Clinical Psychology-Anorexia Nervosa Flashcards
What are the three criteria that must be met for a diagnosis of anorexia to be given?
1) restriction of energy intake resulting in body weight being significantly below what would be expected
2) An intense fear of gaining weight or participating in persistent behaviour that will interrupt the gaining of weight
3) distortion in body image where the body weight is hugely overestimated and the patient is unable to accept the severity of the low body weight
What are the symptoms of anorexia nervosa?
Physical symptoms: intolerance of the cold, osteoporosis, irregular heart rhythms, fatigue, low blood pressure.
Emotional/behavioural signs: a fear of gaining weight, lying about how much food has been consumes, flat mood, preoccupation with food.
Give some risk factors for the development of anorexia nervosa.
Artistic activities- being a dancer or athlete Family history of anorexia Genetics Media and society Being female
What are the features of anorexia nervosa? What are the two different types?
The two types are…
Restricting type- show weight loss through dieting, excessive exercise or fasting in significant periods within the last three months.
Binge-eating/purging- show recurrent bouts of binge eating behaviours alternated with purging such as self induced vomiting or misuse of laxatives
1) Onset of the disorder often appears to coincide with a significant life stressor such as starting university or leaving home
2) Physical effects associated with anorexia as a complication of the illness such as amenorrhea
3) Cultural features of the diagnosis of anorexia, higher prevalence in high income countries that are more industrialised
4) Significantly more females are diagnosed with anorexia than males. Estimated ratio of 10:1 female to male
5) Usually diagnosed during adolescence or early adulthood. Onset before puberty or after 40 is rare.
Describe one biological theory/explanation (genetics/neurotransmitters) of anorexia nervosa
Messages in the brain are sent via electrical impulses within neurons using neurotransmitters. Serotonin is a neurotransmitter which is produced in the hypothalamus which is the part of the brain responsible for regulating both mood and appetite.
When serotonin is released into the synaptic cleft it is picked up by the 5HT-2A receptor. If that receptor is blocked not enough serotonin passes through the brain which can lead to over eating. The reverse is true for sufferers of anorexia, the 5HT-2A receptor is overactive. This allows too much serotonin to pass through the system leading to appetite suppression and anxiety.
Anorexic patients may use starvation as a means of controlling their levels of serotonin and as a result, their anxiety. Serotonin is a product of an amino acid called tryptophan which is produced when you eat. If you don’t eat, your body doesn’t produce tryptophan and so can’t manufacture serotonin. Sufferers of anorexia tend to report that their anxiety levels are reduced when they reduce their food intake.
Connan claims that anorexia is linked with the biology of the stress mechanism. When we are faced with a stressful situation, our need to eat and sleep disappears and our pulse rate and blood pressure increase. Cortisol and adrenaline are responsible for these changes. In normal controls the response is short lived and reversed by argenine vaspressin (AVP). Anorexics have a faulty AVP switch which means the effects aren’t reversed.
Evaluate one biological theory/explanation (genetics/neurotransmitters) of anorexia nervosa.
Holland et al (1988) found that out of the MZ twins, 56% suffered from anorexia whereas only 7% of DZ twins had anorexia. This suggests that there is a genetic component to anorexia however as the concordance rates aren’t 100% there must be another explanation.
We can’t establish a clear cause and effect as we can’t be certain if the physical effects are causing anorexia or if they are as a result of it because we don’t measure levels before.
Mediated causal factors. Too much serotonin leads to self imposed starvation to limit tryptophan to prevent the production of serotonin. Too much adrenaline and cortisol causes damage in the hippocampus which leads to too much serotonin. Inability to isolate one causal factor.
Describe one non-biological theory/explanation (sociocultural) of anorexia nervosa
Media:
Becker et al (2002) found that in Fiji, before TV, girls were unlikely to be concerned with diet and slimming but after TV was introduced, there was evidence that they were more conscious of their body image and diet. Their scores on a questionnaire about diet and eating were much higher after TV had been introduced. In 1995 0% used self induced vomiting to control weight compared to 11.3% in 1998
Ethnicity:
Streigel-More et al (2003) found no Afro-American women with anorexia in a U.S. sample of 2000 women compared to 1.5 percent of white women. Suggests a cultural bias.
Culture:
Engel (1988) found that in places where anorexia has never been diagnosed, medical records indicate that such a diagnosis could have been given at a rate which matches Western Cultures, it just wasn’t diagnosed as such.
Expectations:
Ethnicity, more anorexia in white females. Peer pressure. Career path, dancers, gymnasts and athletes. Media, unrealistic expectations of body shape. Role models, vicarious learning. Variation between cultures, industrialised nations have a higher prevalence.
Evaluate one non-biological theory/explanation (sociocultural) of anorexia nervosa
Plenty of evidence to support the claim that culture has a role to play in anorexia such as Becker et al and Engl et al.
Diathesis-stress model says that anorexia could be caused by a genetic predisposition set off by an environmental/cultural trigger.
Describe the drug therapy treatment for anorexia nervosa.
What would it need to do?
Readdress the damage caused to the hippocampus and the hypothalamus and reduce serotonin in a way that doesn’t cause damage to other systems. It would also need to attempt to reduce anxiety, cortisol and adrenaline to be most effective.
Antidepressants (fluoxetine) have been found to be effective at reducing anxiety and depression in anorexic patients but not for weight gain.
Cyproheptadine is another drug which has relatively safe side effects. In a double blind study of 72 patients, cyproheptadine significantly reduced the number of days to reach normal weight in anorexic patients.
Quetiapine (an atypical antipsychotic drug) has been shown to lead to both physical and psychological improvements in many anorexic patients.
It looks as though we can’t treat anorexia directly with drugs but there may be indirect treatments that either reduce psychotic symptoms or reduce anxiety/depression.
Give some evidence of specific studies to support/oppose the drug treatment for anorexia
Crisp et al (1987) found that domipramine did not lead to significant weight gain for 16 patients with anorexia compared to a placebo.
Halmi et al (1986) carried out a double blind placebo controlled trial with two drugs (amitryptalineand and cyproheptodine) in 72 anorexic patients. Only cyproheptodine resulted in significant weight gain.
Describe the token economy programme as a treatment for anorexia nervosa.
Secondary reinforcers are used to build up to a primary reinforcer for a target behaviour. This is an example of behaviour modification from the learning approach, specifically operant conditioning.
This treatment would be most useful in a mental health unit or a school.
Stage one involves identifying the behaviour that needs to be changed (weight). Both the participant and the member of staff select the token and decide what they can be exchanged for. It is important that the tokens ‘buy’ significant rewards, they must have a meaning for the individual.
It is really important to set goals that are achievable for the patient and the whole programme needs to be explained to the individuals involved. Once a little bit of weight has been gained, a reward should be provided. The programme should be continually reviewed and amendments should be made such as alternating the frequency of tokens given out.
Evaluate the token economy programme as a treatment for anorexia nervosa.
The treatment only seems to mask the symptoms and does not deal with the underlying issues of the causes and triggers.
It may only work in the short term whilst the person is being treated in an institution as it is too controlled. The programme is only targeted at one certain situation so once released from the institution, the situation will no longer be the same and the participant will no longer receive reinforcements.
Reduced social control. It can only work on the basis of voluntary behaviour and hence the individuals involved have some measure of control. This makes them take responsibility for their recovery.
It is possible to use this alongside other treatments such as counselling or drug treatments to maximise effectiveness.
The treatment is good at getting sufferers to a reasonable weight after which the more difficult underlying issues can be addressed. It is a good place to start until you can be sure that the suffer is out if danger.
Programme is available on the NHS so is available to everyone.
