Chapter 11

Question 1

Trigger Warning

Answer 1

Some images and concepts may be stressful and ignite a negative response in some people. It is important to practice self care in all parts of your life, but especially when there are stimuli that can trigger stress reactions. Please practice self care and remove yourself from the class if needed.

Question 2

Statistically if there are 50 people in the room there is likely someone in the room who has delt with an eating disorder : T/F

Answer 2

TRUE

Question 3

DSM-5 Criteria: Anorexia Nervosa

Answer 3

Restriction of food that leads to very low body weight; body weight is significantly below normal

Intense fear of weight gain or repeated behaviors to interfere with weight gain

Body image disturbance

Question 4

Anorexia Nervosa

Answer 4

Weight loss is typically achieved through dieting
Can also occur through purging and excessive exercise

Fear of gaining weight is not reduced by weight loss

Even when emancipated, those with anorexia nervosa may believe they are overweight

• They overestimate their body size
• They will choose a thin figure as ideal

Severity ratings are based on Body Mass Index (BMI)

Question 5

how many subtypes of anorexia?

Answer 5

2

Question 6

the subtypes of anorexia

Answer 6

*Restricting type
Weight loss is achieved by severely limiting food intake

*Binge-eating/purging type
The person has also regularly engaged in binge eating and purging

Longitudinal research suggests limited validity, yet clinical utility of subtypes

Question 7

if the BMI is significant enough then you call it _______

Answer 7

anorexia

Question 8

Figure 11.1:Assessment of Body Image

Answer 8

(a) Ratings of women who scored high on a measure of distorted attitudes toward eating
(b) Ratings of women who scored low

Question 9

Bing eating subtype of anorexia BMI

Answer 9

17 or below

Question 10

*Binge-eating/purging type (Subtypes of Anorexia Nervosa)

Answer 10

*Binge-eating/purging type

The person has also regularly engaged in binge eating and purging

Question 11

In regards to the two subtypes of anorexia- Longitudinal research suggests l:

Answer 11

Longitudinal research suggests limited validity, yet clinical utility of subtypes

Question 12

Anorexia Nervosa: Prevalence

• Onset:
• triggered by
• woman vs men

Answer 12

Onset: early to middle teenage years
Usually triggered by dieting and stress
At least 3x more frequent in woman than men

*Often comorbid with depression, OCD, phobias, panic, personality disorders

Suicide rates are high
5% completing
20% attempting

Question 13

explain - woman vs men - of anorexia

Answer 13

A “womens disorder”

• it does occur in men
• there is shame in men to be seeking help in a women dominated disorder
• low BMI is seen as attractive in women – low BMI is a women ideal

Question 14

Anorexia is often comorbid with:

Answer 14

Often comorbid with depression, OCD, phobias, panic, personality disorders

Question 15

Suicide rates with anorexia

Answer 15

Suicide rates are high
5% completing
20% attempting

Question 16

Anorexia Nervosa: Physical Consequences

Answer 16

Low blood pressure, heart rate decrease
Kidney and gastrointestinal problems
Loss of bone mass
Brittle nails, dry skin, hair loss

Lanugo (a fine, soft hair) may develop

Altered levels of potassium and sodium electrolytes
Can cause tiredness, weakness, and sudden death

Question 17

Lanugo

Answer 17

(a fine, soft hair) may develop

Question 18

Anorexia Nervosa: Prognosis

Answer 18

• 50-70% eventually recover
• May often take 6 or 7 years
• Relapse common
• Difficult to modify distorted view of self, especially in cultures that highly value thinness

Anorexia is life-threatening
Death rates 10x higher than general population
Death rates 2x higher than other psychological disorders
Death often results from physical complications of the illness

Question 19

DSM-5 Criteria: Bulimia Nervosa

-time length

Answer 19

Recurrent episodes of binge-eating
Recurrent compensatory behaviors to prevent weight gain
E.g., purging (vomiting), fasting, excessive exercise, use of laxatives and/or diuretics
Body shape and weight are extremely important in self-evaluation
Behaviors must be present at least 1x/week for 3 months

Question 20

Bulimia Nervosa: Severity Ratings

Answer 20

Based on number of compensatory behaviors/week

• mild
• moderate
• severe:
• extreme:

see slide 17

Question 21

Bulimia Nervosa: Binge Eating

Answer 21

A binge episode includes:
An excessive amount of food consumed in a short period of time
A feeling of losing control over eating

Typically occurs in secret

May be triggered by stress, negative emotions or negative social interactions
Typical food choices:
Cakes, cookies, ice cream, other easily consumed, high-calorie foods
Avoiding a craved food can later increase likelihood of binge
Reports of losing awareness or dissociation
Shame and remorse often follow

Question 22

Bulimia Nervosa: Compensatory Behavior

Answer 22

Feelings of discomfort, disgust, and fear of weight gain lead to inappropriate compensatory behaviour
Attempt to undo the caloric effects of the binge
Vomiting, laxative and diuretic abuse, fasting, excessive exercise are used to prevent weight gain
Binge/purge episode must occur at least once a week for 3 months

Question 23

Bulimia Nervosa: Prevalence

Answer 23

Onset late adolescence or early adulthood
90% of people with bulimia nervosa are women
Prevalence among women: 1 – 2%
Typically overweight before onset and symptoms begin while dieting

Comorbid with depression, personality disorders, anxiety, substance use disorders, conduct disorder

Suicide rates are higher than in general population
But much lower than in anorexia nervosa

Question 24

Bulimia Nervosa: Physical Consequences

Answer 24

Potassium depletion from purging

Laxative use depletes electrolytes, which can cause cardiac irregularities

Vomiting may lead to tearing of the tissue in the stomach and throat

*Loss of dental enamel from stomach acids in vomit

Mortality rate higher than other disorders

Question 25

who may be the first person to notice Bulimia ?

Answer 25

the dentist because of the teeth

Question 26

Bulimia Nervosa: Prognosis

Answer 26

~75% recover

10-20% remain fully symptomatic

Early intervention linked with improved outcomes

Poorer prognosis when depression and substance abuse are comorbid or when more severe symptomatology

Question 27

Bulimia vs. Anorexia

Answer 27

The key difference is weight loss:
People with anorexia nervosa lose a tremendous amount of weight
People with bulimia nervosa do not

Question 28

DSM-5 Criteria: Binge Eating Disorder

Answer 28

Binge eating episodes include at least three of the following:
Eating more quickly than usual
Eating until over full
Eating large amounts even if not hungry
Eating alone due to embarrassment about large food quantity
Feeling bad (e.g., disgusted, guilty, or depressed) after the binge

*Recurrent binge eating episodes

No compensatory behavior is present

Question 29

Binge Eating Disorder: Severity Ratings

Answer 29

Based on number of binges/week

Question 30

Binge Eating Disorder: Prevalence

• BMI
• comorbidity
• risk factors:

Answer 30

Associated with obesity and history of dieting
BMI > 30

Comorbid with mood disorders, anxiety disorders, ADHD, conduct disorder, and substance use disorders

Risk factors include:
Childhood obesity, critical comments about being overweight, weight-loss attempts in childhood, low self-concept, depression, and childhood physical or sexual abuse

More prevalent in women

More prevalent than anorexia or bulimia

Equally prevalent among Euro-, African-, Asian-, and Hispanic-Americans

Question 31

Binge Eating Disorder: Prognosis

Answer 31

This is a relatively new diagnosis
New to DSM-5
Few studies have assessed prognosis

Research so far suggests between 25-82% recover

Duration of just over 4 years

Question 32

Neurobiological Factors (

Answer 32

*Hypothalamus
Regulates hunger and eating
However, it does not seem a likely causal factor in anorexia nervosa
Low levels of endogenous opioids
Substances that reduce pain, enhance mood, and suppress appetite
Released during starvation
May reinforce restricted eating of anorexia
Excessive exercise also increases opioids

*Serotonin
Related to feelings of satiety (feeling full)
Low levels of serotonin metabolites among people with anorexia and bulimia suggests underactive serotonin activity
Antidepressants that increase serotonin often effective in treatment of eating disorders
May be linked to comorbid depression

*Dopamine
Related to feelings of pleasure and motivation
Key role in “liking” of food and the “wanting” or craving for food

Question 33

Sociocultural Factors

Answer 33

The American cultural ideal has progressed steadily toward increasing thinness
Example: marlyn monro would probs not be pretty today

Dieting, especially among women, has become more prevalent
Often precedes onset

Higher BMI and body dissatisfaction is related to higher risk for developing eating disorders

Unrealistic media portrayals
Women may feel shame when they don’t match the ideal
“Pro-eating disorder” websites
Stigma associated with being overweight

Question 34

Gender Influences

Answer 34

*Objectification of women’s bodies
Women defined by their bodies; men defined by their accomplishments
Societal objectification of women leads to “self-objectification”
Women see their own bodies through the eyes of others
Leads to more shame when they fall short of cultural ideals

*Aging and changes in life roles (having a life partner or having children) associated with decreases in eating disorder symptoms

Question 35

Personality Influences

Answer 35

*Severe restriction of food intake can have powerful effects on personality and behaviour
Preoccupation with food, fatigue, poor concentration, lack of sexual interest, irritability, moodiness, and insomnia

*Personality characteristics before an eating disorder
Body dissatisfaction, poor Interoceptive awareness, and negative affect predicted disordered eating
Perfectionism high among women with anorexia and remains high after successful treatment

Question 36

Trauma

Answer 36

Many people who have experienced trauma, especially in their early years, develop an eating disorder.
This is often attributed to be due to a sense of control over their own bodies by restricting eating or purging.
Many therapists who specialize in treating people with eating disorders anecdotally claim that none of their patients are without some sort of trauma history

Question 37

Medications

Bulimia nervosa

Answer 37

Bulimia nervosa
Often treated with antidepressants
Likely because it is often comorbid with depression
Dropout and relapse rates high

Question 38

Medication

Anorexia nervosa

Answer 38

Anorexia nervosa

Medications have been used with little success in improving weight or other core features of anorexia

Question 39

Medications: Binge eating disorder

Answer 39

Binge eating disorder

Limited research suggests that antidepressant medications are not effective in reducing binges or increasing weight loss

Question 40

Psychological Treatment: Anorexia Nervosa

Answer 40

Immediate goal is to increase weight to avoid medical complications and avoid death

Second goal is long-term maintenance of weight gain

CBT
Reductions in symptoms through 1 year

*Family-based therapy (FBT)
Interactions among family members can play a role in treating the disorder
Helps parents support child’s healthy weight while building family functioning
Early results show improved outcomes over individual therapy
Early weight gain may be an important predictor of a good outcome

Question 41

is psych treatment the first thing to do in regards to anorexia?

Answer 41

not really - Immediate goal is to increase weight to avoid medical complications and avoid death

Question 42

Psychological Treatment: for Bulimia Nervosa

Answer 42

CBT for Bulimia Nervosa

*Best-validated and most current standard for treatment

Challenge societal standards for physical attractiveness

Challenge beliefs about weight and dieting

*Challenge all-or-nothing beliefs about food
One bite of high-calorie food does not need to trigger a binge

Increase self-assertiveness skills

Increase regular eating patterns (three meals per day)

*CBT more effective than medication
Adding medication may help alleviate depression
Adding exposure and ritual prevention (ERP) may not add much beyond CBT alone

*Guided self-help CBT
Use of self-help books on topics such as perfectionism, body image, negative thinking, and food and health
Meet for small number of sessions with a therapist to guide them through self-help material

*Interpersonal therapy
Not as effective in the short-term as CBT

Question 43

Psychological Treatment: Binge Eating Disorder

Answer 43

CBT shown to be effective
Targets binge eating through self-monitoring, self-control, and problem-solving skills

CBT more effective than medication

Interpersonal therapy equally as effective as CBT and guided self-help CBT
All three are more effective than behavioral weight-loss programs
Behavioral weight-loss programs promote weight loss, but do not curb binge eating

Question 44

Hospitalization?

Answer 44

There are several options for treatment for people with severe eating disorders
Inpatient treatment, partial hospitalization programs, intensive outpatient treatment, outpatient treatment
The severity of the case and the medical danger usually determines which treatment program will be used.

Question 45

Treatment Team

Answer 45

In general, it is best practice to have several different disciplines working together with a patient
Nutritionist, psychotherapist, physical therapist, psychopharmacologist, art therapist, medical doctor

Question 46

Prevention of Eating Disorders

Answer 46

*Psychoeducational approaches- Early education about eating disorders

*Deemphasize sociocultural influences
Help resist or reject sociocultural pressures to be thin

*Risk-factor approach
Identify people at risk (e.g., weight and body-image concern, restricting food) and intervene to alter these factors

Question 47

If your sister has anorexia nervosa and you are female:

a. ) you are over twenty times more likely to have anorexia nervosa.
b. ) you are over ten times more likely to have anorexia nervosa.
c. ) you are over two times more likely to have anorexia nervosa.
d. ) there is no greater risk to you for developing anorexia nervosa.

Answer 47

b.) you are over ten times more likely to have anorexia nervosa.

Question 48

What is the most likely prognosis for a woman with anorexia nervosa?

a. ) she will recover within a year with no relapses
b. ) she will never recover
c. ) she will eventually recover, but will likely relapse and continue to struggle with the disorder for years
d. ) she will regain normal weight as she enters puberty

Answer 48

c.) she will eventually recover, but will likely relapse and continue to struggle with the disorder for years

Question 49

As compared to anorexia nervosa, the diagnosis of bulimia nervosa is associated with:

a. ) higher mortality rates
b. ) lower mortality rates
c. ) equal mortality rates
d. ) none of the above; data on mortality caused by eating disorders does not exist

Answer 49

b.) lower mortality rates

Question 50

The DSM-5 categorizes bulimia nervosa as:

a. ) an organic mental disorder
b. ) an eating disorder separate from anorexia nervosa
c. ) a subtype of anorexia nervosa
d. ) a subtype of binge eating disorder

Answer 50

b.) an eating disorder separate from anorexia nervosa

Question 51

Anorexia - death rates

Answer 51

Anorexia is life-threatening
Death rates 10x higher than general population
Death rates 2x higher than other psychological disorders
Death often results from physical complications of the illness

Question 52

Which of the following has been shown to lead to reliable long-term maintenance of weight gain in treating anorexia?

a. ) cognitive behavioral therapy
b. ) family therapy
c. ) psychodynamic therapy
d. ) none of the above has been shown to reliably lead to long term maintenance of weight gain

Answer 52

d.) none of the above has been shown to reliably lead to long term maintenance of weight gain

Question 53

Which of the following is most prevalent?

a. ) anorexia nervosa, restricting type
b. ) anorexia nervosa, binge-eating/purging type
c. ) bulimia nervosa
d. ) binge eating disorder

Answer 53

d.) binge eating disorder

Question 54

The principal form of psychological treatment for anorexia nervosa is

a. ) social skills training
b. ) reinforcing appropriate eating behaviors
c. ) providing a safe inpatient environment
d. ) family therapy

Answer 54

d.) family therapy

Question 55

Betsy is excessively concerned that she is becoming fat and restricts her eating to avoid such a consequence. She weighs approximately 20% less than normal body weight given her height. At times, she will sit down with her family and eat a full meal, but immediately afterwards takes several laxatives. Betsy most likely has:

a. ) anorexia, restricting type
b. ) bulimia nervosa
c. ) anorexia, binge-eating-purging type
d. ) binge eating disorder

Answer 55

c

Question 56

In treating bulimia nervosa, the overall goal is to teach the individual to:

a. ) develop normal eating patterns
b. ) monitor caloric intake
c. ) has other social outlets
d. ) accept their natural shape

Answer 56

a.) develop normal eating patterns

Question 57

Cognitive behavioral treatment of bulimia nervosa is effective:

a. ) half the time
b. ) if combined with drug treatment
c. ) but with high relapse rates
d. ) if family and friends are supportive

Answer 57

a.) half the time

Question 58

Research regarding the role of the hypothalamus in anorexia nervosa indicates that:

a. ) dysfunction in the hypothalamus does not seem to be an important factor in anorexia.
b. ) the hypothalamus is damaged in most individuals with anorexia.
c. ) the hypothalamus appears to be overactive in people with anorexia, leading to binge eating.
d. ) hypothalamus dysfunction is the most likely explanation for the fact that people with anorexia do not experience hunger.

Answer 58

a

Question 59

Research has found that in those with anorexia nervosa, endogenous opiods:

a. ) are released by purging, leading to euphoria
b. ) are decreased by bingeing, leading to euphoria
c. ) are at high levels, leading to euphoria
d. ) are at low levels, leading to euphoria

Answer 59

c.) are at high levels, leading to euphoria

Question 60

Which of the following statements is true regarding gender differences in eating disorders?

a. ) Adequate prevalence data on eating disorders has not been collected for men, because men are reluctant to disclose disordered eating patterns.
b. ) Men are more likely to have bulimia, while women are more likely to have anorexia.
c. ) Women are more likely to have both bulimia and anorexia than men.
d. ) Women are more likely to have bulimia, while men are more likely to have anorexia.

Answer 60

c.) Women are more likely to have both bulimia and anorexia than men.

Question 61

Eating disorders are usually caused by:

a. ) sociocultural pressures
b. ) genetic disposition
c. ) neurochemical imbalance
d. ) a combination of factors

Answer 61

d.) a combination of factors

Question 62

Bulimia comes from a Greek word meaning:

a. ) excessiveness
b. ) expulsion
c. ) ox-hunger
d. ) compensatory

Answer 62

c.) ox-hunger

Question 63

Which of the following is a form of cognitive behavior therapy that has some proven success in treating eating disorders?

a. ) guided self-help CBT
b. ) documentation CBT
c. ) family-oriented CBT
d. ) none of the above

Answer 63

a.) guided self-help CBT