Eating Disorder Flashcards
Anorexia nervosa -
Refusal to keep BW above minimum healthy level 17.5 (BMI)
Fear of weight gain (phobia)
Disturbance of body experience
3 consecutive cycles of amenorrhea/erectile dysfunction
Disturbance in the way one’s weight or shape is experienced
Dsm 5:distinguishes restricting and binge-purge type
(Feeding and) ED in DSM 5
- Avoidant restrictive food intake disorder
- pica
- rumination
- anorexia nervosa
- binge eating disorder
- other specified feeding or eating disorder
- -atypical AN, subthreshold BN, subthreshold BED, purging disorder
Feeding disorder and eating disorder are different but now it’s combined in DSM5
Feeding without cognition like AN who have body images
Bulimia nervosa
Episodes of compulsive overeating with loss of control
Methods to counteract weight gain
-vomiting, purging, other medicine
Self-evaluation unduly linked to shape/weight
Usually normal weight
Binge eating and compensatory behaviours occur at least once /week for 3 months
Binge eating disorder
- Recurrent binge eating
- associated with >3 of following: rapid eating, eating full too full, eating large amounts when not hungry, eating alone because of feeling low, embarrassed or disgusted
- marked distress during binge eating
- binge eating occurs at least once a week for 3/12
- no regular use of compensatory behaviours
- obesity is not part of the definition
- most common ED
- CBT is most effective
Clinical features of AN
Entwined with those of starvation
-ie, preoccupation with food, poor concentration, anhedonia, irritability
Avoidance high calorie/ fatty food
Perfectionism & obsessionality
Physical overactivity, hormone imbalance, bone density loss,
Overvalued idea about weight and shape are not expressed by all patient (20% not present even in USA)
Recognition in DSM5 that cognitive criteria can be “inferred” from behaviour because many of them can be denial of their belief or fear of gaining weight
Clinical feature of BN
Normal weight
Binge eating & purging
Psychological and physical effects of acute food restriction
Low self esteem
Overvaluation of the thin ideal & morbid fear of fatness
1/3 PHx AN
1/3 PHx obesity
Comorbid disorder with AN
Depression
OCD
Social phobia
Personality disorder (obsessive)
Comorbid disorder with BN
Depression Anxiety disorder Substance misuse PTSD Deliberate self-harm Personality disorder
History of AN
Description date back 1300-1590
Diagnosis defined 19th century
Exist in all culture
Mostly stable prevalence
History of BN
Relatively new
Often follows AN
Increasing as cultures “westernize”
Binge eating disorder
Early obesity might be a risk factor
As common in F and M
1/3 obese
Possibly later onset
Family studies of ED
Anorexia and bulimia are strongly familial
Relatives with ED have 7-12 times higher risk
Familiality for AN is highest
Family study can’t tell us if due to genes or environment
Twin study show the genetic factor for both AN and BN but BN is slightly stronger
Individual risk factor
Feeding and eating pattern in childhood might increase the risk for ED (esp AN)
Anxiety disorder (OCD) -risk of AN Externalising disorder (ADHD)-risk of BN History of depression
Cognitive and neuropsychological characteristics
Impulsivity has been associated with BN
Evidence of social impairment in patients with AN
Broadly defined social difficulties in childhood predicted ED at age 16
Psychosocial risk in AN
Adverse life event Sexual abusive events Childhood psychological difficulty Family history of eating disorder High parental expectation Feeding problem in childhood Other psychiatric disorder in C&A
