Chapter 10: Eating Disorders Flashcards
1
Q
What is the general prevalence for eating disorders?
A
- more common among women and girls
- WHO → ~75% of Gr. 10 girls indicated they were on diet/needed to lose weight
- 1/4 adolescent females actively dieting
2
Q
What are some consequences of dieting?
A
- failure & cycling
→ dieting is difficult, often ends in failure - eating regulation issues
→ chronic dieters forget how to use hunger as cue for eating
3
Q
What is anorexia nervosa?
A
- eating disorder characterized by pursuit of thinness to dangerously low weight levels
- sufferers have an extreme fear of being fat and often view themselves as fat and underserving of food
→ often view themselves as fat despite being very underweight
4
Q
What is the DSM criteria for anorexia nervosa?
A
A - Restriction of energy intake relative to requirements, leading to significantly low weight.
B - Intense fear of gaining weight or of becoming fat; or persistent behaviour that interferes with weight gain.
C - Disturbance in way in which one’s body weight or shape is experienced.
D - In females who have reached menarche, amenorrhea (absence of at least three consecutive menstrual cycles)
5
Q
What is purging?
A
- engagement of compensatory behaviours intended to “undo” calories that have been consomued
- examples include vomiting, misuse of laxatives
- tends to lose weight but only through dehydration
6
Q
What is objective binging?
A
- eating large amounts of food (more than one person would normally eat) that is consumed in a specific period of time (like two hours)
7
Q
What is the restricting subtype of anorexia nervosa?
A
- refusing to eat as a way of preventing weight garn
→ might go for days without eating - dieting, fasting, excessive exercise
8
Q
What is the binge-purge type of anorexia nervosa?
A
- recurrent episodes of binge-eating/purging type behaviour
9
Q
How is the binge-purge type of anorexia different from bulimia nervosa?
A
1 - people with binge/purge type will continue to be at least 15% below healthy body weight
2 - women with this type may develop amenorrhea, whereas women with bulimia nervosa do not
10
Q
What is bulimia nervosa?
A
- an eating disorder characterized by episodes of binge eating followed by compensatory behaviours designed to prevent weight gain
- sufferers may be normal weight or slightly overweight
- very concerned about weight and base self-evaluation on weight and body shape
11
Q
What are the DSM criteria for bulimia nervosa?
A
A - recurrent episodes of binge eating characterized by
→ eating in a discrete period of time an amount of food that is larger than most people would eat
→ sense of lack of control over eating during this period
B - recurrent inappropriate behaviours to prevent weight gain such as self-induced vomiting or misuse of laxativs
C - binge eating and inappropriate purging behaviours both occur at least twice a week for 3 months on average
D - self-evaluation is unduly influenced by body shape and weight
12
Q
What is the non-purging type of bulimia nervosa?
A
- excessive excercise or fasting to control their weight but do not engage in purging
13
Q
What is the “escape from self-awareness” model of binge-eating episodes?
A
- binge eating occurs in an attempt to escape from high levels of aversive self-awareness
- tend to have high expectations of themselves, constantly monitor themselves, and often fail to meet high standards
- coupled with depression and anxiety, people seek escape
- binge eating shifts attention from perceived failures toward the behaviour and positive associations associated with eating
14
Q
What is binge-eating disorder?
A
- eating disorder characterized by regular binges
→ episodes of inappropriate compensatory behaviours to prevent weight gain do NOT follow binge-eating episodes - includes eating very rapidly, eating large amounts when not hungry, or eating alone out of embarrassment
15
Q
What are the DSM criteria for binge-eating disorder?
A
A - significant distress about binge-eating, embarrassment, uncomfortably full, lack of control
B - eat very rapidly, eat large amounts even when not hungry, in a discrete amount of time
C - feelings of guilt and disgust after bingeing
D - binges occur at least 1/wk for 3 months
E - no compensatory behavior
16
Q
What is the lifetime prevalence of bulimia?
A
- 1.1% for women
- 0.1% for men
17
Q
What is the lifetime prevalence for anorexia?
A
- 0.3% in females
- 0.02% in males
18
Q
What is the lifetime prevalence for binge-eating disorder?
A
- 1-3% of the general public
- 30% of people currently in weight-loss programs
19
Q
What is the prognosis of eating disorders?
A
- mortality rates between 5-8%
→ highest of all psychiatric disorders - most common causes of death are starvation and nutritional complications, and suicide
20
Q
What is the body-mass index?
A
- weight in kg divided by height in metres, squared
→ indicator of fat on a person’s body
21
Q
What is involved with the diagnosis of eating disorders?
A
- rule out medical reasons for symptoms as well as MDD
- type of eating disorder must be determined
→ unique in that there can only be one
→ determine whether behaviours are excessive enough to qualify
22
Q
What is atypical anorexia nervosa?
A
- all criteria for anorexia nervosa are met, except that despite significant weight loss the individual’s weight is within or above the normal range
23
Q
What is bulimia nervosa/BED (of low frequency/limited duration)?
A
- all criteria for bulimia nervose are met, except that the binge eating and inappropriate compensatory behaviours occur, on average, less than once a week and/or less than 3 months
24
Q
What is the Eating Disorder Examination?
A
- structured clinical interview for diagnosing eating disorders that has good reliability and validity
- provides numerical ratings of the frequency and degree of eating disorder symptoms and also provides data on dietary restraint, bulimic symptoms, and eating/weight/shape concerns
25
What are common medical complications of anorexia nervosa?
- high death rate (5-8%)
→ suicide or physiological complications
- medical problems include
→ cardiovascular problems
→ acute expansion of stomach (to point of rupture)
→ kidney damage
→ problems with bone structure due to amenorrhea
→ impaired immune system functioning
26
What is lanugo?
- fine white hair that grows on individuals with anorexia when they have no body fat left to keep themselves warm
27
What are common medical complications of bulimia nervosa?
- dental problems (erosion of teeth enamel)
- electrolyte complications (imbalances which can lead to heart failure)
- laxative abuse or diuretic abuse can lead to
→ cardiovascular and renal functioning problems
28
What are common medical complications of eating disorders in general?
- osteoporosis
- cardiovascular problems
- decreased fertility
- lethargy
- dry skin and hair/hair loss
- sensitivity to cold
29
What is Russell's sign?
- scrapes or calluses on the backs of hands or knuckles
→ caused by self-induced vomiting as teeth scrap across back of hand
- named after Gerald Russell who first identified bulimia nervosa
30
What is the support for eating disorders being conceptualized on a spectrum?
- many individuals move from one diagnostic category to another (and even back again) across time
31
What makes eating disorders primarily culturally bound?
1 - largely restricted to wealthy countries where food is in abundance
2 - restricted to countries where thinness has been valued
32
Why is anorexia not strictly held to the culturally-bound framework of eating disorders?
- self-starvation seen throughout history and across cultures
33
What supports the culturally-bound view of bulimia?
- more common in the past 50 years
- more common in western than non-western cultures
- may vary more by culture and historical period because abundance of food is required
34
What are biological theories of eating disorders?
- genetic predisposition to eating disorders (heritability estimates for anorexia from 48% to 74% and for bulimia from 59% to 83%)
- dysregulation or disruption of the hypothalamus
- imbalance or dysregulation in levels of serotonin, norepinephrine, or dopamine (neurotransmitters) or in levels of cortisol or insulin (hormones)
→ associated with reduced serotonin activity
35
How do the cultural norms of attractiveness cause eating disorders?
- "ideal woman" in western society has become thinner in the past 45 years
- promoted by the media, becomes socially reinforced
→ thin ideal internalization affirms the desirability of socially sanctioned ideals and engaging in behaviours to achieve this ideal
- viewing images of thin models increases women's depression, shame, guilt and decreases self-esteem
36
Which types of athletic activities are prone to encouraging eating disorders?
- gymnastics
- ice skating
- jockeying
- wrestling
- body building
- ballet
37
How do family dynamics play a part in causing eating disorders?
- "good girl" types encouraged to strive for perfection are susceptible
→ family modelling behaviour like dieting or disparaging comments about weight feed into this
- fear of separation and individuation in adolescence
- family often in conflict
- deficits in sense of self
38
What are the cognitive models that explain eating disorders?
- focus on body dissatisfaction + low self-esteem and striving for perfection
→ over-valuation of appearance combined with above
- concern about others' opinions
39
What are predisposing factors of integrative models?
- events or situations that trigger the eating disorder (e.g., death of loved one)
40
What are perpetuating factors of integrative models?
```
- physical and psychological symptoms that serve to maintain the disorder,
→ reduced basal metabolic rate
→ delayed gastric emptying
→ social isolation
→ depression
```
41
What are the maturational issues that may contribute to development of eating disorders?
- female development involves adding body fat.
→ young women move away from the ideal female shape
- eating disorders and body dissatisfaction are most likely to appear around the time of puberty
42
How do adverse events contribute to development of eating disorders?
- incidence of child sexual abuse is higher among individuals with eating disorders
- traumatic events may make some individuals more vulnerable to psychological disturbances in general
43
How is anorexia nervosa treated?
- hospitalization and
refeeding
- behaviour therapy
```
- techniques to help the
patient accept and value
his or her emotions
→ use cognitive or supportive-expressive
techniques to help the patient explore the
emotions and issues underlying behaviour
```
- family therapy
44
How does behaviour therapy treat anorexia?
- make rewards contingent upon eating
| - teach relaxation techniques
45
How does family therapy treat anorexia?
```
- raise the family’s concern about anorexia
behaviour
- confront the family’s tendency to be
overcontrolling and to have excessive
expectations
```
46
What is nutritional therapy?
- hospitalization & re-feeding method
- weight restoration can alleviate many of the symptoms, including cognitive impairment
→ typically a prerequisite for psychotherapy
47
What are some treatments for bulimia nervosa?
- cognitive-behavioural therapy
- interpersonal therapy
- supportive-expressive psychodynamic therapy
- tricyclic antidepressants and selective serotonin reuptake inhibitors
48
How does cognitive-behaviour therapy treat bulimia?
- targets faulty cognitions and maladaptive behaviours
- teach the client to recognize the cognitions around eating and to confront the maladaptive cognitions.
- introduce “forbidden foods” and regular diet and help the client confront irrational cognitions about these
49
What is the regimen for CBT treatment of bulimia?
- 19 sessions over 20 weeks and proceeds in three phases:
1 → psychoeducation about normalized eating & connection between excessive control of eating and binging
► self-monitoring to identify triggers of eating-disordered thoughts
2 → problem-solving skills about body weight and shape
3 → strategies to maintain change and prevent relapse
50
How does interpersonal therapy treat bulimia?
- focuses on maladaptive interpersonal relationships
→ grief, role transitions, interpersonal role disputes, interpersonal deficits
- help the client identify interpersonal problems associated with bulimic behaviours deal with these problems more effectively
51
How does supportive-expressive psychodynamic theory treat bulimia?
- provide support and encouragement for the client’s expression of feelings about problems associated with bulimia in a nondirective manner
52
How do medications treat bulimia?
- help to reduce impulsive eating and negative emotions that drive bulimic behaviours
→ reduce frequency of binging and purging
→ improve attitudes about weight/shape/eating
- seldom helpful
