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PSYC 337 > Chapter 9 > Flashcards

Chapter 9 Flashcards

1
Q

Eating disorders

A
  • characterized by persistent disturbance in eating behaviors
  • focus in course on anorexia nervosa, bulimia nervosa, and binge-eating disorder
  • see slides for graph comparing the 3
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2
Q

Anorexia Nervosa

A
  • term means “lack of appetite induced by nervousness” (not true!)
  • relentless pursuit of thinness leading to significantly low body weight
  • 2 types: restricting type and binge-eating/purge type
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3
Q

DSM5 Criteria for Anorexia Nervosa

A

A: restriction of energy intake leading to significantly low body weight
B: intense fear of gaining weight
C: disturbances in way weight/shape is experienced (perception issue)

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4
Q

Gull and eating disorders

A
  • first person to describe treatment of someone with anorexia
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5
Q

Bulimia Nervosa

A
  • uncontrollable binge eating and efforts to prevent resulting weight gain (vomiting/exercise)
  • comes from Greek words bous (ox) and limos (hunger)
  • similar to binge-eating/purging type of anorexia (distinguish between them based on weight – here are normal or slightly above normal rate)
  • might have as much as 4,800 calories in binge
  • behaviors both occur avg. 1x/week for 3 months
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6
Q

Binge-eating disorder

A
  • like bulimia but without inappropriate compensatory behavior
  • less dietary restraint (not thinking ab losing weight)
  • associated w being overweight or obese
  • binging occurs avg. 1x/week for 3 months
  • more likely to have overvalued ideas ab importance of weight/shape vs overweight/obese ppl w/o BED
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7
Q

Age of onset and gender differences (eating disorders)

A
  • anorexia nervosa most likely to develop in 16-20yo
  • bulimia nervosa most likely in women 21-24
  • binge-eating more common between 30 and 50
  • 3x more women than men w eating disorder
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8
Q

Prevalence of eating disorders

A

Binge-eating disorder
- most common form
- lifetime prevalence 2% worldwide (3.5% in women and 2% in men in US)
- prevalence higher in obese people (6.5-8%)
Bulimia
- worldwide prevalence est. 1%
- lifetime prevalence in US about 1.5% in women and 0.5% in men
Anorexia
- lifetime prevalence in US 0.9% in women and 0.3% in men (similar to Sweden)
- risk of developing anorexia increased in 20th century, risk for bulimia has gone down in last decade
- many young people have body image issues

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9
Q

Medical Complications in Anorexia Nervosa

A
  • mortality rate over 5x higher than for females 15-34
  • 3% of ppl with anorexia nervosa die
  • malnutrition takes toll on body
  • thiamin deficiency can lead to depression and cognitive changes
  • laxative abuse can lead to dehydration, kidney disease, damage to bowels/intestines
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10
Q

Medical Complications in Bulimia Nervosa

A
  • mortality rate ab 2x higher than comparable groups
  • calluses on hands from sticking fingers down throat
  • damage teeth bc of acidity of vomit (mouth ulcers and cavities)
  • often small red dots around eyes caused by pressure of throwing up
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11
Q

Course and outcome of Anorexia Nervosa

A
  • suicide 2nd highest cause of death after complications
  • 18x more likely to die by suicide
  • possible to become well again even after series of treatment failures
  • can still have food issues when they have become ‘well’
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12
Q

Course and outcome of Bulimia Nervosa

A
  • long-term prognosis quite good, high rates of remission
  • can still have food issues when they have become ‘well’
  • suicide attempts in 25-30% of cases
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13
Q

Course and outcome of binge-eating disorder

A
  • high rates of clinical remission
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14
Q

Diagnostic crossover of eating disorders

A
  • some eds so similar that there is debate about if they should be diagnosed as distinct disorders
  • when someone has been diagnosed w an eating disorder they are more likely to later be diagnosed w another ed
  • bidirectional transitions between two types of anorexia is common
  • shift from anorexia to bulimia in 1/3 of patients in study
  • binge-eating and anorexia are very different
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15
Q

Comorbidities of eating disorders

A
  • 68% of patients w anorexia, 63% w bulimia, and 50% w BED are also diagnosed w depression
  • OCD often found in ppl w anorexia and bulimia
  • 2/3 of sample of anorexic patients were rigid and perfectionistic even as children
  • often comorbid personality disorders
  • binging/purging disorders associated w substance abuse disorders
  • more than 1/3 of patients w eds have engaged in SH
  • BED: high rates of anxiety disorders (65%), mood disorders (46%), and substance abuse disorders (23%)
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16
Q

Eating disorders across cultures

A
  • not culture-bound; increased prevalence w exposure to Western ideals
  • white ppl have more subclinical problems that may put them at higher risk for developing EDs
  • study in Fiji; ideal was being fat but changed after tv was introduced, women started dieting
  • bulimia nervosa is pretty bound to western culture
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17
Q

Genetics and eating disorders

A
  • anorexia: risk for relatives 11.4x higher
  • bulimia: risk for relatives 3.7x higher
  • association w genes linked to psychological (schizophrenia, neuroticism) and metabolic (ie diabetes) problems
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18
Q

Area of brain linked to body image perception

A

temporal cortex

19
Q

Serotonin + Dopamine in eating disorders

A
  • serotonin involved in modulating appetite and feeding behaviors; implicated in obsessionality/mood disorders
  • new research centers on reward pathways/neurotransmitters (dopamine!)
  • theory that normally rewarding stimuli (food) becomes aversive bc reward/punishment systems get contaminated
20
Q

Family influences and eating disorders

A
  • family dysfunction not more prevalent in those w eds
  • influence is belief oriented (ie parent focus on thinness)
  • anorexia: rigidity, parental overprotectiveness, excessive control, marital discord
  • bulimia: high parental expectations, perceiving family as less cohesive, other members who are dieting/concerned ab weight or make critical comments ab weight/eating
  • disordered eating attitudes may predate parent-child conflict/family dysfunction
21
Q

Gender/Age Differences in eating disorders

A
  • women more at risk (esp for anorexia/bulimia)
  • adolescence is greatest risk period
  • for men, sexual orientation is risk factor
  • in binge-eating onset is later and more common in men
22
Q

Psychological Factors in eating disorders

A
  • internalizing the thin ideal
  • perfectionism (may help maintain bulimic pathology, more common in women, may have genetic basis)
  • negative body image (often bc sociocultural pressure)
  • dieting (risk factor for dev. or worsening)
  • negative emotionality (food behaviors can be a strategy to reduce negative affect)
  • gay/bisexual men are more at risk
23
Q

Treatment of Anorexia Nervosa

A
  • generally pessimistic ab potential of recovery
  • high therapy dropout rate
  • immediate concern to restore weight to non-life-threatening level
  • aggressive treatment efforts can backfire (eg hospitalization puts them around other anorexia patients, they want to be even thinner)
  • antidepressants may be used, no evidence for effectiveness
  • antipsychotic med olanzapine may be beneficial
  • family therapy pretty effective in adolescents (Maudsley Model, 6-12 months, work with family to change behaviors relating to feeding, works on relationships)
  • CBT has limited success (very effective in bulimia!)
24
Q

Treatment of Bulimia Nervosa

A
  • use of antidepressants is common
  • goal to decrease frequency of binges, improve mood/preoccupation w shape/weight
  • CBT is leading treatment (better than meds)
  • behavioral component (meal planning, nutritional education, ending binge-purging cycles) and cognitive element (changing cognitions that perpetuate cycle)
25
Q

Treatment of Binge-Eating Disorder

A
  • antidepressants sometimes used (high comorbidity)
  • appetite suppressants and anticonvulsants also used
  • for racial/ethnic minorities interpersonal psychotherapy might work best
26
Q

BMI

A
  • body mass index
  • measure of weight relative to height
  • obesity defined on having BMI above 30 (morbid obesity is BMI over 40/100lbs overweight)
  • BMI of 25-29.9 is overweight
27
Q

Prevalence and medical issues of obesity

A
  • more prevalent in ethnic minorities (except asians)
  • more prevalent in men (except in Black population)
  • increased risk for high cholesterol, hypertension, heart disease, arthritis, diabetes, and cancer
  • reduced life expectancy of 5 to 20 years
  • less than 1/3 US population at normal/healthy weight
28
Q

US Obesity prevalence by race/ethnicity

A
  • highest in Black women (56.9%)
  • 45.7% of Hispanic women, 39% of Hispanic men
  • lowest in Asian men and women
29
Q

BMI equation

A

weight (lb)/[height (in)]squared X 703 = BMI

30
Q

Healthy BMI range

A

18.5-24.9

31
Q

Overweight BMI range

A

25-29.9

32
Q

Obese BMI range

A

30-39.9

33
Q

Morbidly obese BMI range

A

40+

34
Q

Distribution of obesity in US

A
  • greatest problem in south east US
  • lowest rates in Colorado and Massacheusets
  • cultural factors play big role, seen as major health crisis in US
35
Q

Genetics and obesity

A
  • thinness seems to run in family
  • genetic mutation associated w binge eating found in only 5% of obese population (only 14% of obese ppl without gene have issues w binge eating)
  • BMI likely polygenic
  • groups historically more susceptible to starvation are more at risk for obesity when living sedentary lifestyle
36
Q

Hormones in Appetite and Weight Regulation

A
  • leptin (hormone) acts to reduce intake of food
  • inability to produce leptin linked to morbid obesity
  • overweight ppl tend to have high levels of leptin but are resistant to effects
  • ghrelin has opposite effect
37
Q

Prader-Willi Syndrome

A
  • chromosomal abnormalities lead to high levels of ghrelin
  • sufferers are extremely obese and often die of obesity-related causes before age 30
  • food often has to be locked away to avoid binging
38
Q

Set points

A
  • bodies have tendency to resist variation from biologically determined ‘set point’ or weight that individual bodies try to ‘defend’
  • we can only lose or gain a certain amount of weight before body starts resisting a lot
39
Q

Sociocultural influences in obesity

A
  • culture w access to high-fat, high-sugar foods encourages overconsumption, makes it easy to avoid exercise
  • leads to more weight-related problems
  • explains higher numbers in low SES bc ‘junk’ food is often cheaper
40
Q

Family influences in obesity

A
  • family attitudes are important!
  • if someone close to us becomes obese, risk of us becoming obese increases by as much as 57%
41
Q

Stress and comfort food

A
  • when we are stressed/anxious we are conditioned to eat comfort food
  • eating in response to these events is reinforced bc food tastes good and emotional tension is reduced
  • lifetime rates of mood disorders higher in obese pop.
42
Q

Treatment of obesity

A
  • many dimensions!
  • low calorie diet, exercise, behavioral intervention
  • weight watchers has demonstrated efficacy
  • ‘crash’ diets and extreme treatments ineffective
  • bariatric surgery is most effective long-term treatment (stomach size is reduced to reduce food intake – wright loss avg 44-88 pounds)
  • meds have limited benefits
43
Q

Prevention of obesity

A
  • need to work on what food is available to ppl (esp in schools)
  • Hill et al. 2003 argue that ppl can avoid weight gain by eating 3 less bites at every meal, taking the stairs, and sleeping more

PSYC 337 (15 decks)

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