Chapter 9: Eating Disorders and Obesity

Question 1

According to the DSM-5, what are eating disorders characterized by?

Answer 1

A persistent disturbance in eating behaviour.

Question 2

What are the three DSM-5 eating disorders?

Answer 2

Anorexia nervosa, bulimia nervosa, and binge-eating disorder

Question 3

What is anorexia nervosa?

Answer 3

Anorexia nervosa is a pursuit of thinness that is relentless and that involves behaviours that result in a significantly low body weight.

Question 4

There are two types of anorexia nervosa. What are they?

Answer 4

The restricting type and the binge-eating/purging type.

Question 5

What is the central difference between the two subtypes of anorexia nervosa?

Answer 5

The central difference between these two subtypes concerns the way in which patients maintain their very low weight. In the restricting type, every effort is made to limit the quantity of food consumed. Patients with the binge-eating/purging type of anorexia nervosa differ from patients with restricting anorexia nervosa because they either binge, purge, or binge and purge.

Question 6

Patients with the binge-eating/purging type of anorexia nervosa binge, purge, or binge and purge. What is a binge?

Answer 6

A binge involves an out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances.

Question 7

Patients with the binge-eating/purging type of anorexia nervosa binge, purge, or binge and purge. What is a purge?

Answer 7

The removal of the food they have eaten from their bodies. Methods of purging commonly include self-induced vomiting or misuse of laxatives, diuretics, and enemas.

Question 8

What is bulimia nervosa characterized by?

Answer 8

Bulimia nervosa is characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by using inappropriate behaviours such as self-induced vomiting and excessive exercise.

Question 9

What is the different between bulimia nervosa and a person with the binge-eating/purging type of anorexia nervosa?

Answer 9

Weight. By definition, the person with anorexia nervosa is severely underweight. This is not true of the person with bulimia nervosa.

Question 10

T or F: If the person who binges or purges also meets criteria for anorexia nervosa, the diagnosis is anorexia nervosa (binge-eating/purging type) and not bulimia nervosa.

Answer 10

True.

Question 11

Binge-eating disorder (BED) is clinically similar to bulimia nervosa, but what is an important difference?

Answer 11

After a binge the person with BED does not engage in any form of inappropriate “compensatory” behaviour such as purging, using laxatives, or even exercising to limit weight gain.

Question 12

T or F: binge eating disorder is associated with being overweight or even obese.

Answer 12

True.

Question 13

When is anorexia nervosa most likely to develop?

Answer 13

Anorexia nervosa is most likely to develop in 16-to 20-year-olds.

Question 14

When is bulimia nervosa most likely to develop?

Answer 14

The age group at highest risk is young women the age range of 21 to 24

Question 15

When is binge eating disorder most likely to develop?

Answer 15

Most patients with binge eating disorder are older than those with anorexia nervosa or bulimia nervosa, generally between 30 and 50 years of age.

Question 16

What are the gender estimates for eating disorders?

Answer 16

Recent estimates suggest that there are three females for every one male.

Question 17

What is a risk factor for eating disorders in men?

Answer 17

An established risk factor for eating disorders in men is homosexuality. Gay and bisexual men have higher rates of eating disorders than heterosexual men do.

Question 18

What is the most common form of eating disorders?

Answer 18

The most common form of eating disorder is binge eat-ing disorder.

Question 19

Anorexia nervosa in its severe form it is about as common as schizophrenia.

Answer 19

True.

Question 20

T or F: Bulimia nervosa is much less lethal

than anorexia nervosa

Answer 20

True.

Question 21

After medical complications, the second most common cause of death in those who suffer from anorexia nervosa is ____________.

Answer 21

Suicide.

Question 22

There is a lot of diagnostic crossover with eating disorders. What does this mean?

Answer 22

It is quite common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder. Bidirectional transitions between the two sub-types of anorexia nervosa (restricting and binge-eating/ purging) were especially common. Transitions from the binge-eating/purging subtype of anorexia nervosa to bulimia nervosa also often occur.

Question 23

T or F: For eating disorders, comorbidity is the rule rather than the exception.

Answer 23

True. Depression is the most common comorbid disorder.

Question 24

T or F: Comorbid personality disorders are frequently diagnosed in people with eating disorders

Answer 24

True.

Question 25

T or F: Eating disorders are best conceptualized in terms of the diathesis–stress model.

Answer 25

True. Genes render some people more susceptible to environmental pressures and hence to the development of problematic eating attitudes and behaviours.

Question 26

In what ways do genetics contribute to eating disorders?

Answer 26

The biological relatives of people with anorexia nervosa or bulimia nervosa have elevated rates of anorexia nervosa and bulimia nervosa themselves.

Question 27

T or F: Research suggests that both anorexia nervosa and bulimia nervosa are heritable disorders.

Answer 27

True.

Question 28

Which brain area plays an important role in eating?

Answer 28

The hypothalamus. However, there is no good evidence that obvious abnormalities in the hypothalamus play a central role in eating disorders.

Question 29

What are “set points”?

Answer 29

Well-established tendency for our bodies to resist marked variation from some sort of biologically determined set point or weight that our individual bodies try to “defend”.

Question 30

Why is serotonin an important neurotransmitter to consider in relation to eating disorders?

Answer 30

Serotonin is a neurotransmitter that has been implicated in obsessionality, mood disorders, and impulsivity. It also modulates appetite and feeding behaviour. Some researchers have concluded that eating disorders involve a disruption in the serotonergic system

Question 31

How do family influences impact eating disorders?

Answer 31

Patients with anorexia nervosa perceive their families as more rigid, less cohesive, and as having poorer communication than healthy control participants do. More than one-third of patients with anorexia nervosa reported that family dysfunction was a factor that contributed to the development of their eating disorder

Question 32

How does internalization of the thin ideal relate to eating disorders?

Answer 32

The extent to which people internalize the thin ideal is associated with a range of problems that are thought to be risk factors for eating disorders.

Question 33

T or F: Men with eating disorders are less perfectionistic than are women with eating disorders

Answer 33

True.

Question 34

The research literature strongly implicates body dissatisfaction as an ________________ for pathological eating

Answer 34

important risk factor

Question 35

Negative affect (feeling bad) is a causal risk factor for ____________.

Answer 35

body dissatisfaction; When we feel bad, we tend to become very self-critical.

Question 36

What is the immediate concern for patients who have anorexia nervosa in terms of treatment?

Answer 36

To restore their weight to a level that is no longer life threatening. However, without treatment designed to address the psychological issues that fuel the anorexic behaviour, any weight gain will be temporary and the patient will soon need medical attention again.

Question 37

Is medication effective for anorexia nervosa?

Answer 37

No evidence that antidepressants are effective, but research suggests that treatment with an antipsychotic medication called olanzapine may be beneficial.

Question 38

What is the Maudsley model?

Answer 38

A type of family therapy that blames neither the parents nor the child for the anorexia nervosa. The treatment has three phases.

Question 39

What are the three stages of the Maudsley model?

Answer 39

In the re-feeding phase, the therapist works with the parents and supports their efforts to help their child to eat healthily once more.

After the patient starts to gain weight, the negotiations for a new pattern of relationships phase begins, and family issues and problems begin to be addressed.

Later, in the termination phase of treatment, the focus is on the development of more healthy relationships between the patient and her parents

Question 40

Why is family therapy the treatment of choice for anorexia nervosa?

Answer 40

Randomized controlled trials have shown that patients
treated with family therapy for 1 year do better than patients who are assigned to a control treatment (where they receive supportive counselling on an individual basis). *This does not mean that individual therapy is not effective because that’s not true.

Question 41

Is cognitive behavioural therapy more effective for anorexia nervosa or bulimia nervosa?

Answer 41

Bulimia nervosa. *BUT because anorexia nervosa shares many features with bulimia nervosa, CBT is often used with patients with anorexia nervosa as well.

Question 42

T or F: It is common for patients with bulimia nervosa to be treated with antidepressant medications.

Answer 42

True. Patients taking antidepressants do better than patients who are given inert, placebo medications. Antidepressants seem to decrease the frequency of binges as well as improve patients’ mood and preoccupation with shape and weight.

Question 43

What is a transdiagnostic approach to treatment of eating disorders?

Answer 43

The new treatment is called enhanced cognitive-behaviour therapy (CBT-E). One form of the treatment (the default treatment) is quite focused, targeting eating issues as well as concerns about shape and weight, extreme dieting, purging, and binge eating. The other form of the treatment is broader and also addresses such things as perfectionism, low self-esteem, and relationship problems.

Question 44

What is interpersonal psychotherapy (IPT)?

Answer 44

IPT, which seeks to improve interpersonal functioning, is often used in the treatment of mood disorders and is also the leading alternative treatment for eating disorders.

Question 45

T or F: Obesity is defined on the basis of a statistic called the body mass index (BMI).

Answer 45

True. It is a measure of a person’s weight relative to height.

Question 46

T or F: Obesity is more prevalent in ethnic minorities.

Answer 46

True (excluding Asians).

Question 47

T or F: Rates of obesity are somewhat higher in women than men.

Answer 47

False. Rates of obesity are also somewhat higher in men than they are in women (exception = African Americans).

Question 48

T or F: Obesity is considered an eating disorder, and therefore included in the DSM-5.

Answer 48

False.

Question 49

What is leptin?

Answer 49

Leptin is produced by fat cells. It provides a key metabolic signal that informs the central nervous system about the state of the body’s fat reserves. When body fat levels decrease, leptin production decreases and food intake is stimulated

Question 50

What is ghrelin?

Answer 50

Ghrelin is a hormone that is produced by the stomach. It is a powerful appetite stimulator. Under normal circumstances, ghrelin levels rise before a meal and fall after we have eaten.

Question 51

What is Prader–Willi syndrome?

Answer 51

Chromosomal abnormalities that create many problems, one of which is very high levels of ghrelin.

Question 52

T or F: Genes exclusively explain obesity.

Answer 52

False. Genes alone can sometimes explain why people differ in their weight and eating pat-terns. However, in most cases environmental factors also play an important role.

Question 53

What study suggests that sociocultural factors are likely to be playing a major role in obesity?

Answer 53

Although recent immigrants are less likely to be overweight and obese than people born in the United States, after they have lived in the country for 10 years or longer they have a significant increase in their body mass index.

Question 54

What does it mean that obesity might be “socially contagious”?

Answer 54

If someone close to us (e.g., a spouse, sibling, or friend) becomes obese, the chance that we ourselves will later become obese can increase by as much as 57 per-cent.

Question 55

How does stress or aversive emotional states relate to obesity?

Answer 55

Research has found that a striking percentage of people with an eating disorder binge eat in response to aversive emotional states, such as feeling depressed or anxious

Question 56

If it has been established that binge eating is a predictor of later obesity… what should we do?

Answer 56

This suggests that we should pay close attention to the causes of binge eating.

Question 57

T or F: low levels of support from peers, as well as depression, made girls more at risk for binging.

Answer 57

True.

Question 58

There are three treatment options that are used with people who are overweight or obese. What are they?

Answer 58

(1) lifestyle modifications (diet, exercise, and behaviour therapy), (2) medications, and (3) bariatric surgery.

Question 59

What does lifestyle modification treatment involve?

Answer 59

Involves a low-calorie diet, exercise, and some form of behavioural intervention.

Question 60

Out of the four diets tested in a research study (Atkins diet, the Zone diet, the Ornish diet, and a more traditional diet approach), which was the most successful? Which one was the least successful.

Answer 60

Atkins diet had lost the most weight (10.4 pounds or 4.7 kilograms) compared with a weight loss of 3.5 pounds (1.6 kilograms) for the Zone diet.

Question 61

T or F: Bariatric or gastric bypass surgery is the most effective long-term treatment for people who are morbidly obese

Answer 61

True.