Chapter 10 - Eating Disorders Flashcards
anorexia nervosa
development of morbid fears of fatness, perceive themselves as fat, and reduce their food intake to the point of the state of being abnormally thin or weak
bulimia nervosa
periods of food restriction alternate with periods of binge eating, where excessive amounts of food are consumed
binge-eating disorder
rapidly, eating until uncomfortably full, eating despite not being hungry, eating alone because of embarrassment etc. and then feeling guilty or disgust
what kind of fear do people with anorexia have
intense fear of gaining weight or becoming fat
ARFID
characterized by a feeding disturbance that leads to being underweight and/or an inability to eat enough food to meet nutritional/energy needs
purging
self-induced vomiting, laxative abuse, or abuse of enemas or diuretics
objective binge
consists of eating a large amount of food in a specific time period
subjective binge
small or normal amounts of food during these episodes
what kind of binge eating do bulimic individuals engage in
objective binge eating
BMI
weight in kilos/height in metres squared
restricting type
attain extremely low body weights through strict dieting and sometimes excessive exercise
binge-eating/purging type
engage in strict dieting, sometimes excessive exercise but also regular binge eating/purging behaviors
what two things is bulimia nervosa characterized by
1) eating in a 2 hour period and an amount of food that is deemed more than normal
2) sense of lack of control over eating during episode
eating disorder examination
structured clinical interview for diagnosing eating disorders that has good reliability and validity
lanugo
fine downy hair - may grow on on the body in order to maintain body warmth
amenorrhea
absence of at least three consecutive periods
what disorder does amenorrhea occur the most in
anorexia nervosa
Russell’s sign
scrapes or calluses on the backs of hands or knuckles
what disorder does Russell’s sign occur most in
bulimia nervosa
what is considered a casual risk factor for the development of an eating disorder
thin media images
do individuals with anorexia or bulimia have more negative schemas?
yes
precipitating factors
events or situations that trigger the eating disorder
perpetuating factors
physical and psychological symptoms that serve to maintain the disorder such as reduced basal metabolic rate, depression, social isolation etc.
best biological treatment for bulimia nervosa
CBT and antidepressant medication
first priority for a patient with anorexia nervosa
restore body weight to a healthy minimal level
what can self-help manuals be used for
1) for individuals who might not otherwise have access to expert help or may be too embarrassed to access help
2) conjunction with guidance by a non-specialist professional such as a nurse or family doctor
3) as a first step to treatment slivery and for treatment that may be more intense
history of eating disorders
prior to 60s - few eating disorders
60s-70s - increase in cases of anorexia
late 70s - bulimia nervosa
2013 - bing eating disorder
symptoms of anorexia nervosa
low body weight, fear of gaining weight, body image disturbance
symptoms of bulimia nervosa
objective binge eating episodes, inappropriate compensatory behaviour, undue influence of body shape/weight on self evaluation, not exclusively during AN
how long must symptoms show for BN
at least a week for three months
are people with BN usually normal weight or slight overweight?
yes
BED symptoms
eating more rapidly, eating until uncomfortably full, eating large amounts when not hungry, eating alone because embarrassed by amount, feeling disgusted/depressed/or very guilty afterwards
requirements for BED
- recurrent binge eating at least once a week for three months
- at least three symptoms
- no regular use of inappropriate compensatory behaviours
- not during BN or AN
is ARFID due to weight or shape concerns or body image disturbance
no
criteria for other eating disorders
- atypical AN, BN/BED with low frequency or limited duration, purging disorder, night-eating disorder
are eating disorders more prevalent in men or women
women - 2-3x more common
age onset of AN
19
age onset of BN
20
age onset of BED
25
are interviews more accurate than self-report measures
yes
complications of AN
osteoporosis, heart problems, lethargy, hair loss, sensitivity to cold, lanugo, amenorrhea, kidney failure etc
consequences of starvations
emotional instability, inability to focus, decreased heart rate, lethargy, etc.
complications of BN
dental problems, electrolyte imbalance, heart and kidney problems, obesity etc
complications of BED
obesity, risk of diabetes, heart disease, sleep apnea
associated features of AN
Social withdrawal
Irritability
Preoccupation with food
Depression
subtypes of AN
restrictive and binge-eating purging
Compensatory behaviours
Fasting
Excessive exercise
Purging
What types of binges take place in BN
objective
Are compensatory behaviours used in BED
no not regularly
most common eating disorder
BED
second most common eating disorder
BN
Weight of anorexic patients
BMI under 18
Rarest eating disorder
AN
Which disorder shows the most gender differences
AN
Which disorder shows the least gender differences
BN
What eating behaviours do men participate in the most
Binge-eating and excessive exercise
Which male group reports the highest level of symptoms
middle aged men
Restrictions in AN
Amount of food
Type of food
recovery rate in BN
50% no symptoms
20% show no change in symptoms
How many ED diagnosis can you have at one time
one at a time
etiology of eating disorders
Genetics
Neurotransmitter deregulation
Pre-existing obesity
Psychosocial factors
biological factors of eating disorders
Genetics (50%) Neurotransmitter deregulation (Dysfunctional serotonin activity)
differential diagnosis
Must rule out medical reasons for symptoms and MDD
What differentiations must be made to diagnosis
Is it BN or binge-eating/purging AN?
Is it BED or BN? Are compensations excessive and inappropriate?
Psychosocial factors of EDs
Physical/ sexual abuse
Personality characteristics
Personality characteristics that influence development of EDs
Perfectionism Neuroticism Punishment avoidance Sensitivity to social rewards Negative urgency Low extraversion Level of Impulsivity
Neuroticism
personality trait characterized by anxiety, fear, moodiness, worry, envy, frustration, jealousy, and loneliness.
Negative urgency
Tendency to act rashly when distressed
extraversion
Measure of outgoingness and social ability of a person
family factors
Family history of EDs
High parental expectations
Transmission of pathological values (value on weight and attractiveness)
Miscommunication (Mothers can give false/ inaccurate info)
Family relationships
sociocultural factors
Thin ideal
Thin ideal > increased body dissatisfaction > increased risk of disorder
How does the media portray eating disorders
Young White females
Rarely discuss bad aspects
Never see biological/genetic reasons for the disorder
Treatment of Anorexia Nervosa
Family based treatments (Most Effective) CBT for relapse prevention Focal psychoanalytical therapy Motivational interviewing Specialist supported clinical management
Family based treatment
3 phases involving family
- Weight restoration
- Return of eating control
- Promote normal development (Non-weight based identity)
Who is family based treatment effective for
Teens
Treatment of Bulimia Nervosa
CBT (Most Effective) Interpersonal therapy Family-based treatment Motivational enhancement Dialectical behaviour treatment
CBT for BN
Reduce dysfunctional dieting
Develop skills to deal with high risk situations
Modify thoughts and feelings about shape and weight
How does CBT reduce dysfunctional dieting
Promote moderation
Nothing is completely good food or bad food
Theory behind CBT for BN
Dietary restriction + negative emotions = binge-eating/purging
Treatment of BED
CBT Interpersonal therapy Behavioural weight loss Dialectical Behaviour Therapy (Most Effective) Motivational interviewing
Behavioural Weight loss
There is a good and bad foods list
Evidence based treatment
dialectical behaviour therapy
Emotion regulation
3 Components
components of DBT
Group Skills Training
Individual Therapy
Telephone Coaching
goals of DBT in BED
Mindfulness
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
what is mindfulness in DBT
Learn that negative emotions are brief states
Distress Tolerance in DBT
Learn skills to help yourself through a crisis
Emotion Regulation in DBT
Reduce vulnerability to negative emotions
Interpersonal Effectiveness in DBT
Develop relationship skills
levels of prevention
Universal
Selected
Indicated
universal prevention
Targets cultural attitudes and practices
Main focus are public institutions and public policies
Selected Prevention
Targets high risk groups
indicated prevention
Targets people showing early warning signs
Girls with high weight/shape concerns
Dissonance-based Prevention programs
Have people critique the thin ideal
Reduce discrepancy between beliefs and actions
What levels of prevention are most effective
indicated and Selected
Which group benefits the most from prevention programs
adolescents
Are interactive or presentation(didatic) based prevention more effective
interactive
types of binges in AN
subjective
Should prevention focus on teaching about EDs
More effective when they are focused on body acceptance
