Eating Disoders

Question 1

Eating Disorders

Answer 1

Eating disorders are severe disturbances in eating behaviors, such as eating too little or eating too much

Question 2

Dieting Data

Answer 2

• Prevalence of eating disorders in teens increased during the past 50 years

• 40% to 60% of high school girls diet to lose weight

• 13% induce vomiting or use diet pills, laxatives, or diuretics

• 30% - 40% of junior high girls admit concern about weight

Question 3

Types of Eating Disorder

Answer 3

i. Anorexia nervosa (AN)
ii. Bulimia nervosa (BN)
iii. Binge-eating disorder (BED)
iv. Eating disorder not otherwise specified (EDNOS)

Question 4

Anorexia Nervosa(Criteria)

Answer 4

1. Restriction of behaviors that promote healthy
   weight; body weight is significantly below normal
   • BMI (Body Mass Index) less than 18.5 for
   adults
2. Intense fear of gaining weight and being fat
3. Distorted body image or sense of body shape
   • Feel “fat” even when emaciated
4. Amenorrhea
   • Loss of menstrual period

Question 5

Two subtypes of Anorexia Nervosa:

Answer 5

– Restricting
• weight loss is achieved by severely limiting food intake, with no binge-eating/purging during the last three months

– Binge-eating/purging
• the person has also regularly engaged in binge- eating and purging during the last three months

Question 6

Anorexia Nervosa

Answer 6

• Onset: early to middle teen years

• Usually triggered by dieting and stress

• Women 10x as likely to develop disorder as men
– Symptomatology in men similar to that of women

• Often comorbid with depression, phobias, panic, alcoholism

• In men, comorbid with substance dependence, mood disorders, or schizophrenia

• Suicide rates high in anorexia
– 5% completing
– 20% attempting

Question 7

Physical Changes in Anorexia

Answer 7

• Low blood pressure, heart rate decrease

• Kidney and gastrointestinal problems

• Loss of bone mass

• Brittle nails, dry skin, hair loss

• Lanugo
– Fine hair on face and arm

• Depletion of potassium and sodium electrolytes
– Can cause tiredness, weakness, and death

Question 8

Prognosis of Anorexia

Answer 8

• 50-70% eventually recover
– May often take 6 or 7 years
– Relapse common

• Difficult to modify distorted view of self,
especially in cultures that highly value thinness.

• Anorexia is life threatening
– Death rates 10x higher than general population
– Death rates 2x higher than other psychological
disorders

Question 9

Bulimia Nervosa

Answer 9

Uncontrollable eating binges followed by compensatory behavior to prevent weight gain

2) Onset late adolescence or early adulthood

3) 90% women

4) 1 – 2% prevalence among men

5) Typically overweight, that led to dieting

6) Comorbid with depression, anxiety, substance abuse, conduct disorder

7) Suicide attempts and completions higher than in a general population but much lower than in anorexia nervosa

8) Bulimics typically have normal BMI

Question 10

Bulimia Nervosa (Criteria)

Answer 10

– Recurrent episodes of binge-eating
• An excessive amount of food consumed in under 2 hours
• A feeling of loss of control over eating

– As if one cannot stop; continues until uncomfortably full

– Recurrent compensatory behaviors to prevent weight gain
• Purging (vomiting), fasting, excessive exercise, use of laxatives and/or diuretics

– Body shape and weight are extremely important for self-evaluation

– The binge eating and compensatory behaviors both occur, on average, at least once a week for 3 months.

Question 11

Bulimia Nervosa (Criteria)

Answer 11

– Recurrent episodes of binge-eating
• An excessive amount of food consumed in under 2 hours
• A feeling of loss of control over eating

– As if one cannot stop; continues until uncomfortably full

– Recurrent compensatory behaviors to prevent weight gain
• Purging (vomiting), fasting, excessive exercise, use of laxatives and/or diuretics

– Body shape and weight are extremely important for self-evaluation

– The binge eating and compensatory behaviors both occur, on average, at least once a week for 3 months.

Question 12

Eating Binges (BN)

Answer 12

• Triggered by stress or negative emotions or negative social interactions

• Typical food choices:
– Cakes, cookies, ice cream, other easily consumed, high-calorie foods

• Avoiding a craved food can later increase a likelihood of binge

• Typically occur in secret

• Shame and remorse often follow

Question 13

Physical Changes in Bulimia

Answer 13

• Menstrual irregularities

• Potassium depletion from purging

• Laxative use depletes electrolytes, which can
cause cardiac irregularities

• Loss of dental enamel from stomach acids in
vomit

• Mortality rate of 4%

Question 14

Prognosis of Bulimia

Answer 14

• ~75% recover

• 10-20% remain fully symptomatic

• Early intervention linked with improved outcomes

• Poorer prognosis when depression and substance abuse are comorbid or more severe
symptomatology

Question 15

Binge-Eating Disorder

Answer 15

• Characterized by compulsive overeating in which
people consume huge amounts of food while feeling out of control and powerless to stop

• The symptoms of binge eating disorder usually begin in late adolescence or early adulthood, often after a major diet.

Question 16

Criteria for Binge Eating Disorder:

Answer 16

– Recurrent episodes of binge eating; on average, at least once a week for three months

– Binge eating episodes include at least three of the following:
• eating more rapidly than normal
• eating until uncomfortably full
• eating large amounts when not hungry
• eating alone due to embarrassment about large food quantity
• feeling disgusted, guilty, or depressed after the binge

– No compensatory behavior is present

Question 17

Binge-Eating Disorder vs. Anorexia and Bulimia

Answer 17

• Binge Eating Disorder vs. Anorexia:
– Absence of weight loss in Binge Eating Disorder

• Binge Eating Disorder vs. Bulimia:
– Absence of compensatory behaviors (purging,
fasting, or excessive exercise) in Binge Eating
Disorder

Question 18

Binge-Eating Disorder

Answer 18

• Associated with obesity and history of dieting
– Body mass index (BMI) > 30

• Not all obese people meet criteria for binge eating disorder
– Must report binge eating episodes and a feeling of loss of control over eating to qualify
– Approximately 2-25% of obese may qualify

Question 19

Risk factors of BED include:

Answer 19

– Childhood obesity, early childhood weight loss attempts, having been taunted about their weight, low self-concept, depression, and childhood physical or sexual abuse

• Equally prevalent among Euro-, African-, Asian-, and Hispanic-Americans

Question 20

Physical Changes in Binge-Eating Disorder

Answer 20

• Problems associated with obesity:
– Increased risk of Type II diabetes
– Cardiovascular disease
– Breathing problems
– Physical ailments (joint/muscle pain)

• Problems independent of obesity:
– Sleep problems
– Anxiety/Depression
– Irritable Bowl Syndrome
– Early menstruation in women

Question 21

Prognosis of Binge-Eating Disorder

Answer 21

• About 60% recover
• Binge Eating Disorder is the most common and lasts the longest of the three Eating Disorders
– Lasts on average: 14.4 years

Question 22

Eating Disorder Not Otherwise Specified (EDNOS)

Answer 22

The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder.

Question 23

Examples of EDNOS

Answer 23

1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is the normal range.
3. All of the criteria for Bulimia Nervosa are met except that thebinge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
4. The regular use of inappropriate compensatory
   behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).
5. Repeatedly chewing and spitting out, but not
   swallowing, large amounts of food.

Question 24

Psychological factors (EDNOS)

Answer 24

• Low self-esteem
• Feelings of inadequacy or lack of control in life
• Depression, anxiety, anger, or loneliness

Question 25

Interpersonal Factors (EDNOS)

Answer 25

• Troubled family and personal relationships

• Difficulty expressing emotions and feelings

• History of being teased or ridiculed based on size or weight

• History of physical or sexual abuse

Question 26

Social Factors (EDNOS)

Answer 26

• Cultural pressures that glorify “thinness” and
place value on obtaining the “perfect body”

• Narrow definitions of beauty that include only
women and men of specific body weights and
shapes

• Cultural norms that value people on the basis
of physical appearance and not inner qualities
and strengths

Question 27

Antidepressants

Answer 27

– Effective for bulimia

– Limited research suggests that antidepressant
medications are not effective in reducing binges or
increasing weight loss in binge-eating disorder

Question 28

Anorexia

Answer 28

– Immediate goal is to increase weight to avoid medical complications and avoid death
– Second goal is long-term maintenance of weight gain
• Can be even more challenging

Question 29

Family-based therapy (FBT)

Answer 29

– Reductions in symptoms through 1 year
• Family-based therapy (FBT) was found to be effective
– Anorexia viewed as an interpersonal, rather than individual issue
– Use of “Family Lunch” sessions
– Early results show improved outcomes over individual therapy

Question 30

Bulimia

Answer 30

– Challenge beliefs about weight and dieting
– Challenge all-or-nothing beliefs about food
• One bite of high-calorie food does not have to lead to bingeing
– Increase self-assertiveness skills to improve interpersonal
relatedness
– Increase regular eating patterns (three meals a day)
– FBT more effective than medication

Question 31

Binge-Eating Disorder

Answer 31

Binge-Eating Disorder
– FBT shown to be effective treatment modality
• Teaches restrained eating through self-monitoring, selfcontrol,
and problem solving skills
– FBT more effective than medication
– Interpersonal Therapy (IPT) equally as effective as FBT
– Behavioral weight-loss programs may promote weight loss,
but do not curb binge eating