chp 10 - eating disorders

Question 1

EDs in DSM

Answer 1

appeared 1980, category of youth disorders

DSM-5: ana and buli are distinct cats
- inc attention on EDs
- inc criteria

now includes BED

Question 2

canadian prevalence

Answer 2

ana and buli women > men, binge eating is equally common

1 mil Canadians, many undiagnosed

10-15% mortality
- inc suicide and attempts

high rates dieting in kids 11-14 leads to ED

Question 3

OSFED

Answer 3

other specified feeing or eating disorder

atypical, mixed conditions i.e. night eating, purging disorder

may be used when insufficient info or causes distress but not reach criteria

Question 4

orthoexia

Answer 4

not in DSM-5

preoccupation w eating healthy, similar to OCD

behaviours and thoughts cause impairment, malnourishment/deficiencies

Question 5

purging disorder

Answer 5

lvls disturbed eating and psychopathology comparable to ED patients

high impulsivity

Question 6

commonalities of ana and buli

Answer 6

intense fear of being overweight

some ppl argue they are 2 variations of the same disorder

ppl w ana more likely to have buli

Question 7

anorexia nervosa

Answer 7

anorexia: loss of appetite
nervosa: loss of appetite due to emotional reasons

still FEEL HUNGER, are preoccupied w food

criteria: restrict intake leading to low BW w/in context of age, sex, health status
- fear weight gain
- distorted body image and checking

high cormobidity: depression, panic, social anx
- inc mania in women, agora, subs abuse

prognosis: 70% recover in 6-7 yrs, common relapse
- 10x greater death risk than normals
- 2x greater death than other ppl w psych disorders

Question 8

predictors of death

Answer 8

low BMI, older age at treatment, alcohol use

25yr reduced life expectency for ana only
- bulimia doesn’t have inc rates, even tho experience suicidal thoughts

Question 9

bulimia nervosa

Answer 9

binge in under 2 hrs followed by purging as compensation
- can be stress triggered
- lack of control

must occur ONCE A WEEK FOR 3 MONTHS
- not diagnosed if w ana and experience weight loss

binge episodes caused by poor mood, social interactions, self image
- high interpersonal sensitivity

requires morbid fear of fat:
- makes diagnosis more restrictive
- makes closer to ana

Question 10

development of bulimia

Answer 10

late asolescence and early adulthood

fat talk: focus on fear of becoming fat and -ve appraisals of self for being fat
- fem friends tend to talk about bodies to e/o
- avg and overwight ppl seen as more likeable in fat talk
- defensive and -ve self talk

many ppl semi overweight before onset and binge eat during diet

70% recover, 10% symptomatic

Question 11

phys features of bulimia

Answer 11

K depletion, diarrhea, electrolyte changes

tear throat and stomach tissue

irregular heartbeat

enamel loss, swollen salivary glands

Question 12

binge eating disorder

Answer 12

aka BED, new DSM-5 condition

recurrent binges 1/WEEK FOR 3 MONTHS
- lack control and feel distress

must have 3 of the following:
- eat alone bcs embarassed
- eat until overly full
- eat rapidly
- ea large amounts but not hungry
- feel disgusted w self or guilty

no weight loss, and no compensation

more treatment responsive than ana or buli

Question 13

risk factors of BED

Answer 13

childhood obesity, critical comments

low self concepts, depression

childhood phys or sexual abuse

avg life term duration of BED = 14.4yrs, much more than ana or buli
- ana = 5.9
- buli = 5.8

Question 14

genetics and EDs

Answer 14

ignored bcs of sociocultural factors

ana and buli run in family, 4x more likely

Question 15

bio factors EDs

Answer 15

lateral hypothalamus: if lesioned, has no appetite and results in weight loss
- damage may occur in RESPONSE to ED

ghrelin: assoc w hunger

leptin: assoc w sateity

endogenous opioids: substance body makes to reduce pain, enhance mood, dec appetitie
- starvation inc lvls, making +ve reinforcement
- low lvls opioid promote craving, binging causes euphoria

serotonin and buli: genetic polymorphisms limit sero
- genes mau be limited by harsh environ
- estrogen causes fem weight gain, inc perceptions of need diet

Question 16

sociocultural factors and EDs

Answer 16

ideal female body changes over time
- old picture overweight
- playboy became thinner, but now models becoming larger

Question 17

scarlett ohara effect

Answer 17

eat lightly to project femininity

women who eat more perceived as masc

Question 18

high prevalence of obesity

Answer 18

while desire thinness, obesity at 25%

evolution to store energy for time when food is inaccessible

Question 19

culture and EDs

Answer 19

body fat seen as unsuccessful, poor control or intelligence

bias is automatic among thin ppl

on TV: underweight is overrepresented, overweight have -ve self talk

Question 20

cross-cultural studies and EDs

Answer 20

EDs common in industrialized societies i.e. US, Canada, Europe

immigrant women vuln as adapt to culture change

Question 21

thinspiration

Answer 21

dieters feel thinner after seeing ideal body image

fear fatness motivates anorexics

Question 22

cog-behav views and EDs

Answer 22

weight loss is reinforced by sense of self control over eating

brief exposure to models can cause -ve mood in those dissatisfied w body

Question 23

psychodynamic views

Answer 23

cause is parent-child relationship and core personality traits i.e. perfectionism

ED fulfills needs i.e. control

Hilde Bruch: says ana is attempts for kids to gain competence and ward off helplessness

Question 24

family systems and characteristics

Answer 24

families of kids w EDs are:
- enmeshed: overly involved parents speak on kids behalfs
- overprotective
- rigid
- lack conflict resolution

family characteristics may be result of ED, not the cause

Question 25

child abuse and ED

Answer 25

self-reports child SA higher in ppl w ED, especially bulimia

25% women experienced SA

Question 26

retrospective studies

Answer 26

clients w ana perfectionistic, shy, complaint before onset

bulimics history affective instability, outgoing socially

Question 27

neuroticism and ED

Answer 27

high for ana and buli

long-term predictor in twin study

high traditionalism, endorse societal role

Question 28

narcissism and perfectionism

Answer 28

high for ana and buli, even in remission
high drop out bcs of defensiveness
EDs related to inc perfectionism

Question 29

self-oriented vs socially prescribed perfectionism

Answer 29

self-oriented perfectionism: high self standards
- high in weight restored and underweight anas

socially prescribed perfectionism: high in underweight anas

Question 30

3 factor model of bulimia

Answer 30

perfectionism, body dissatisfaction, low self esteem

preoccupied w self presentation

limitation: cause not established

Question 31

treating EDs

Answer 31

90% not in treatment, deny problem

high freq hospitalization for ana, may need IV feeding

relapse rates: 41% relapse in 1 yr check up, more likely for
- binge-purge anorexics
- those w OCD checking
- lower motivation to recover

Question 32

medications

Answer 32

antidepressants for bulimia
- more patients drop out of drug therapy than CBT

no drug for ana

Question 33

psych treatment anorexia

Answer 33

1. immediate goal: help person gain weight and avoid medical comps
2. second goal: long-term maintenance of weight gain

family therapy equally as effective as individ, but has greater short term outcomes

Question 34

CBT-E

Answer 34

enhanced cog behav therapy

most successful treatment for buli and BED
- may be used for ana

assistance for mood intolerance, perfectionism, interpersonal difficulties
- these are extra to normal CBT

no other treatment as effective

CBT for bulimia: eat small amount forbidden food w/p purging

limitations: 50% won’t recover
- many have other psych disorders
- those w -ve self efficacy abt ability to recover are harder to treat