Chapter 13 - Eating Disorders Flashcards
What is the EAT-26?
screening tool for eating disorders
honesty and accuracy needed
- best done privately to avoid social desirability/self-consciousness
score provides indication of risk and is intended to be used to determine if an individual should be referred to specialist for full evaluation of eating disorder
does not provide or replace diagnosis
What are the 3 main categories of eating disorder?
anorexia nervosa
bulimia nervosa
binge eating disorder
How many Canadian adolescent girls are obese? How many girls wish to lose weight?
25% are obese
40% of grade 8 girls want to lose weight even though most were not overweight
What is the Canadian prevalence for eating disorders?
0.3-1% for AN
1-2.5% for BN
2% for BN
AN least common despite being most well known
What are the sex differences in ED prevalence?
80-95% are female
70% of children with ED are female
less well known in males
What age has the highest rate of ED?
21 year olds/14-25 age group
95% of 1st time cases appear by 25
What is the mortality rate for ED? Which disorder is highest?
10-15%, highest mortality rate of any mental illness
AN has highest mortality rate, 10% will die within 10 years of onset
females 15-24 with AN have mortality 12x greater than all other causes of death combined
What is the cause of the high mortality rate associated with ED?
organ failure
suicide
What is NSSI?
non-suicidal self-injury
deliberate and direct injury or damage of body tissue
usually intended without suicidal ideation
Why do individuals self harm?
relieve and regulate internal emotions/memories
punish oneself in response to feeling guilt/shame
gain a sense of control
Describe the self-destructive cycle of an eating disorder?
anxiety/dissatisfaction/emotional pain -> coping (disordered eating) -> immense guilt -> coping (self-harm) -> anxiety/dissatisfaction/emotional pain
What are the 2 features common to EDs?
extreme concern for weight and shape
- immense fear of being fat, exaggerated desire for thinness
extreme practices of weight control
What different factors play into the fear of being overweight?
social - culture of thinness
psychological - determines self-worth, self-acceptance, and perceived acceptance
neurobiological - biochemical differences create vulnerabilities, impact on perceptual processes leading to perceptual distortions
What are the most common areas of body dissatisfaction?
butt
thighs
abs
What did Nichter and Vuckovic discover about the way girls in middle school talked about their body?
self-abasing and apologetic
obsessed with body talk
coined the term “fat talk”
When does body dissatisfaction start?
early!
42% of grade 1-3 students want to be thinner
81% of 10 year olds afraid of being fat
40-60% of 6-12 year old girls are concerned about their weight or becoming too fat
What is fat talk?
tendency for friends, particularly female, to take turns disparaging their bodies to each other
common and expected for women to self-degrade
normative discontent
young people seen as more likeable if they engage in fat talk
believe in provides reassurance but creates back and forth comparison that are never ending
What are some negative effects associated with fat talk?
body dissatisfaction negative affect depression anxiety ED symptoms or full on disordered eating more frequent checks of ones body
also creates body dissatisfaction in others
What is meant by distortions in body view?
dissatisfactions with weight and shape regardless of actual weight/shape
distorted view of the self
very common
What are some of the extreme practices used to lose weight?
self-induced vomiting amphetamines laxative and diuretic abuse fasting excessive exercise enemas diet pills
What is anorexia nervosa?
term defined means chronic lack of appetite/desire for food, but this is inaccurate
become preoccupied with food
self-imposed starvation
avoiding food even when hungry
What is the DSM-5 criteria for AN?
a) restriction of food/energy intake leading to significantly low body weight
b) intense fear of gaining weight or persistent behaviour that interferes with weight gain
c) disturbance in the way body weight or shape is experienced
What are the 3 different ways in which disturbance of body weight/shape can be experienced?
distorted body view
undue influence of body weight/shape on self-evaluation
persistent lack of recognition of the seriousness of current low weight
What are the 2 subtypes of AN?
restricting type
- weight loss through extreme methods of weight control
binge-eating purging type
- exhibit AN but also engage in binge eating or 1+ purging behaviour
- typically those who binge eat purge, but some don’t binge and still purge
When is AN most likely to develop?
early to mid teens
often after an episode of dieting and exposure to life stress
co-occurs with substance use disorder
What is drunkorexia?
restricted eating or purging used to control weight gain from binge drinking
common in college/university females
What are the health consequences of AN?
body starved of essential nutrients needed for function
body processes slowed to conserve energy
results in serious medical consequences
- malnutrition
- low BP
- heart damage
- osteoporosis
- brain dysfunction
- infections
eventually death
Why do adolescents deny or downplay the problem?
cognitive factors
underdeveloped ability to see future consequences
personal fable
better arguers - more easily rationalize or provide explanations for behaviour
What are the outcomes of AN?
of 5 AN deaths, 4 are from health complications and 1 is from suicide
males at higher risk of death
- diagnosed later, tend not to seek treatment
70% recover
- slow and difficult
- relapse is common and frequent
What is bulimia nervosa?
episodes of binge eating
followed by anxiety and disgust over possible weight gain and desire to be rid of food
What are the diagnostic criteria for BN?
a) recurrent episodes of binge eating
- eating more than most people would, feeling lack of control over it
b) repeated compensatory behaviours to prevent weight gain
c) at least once a week over 3 months
d) self-evaluation unduly influenced by body shape/weight
e) if separate from AN: if part of AN, then AN binge-purging type
Why can BN go unnoticed?
weight normal to overweight
well-hidden, may go on for years
What is the binge purge cycle?
strict dieting -> diet slips/difficult situations -> binge eating triggered -> purge to avoid weight gain -> feelings of shame/self-hatred -> strict dieting
What are the health consequences of BN?
binge-purge cycles affect the entire body
- digestive problems
- electrolyte/chemical imbalances
- depressed immune function
- dental problems
- osteoporosis
- cognitive issues
- seizures
- abdominal pain
often in a state of starvation despite normal weight
- malnutrition
- fainting, weakness, rapid HR, etc.
mortality
- less common than AN
What is binge eating disorder?
recurrent episodes of eating large quantities of food (quickly to the point of discomfort)
loss of control during binge
feeling shame, distress, or guilt
not using compensatory measures to counter the binge
most common ED
What is the DSM-5 criteria for BED?
a) recurrent episodes of binge eating
- lack of control over eating
- eating an amount of food definitely larger than standard
b) episodes associated with 3+ of:
- rapid eating
- eating until uncomfortably full
- eating a lot when not physically hungry
- eating alone due to embarrassment of how much eating
- feeling disgusted, depressed, or guilty
c) marked distress
d) at least once a week for 3 months
e) not associated with BN or AN
What are the different severity levels for BED?
episodes per week:
mild: 1-3
moderate: 4-7
severe: 8-13
extreme: 14+
What are some health consequences of BED?
weight gain and obesity
- and associated health problems
depression
What are some sociocultural factors leading to ED?
idealization of thinness
media/movie portrayals don’t fit the reality of a pubescent body
unrealistic expectations
What types of social pressures lead to ED in males?
idealized lean, muscular bodies
increases body dissatisfaction in males
silent epidemic
What is the Scarlett O’Hara effect?
eating lightly to project femininity
What is the anti-fat bias?
fat-phobic society
promoted in the media
- in TV, more negative comments given and reinforced by laughter towards heavier females
excessive body fat tends to have negative connotations in our society
- lazy, unsuccessful
What is fat shaming?
point out/nag/embarrass based on weight
leads to depression and low self-esteem
eating/weight may INCREASE
can trigger/exacerbate disordered eating
leads to lower levels of PA, negative attitudes towards sports in youth
often done by family or friends
What is thin shaming?
assumed to be anorexic
food and exercise are policed
eating/weight may DECREASE
can trigger/exacerbate disordered eating
What is the issue with dieting?
puts youth at risk for ED
far more likely to later engage in ED
dieting is increasing among Canadian youth
What are some psychological factors contributing to ED?
pressure to succeed
competitive domains (gymnastics, dance, modelling, sports)
perfectionism
painful life situations
- food to cope with life stressors
issues of control
- overly controlled by others, body is the one thing they can control
What is the relation between athletic competition and ED?
many D1 and D2 NCAA female athletes had attitudes, symptoms, or actual ED symptoms
What biological factors contribute to ED?
genetics
- ED runs in families
- body dissatisfaction/desire to be thin are heritable
brain chemistry
- hormones
- endogenous opiods
- neurotransmitters
genetics and brain chemistry create predisposition/vulnerability
Describe the eating disorder trap.
predisposition (genetics, brain chemistry)
->
environmental factors (sociocultural pressure, negative life situations)
->
feeling out of control and unlovable
- > feel fat/body dissatisfaction
- > weight control
- > weight loss/control
- > feel relief/accomplishment over weight
- > recurrence of fear of weight gain
- > restart the cycle
What are pro-ana sites?
view ED or diet behaviours as a lifestyle choice
offer tips, support, ideas
challenges to maintain behaviours
What are lifestyle views of ED?
normalize or even glamourize extreme restriction and severe control of the self
ignore emotional issues and destructive physical impacts
delay acknowledgement/treatment seeking
contribute to relapse
What are some different treatments for ED?
extremely difficult to get them into treatment, often deny having a problem
education
- on disorders or nutrition
individual therapy
- psychotherapy, CBT
family therapy
drug therapy
support groups
- can be problematic, pick up tips
hospitalization/private treatment centres
best approach is multidimensional and multi-professional
What can we do to reduce ED behaviour?
stop talking about dieting
don’t engage in fat talk
resist negative advertising
assess personal/family attitudes towards weight and avoid negative interactions
power of modelling!
- mothers especially
ensure areas of independence
- decision making and control outside ones own body
emphasize many ways to succeed/many parts in the self
model good eating
don’t weigh yourself!
What is the message of the 34x25x36 video?
“there are no perfect bodies, we make the perfect bodies”
mannequin industry replicates what the “perfect girl” is for the times, dictated by fashion companies
make the buyer think that they could look like that
What were some interesting new points provided in the “Recovering: Anorexia Nervosa and Bulimia Nervosa” video?
lose your friends, they get sick of your games
lot of stigma around people with ED
many triggers
cognitive effects - feel like a zombie, a shell of a person
feel a gap in their life once they get rid of the time commitment of their eating disorder
feel unique and like no one can help them
What is basal metabolic rate?
minimal amount of energy used by the body during a resting state
drops to about 15% during puberty
- on top of fat-muscle ratio increasing markedly during puberty -> weight gain
Why is obesity an adolescent issue?
eating high calorie, low fibre foods
physically inactive
excessive screen time
not enough sleep
