Ch11 (lesson 13) eating disorders Flashcards
Types of Eating Disorders (DSM-5 Feeding and Eating disorders) (main 3 + other 3)
1) Anorexia Nervosa
2) Bulimia Nervosa
3) Binge Eating Disorder
- pica
- rumination
- avoidant/restrictive food intake disorder
Eating Disorders, definition
severe disturbances in eating behaviors such as eating too little/much
Anorexia Nervosa DSM-5 Criteria
1) Restriction of behaviors that promote healthy weight; body weight significantly below normal
- BMI less than 18.5 for adults
- usually through dieting, can also involve purging (vomiting or laxatives/diuretics) and excercise
2) Intense fear of gaining weight and being fat
- can’t be “too thin”
3) distorted body image/ sense of body shape
- feel “fat” even when emaciated
(amenorrhea (period stops) no longer required for diagnosis)
two subtypes of anorexia nervosa:
Restricting
- weightloss achieved by severly limiting food intake, w/ no binge-eating/purging during last 3 months
Binge-eating/purging
- also engages in binge-eating and purging during last 3 months
longitudinal research suggests questionable validity of subtypes
how do people with anorexia see their body/ weight
- they overestimate their own body size
- but fairly accurate on weight b/c they weigh themselves frequently
Anorexia Nervosa onset, triggers
onset: early to middle teen years
- usually triggered by dieting and stress
Anorexia Nervosa prevalence (w vs m)
women 10x more likely
- symptomatology in men similar to women, though
anorexia Nervosa comorbidity (+ suicide rates)
often comorbid w depression, OCD, phobias, panic, alc, personality disorders
- in men, comorbid w substance dependence, mood disorders, or schizophrenia
suicide rates high in anorexia
- 5% complete
- 20% attempts
Physical Changes in Anorexia
- low blood pressure, heart rate decrease
- kidney and gastrointestinal problems
- anemia
- loss of bone mass
- brittle nails, dry skin, hair loss
- Lanugo (soft downy body hair)
- depletion of potassium and sodium electrolytes
- causes tiredness, weakness, death
prognosis of anorexia (+ death rates)
50-70% eventually recover
- may often take 6-7 years
- relapse common
difficult to modify distorted view of self esp. in cultures that value thinness
anorexia is life threatening
- death rates 10x higher than gen pop
- death rates 20x higher than other psych disorders
Bulimia Nervosa DSM-5 criteria
- Recurrent eps of binge-eating (excessive amount consumed under 2 hrs)
- feeling loss of control over eating (eats till uncomfortably full)
- recurrent compensatory behaviors to prevent weight gain
- purging, fasting, exercise, laxatives/diuretics
- body shape/weight extremely important to self-eval
- binge eating and compensatory behaviors occur on avg 1x per week for 3 mo
bulimia- binge triggers and characteristics
- triggered by stress, neg emotions, neg social interactions
- typical food choices: sweets, easily consumed high-calorie foods
- avoiding craving can later increase likelihood of binge
- typically occur in secret
- reports of losing awareness/dissociation
- followed by shame and remorse
bulimia nervosa prevalence(among w) /onset
- onset late adolescence early adulthood
- 90% women
- 1-2% prevalence among women
- typically overweight that led to dieting
- bulimics typically have normal BMI
Comorbidity- Bulimia (+ suicide)
-comorbid w depression, personality disorders, anxiety, substance abuse, conduct disorder
- suicide attempts and completions higher than general pop but much lower than anorexia
physical changes due to bulimia
- menstrual irregularities
- potassium depletion from purging
- laxative use depletes electrolytes, which can cause cardiac irregularities
- loss of dental enamel from stomach acids
- mortality rate of 4%
prognosis of bulimia
- 75% recover
- 10-20% remain fully symptomatic
- early intervention linked w improved outcomes
- poorer prognosis/ higher severity when depression and substance abuse are comorbid
Binge-Eating Disorder DSM criteria
Recurrent episodes of binge eating, on avg atleast 1x a week for 3 mo
Binge eating episodes include at least 3:
- eating more rapidly than norm
- eating until uncomfortably full
- eating large amounts when not hungry
- eating alone b/c embarrassed of quantity
- feeling disgusted, guilty, depressed after binge
no compensatory behavior present
Binge eating disorder vs Anorexia vs Bulimia
Binge eating vs Anorexia:
- absence of weight loss in binge eating
binge eating vs bulimia:
absense of compensatory behaviors in binge eating disorder
anorexia vs bulimia:
- anorexia can have binging and purging, but there must be weight loss. Bulimia doesn’t have weight loss
Binge-Eating disorder and obesity
- associated with obesity and history of dieting
- BMI >30
- Not all obese ppl meet criteria for binge eating
- must report binge eps and feeling loss of control over eating
- approx 2-25% qualify
risk factors for (leading to) binge eating
childhood obesity, early childhood weight loss attempts, been taunted about weight
- low self-concept
- depression
- childhood physical/sexual abuse
prevalence binge eating (ethnic, sex)
equally prevalent among euro, african, asian, hispanic-americans
more women than men
0.2- 4.7% lifetime prevalence
Psychical changes binge eating disorder- problems assoc. w obesity
- increased risk type II diabetes
- cardiovascular disease
- breathing problems
- physical ailments (joint/muscle pain
Psychical changes binge eating disorder- independent of obesity
- sleep problems
- anxiety/ depression
- irritable bowl syndrome
- early menstruation
prognosis binge eating
- about 60% (btwn 25-85%)
- most common and lasts longest of three eating disorders
- lasts 14 yrs on avg
comorbidity binge eating
mood disorders, anxiety, adhd, conduct disorder, substance use
Etiology of Eating Disorders- Genetics
- Family + twin studies support genetic link
- 1st degree relatives of ppl w anorexia >10x more likely
- 1st degree relatives of ppl w bulimia 4x more likely
- higher MZ concordance rates for both anorexia and bulimia
- body dissatisfaction, desire for thinness, binge eating, weight preoccupation heritable
- environmental factors (eg family interactions) play greater role in etiology
- more research on genetic/enviro interaction needed
Etiology of Eating Disorders- neurobiological factors - endogenous opioids
low levels of endogenous opioids
- substances that reduce pain, enhance mood, suppress appetite
- released during starvation
- may reinforce restricted eating of anorexia
- excessive exercise increases opioids
- low leves of opioids (beta-endorphins) in bulimia promote craving
- reinforce binging
Etiology of Eating Disorders- Neurobiological factors- Neurotransmitters
Serotonin related to feelings of satiety
- low levels of serotonin metabolites in anorexics and bulimics
- antidepressants that increase serotonin often effective in treating eating disorders
dopamine related to feelings of pleasure and motivation
- anorexics feel more positive and rewarded when viewing pictures of underweight women
Etiology of Eating Disorders- Neurobiological factors- parts of the brain
hypothalamus not directly involved
(txtbook adds)
brain imaging studies in areas assoc w rewards
- both women w and w/out anorexia showed comparable brain activation in ventral straitum
- anorexics showed activation in dorsal striatum
- suggests the habit of food restriction becomes rewarding
-
the restraint scale- eating disorders
- excessive restraint in anorexia
- in binge eating and bulimia restraint leads to loss of control
restrained eaters may be on their way to an eating disorder
Etiology of Anorexia- Cognitive Behavioral View
Anorexia
- focus on body dissatisfaction and fear of fatness
- certain behaviors ( restrictive eating, exercise) negitively reingforcing
- reduce anxiety about weight gain
- feelings of self control about weight loss positively reinforcing
- Perfectionism and personal inadequacy lead to excessive concern about weight
- criticism from family and peers regarding weight can play a role
Etiology of Bulimia - Cog Behavioral view
- self-worth strongly influenced by weight
- low self-esteem
- rigid restrictive eating triggers lapses, which can become binges (“off limit” foods)
- after binging, disgust w oneself and fear of gaining weight lead to compensatory behavior
- purging temporarily reduces anxiety about weight gain
-neg feelings about purging lead to lowered self-esteem which triggers further bingeing - stress, negative affect trigger binges
- restrained eating plays central role in bulimia
- restraint scale
schematic of cognitive behavioral theory of Bulimia
low self esteem and high neg affect —>
dieting to feel better about self —>
food intake restricted too severely —>
diet broken —>
binge —>
compensatory behaviors to reduce fears of weight gain
Etiology of Eating disorders: sociocultural factors
- american society values thinness for women, muscles for men
- dieting esp among women, more prevalent
- precedes onset
- body dissatisfaction and preoccupation w thinness also predict eating disorders
- societal objectification of women (sexual objects)
- unrealistic media portrayals (shame not meeting ideal)
- overweight individuals viewed w disdain, more pressure to be thin
Etiology of Eating disorders: gender factors
objectification of women’s bodies
- women defined by bodies; men by accomplishments
- leads to “self-objectification”(objectification theory)
- women see their bodies through eyes of others
- leads to more shame when fall short
aging and changes in life roles associated w decreased eating disorder symptoms
Etiology of Eating disorders: cross-cultural factors
- anorexia found in many cultures
- even those not under west influence
- may not include fears of getting fat
- in some cultures, higher weight sign of fertility/healthiness
- as countries westernize, eating disorders increase
- bulimia more common in industrialized societies
Etiology of Eating disorders: ethnic factors
white women compared to women of color:
- gap btwn white women and WoC diminishing, esp for bulimia
- biggest gap for college women
- more dieting and body dissatisfaction in white teens
- BMI increases linked to body dissatisfaction
body dissatisfaction and symptoms of bulimia strongly correlated with high acculturation stress in ethnic minorities
prevalence of binge eating disorder and bulimia in Latina women comperable to white
- anorexia rare
Etiology of Eating disorders: personality factors
- eating behaviors impact personality
- semi-starvation leads to preoccupation w food and personality changes
- personality characteristics impact eating
- perfectionism, lack of interoceptive awareness (body states), neg affect predicted disordered eating
- perfectionism remains high even after treatment
- perfectionism, lack of interoceptive awareness (body states), neg affect predicted disordered eating
Etiology of Eating disorders: family factors
family characteristics
- self report indicates high levels of family conflict
- parental reports don’t always indicate family problems
- one observational study showed parents no greater levels of neg statment than controls
- more observational studies needed
Etiology of Eating disorders: child abuse
- self reports of high rates of childhood sexual and physical abuse
- reports of abuse not specific to eating disorders, also found in other diagnostic categories
- presence of abuse may be too general variable
- age and type of abuse may be more sig.
treatments of eating disorders: medications
antidepressants:
- effective for bulimia not anorexia
- dropout and relapse rates high
- limited research suggests not effective in binge eating disorder
- for weight loss or reducing binges
treatments of eating disorders: anorexia psychological treatments
- immediate goal to increase weight to avoid medical complications and death
- 2nd goal long term maintenance of weight gain
- can be even more challenging
CBT
- reductions in symptoms through 1 yr
Family-based therapy (FBT) found to be effective
- anorexia viewed as interpersonal issue (rather than individual)
- use of “family lunch” sessions
- early results show improved outcomes over individual therapy
treatments of eating disorders: Bulimia psychological treatments
- CBT more effective than medication
- adding Exposure and Ritual Prevention (ERP) increases effectiveness of CBT in short term
- Challenge societal ideals of thinness
- Challenge beliefs about weight/dieting
- challenge all-or-nothing beliefs about food
- one bite doesn’t have to lead to binging
- increase self-assertiveness skills to improve interpersonal relatedness
- increase regular eating patterns (three meals a day)
treatment of eating disorders: psych treatment of binge-eating disorder
- CBT shown to be effective
- teaches restrained eating through self-monitering, self-control, and problem solving skills
- CBT more effective than medication
- esp group CBT
- ITP (Interpersonal Therapy) equally as effective as CBT
- Behavioral weight-loss programs promote weight loss, but don’t curb binge eating
Prevention of Eating Disorders
psychoeducational approaches
- educate early about dangers of eating disorders
deemphasize sociocultural influences
- dissonance reduction intervention to deemphasize sociocultural influences
risk-factor approach
- healthy weight intervention to develop healthy weight and exercise programs
most helpful:
- interactive
- adolescents 15 or older
- girls only
- multiple sessions
