Chapter 8 - Feeding/Eating, Sleep/Wake Disorders Flashcards
-eating disorders like bulimia Nervosa and anorexia often affect people at
high school or college age, especially young women
-incidence tends to be significantly higher in females than males
-Anorexia Nervosa
an eating disorder primarily affecting young women, characterized by maintenance of an abnormally low body weight, distortions of body image, intense fear of gaining weight
DSM-5: Anorexia Nervosa
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self- evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Type: Restricting Type vs. Binge-Eating/Purging Type
-Severity of Anorexia is based based largely on
Body Mass Index (BMI), which is calculated from weight (in KGs) and height (in meters)
BMI calculation is
-BMI = kg / m^2,
low end of normal ranged BMI is considered to be (WHO)
- 5 by WHO and CDC, with 17.0 considered “moderate to severe ‘thinness’”
- Mild greater than or equal to 17
- Moderate 16 – 16.99
- Severe 15 – 15.99
- Extreme less than 15
- in partial remissions (some but nit all criteria met for a “sustained period of time”)
- in full remission (no criteria met for a “sustained period of time”)
feeding and eating disorders
psychological disorders involving disturbed eating patterns and maladaptive ways of controlling body weight
Medical Complications of Anorexia
- Amenorrhea
- Low estrogen
- absence or suppression of menstruation
- Osteoporosis
- fractures or bone brittleness
- inadequate dietary calcium
- Kidney damage
- Dehydration
- laxative abuse
- Heart arrhythmias
- Hypotension
- low blood pressure
- Anemia
- Death (about 15% of patients) - highest among all the mental disorders
- malnutrition
- suicide
- yellow skin, downy hair, cracked skin (may persist for years even after treatment)
eating disorders are usually accompanied by
other forms of psychopathology such as: mood, anxiety, impulse control, and substance use disorders
typically these disorders begin (eating)
begin in adolescence or early adulthood (when pressures of being thin are strongest) and sometimes late-adulthood
anorexia means
without desire for food
typically anorexia begins
between the ages of 12 - 18
restricting type
during the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior. This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting and/pr excessive exercise
binge-eating/purging type
during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior, different from bulimia because of BMI. Issues with impulse control. Bounce between periods of intense control to impulsive behavior
one common pattern of anorexia is
begins after menarche and/or when they leave home to attend secondary education
Those with anorexia almost always
deny that they are losing too much weight or wasting away. they argue that their ability to engage in strenuous exercise proves their fitness.
Also likely to view themselves heavier than they actually are (distorted body image)
-Bulimia Nervosa:
an eating disorder characterized by a recurrent pattern of binge eating followed by self-induced purging and accompanied by persistent over concern with body weight and image
DSM-5 – Bulimia Nervosa
• A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
• C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
• D. Self-evaluation is unduly influenced by body shape and weight.
• E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
– Specifiers:
• Mild (1-3/wk)
• Moderate (4-7)
• Severe (8-13)
• Extreme (14 or more)
– In partial remission (some but not all criteria met for a “sustained period of time”)
– In full remission (no criteria met for a “sustained period of time”)
Binge-eating disorder
-new DSM-5 diagnostic category that involved the same binge-eating features found in Bulimia Nervosa but without the behaviors aiming to compensate for the binging
Medical complications of Bulimia
• Tooth erosion, cavities, and gum problems -damaged taste receptors -damage of skin around the mouth -loss of aversive sensitivity to vomit • Blockage of salivary ducts • Pancreatitis • Water retention, swelling, and abdominal bloating • Acute stomach distress • Fluid loss with low potassium levels – extreme weakness (near paralysis) – Heart arrhythmias • Irregular periods – esophagus damage (including rupture) • Weakening of the rectal walls Behavioral complications • Substance abuse (30 to 70%) • Impulsive behaviors (up to 50%) – Promiscuity – Cutting – Theft
bulimia means
“hunger”
bulimic individuals are typically
normal weight
fear of weight gain is a common factor as well but do not pursue extreme thinness of anorexia
binging typically occurs
at home, during unstructured afternoon or evening hours. Can last from 30 to 60 mins. Can consume 5000 to 10,000 calories in one sitting
binging episodes continue until
the binger is exhausted, suffers painful stomach distension, induces vomiting, or they run out of food
-Risk-factors (both Anorexia and Bulimia)
- participation in competitive activities that emphasize endurance, aesthetics, and weight levels put athletes at risk for developing an eating disorder
- Female gender
- age in late teens to early 20s
- having a first degree relative with an eating disorder
- Social pressures including distorted medial portrayals
- Emotional issues such as: low self-esteem, anxiety, depression, OCD, impulsivity, need for control
Causes of Anorexia and Bulimia
- SES factors
- generalized among all SES
- social pressures to be thin or lose weight
- importance attached to appearance
- media, social-media
- Psychosocial factors
- history of rigid dieting
- purging is negatively reinforced by the relief from anxiety (gaining weight)
- body dissatisfaction
- higher perfectionist attitudes
- dichotomous thinking (bulimic individuals)
- exaggerated beliefs about gaining weight
- shy and have few friends (bulimic)
- less social support
- lower self-esteem
- Family factor and eating disorders.
- systems perspective: view that problems reflect the systems (family, social, school, ecological etc.) in which they are embedded
- pressures form mothers
- refusal to eat due to “cold” parents
- lack of independence promotion
- Biological factors
- largely focused on the role of serotonin (especially bulimia)
- decreased levels may prompt binges
- anti-depressants can reduce binging by increasing serotonin levels
- dopamine (reward center), bulimia affects this, may even have atypical functions due to bulimia
- genetic links but do not fully account for the cause
-stress-diathesis model plays an important role
-systems perspective:
view that problems reflect the systems (family, social, school, ecological etc.) in which they are embedded
Treatment of Anorexia and Bulimia Nervosa
often difficult to treat because of the resistance and denial from patients (especially anorexia)
- Hospitalization
- placed on feeding regime
- must consider ethics
- break up the binging-purging cycle
-Cognitive analytic therapy
- Family therapy
- resolve conflicts
- provide information about the disorder - FGP
- CBT
- used with rewards contingent on adherence
- disrupt self-defeating thoughts (bulimia), perfectionist attitudes
- response prevention, similar to OCD treatment
- appears to be the best and first choice for bulimic patients
- Interpersonal psychotherapy
- healthier relationships will lead to healthier food habits
- pharmacological treatments are typically disappointments
- antidepressants are only effective in the short term
even with treatments
about 50% still continued bulimic behavior
-anorexia recovery is a long process, 50% of patients in one study did not recover after 6 years after their first hospitalization.
