Chapter 10 Flashcards
Prevalence of Anorexia in women
believed to affect approximately 0.3% of women
Prevalence of Bulimia in women
believed to affect about 1% to 3% of women
Prevalence of Bulimia and Anorexia among men
estimated at about 0.02 for anorexia and 0.1%
According to its Greek roots, Anorexia means
Anorexia means “without desire for [food].”
Average age group that Anorexia develops
between the ages of 12-18
The 3 Clinical Features of Anorexia Nervosa
- Restriction of food intake leading to weight loss or a failure to gain weight resulting in a “significantly low body weight” of what would be expected for someone’s age, sex and height.
- Fear of becoming fat or of gaining weight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Criteria for anorexia from DSM4 that was not put in DSM5 and why
menstrual cycle eliminated in DSM 5 because it is unfair to men and women and anorexic women could take hormone pills to change this criteria
BMI criteria for anorexia
Less than 85% of your expected weight = anorexia
- Does not take into account muscle mass or being heavier to start with
“Safe” vs. “Feared” foods
Safe - safe for consumption, will not cause too much weight gain, like rice cakes and celery
Feared food – will cause weight gain, meat, ice-cream
Role of “social support” in anorexia
- Pro- ‘Ana’ websites
- Thinspiration
- Other people with anorexia can further someone’s illness
2 general subtypes of anorexia
- binge eating/purging type
2. restrictive type
Restricting Type of Anorexia involves
- Weight restriction through fasting & exercise
Binge Eating/Purging Type of Anorexia involves
Regular objective binge eating or purging
- Vomiting, laxatives, diuretics, or enemas
Poorer prognosis
Tend to have problems relating to impulse control
May involve substance abuse or stealing.
Underweight
Some Medical Complications of Anorexia
- dermatological problems such as dry, cracking skin; fine, downy hair; even a yellowish discoloration of the skin
- Cardiovascular complications such as heart irregularities, hypotension (low blood pressure), dizziness upon standing, and sometimes blackouts
Weight loss complications of Anorexia
Osteoporosis
Cardiovascular problems (incl cardiac arrhythmia)
Dry hair, hair loss, & lanugo (fine fuzzy hair)
Decreased fertility
Lethargy
Dry skin
Renal failure (kidney failure)
According to its Greek roots, Bulimia means
Large hunger
Bulimia nervosa is characterized by
recurrent episodes of gorging on large quantities of food, followed by use of inappropriate ways to prevent weight gain like purging, fasting, or engaging in excessive exercise
Clinical Features of Bulimia Nervosa
- Recurrent episodes of binge eating
- Excessive amount of food in 2 hrs or less
Sense of lack of control while binging - Inappropriate compensatory behaviours
- Binging/purging occur ~2/week for 3 months or more
- Self-evaluation excessively influenced by weight & body shape
Subtypes of Bulimia Nervosa
Purging – take in the food then compensate by getting it out
Non-purging – don’t take in the food, compensate with long periods of fasting or excessive exersise
Difference between Binge/Purge Anorexia and Purging Bulimia
Maintaining of extremely low body weight is a characteristic of Anorexia but not of Bulimia
Medical Complications of Bulimia
- Skin irritation around the mouth due to frequent contact with stomach acid, blockage of salivary ducts, decay of tooth enamel, and dental cavities.
- The acid from the vomit may damage taste receptors on the palate, making the person less sensitive to the taste of vomit. - Russell’s signs
- People who can induce vomiting; scratched knuckles from putting them in your mouth - Electrolyte imbalance
EDNOS
- Eating Disorder Not Otherwise Specified
- Disturbances in eating behavior that do not necessarily fall into the specific category of anorexia, bulimia, or binge eating disorder
- Most common diagnosis
Binge Eating Disorder
- Objective binge eating without compensation
- Distress in regard to binging
- Feelings of lack of control
- Occurs on average 2/week for 6 months
- Associated with obesity
Pica
Persistent eating/chewing/licking of non-nutritive substances
Ex. my strange addictions
Rumination Disorder
Repeated regurgitation of food for a period of at least one month Regurgitated food may be re-chewed, re-swallowed, or spit out.
Avoidant/Restrictive Food Intake Disorder
An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs
Treatment and Recovery rate for EDs
Notoriously difficult to treat with the highest mortality rate of all disorders
About 70% will eventually recover, but there are high relapse rates and residual food issues still persist after treatment
Genetic factors of EDs
Genes on chromosomes 1 & 10 linked to increased risk
Neurochemistry factors of EDs
- Endogenous opioids
- Serotonin
is important for regulating satiety (fullness)
dysregulation in patients with Eds
Psychosocial factors of EDs
- social pressures
- media
- Body dissatisfaction
Sociocultural factors of EDs
- social pressures and expectations
- peer pressure
Dieting statistics for young women
Four out of five (80%) young women in the U.S. have gone on a diet by the time they reach their 18th birthday.
Family Factors of EDs
- Families of young women with EDs tend to be more often conflicted, overprotective, dysfunctional, but less nurturing and supportive.
- The parents seem less capable of promoting independence in their daughters.
- Conflicts with parents over issues of autonomy are often implicated in the development of both anorexia nervosa and bulimia.
- The girl may be the identified patient although the family unit is what is dysfunctional.
Personality of girls with EDs
Perfectionists
Emotional Factors of EDs
- Restricting food intake may be a misguided attempt to relieve upsetting emotions by seeking mastery or control over one’s bodies.
- Binge eating may represent an attempt at coping with emotional distress
Learning perspective on EDs
- Conceptualizes eating disorders as a type of weight phobia
- In bulimia, the binge-purge cycle usually begins after dieting to lose weight.
- For anorexia, food rejecting behavior is negatively reinforced by relief from anxiety about weight gain.
ED treatments
SSRIs (antidepressant) will reduce symptoms but
usually does not successfully treat patients and is less effective than Cognitive behavioral therapy (CBT) which is the gold standard for treatment of bulimia
Anorexia recovery rates with treatment
Only 17% showed full recovery and 0% receiving nutritional counselling recovered
Cognitive Behaviour Therapy treatment stages for Bulimia
Stage 1 (behavioral) - Focus on establishing control over eating using Psychoeducation Behavioral strategies to normalize eating Stage 2 (cognitive) - Focus on distorted thoughts about body & food Stage 3 (maintenance & relapse)
Therapy for Anorexia
- Family therapy is the most effective treatment for anorexia
- Inpatient hospitalization (Force feed, programs, etc.) are often needed in extreme cases
- Behavioral therapy with rewards (like privileges and social opportunities) made contingent on adherence to the refeeding protocol.
Binge Eating Disorder Treatment
Cognitive-behavioral therapy (CBT) is used by remove situation that leads to the binge eating
Changes to Anorexia from DSM-IV-TR to DSM 5
- Amenorrhea (the absence of a menstrual cycle in a woman) has been removed as a requirement for anorexia to be diagnosed in women.
- Criterion A, now focuses on behaviors, like restricting calorie intake and no longer includes the word “refusal” in terms of weight maintenance
- Criterion B has been expanded to include not only overtly expressed fear of weight gain, but also persistent behavior that interferes with weight gain
Changes to Bulimia from DSM-IV-TR to DSM 5
• The DSM-5 criteria reduces the frequency of binge eating and compensatory behaviors that people with bulimia nervosa must exhibit from a minimum of twice a week to just once a week
Changes to Binge Eating Disorder from DSM-IV-TR to DSM 5
- Binge eating disorder graduates from the DSM-IV category of “disorders needing further research” into its own diagnostic label
- The minimum average frequency of binge eating has been changed from at least twice weekly for 6 months to at least once weekly over the last 3 months
Changes to Avoidant/Restrictive Food Intake Disorder from DSM-IV-TR to DSM 5
- The DSM-IV feeding disorder of infancy or early childhood has been renamed avoidant/ restrictive food intake disorder
- The category was broadened and expanded
Changes to Pica and Rumination Disorders from DSM-IV-TR to DSM 5
• Revised for clarity and to indicate that the diagnoses can be made for individuals of any age
Online test questions
Discuss eating disorders in men.
What are two major treatments for bulimia nervosa? Comment on their success rate.
What are two major treatments of anorexia nervosa? Comment on their success rate.
Summarize the current state of our understanding of the cause of eating disorders.
Discuss the type of program used in the day hospital program of Toronto General Hospital.
What are some of the comorbid disorders associated with anorexia nervosa and bulimia nervosa?
Describe, discuss, and differentiate between the two major eating disorders, anorexia nervosa and bulimia nervosa.
