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PSY240 > Chapter 10: Eating Disorders > Flashcards

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
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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
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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
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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)

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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
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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)
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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
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8
Q

What is the binge-purge type of anorexia nervosa?

A
  • recurrent episodes of binge-eating/purging type behaviour
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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

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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
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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

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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
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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
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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
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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

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16
Q

What is the lifetime prevalence of bulimia?

A
  • 1.1% for women

- 0.1% for men

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17
Q

What is the lifetime prevalence for anorexia?

A
  • 0.3% in females

- 0.02% in males

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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

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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
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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

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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
Q

What are common medical complications of anorexia nervosa?

A
  • 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
Q

What is lanugo?

A
  • fine white hair that grows on individuals with anorexia when they have no body fat left to keep themselves warm
27
Q

What are common medical complications of bulimia nervosa?

A
  • 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
Q

What are common medical complications of eating disorders in general?

A
  • osteoporosis
  • cardiovascular problems
  • decreased fertility
  • lethargy
  • dry skin and hair/hair loss
  • sensitivity to cold
29
Q

What is Russell’s sign?

A
  • 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
Q

What is the support for eating disorders being conceptualized on a spectrum?

A
  • many individuals move from one diagnostic category to another (and even back again) across time
31
Q

What makes eating disorders primarily culturally bound?

A

1 - largely restricted to wealthy countries where food is in abundance

2 - restricted to countries where thinness has been valued

32
Q

Why is anorexia not strictly held to the culturally-bound framework of eating disorders?

A
  • self-starvation seen throughout history and across cultures
33
Q

What supports the culturally-bound view of bulimia?

A
  • 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
Q

What are biological theories of eating disorders?

A
  • 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
Q

How do the cultural norms of attractiveness cause eating disorders?

A
  • “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
Q

Which types of athletic activities are prone to encouraging eating disorders?

A
  • gymnastics
  • ice skating
  • jockeying
  • wrestling
  • body building
  • ballet
37
Q

How do family dynamics play a part in causing eating disorders?

A
  • “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
Q

What are the cognitive models that explain eating disorders?

A
  • focus on body dissatisfaction + low self-esteem and striving for perfection
    → over-valuation of appearance combined with above
  • concern about others’ opinions
39
Q

What are predisposing factors of integrative models?

A
  • events or situations that trigger the eating disorder (e.g., death of loved one)
40
Q

What are perpetuating factors of integrative models?

A 
- physical and psychological symptoms that serve to maintain the disorder, 
→ reduced basal metabolic rate
→ delayed gastric emptying
→ social isolation
→ depression
41
Q

What are the maturational issues that may contribute to development of eating disorders?

A
  • 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
Q

How do adverse events contribute to development of eating disorders?

A
  • 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
Q

How is anorexia nervosa treated?

A
  • 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
Q

How does behaviour therapy treat anorexia?

A
  • make rewards contingent upon eating

- teach relaxation techniques

45
Q

How does family therapy treat anorexia?

A 
- raise the family’s concern about anorexia
behaviour
- confront the family’s tendency to be
overcontrolling and to have excessive
expectations
46
Q

What is nutritional therapy?

A
  • hospitalization & re-feeding method
  • weight restoration can alleviate many of the symptoms, including cognitive impairment
    → typically a prerequisite for psychotherapy
47
Q

What are some treatments for bulimia nervosa?

A
  • cognitive-behavioural therapy
  • interpersonal therapy
  • supportive-expressive psychodynamic therapy
  • tricyclic antidepressants and selective serotonin reuptake inhibitors
48
Q

How does cognitive-behaviour therapy treat bulimia?

A
  • 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
Q

What is the regimen for CBT treatment of bulimia?

A
  • 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
Q

How does interpersonal therapy treat bulimia?

A
  • 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
Q

How does supportive-expressive psychodynamic theory treat bulimia?

A
  • provide support and encouragement for the client’s expression of feelings about problems associated with bulimia in a nondirective manner
52
Q

How do medications treat bulimia?

A
  • 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

PSY240 (16 decks)

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