Chapter 10 - Eating Disorders Flashcards
What are the most common forms of eating disorders?
Anorexia nervosa, bulimia nervosa, and binge eating disorder
What is at the heart of both anorexia and bulimia?
An intense fear of becoming overweight and fat & a pursuit of thinness that is relentless and sometimes deadly
Which groups have more of the attitudes that lead to eating disorders?
More common in whites and Asian Americans than African Americans
Which disorders can be co-morbid with eating disorders?
Anxiety disorders, mood disorders, impulse control disorder, substance use disorder, and others
What are the two types of anorexia nervosa?
The restricting type and the binge/purge type
What is the restricting type of anorexia?
Restricting food intake
What is the binge/purge type of anorexia?
Consuming large quantity of food and purging it
What is the DSM-5 criteria for anorexia nervosa?
- refusal to maintain body weight at or above minimally normal weight for age and height
- intense fear of gaining weight or becoming fat despite being underweight or persistent behaviors that interfere with weight gain
- distortions in the perception of one’s body weight or shape, undue influence of body weight or shape on self-evaluation, or denial of seriousness of current low body weight
What is the lifetime prevalence of anorexia? Is it more common in women or men?
0.6%, being more common in women
What percent of individuals with anorexia die from complications?
As many as 6%, with 1 in 5 being by suicide (not necessary to memorize this)
How many people with anorexia have co-morbid disorders?
33-50% have a mood disorder
about 50% have an anxiety disorder
What is the process of anorexia?
A normal to overweight female is on a diet -> escalation toward anorexia may follow a stressful event -> most patients recover, but many do not
What is the clinical picture of anorexia?
- Key goal is becoming thin
- Driving motivation is fear
- Preoccupation with food
- Distorted thinking
- Psychological problems
What is amenorrhea?
The absence of menstrual cycle
What is lanugo?
Fine, silky hair, usually on newborns, which grows on the body
What are the medical complications involved with anorexia?
- cardiovascular, metabolic, fluid and electrolyte, hematological, dental, endocrine, gastrointestinal
- lowered body temp, low blood pressure, body swelling, reduced mineral density, slow heart rate
- scalp hair loss, dry skin, brittle nails, cold and blue feet and hands
- amenorrhea and lanugo
What is bulimia nervosa?
It is characterized by frequent episodes of binge eating, lack of control over one’s eating, recurrent inappropriate behavior to prevent weight gain
Unlike anorexia patients, bulimic patients are typically of ____ weight
Normal weight
What is the DSM-5 criteria for bulimia nervosa?
- recurrent episodes of binge eating (eating in a discrete period of time within any 2 hour period, an amount of food that is larger than most people would eat during a similar period of time under similar circumstances, a sense of lack of control over eating during an episode)
- recurrent inappropriate compensatory behavior to prevent weight gain (self-induced vomiting, laxatives, diuretics, other meds, fasting, excessive exercise)
- the binge eating and compensatory behavior both occur on average at least once a week for 3 months, self evaluation is unduly influenced by body shape and weight
What is the lifetime prevalence of bulimia?
1%, higher in women
What are the likelihoods of people with bulimia having comorbid disorders?
Almost 50% have a mood disorder, more than 50% have an anxiety disorder, and almost 10% have substance use disorder
What are the 2 types of bulimia?
Purging type and non-purging type (using other forms to compensate for binge eating)
What is body dissatisfaction?
when people evaluate their weight and shape negatively
What is the progression of bulimia?
- normal to slightly overweight female has been on an intense diet
- begins in adolescence or young adulthood
- lasts for years with periodic letups
- weight fluctuates but often stays within a normal range
What are the medical complications with bulimia?
Renal, gastrointestinal, electrolyte, dental, laxative abuse
What are the problems with bulimia diagnostic criteria?
Subjective issue of meal size, timing of binge-eating episode
What are the similarities between bulimia and anorexia?
- distorted body perception
- fear of becoming obese
- preoccupation with food, weight, and appearance
- disturbed eating attitudes
- feelings of anxiety, depression, obsessiveness, and perfectionism
- heightened risk of suicide attempts and fatalities
What are the differences between bulimia and anorexia?
- bulimia has more concern about pleasing others
- tend to be more sexually experienced
- mood swings, frustration, boredom, and impulsivity more likely
- dental problems more likely
- amenorrhea less likely
What is binge-eating disorder?
Repeated eating binges without inappropriate compensatory behavior
What is the DSM-5 criteria for binge-eating disorder?
- recurrent episodes of binge eating
- episodes are associated with 3 or more of the following: eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not feeling physically hungry, eating alone out of embarrassment, feeling disgusted with oneself
- marked distress regarding binge eating is present
- at least once a week for 3 months
- not associated with compensatory behaviors
What is the lifetime prevalence of binge eating disorder?
2.8%
What are the likelihoods of comorbid disorders with binge eating disorder?
Almost 50% have mood disorder, more than 50% have an anxiety disorder, over 20% have substance abuse disorder
What are the medical problems from binge eating disorder?
Obesity, diabetes, high blood pressure, heart disease, high cholesterol, gastrointestinal
What perspectives do most theorists and researchers use for eating disorders?
A multidimensional risk perspective, where several key factors place an individual at risk
What are the psychodynamic factors for eating disorders? (Bruch)
- ego deficiencies from disturbed mother-child interactions
- perpetual disturbances
- ineffective parenting raises children who are confused and unaware of internal needs
What are effective and ineffective parents?
Effective parents accurately attend to their children’s biological and emotional needs
Ineffective parents fail to attend to their children’s needs
What is the percentage of individuals diagnosed with bulimia or anorexia that are male?
25%
What is the median duration of an eating disorder?
7 years
What is the male/female prevalence of binge eating disorder?
40/60
What are the biological factors that contribute to eating disorders?
- genetic predisposition
- dysregulation of hypothalamus
- dysfunctional brain circuits
- set point theory
What is the genetic predisposition to eating disorders?
There is a high heritability for anorexia which is linked to neuroticism and perfectionism
What are the dysfunctional brain circuits that can contribute to eating disorders?
- larger and more active insula, orbitofrontal cortex, and striatum
- smaller prefrontal cortex
- abnormal activity levels of serotonin, dopamine, and glutamate
What is the set point theory?
The body’s predetermined weight
What are the societal pressures that contribute to eating disorders?
- Western standards of attractiveness
- socially accepted prejudice against overweight people
- higher risk within subcultures (models, dancers, etc.)
- social media, TV, and internet use, dark sides of the internet & pro-ana sites
What are the sociological and psychological factors that contribute to eating disorders?
- pressure to be thin
- cultural norms of attractiveness
- use of food to cope
- over-concern with others’ opinions
- rigid thinking style
- poor family dynamics
- history of sexual abuse
What are the risk & causal factors of eating disorders?
- sociocultural influences like magazines idealize extreme thinness, often women internalize the thin ideal, cultural influences, photoshopped models
- families of anorexics have certain characteristics (confirmed by studies, but are also seen in families of other disorders)
What are the characteristics of families with anorexics?
- limited tolerance of disharmonious effects or psychological tension
- an emphasis on propriety (conforming to societal norms)
- parental over-direction of child or subtle discouragement of autonomous strivings
- poor conflict resolution skills
- preoccupation with thinness, dieting, and having a good physical appearance
What are the racial and ethnic differences in eating disorders?
- different beauty ideals
- African American females demonstrate healthier eating behaviors and attitudes
- Hispanic American female attitudes are more similar to whites
- increase in eating disorders in Asian American females
What are the BIPOC facts about eating disorders?
- they are significantly less likely than white people to have been asked by a doctor about eating disorders
- half as likely to be diagnosed or receive treatment
- gay boys more likely than straight
- gender and body dissatisfaction in trans people, non-binary people restrict eating to become thinner
What are the cognitive-behavioral factors that contribute to eating disorders?
- several cognitive factors, such as improper labeling of internal sensations and needs
- little control over life may result in excess control of body size
- depression helps set stage for eating disorders
(similar brain circuit abnormalities in those with eating disorders and depression, close relatives have higher rates of depression)
What are the two goals of treating eating disorders?
1) correct dangerous eating patterns ASAP
2) address broader psychological and situational factors that have led to and maintain the eating problem
What are the treatments for anorexia?
- hospitalization and refeeding (most effective if patient returns to normal weight), tube and intravenous feedings if necessary
- behavior therapy or CBT, family therapy, motivational interviewing
- antidepressants or other meds
- techniques to help patient accept and value their emotions
- restoring weight and normal eating methods
- combination of supportive nursing are, nutritional counseling, and high-calorie diet
How are lasting changes achieved for anorexia using CBT?
- identification of core pathology and problem-solving strategies
- monitoring ties between feelings, hunger levels, and food intake
- changing attitudes about weight and eating
- most successful when continued for at least a year beyond recovery and supplemented by other approaches
How are lasting changes achieved for anorexia by changing family interactions?
- involvement of whole family
- separation of feelings and needs from those of family members
What is the treatment aftermath of anorexia?
- weight is quickly restored
- continued improvement for majority
- psychological and health problems may persist
What are the treatments for bulimia?
- cognitive-behavioral therapy
- behavioral techniques
- cognitive techniques
- other forms of psychotherapy in individual or group formats (interpersonal, psychodynamic, family therapy)
- antidepressants
What are the behavioral techniques to treat bulimia?
- diaries
- exposure and response prevention (ERP)
What are the cognitive techniques to treat bulimia?
- help client recognize and change maladaptive attitudes towards food, weight, eating, and shape
- teach individuals to identify and challenge negative thoughts that precede urge to binge
What is the treatment aftermath of bulimia?
most people recover, relapses can be triggered by stress
What are the treatments for binge eating disorder?
- similar to those for bulimia
- reduction or elimination of binge-eating patterns
- cognitive-behavioral therapy
- other forms of psychotherapy
- antidepressants help reduce or eliminate binge-eating patterns and change disturbed thoughts
- short-term effectiveness, high relapse risk
- additional weight management interventions are often needed
