Chapter 10 - eating disorders

Question 1

Criteria for BN?

Answer 1

• Recurrent episodes of binge eating & feeling out of control.
• Recurrent inappropriate compensatory behavior in order to prevent weight gain
• once a week for 3 months
• Self-evaluation is unduly influenced by body shape and weight

Question 2

Associated features of BN? relation to AN?

Answer 2

• daily routine centers on weight, diet, and appearance
• Sensitive to comments about their weight or appearance
• Often have history of anorexia

Question 3

Binge eating characteristics?

Answer 3

• Individual eats rapidly
• Uncomfortably full
• Done alone
• triggered by unhappy moods*
• Maybe temporarily comforting
• Lack of control
• Followed by guilt/shame

Question 4

2 types of compensatory behaviors?

Answer 4

• purging
• non-purging

Question 5

Purging examples?

Answer 5

• Vomiting
• Laxative
• Diuretics
• Enemas

Question 6

Non-purging examples?

Answer 6

• extreme exercise
• restricted fasting

Question 7

BN effects on body?

Answer 7

• Irritated throat
• Acid erosion on enamel / throat
• Low electrolytes **
• Heart problems
• Scarring on the back of the knuckles due to vomiting
• Enlarged salivary glands → producing extra saliva to throw up

Question 8

Binge Eating Disorder (BED) criteria / characteristics?
what don’t they have? what are most patients like?

Answer 8

• Binge eating once a week on average for three months WITHOUT compensatory behaviors
• Marked distress regarding binge eating
• eat more than others
• NO AN or BN
• Most often patients are overweight/obese

Question 9

Anorexia criteria?

Answer 9

• restriction → significantly low weight
• Intense fear of being fat
• disturbance in body weight/shape experience / undue influence
  OR
  don’t recognize seriousness of problem, proud of it

Question 10

AN specifiers? controversial…?

Answer 10

• Restricting:
  → NO binging or purging
• Binge-eating/purging Type:
  → recurrent episodes of binging OR purging

Controversial bc there’s no differences between them in comorbidities, outcomes, response to treatment, etc

Question 11

AN cognitive/mental problems?

Answer 11

• preoccupation with food
• struggle for control of hunger
• loss of interest in or sexual difficulties
• risk of suicide
• Inability to concentrate
• Depression
• Memory problems

Question 12

AN medical problems?

Answer 12

• Heart failure
• Constipation/bloating
• Kidney stones/failure
• Swollen joints/brittle bones
• Brittle hair
• Anemia/blood problems
• Lanugo:
  → Fine hairs on face and body

Question 13

Difference between AN binging/purging type and BN??

Answer 13

AN is underweight!!

Question 14

OSFED meaning? why does it exist? what are the 3 OSFED diagnoses?

Answer 14

Other Specified Eating Disorder

• used to be ED not specified
• got rid of unnecessary criteria, changed categories / diagnoses

Diagnoses:
- atypical anorexia
→ AN w/o weight requirement
- BN (&BED) w/ LOW frq
- Purging disorder
→ compensatory disorder w/o binge

Question 15

Onset for EDs?

Answer 15

BN & AN → late adolescence / early adulthood
BED → late 20s/early 30s

Question 16

Lifetime prevalence of AN/BN?
AN → increase in risk for…?

Answer 16

AN → ~1-1.5%
BN → ~3%

AN → increase in risk for incidence risk of 15-19 yr old girls!

Question 17

Cohort effect? What does it effect most?

Answer 17

• Certain cohort (in this case age group) has highest lifetime prevalence & risk for ED
• affects women born after 1960

Question 18

Where are EDs most common??

Answer 18

• industrialized nations
• Americas / Europe
• Asia: china, taiwan, korea, japan, singapore

Question 19

Groups of men most at risk for “classic” EDs?

Answer 19

• gay men
• wrestlers
• body builders
• jockeys
• sport involves gaining & losing weight, focusing on body image & weight

Question 20

Possible alternative type of ED in men?

Answer 20

• body dysphoric disorder
• pressure to be muscular, rather than thin
• compulsive weight lifting &/or steroid use

Question 21

Highest comorbidity for AN?
For BN?

Answer 21

AN → OCD, MDD
BN → AUD, MDD, PTSD

Question 22

Mortality AN?

Answer 22

• 3% medical complications, starvation
• suicide common, even if in remission
• mortality 12X higher for AN than women W/O AN

Question 23

Mortality BN?

Answer 23

• a lot less than AN
• still more suicide attempts than gen pop

Question 24

Long term course:
AN 21 yr after diagnosis

Answer 24

really bad

• 16% dead
• 10% AN
• 21% partial recovery
• 51% full remission

Question 25

Long term course:
BN 10 yr after diagnosis

Answer 25

• 70% remission
• 30% BN

Question 26

__% of adolescents report feeling worse about their lives as a result of things they see on social media

Answer 26

67%

Question 27

What are some solutions? (ab social media / culture)

Answer 27

• reduce internalization of the media
  → dissonance-based intervention is effective
• interrupt social comparison process
• questioning diet recommendations by influencer
• better treatments

Question 28

Bio influences: Minnesota semi-starvation experiment? results?

Answer 28

• WWII → people put on starvation diet to see their response
• loss of weight led to…
  → extensive obsessions about food
  → compulsive eating rituals
• these did not go away even when they returned to a healthy weight
• something about food restriction results in obsession of food & body shape

Question 29

role of serotonin?

Answer 29

• some people may have too much serotonin or overactive receptors
• overactive receptors = anxiety, stress, negative mood
• tryptophan → amino acid from food
  → essential for production of serotonin
  → dieting decreases tryptophan = decreases serotonin

diet = decreased serotonin = improved mood

restrict = improved mood

Question 30

Best risk factor / predictor for subsequent disordered eating?

Answer 30

• shape & weight-related concerns
  (body dissatisfaction, negative self evaluation, undue importance of weight/shape on self evaluation)

Question 31

Family history (and genetic factors) account for __% of risk for ED?

Answer 31

40-60%