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Clinical and Neuropsychology 2 > CPch11 - Eating disorders > Flashcards

CPch11 - Eating disorders Flashcards

1
Q

What are the Eating Disorders (ED) in DSM-5?

A
  • in children: pica, rumination disorder, avoidant/restrictive food intake disorder
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge-Eating Disorder
  • Other specified feeding or eating disorder
  • Unspecified feeding or eating disorder
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2
Q

What are some common missconception about ED?

A
  • People with ED are self-destructive, responsible for their condition, more fragile, more likely to be trying to get attention (especially women)
  • ED as easy to overcome (men especially - study)
  • You cannot fully recover from an ED
  • People with bulimia are overweight due to the binges
  • If you are obese you have ED
  • If you are diagnosed with OSFED, you don’t have a real disorder
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3
Q

Why is there so much stigma around ED?

A
  • Because of those misconceptions
  • Ads (media)
  • Cultural expectation especially for women about their body shape and weight
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4
Q

What are some functions of EDs?

A

ED is a form of expression of underlying problems and additional factors, not the problem itself
↪ Every person can have different function of their ED (to starve yourself/binge):
- Supressing/punishing (I don’t deserve it, I have no right to exist)
- Indirect expression of emotion (I’m expressing myself but in another way)
- Comforting, reassuring (I’m caring for myself, but differently)
- Avoiding (I don’t have to feel/do what I find difficult)
- Because it (ED) is familiar, it’s safe, there is a guarantee (I can trust it, it gives me certainty and something to hold onto)

In treatment, it’s important to give something back before taking away this function:
- Set boundaries, challenge, asking for help, feeking strong, being accepted, structure, comfort, distraction, self-esteem…

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5
Q

How do classifications of EDs develop over time?

A

People meeting classifications for different disorders changes over time
↪ one year you have BED which changes to AN after two years
↪ Might be explained by transdiagnostic model - underlying pathology might be the same (body shape and weight is important for their self-evalution)

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6
Q

Anorexia Nervosa

A
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7
Q

What is the meaning of the word anorexia nervosa?

A

Anorexia - loss of appetite
Nervosa - loss is due to emotional reason
However, most people with anorexia don’t lose their apetite or interest in food
- On the contrary, they become preoccupied with food

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8
Q

DSM-5 criteria for Anorexia Nervosa

A

A. Restriction of behaviours (food) that promote healthy body weight. Body weight is significantly below normal (BMI of less than 18.5 for an adult)
B. Strong fear of gaining weight or repeated behaviours that interfere with weight gain
C. Distorted body image or sense of body shape, or undue influence on self-evaluation (self-esteem is closely linked to maintaining thinness), or lack of recognition of the seriousness of the current low weight
↪ (weight themselves frequently, measure the size of the different parts of the body, mirror-checks)

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9
Q

What are the subtypes of AN and how is the severity determined?

A
  1. Restricting
  2. Binge-eating/purging (subjective binge - feeling of loosing control)
  • Severity is determined on BMI (divided weight in kg by height in m²
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10
Q

What are different measures used to assess the distorted image perception of people with AN?

A
  1. Eating Disorders Inventory
  2. Shown line drawings of women with varying body weights, pick closest to thei body and an ideal shape
    ↪ overestimate their body size and choose thin figure as their ideal
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11
Q

Onset, prevalence and comorbidity

A
  • Onset: early to middle teenage years
  • Prevalence less than 1% to over 3%
    ↪ 3x more frequent in women than in men (emphasis on mascularity, thin, lean body)
    ↪ greater cultural emphasis on women’s beauty
  • Comorbid: depression, OCD, specific phobias, panic disorder, various personality disorders
  • Suicide rates: 5% completed, 20% attempting
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12
Q

What are physical consequences of AN?

A
  • Self-starvation and use of laxative = cause
  • Blood pressure falls, heart rate slow, kidney and gastrointestinal problems, bone mass decline, skin dries out, nails become brittle, hormone levels change, mild anemia, lanugo (fine, soft hair)
  • Levels of electrolytes (K, Na) altered → tiredness, weakness, cardiac arythmias, even sudden death
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13
Q

What is the prognosis of AN

A
  • 50-70% recover or significantly improve but takes 6-7 yrs and relapses are common
  • Life-threatening illness - death-rates are 10x higher than general population, twice as high as among people with other psych. disorders
  • Highest death rate from other EDs
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14
Q

Bulimia Nervosa

A
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15
Q

DSM-5 criteria of Bulimia Nervosa (BN)

A
  1. Recurrent episodes of binge-eating
    ↪ Binge:
    a) large amount of food (4000-6000 calories) in short time (e.g. 2 hrs) = objective binge
    b) feeling of loosing control over eating
  2. Compensatory behaviours to prevent weight gain (vomiting, fasting, excessive exercise, use of laxatives…)
  3. Self-evaluation is unduly influenced by body shape and weight
  4. At least 3 months, once a week
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16
Q

What are characteristics of binges? What are they triggered by? What do they lead to?

A
  • Typically occur in secret (often ashamed and try to conceal them); continue until the person is uncomfortably full
  • Triggered by stress and negative emotions
  • Report that they lose control during a binge (experiencing something similar to what happens in addiction)
  • Study: avoiding a craved food on one day was associated with a binge episode with that food the next morning
  • After the binge is over, feelings of discomfort, disgust, and fear of weight gain lead to inappropriate compensatory behaviours (purging)
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17
Q

Onset, prevalence of BN, comorbidity

A
  • Onset: late adolescence or early adulthood
  • 90% are women
  • 1-2% of population has BN
  • Comorbidity: depression, personality disorders, anxiety, substance use disorders, conduct disorder
  • Suicide rates are higher than general population, lower than AN
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18
Q

What are physical consequences of BN?

A
  • Purging = potassium depletion
  • Heavy use of laxatives = changes in electrolytes = irregularities in heartbeat
  • Vomiting = tearing of stomach and throat tissue, loss of dental enamel - stomach acids eat away at the teeth which become ragged; salivary glands become swollen
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19
Q

Prognosis of BN?

A
  • 68-75% recover but 10-20% remain fully symptomatic
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20
Q

What are some similarities between Anorexia Nervosa and Bulimia Nervosa?

A
  • Disordered eating (restricting, fasting, binging)
  • Body shape and weight are important in self-evaluation
    ↪ Depend heavily on maintaining normal weight to maintain self-esteem
    ↪ Spending lot of time thinking about food, body shape…
  • Body dissatisfaction
  • Both can persist into adulthood and middle age
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21
Q

What is the key difference between AN and BN?

A

Weight loss - people with AN lose extreme amount of weight, people with BN don’t

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22
Q

Binge Eating Disorder

A
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23
Q

DSM-5 criteria of Binge Eating Disorder (BED)

A
  1. Recurrent episodes of binge eating
    ↪ binge: a) large amount of food in short time
    b) loss of control
  2. Episodes include 3 or more:
    a) eating more rapidly than normal
    b) eating until uncomfortably full
    c) eating large amounts when not hungry
    d) eating alone due to embarrasment
    e) feeling disgusted, guilty, or depressed afterwards
  3. Marked distress regarding binge eating is present
  4. No compensatory behaviour
  5. At least 3 months, once a week
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24
Q

Severity, Comorbidity, prevalence, risk factors of BED

A
  • Severity: number of binges/week
  • Comorbid with: mood disorders, anxiety, ADHD, conduct disorder, substance use disorder
  • Risk factors: childhood obesity, critical comments about being overweight, weight-loss attempts in childhood, low self-esteem, depression, childhood physical or sexual abuse
  • Prevalence: more prevalent than BN or AN (0.2-4.7%); more in women (gender difference not as great as in AN or BN); equally prevalent across cultures
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25
Q

Physical consequences of BED and prognosis

A
  • Usually function of the associated obesity: increased risk of type 2 diabetes, cardiovascular problems, chronic back pain, headaches
  • Independent from obesity: sleep problems, anxiety, depression, irritable bowel syndrome, early onset of menstruation
  • Prognosis: 25-82% of people recover
26
Q

How is obesity and binge eating associated?

A
  • Most people with BED are obese (BMI of 30 or more) however not all people who are obese meet the DSM-5 criteria (2-5% are obese and BED)
    ↪ only those who have binge episodes and report feeling a loss of control over their eating qualify for this diagnosis
27
Q

How many people are obese?

A
  • 650 mil people in the world are obese (18-24 yrs lowest rates; 65-74 highest rates)
  • 38 mil children under 5 yrs overweight or obese
  • Linked to many health problems: diabeter, hypertension, cardiovascular disease, several forms of cancer
28
Q

What are factors contributing to obesity?

A
  1. Environment: availability and amount of food, especially highly processed foods; portion sizes increased; more sedentary lifestyles; less cooking at home; chemicals disrupting endocrine system; bacteria; infections;
  2. Stress: neg. moods = induce eating; foods rich in fat and sugar reduce stress (comfort food); prolonged stress > HPA axis releases more cortisol > weight gain
  3. Advertisements: present alluring high-calorie products, unhealthy products, fast food restaurants
    ↪ Contribute to unhealthy eating habits of children under 8 yrs (study: snacks while cartoon with/without food ads)
    ↪ Solutions: limid food marketing, add info or warning labels and place taxes on unhealthy foods
  4. Heredity: several genes identified
  5. Activation of nucleus accumbens and striatum (rewards - dopamine) in response to tasty, high-calorie foods or food cues

These show that it’s a very complex issue so saying that obesity is matter of personal responsibility is not reasonable.

29
Q

Treatments for obesity

A
  • Weight loss programmes for at least 1 year
  • Treatment should include family and should include these aspects:
    1. physical activity
    2. diet change
    3. education about health and diet
    4. behavioural techniques to make and sustain changes in diet and physical activity
30
Q

Etiology

A
31
Q

What are the genetic influences associated with EDs?

A

AN & BN:
- First-degree relatives of women with:
1. AN - 10x more likely to have AN
↪ heritability: 0.48-0.74
2. BN - 4x more likely
↪ heritability: 0.55-0.62
- In both, higher concordance rates for MZ twins than for DZ twins

BED:
- Relatives of people with BED and obesity - more likely to have BED (20%) than obese relatives without BED (9%)

ALL:
- non=shared/unique enviornmental factors (different interactions with parents or different peer groups) of twins contribute to development of ED
- Features of ED (dissatisfaction with one’s body, a strong desire to be thin, binge eating, preoccupation with weight) are heritable

32
Q

Neurobiological influences

What does the hypothalamic model proposes as an explanation for AN? What evidence is there?

A
  • Hypothalamus = key center for regulating hunger and eating
  • Animals with hypothalamic lesions - lose weight and no appetite; however, people with AN continue to starve themselves despite being hungry and having interest in food
  • It doesn’t explain the body-image disturbances or fear of gaining weight
  • Hypothalamus dysfunction - not a likely cause of AN
33
Q

Neuropsychological influences

What does neuroimaging suggest about reward centers as a cause of AN?

A

Study: women had to choose between 2 foods - women with AN chose the high-fat foods less
- AN women and controls had comparable activation in the ventral striatum (reward system)
- But AN women higher activation of dorsal striatum - linked with habitual choices and anxiety
↪ suggests that dieting and restrictive eating may become habitual and these habits become rewards

34
Q

Neuropsychological influences

What role does dopamine play in EDs?

A
  • AN: changes in dopamine system rather consequence of AN than cause
  • Incentive-sensitization theory: dopamine plays a key role in liking (pleasure when eating, esp. high-calorie foods) and wanting (craving) of food
    ↪ Cues in envirionment (billboards, ads…) can elicit dopamine responses which promote strong cravings of food and those can lead to (over)eating and binging
    ↪ evidence: people with greater activation in areas linked to dopamine and reward during presentation of food cues are more likely to subsequently gain weight
35
Q

Neuropsychological influences

What is serotonin’s role in EDs?

A

Serotonin related to eating and satiety (feeling full)
- rather consequence of EDs but some research shows that low levels of serotonin metabolites indicate low serotonin activity
- Antidepressants can be effective treatment for some people with BN and BED

36
Q

Cognitive Behavioural and Emotional influences

How do cognitive behavioural theories explain body-image disturbance and drive for thinness?

Anorexia

A
  • Dieting and weight loss are negatively reinforced by the reduction of anxiety about gaining weight
  • They are positively reinforced by comments from others, sense of mastery, self-control they create
  • Criticism from peers and parents about being overweight contribute as well
    ↪ study: first assessment: obesity and teasing by peers related; second assessment: body dissatifaction related to symptoms of ED
37
Q

Cognitive Behavioural and Emotional influences

What role do emotions play in anorexia?

Anorexia

A
  • Mixed evidence whether neg. emotions predict restricted eating or restricted eating predicts neg. emotions
  • Low positive emotion differention - people with AN exprience pos. emotion very intensely (mainly pride after losing weight or avoiding eating a cake) and this leads those emotions to be indistinguishable from happiness or success
38
Q

Cognitive Behavioural and Emotional influences

How does self-evaluation of people with ED explains their behaviours?

A

People with EDs are overly concerned with weight gain and body - view their self-worth in terms of those things
- May have low self-esteem and weight and shape are somewhat more controllable than other features of the self
- They think controlling those will make them feel better generally

39
Q

Cognitive Behavioural and Emotional influences

How does the transdiagnostic model explain BN?

A
  • Because of low self-esteem and high negative affect (things mentioned in the previous flashcard), people with BN try to follow very rigid pattern of restrictive eating with strict rules
  • These rules are inevitably broken and this can escalate into a binge
  • After the binge feelings of disgust and fear of becoming fat builds up which leads to compensatory actions (purging)
  • Purging temporarily reduces anxiety but at the same time, it lowers the person’s self-esteem (shame) which triggers still more bingeing and purging…
  • It’s a viscious cycle
40
Q

Cognitive Behavioural and Emotional influences

How do events and associated mood change contribute to the whole cycle?

A
  • Stress and negative events increase the likelihood of a binge and consequently purging
  • BED: ↑ in neg. affect and guilt and ↓ in pos. affect hours before a binge; however, after a binge pos. affect remains low but neg. affect and guilt ↓ which suggest that they binge to reduce negative feelings
  • BN: ↓ neg. feelings but ↑ in pos. feelings after a binge followed by a purge
41
Q

Cognitive Behavioural and Emotional influences

How does the transdiagnostic model explain AN?

A
  • Over-evaluation of shape, weight and their control (what we said in flashcards 34) leads to strict dieting and non-compensatory weight-control behaviour
  • This leads to significantly lower weight which increases satiety and rigidity which leads to more dieting
  • Dieting and behaviours preventing weight loss contribute to social withdrawal which leads to over-evaluation of shape, weight and control… viscious cycle
42
Q

Cognitive Behavioural and Emotional influences

How are memory, attention and problem solving affected in people with EDs?

A
  • focus on food-related words and images, pay more attention to and remember other people’s body sizes than images depicting emotion
  • AN people who score high on restrained eating, remember food words better when they are full but not when they are hungry
43
Q

Sociocultural influences

How do sociocultural standards influence development of ED/being preoccupied with body shape and weight?

A
  • Societies became more health conscious - dieting to lose weight has become more common
    ↪ 1/3 of women reported spending more than half of their lifetime trying to lose weight
    ↪ women are more likely than men to be dieters
  • Media portrayals of unrealistically thin models
    ↪ viewed digitally altered images of models in magazines > still felt worse about their own bodies even when they were made aware that the images are not real beforehand
  • Being overweight has neg. connotations (being unsuccessful, having little self-control)
    ↪ obese people are viewed by others as less smart and are stereotyped as lonely, lazy, shy
  • viewing pro-eating disorder websites = predicted restricted eating in healthy women 1 week after the experiment
44
Q

Sociocultural influences

How do gender influences contribute to development of EDs?

A
  • higher risk in women exposed to concerns about thinness and their weight (e.g. dancers, gymnasts)
  • Objectification theory: prevalence of messages objectifying women’s bodies in western cultures led women to ‘self-objectify’ (see their own bodies through critical eyes of others) which causes them to feel more shame about their bodies
    ↪ experience body shame when they observe a mismatch between their ideal self and the cultural (objectified) view of women
    ↪ men are usually esteemed for their accomplishments
45
Q

Sociocultural influences

How do eating habits, view of self, symptoms of EDs change with age?

A
  • At age 40, women diet less, less concerned about weight and body images than when they were at college even though they weigh more
  • Age 50, women’s ED symptoms and risk factors decreased
  • can be explained by change in life roles (having a life partner, having a child)
  • At the age of 50, men had more concerened about their weight and were dieting more (also weighted more)
46
Q

Sociocultural influences

How are EDs prevalent across-cultures?

A
  • Cases of AN in very diverse cultures, not just western ones
    ↪ However, the anorexia observed in the diverse cultures don’t always include intense fear of gaining weight, at least intially > likely reflects an ideal more widely espoused in more Westernized cultures
  • Bulimia more common in industrialized societies but this is slowely changes as non-industrialized societies adopt the practices of western cultures (e.g. having access to more food) = the incidence of bulimia increases
47
Q

Sociocultural influences

How do racial and ethnic differences influence EDs?

A
  • AN more prevalent in white women than among black or hispanic women
  • BN or BED don’t have those racial or ethnic differences
48
Q

Other influences - personality

What did the Minnesota Starvation experiment show?

A
  • Personality of people with ED is affected by their weight loss
  • Minnesota Starvation Experiment: 6 weeks, 1500 calories per day, 2 meals per day = lost 25% of their body weight
    ↪ Soon became preoccupied with food, increased fatigue, poor concentration, lack of sexual interest, irritability, moodiness, insomnia
49
Q

Other influence - personality

How does perfectionism explain AN?

A
  • Perfectionism predicted the onset of anorexia in young adult women
  • Perfectionism combined with body dissatisfaction predicted drive for thinness and concern about weight
    ↪ Perf. remains high even after successful treatment for AN
  • Perfectionsim can be self-oriented (setting high standards for oneself), others-oriented (setting high standards for others), socially oriented (trying to conform to the high standards imposed by others)
    ↪ AN scored higher on self- and other-oriented types of perfectionism
50
Q

Other influences - family

How do the characteristics of the family contribute to EDs?

A

Troubled family relationships are fairly common among people with eating disorders, but this could be a result of the eating disorder, not necessarily a cause of it

51
Q

Treatment

A

Side note: hospitalisation is frequently required to treat people with anorexia through intravenous feeding

52
Q

How does help-searching and recovery looks like in people with EDs?

A
  • Average time it takes for someone to seek help: 4 yrs
  • Avg. time it take to find the right help: 1 yr
  • Avg. duration of an ED: 6/7 yrs
  • The relapse % in the first 18 months following symptom-focussed treatment is a huge 50-70%
53
Q

What can be done instead of fighting the symptoms?

A
  • Gain insight into ED - causes, consequences, functions
  • Work on underlying problems
  • Increase autonomy, self-esteem
  • Attention for behaviours and thoughts around eating and weight
  • Involvement of and support for next of kin

Help clients understand their ED and why they need it (functions), you can ask:
- In what ways does the ED benefit me?
- What does my ED mean to me?
- What is my ED protecting me from?
- What does my ED help me with? (coping)

54
Q

What medications are used to treat EDs?

A
  • BN: antidepressants
    ↪ not effective in reducing binges or weight loss > not for BED
  • No meds that successfully improved weight or other core features of anorexia
55
Q

Psychological treatment of AN

A
  • Immediate goal: help the person gain weight
  • Second goal: long-term maintenance of weight gain
  • CBT - effective especially after hospitalisation to reduce the risk of relapse
  • Supportive psychotherapy + education about anorexia = as effective as CBT
  • Family-based therapy (FBT) - focuses on helping parents restore their daughter to a healthy weight + to build family functioning
56
Q

Psychological treatment

How can CBT help people with BN?

A
  • Question society’s standards for physical attractiveness, uncover and change their beliefs about food, weight and body shape
    ↪ Develop less extreme beliefs about themselves
  • Identify events, thoughts, and feelings that trigger an urge and learn more adaptive ways to cope with these situations
  • Goal: to see that healthy weight can be maintained without severe dieting and that unrealistic restriction of food can often lead to a binge
    ↪ focus on more healthy patterns, eating 3 meals a day and some snacks in between meals without sliding back to bingeing or purging
  • CBT alone is more effective than antidepressants but adding those can help alleviate depression that occurs with bulimia
57
Q

Psychological treatment

What is CBT-guided self-help and how does it help people with BN and BED?

A
  • Receive self-help on topics about perfectionism, body image, neg. thinking and food and health
  • Meet for few sessions with a therapist who helps guide them through the self-help material
  • More effective for BED than for BN
58
Q

Psychological treatment

What other types of therapy can be used in treatment of BN?

A
  1. Interpersonal therapy (IPT) - slower results than CBT but after 1 year similar results as CBT
  2. Family therapy
59
Q

What is psychological treatment of BED?

A
  1. CBT: targets binges and emphasizes self-monitoring, self-control, and problem solving related to eating
  2. IPT as effective as CBT and CBT-guided self-help; more effective than behavioural weight-loss programs (promote weight-loss but don’t help with binge eating)
  3. Therapist-led group CBT - helps keep people in treatment and help reduce binges
60
Q

What are some preventive interventions for EDs?

A
  1. Body Project - dissonance reduction intervention, focused on deemphasizing sociocultural influences on thinness
    ↪ talking, writing and role-playing between the girls to challenge society’s notions of beauty
  2. Healthy Weight programme - targeted ED risk factors
    ↪ girls work together to develop healthy weight and exercise programs for themselves

Body Project more effective than Healthy Weight (even with other samples than adolescents)

61
Q

How does recovery from an ED look like?

A
  1. Normalised eating patterns
  2. Physical recovery
  3. Acceptance/improved body-image
  4. Emotional regulation
  5. Comorbidity
  6. Feelings of self-worth/appreciation
  7. Social skills and optimal functioning within society

Clinical and Neuropsychology 2 (12 decks)

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