight

2000-5000 calories/binge

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Compensatory behaviors for bulimia

Any behavior that compensates for food intake

ex. vomiting, laxatives, exercise

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“Exercise bulimia/addiction”

Strong relationship with eating disorders

~70% also meet criteria for eating disorder

DSM-5 criteria for bulimia

at least 1 episode/week for at least 3 months

Evidence for impulse control problems

More evidence for problems with substance abuse, gambling, etc.

Comorbid mental disorders for bulimia

Mood disorders
GAD
Panic Disorder
Social Phobias
Substance use disorders
Borderline PD

Central issue for ALL eating disorders

CONTROL

Binge eating disorder

*New to DSM

Binges in eating without purging
NO compensatory behaviors

Diagnostic criteria for Binge Eating Disorder

eat more rapidly
eat large amounts
secretive
may eat when not hungry
lack of control over eating

severity rating of BED

Mild: 1-3 episodes/wk Moderate: 4-7 episodes/wk Severe: 8-13 episodes/wk Extreme: 14+ episodes/wk

Prevalence rates of BED

Females: 1.5x more likely than males Clinical samples: majority white females Community samples: Black & white females = equal rates

Cultural differences in african american women for BED

less likely to be treated for eating disorder more likely to be obese express less concern about eating/body shape/weight report less distress over body weight

Comorbid Mental Disorders for BED

Major depression OCD Avoidant PD

Emotional eating

eating in response to negative affect *typically eat foods high in fat, sugar, calories (comfort foods)

Schneider et al. study on emotional eating

Subjects induced into anxiety states showed higher preference for high calorie foods

Obesity/Overweight changes over time in US

1975: 47% 2000: 61% 2003: 67% 2012: 69% (35% of which are obese)

BMI

based on height & weight <18 underweight >25 overweight >30 obese >40 Morbid obesity U shaped curve for mortality rates *limitation distinguishing fat from muscle weight

Irony in actual weight vs ideal body size

Body ideals in weight-->decreased over time Actual body weights-->increased over time

sociocultural factors in eating disorders

Social roles & cultural ideals push expectations on us -->discrepancies

Cited reasons for body image concerns/dieting in adolescent girls

- mass media - peer influences - criticism from family members

Causes of eating disorders

MULTIFACTORIAL & MULTIDEMENSIONAL

Biological causes of eating disorders

Subcallousal cingulate: affects moods & emotion regulation Resistant anorexia w/ nothing else that works: Treatment w/ deep brain stimulation

Genetic causes of eating disorders

- Tend to run in families - families with comorbid disorders (OCD, other anxiety disorders) Mutations in genes: increase likelihood of developing eating disorder by 90%

Perseverative behaviors

behaviors that persist/continue even when reinforcement has stopped -more likely to develop eating disorder

Waller study eating disordered attitudes

Those scoring higher on disordered eating attitudes: - lower levels persistence (stopping once reaching goal) - higher levels perseveration (continuing even though they will never be satisfied/succeed)

psychological causes of eating disorders

- depression - impulse control - parenting received: emphasis on weight, appearance, enmeshed, lack of expression of negative affect - self-esteem issues

Social causes of eating disorders

- peer/family influences - sociocultural values - media influences

Anne Becker fiji study

1995: intro to TV, NO disordered eating 1998: 11.3% began purging 2007: 45% reported purging