chapter 10 Flashcards
when did eating disorders appear in the DSM?
in 1980
how did eating disorders appear in the DSM in 1980?
subcategory of disorders beginning in childhood or adolescence
what does eating disorders in DSM 4 formed a distinct category reflects?
increase attention that eating disorders received at time from clinicians and researchers
when was eating disorders less common?
in earlier times
in earlier years, who was seen with eating disorders?
upper class and upper middle class people
girls in private school
what type of eating disorder was added to DSM 5?
binge eating disorder
what did the DSM 5 improve criteria for?
anorexia nervosa and bulimia nervosa
what eating disorder has the highest recovery rate?
binge eating disorder
is anorexia and bulimia more common in males for females?
females
is binge eating disorder more common in males or females?
equally common
how many Canadians have an eating disorder?
about 1 million
what are the high rates associated with eating disorders?
high mortality rates :10-15%
high suicide and suicide attempts
high rates of dieting children (age 11-14) develop an eating disorder
what does sub threshold disorder mean?
person doesn’t quite meet criteria but is still at risk
what are other specified feeding or eating disorders?
night eating syndrome
purging disorder
what is night eating disorder?
lost of food control at night
will get up in middle of night to binge eat
only happens at night
is orthorexia apart of the DSM?
no
what os orthorexia?
preoccupied with eating healthy foods
actions cause distress or impairment
what does orthorexia cause?
extreme restricted diet and nutritional deficiencies
what is a clear feature of a purging disorder?
high impulsivity
what are the different ways of purging?
throwing up
use of laxatives
extreme over exercise
diaretics
what is common btwn anorexia and bulimia?
intense fear of being over weight
genetic components
what does anorexia mean?
loss of appetite
what does nervosa mean?
appetite loss due to emotional reasons
what are people with anorexia very focused on?
very focused on food more than one would think
what is the criteria in the DSM for anorexia nervosa?
significantly low body weight
intense fear of gaining weight and fear not reduced by weight loss
distorted sense of body shape
what do people with anorexia link self esteem with?
thinness
(in acute anorexia -> lower body weight, increased self esteem)
when does development of anorexia happen?
early to middle teenage Yeats
what os often the factor for the development of anorexia?
early exposure to dieting and exposure to life stress
is comorbidity high in anorexia?
yes
what are people with anorexia prone to?
depression, panic disorder and social phobia
what are women with anorexia at great risk for?
mania, agoraphobia an substance dependance
what are the physical changes with anorexia?
decrease blood pressure
decrease heart rate
decrease bone mass
GI problems
dry skin
brittle nails
change in hormone levels
mild anemia
what is the prognosis of anorexia nervosa?
70% of patients recover (in 6-10 years)
relapse is common
what is the difference of death rates btwn anorexia and population
5-10 times greater than general population
what is death in eating disorders caused by?
low BMI, alcohol misuse, physical complications, suicide
25 year reduction in life expectancy
what is the prevalence of suicide in eating disorders
highest in anorexia (1 in 5 suicides)
people with bulimia have suicidal thoughts
what does bulimia mean?
ox hunger
what is an bulimic episode?
rapid consumption of large amounts of food followed by compensatory behaviours
what is a binge?
eating excessive amounts of food in more that 2 hours
what are characteristics of a binge?
typically occur in secret
triggered by stress
lack of control over the behaviour
what is the criteria in the DSM 5 for purging and bulimia?
must continue at least once a week for 3 months
when is bulimia not diagnosed?
when in the context of anorexia and extreme weight loss
what are the typical binge foods?
high calorie foods
what eating disorder has the most shame and concealment?
bulimia
what is the development of bulimia nervosa?
begins in late adolescence or early adulthood
kids at risk can be identified at fairly young age
what was the percent and age group in Nova Scotia with extreme body dissatisfaction?
7-8% of girls and boys in grade 5
what does fat talk reflect in bulimia?
highly defensive and negative sense of self
what is the prognosis of bulimia nervosa?
70% of patients recover
10% remain fully symptomatic
7% will develop anorexia nervosa
what are the physical side effects of bulimia nervosa?
potassium depletion (muscle cramps)
diarrhea
changes in electrolytes
irregularities in heart bear
tearing in stomach and throat
teeth degrations
swollen salivary glands (chickmunk look)
what is the criteria of binge eating disorder in DSM 5?
at least once per week for at least 3 months
need 3 symptoms
what are the symptoms of BED?
eating more rapidly than normal
eating until uncomfortably full
eating alone due to embarrassment
eating large amounts when not hungry
feeling disgusted with self to depressed of very guilty
is BED more responsive to treatment than anorexia and bulimia?
yes
what are risk factors for developing BED?
childhood obesity
critical comment s regarding being overweight
low self concept
childhood physical or sexual abuse
what is the biological ethology of eating disorders
inheritable (first degree relatives)
what regulates hunger in the brain?
the hypothalamus
what happens when the medal hypothalamus is damaged?
lots of weight gain
what happens when lateral hypothalamus is damaged?
loss of weight and no appetite
what are the hormones associated with eating?
ghrelin and leptin
what is ghrelin?
hormone associated with hunger
what is leptin?
hormone associated with fullness
what are the biological factors that are affected in anorexia?
hormones regulated by the hypothalamus are chronically elevated
occur due to self starving
levels go back when weight gain happens
what are the problems with biological explanations for anorexia?
clients continue to starve themselves despite being hungry and having interest in food
hypothalamus model doesn’t count for body image disturbance to fear of becoming fat
what are endogenous opioids?
produces by body that reduce pain sensations enhance mood and suppress appetite
what is the relation between endogenous opioids and eating disorders?
starvation may increase levels of endogenous opioids (reinforcing euphoric state)
excessive exercise would increase opioids and be reinforce
what did harry and waller hypothesize about endogenous opioids and eating disorders?
bulimia is mediated by low levels of endogenous opioids that reinforce binging
what are the neurotransmitters related to eating disorders?
low levels of serotonin metabolites and serotonin in people with bulimia
what is serotonin linked to?
serotonin and metabolites been linked with negative mood and self concept changes precipitate binge episodes
who developed a model that links serotonin and estrogen in bulimia?
hildebrandt
development model that links serotonin and estrogen in bulimia `
what are the key principles of hildebrandt model?
- genetic polymorphism at birth limits serotonin system
- associated games may be further limited by exposer to harsh environments
- subsequent environmental estrogens predispose female adolescents to weight gain (increase perceived need to diet)
what are the socio culture factors and eating disorders?
standards societies have set the ideal body especially ideal female body
playboy magazine centerfold modle became thinner btwn 1959 and 1978
what are socio-cultural variables: barbie
promote unrealistic images, females feel more pressure than males
want to achieve same figure as the doll
insidious effects of exposing young girls to barbie tools with inelastic images shown in experiment
scarlet O’hara effect?
women respond to socio culture pressure by eating lightly and attempt to profit images of femininity
researchers confirmed women who eat heavily seen less feminine
are people becoming overweight even though the cultural standards is to be thin?
yes
what is the prevalence of of obesity?
has doubled since 1900
25% of Canadians are overweight
increase prevalence to evolutionary tendency to eat excess to store energy in bodies
what are the cultural aspects surrounding obesity?
can indecate as unsuccessful and little self control
less intelligent, lazy
what is a Pro-Ana websites?
glorify starvation and reinforce irrational beliefs about thinness and reward being dangerously thin
why is the eating disorders prevalence greater in women than men?
women appear to have been heavily influenced by the cultural ideal of thiness
what is the increasing pressure on men?
increase drive for muscularity
can cause extreme muscle dysmorphia
what are the cross cultural studies?
Eds are more common in industrialized societies than non- industrialized nations
young women who immigrate may be more prone to developing ED
what is the cognitive behavioural theories of anorexia?
emphasize fear of fatness and body image disturbances that lead to self starvation and weight loss reinforcers
achieve thinness -‘vely reinforce reduction of anxiety about becoming fat
what can reinforce dieting and weightless in a positive way?
through the sense of mastery or self control they create
what is the effects on cognition when exposed to media?
biers exposure to pictures of fashion models can install negative moods in young women and women who are dissatisfied with their bodies seem especially vulnerable when exposed to the images
what is the timing of binging?
known that binging result recently when diets are broken
lapse that occurs in the strict dieting of a person with anorexia nervosa is likely to escalate into a binge
what can purging after a binge be motivated by?
the fear of gaining weight that the binge elicited
what might people with anorexia who don’t binge and purge may have?
more intense preoccupation with and fear of weight gain or more able to exercise self control
what is the psychodynamic views?
core cause lies in disturbed parent-child relationships; core personality traits like low self-esteem and protectionism found among with eating disorders
what is the psychodynamic views of symptoms of an eating disorder
fulfill some need as the need to increase one’s sense of personal effectiveness
how can characteristics of family effect EDs?
high levels of conflict in family among people with EDs
ow levels of support only loosely fit the family system theory
is family characteristics cause of EDs?
no, but could be a result of one
childhood sexual abuse and eating disorders?
higher reports of childhood sexual abulse higher than normal with EDs especially bulimia
what is the prevalence of childhood sexual abuse and eating disorders prevalence?
25% of women with EDs reported experience go previous sexual abuse
unethical research on starvation
hunger and malnutrition experiments conducted in aboriginal communities
lack of informed consent conducted on northern cree people
what is the ideology of eating disorders? retrospective studies:
described clients with anorexia having been perfectionistic, shy, and compliant before the onset of the disorder
ethology of eating disorders: role of neuroticism?
anorexia and bulimia high in neurotic and anxiety and low self esteem
long term predictor
narcissism perfectionism and eating disorders?
anorexia and bulimia characterized high levels of narcissism
“por me” defensive style
eating disorders been related to increase perfectionism
perfectionism and eating disorders?
under weight anorexics higher scores on socially prescribed perfectionism
engage in excessive exercise have high levels of self oriented perfectionism
what does the multidimensional perfectionism scale have?
- self oriented perfectionism
- socially prescribed perfectionism
what is the three factor interactive model of bulimia?
characterized not only by perfectionism but also their body dissatisfaction and low self esteem
what is perfectionistic self presentation?
try to create image of perfection and highly focused on minimizing mistakes they make in front of others
what are the limitations of perfectionistic self presentation?
causal role of dimensions of perfectionism yet be firmly established
why is it difficult to get someone with ED into treatment?
they deny that they have a problem
how many people with EDs don’t get treatment?
90%
what is the frequent treatment to treat anorexia?
hospitalization so food ingestion can gradually be increased and monitored
when weight loss is severe what is the treatment?
intravenous feeding
what are the relapse rate?
high rate
out of 100 patient only 41% relapse
who is more likely relapse?
binge purge anorexia subtype
more OCD-like checking behaviour
lower motivation to recover predicted subsequent relapse
what are medications for eating disorders?
antidepressant medication for bulimia
more drop out of therapy
no drugs have been found effective in treating anorexia nervosa
what are the psychological treatments of anorexia nervosa?
- immediate goal: help gain wright ti avoid medical complications
- second goal: long term maintenance of weight gain
wha is family therapy for EDs?
family and individual based therapy equally effective
family therapy yielded superior outcomes assessed 6 to 12 months post treatment
what is enhanced cognitive behavioural therapy for all EDs?
most successful
potential recommended for anorexia
assistance for mood tolerance, perfectionism, low self esteem and interpersonal difficulties
