eating disorder chapter questions Flashcards
What is bulimia nervosa?
Bulimia nervosa: out-control eating episodes, or binges are followed by self-induced vomiting, excessive use of laxatives, or other attempts to purge (get rid of food).
How is bulimia diagnosed?
DSM-IV-TR Diagnostic Criteria for Bulimia Nervosa
The 1st criterion is the recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. 2. A sense of lack of control over eating during the episode.
The 2nd criteria is the recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting misuse of laxatives, diuretics or other medications; fasting; or excessive exercise.
The third criterion is that the duration of both binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for 3 months.
The 4th criterion is that self-evaluation is unduly influenced by body shape and weight
The 5th criterion is that the disturbance does not occur exclusively during episodes anorexia nervosa.
Specify type: 1) purging type: during the current episode of bulimia, the person regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas; 2) nonpurging type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviours, such as fasting or exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Why do people purge?
People purge to compensate the binge eating and potential weight gain
What factors maintain the cycles of bingeing and purging?
Minor events related to eating may activate fear of gaining weight and further distortions in body image. Purging is used to compensate the binge eating and potential weight gain. Studies have shown that anxiety relieved after purging and the state of relief strongly reinforces the purging, in that we tent to repeat behaviour that gives us pleasure or relief from anxiety.
Another important observation is that at least a subgroup of these patients have difficulty tolerating any negative emotion (mood intolerance) and may binge or engage in other behaviours, such as self-induced vomiting or intense exercise, in an attempt to regulate their mood. This is consistent with a study that discovered women with BN, when hungry, had more intense negative emotional actions (distress, anxiety, and depression) when viewing pictures of food and subsequently ate more at a buffet, presumably to decrease their anxiety and distress and make themselves feel better. These individuals, understandably, then evidenced even more intense negative affect after overeating and seemed threatened by food cues.
What is anorexia nervosa?
Anorexia nervosa occurs when the person eats nothing beyond minimal amounts of food so body weight sometimes drops dangerously.
How is anorexia diagnosed?
A. refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected)
B. Intense fear of gaining weight or becoming fat, even though underweight
C. Disturbance in the way in which one’s body weight or shape is experienced; undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
D. In post-menarcheal females, amenorrhea, that is, the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
Specify type: 1) Restricting type: During the episode of anorexia nervosa, the person does not regularly engage in binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives or diuretics). 2) Binge-eating/ purging type: During the episode of anorexia nervosa, the person has regularly engaged in binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives or diuretics).
In what ways is anorexia dangerous?
Individual with Anorexia Nervosa can have serious medical problems. One common medical complication is cessation of menstruation (amenorrhea). Other medical signs include dry skin, brittle hair or nails and sensitivity to or intolerance of cold temperature. Also it is relative common to see lanugo, downy hair on the libs and cheeks. Cardiovascular problems, such as chronically low blood pressure and heart rate, can also result. If vomiting is part of the anorexia, electrolyte imbalance and resulting cardiac and kidney problems can result.
Anxiety disorders and mood disorders are often present in individuals with anorexia. Substance abuse is also common in individuals with anorexia nervosa, and, and in conjunction with anorexia, is a strong predictor of mortality, particularly by suicide.
The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females aged 15-24 years old. 5-10% anorexics die within 10 years; 18-20% after 20 years and only 30-40% fully recover.
What is binge-eating disorder?
Binge eating disorder (BED): individuals may binge repeatedly and find it distressing but do not attempt to purge the food.
How is binge-eating related to dieting?
Individual who meet preliminary criteria for BED are often found in weight-control programs. About half of individual with BED try dieting before bingeing , and half start with bingeing and then attempt to diet; those who begin bingeing first become more severely affected by BED and are more likely to have additional disorders. There is also evidence that individuals with BED have some of the same concerns about shape and weight as people with AN and BN.
What evidence is there to support sociocultural accounts of the development of eating disorders?
The cultural imperative for thinness directly results in dieting, the first dangerous step down the slippery slope to anorexia and bulimia. Most females in magazines and on TV are thinner than average American women. A review of 77 studies demonstrated a strong relationship between exposure to media images depicting the thin-ideal body and body image concerns in women. An analysis of prime-time situation comedies revealed that 12% of female characters were dieting and many were making disparaging comments about their body image. Researchers also found that risk for developing eating disorders was directly related to the extent to which women internalize or ‘buy in’ to the media messages and images glorifying thinness. Today’s standards are increasingly difficult to achieve due to improved nutrition and there is also a general increase in size throughout history. This collision between our culture and physiology has had some negative effects, one of which is females’ dissatisfaction with their bodies.
Studies have also found a gender difference in body image perception. Men generally desire to be heavier and more muscular than they are. There is evidence that most women preferred an ordinary male body without the added muscle while men prefer to be more muscular. Researchers have found men rated their ideal body weight heavier than the weight women thought was most attractive for men.
Studies on adolescent girls have found that friendship cliques tend to share the same attitudes toward body image, dietary restraint, and the importance of attempts to lose weight. It is also clear from the study that these friendship cliques contributed significantly to the information of individual body image concerns and eating behaviours. In other words, if your friends tend to use extreme dieting or other weight-loss techniques, there is a greater change that you will, too.
The abhorrence of fat can have tragic consequences. In one study, toddlers with affluent parents appeared at hospitals with ‘failure to thrive’ syndrome, in which growth and development are severely retarded because of inadequate nutrition. In each case, the parents had put their young, healthy, but somewhat chubby toddlers on diets in the hope of preventing obesity at a later date.
One of the reasons attempts to lose weight may lead to eating disorders is that weight-reduction efforts in adolescent girls are more likely to result in weight gain. A 4-year study on girls who were initially same weight showed that those attempted dieting faced more than 300% greater risk of obesity than those who did not diet. In one study conducted a ‘taste test’ on undergraduates who have either dieted for one week or not. Investigators found that people who expected to go on a diet ate more than the group that didn’t – but only if they were ‘restrained eater’ who were continually attempting to restrict their intake of food, particularly fattening food. Thus, attempts to restrict intake may put people at risk for binging.
Dietary restraint can contribute to the development of eating disorder. During World War II, Keys and colleagues conducted a semi-starvation experiment involving 36 objects. For 6 months, these healthy men were given about half their former full intake of food. This period was followed by a 3-month rehabilitation phase, during which food was gradually increased. During the diet, the participants lost an average of 25% of their body weight. The investigators found that the participants became preoccupied with food and eating. Conversations, readings and daydreams revolved around food. Many began to collect recipes and to hoard food-related items.
Much has been made of the possible significance of family interaction patterns in cases of eating disorders. A number of investigators have found that the ‘typical’ family of someone with anorexia is successful, hard-driving, concerned about external appearances, and eager to maintain harmony. To accomplish these goals, family members often deny or ignore conflicts or negative feelings and tend to attribute their problems to other people at the expense of frank communication among themselves. Researchers have confirmed the differences in interactions within the families of girls with disordered eating in comparison with control families. Basically, mothers of girls with disordered eating seemed to act as ‘society’s messengers’ in wanting their daughters to be thin. They were likely to be dieting themselves and generally were more perfectionistic attitudes. Despite the pre-existing relationship, after the onset of an eating disorder, particularly anorexia, family relationships can deteriorate quickly. Nothing is more frustrating than watching your daughter starve in front of food. Educated and knowledgeable parents have reported resorting to physical violence (e.g., hitting or slapping) in moments of extreme frustration, in a vain attempt to get their daughters to put some food in their mouths.
What biological factors have been identified as having a role in the development and maintenance of eating disorders?
Like most psychological disorders, eating disorders run in families and thus seem to have a genetic component. Studies have suggested that relatives of patients with eating disorders are 4 to 5 times more likely than the general population to develop eating disorders themselves. In 23%of MZ twin pairs, both twins had bulimia, as compared to 9% DZ. In anorexia, numbers were too small for precise estimates. But the disorder in one twin did seem to confer a significant risk for both anorexia and bulimia in the co-twin. In any case, an emerging consensus is that genetic makeup is about half of the equation among causes of AN and BN. Again, there is no clear agreement on just what is inherited. Some suggest that nonspecific personality traits such as emotional instability and perhaps, poor impulse control might be inherited. Perfectionist traits might be inherited as well. This biological vulnerability might then interact with social and psychological factors to produce an eating disorder.
Biological process might be related to eating disorder. There is substantial evidence that hypothalamus and major neurotransmitter systems play an important role. Low levels of serotonergic activity are associated with impulsivity generally and binge eating specifically.
What psychological factors have been proposed to play a part in the development of eating disorders?
Low self-esteem; perfectionistic attitudes; intensely preoccupied with how they appear to others (anxiety and mood intolerance)
Clinical observations indicate that many young women with eating disorders have a diminished sense of personal control and confidence in their own abilities and talents. This may manifest as low self-esteem.
They also display more perfectionistic attitudes, perhaps learned or inherited from their families, which may reflect attempts to exert control over important events in their lives. One study that instructed female participants to pursue highest possible standards showed decreased amount of eating and more regret after eating.
Perfectionism alone, however, is only weakly associated with the development of an eating disorder, because individuals must consider themselves overweight and manifest low self-esteem before the trait of perfectionism makes a contribution. But when perfectionism is directed to distorted perception of body image, a powerful engine to drive eating disorder behaviour is in place.
Women with eating disorders are intensely preoccupied with how they appear to others. They also perceive themselves as frauds, considering false any impressions they make of being adequate, self-sufficient, or worthwhile. In this sense, they experience heightened levels of social anxiety. These social deficits are likely to increase as a consequence of eating disorder, further isolating the woman from the social world. Specific distortions in perception of body shape change often depending on day-to-day experience. Minor events related to eating may activate fear of gaining weight, further distortions in body image and corrective schemes such as purging. Another important observation is that at least a subgroup of these patients have difficulty tolerating any negative emotion (mood intolerance) and may binge or engage in other behaviours, such as self-induced vomiting or intense exercise, in an attempt to regulate their mood.
What are the major treatment approaches that have been developed for bulimia nervosa
CBT; IPT
CBT: pioneered by Fairburn (1985), the 1st stage is teaching the patient the physical consequences of binge eating and purging, as well as the ineffectiveness of vomiting and laxative abuse for weight control. The adverse effects of dieting are also described, and patients are schedule to eat small, manageable amounts of food five or six times per day with no more than a 3-hour interval between any planned meals and snacks, which eliminates the alternating periods of overeating and dietary restriction that are hallmarks of bulimia. In later stages of treatment, cognitive therapy focuses on altering dysfunctional thoughts and attitudes about body shape, weight and eating. Coping strategies for resisting the impulse to binge and purge are also developed, including arranging activities so that the individual will not spend time alone after eating during the early stages of treatment.
IPT: focus on improving interpersonal functioning, takes longer time to work compare to CBT, but may work on some who cannot benefit from ST CBT
What are the main treatment goals for anorexia nervosa?
Main treatment goal for AN is to reduce with marked anxiety of over becoming obese and losing control of eating, as well as their undue emphasis on thinness as a determinant of self-worth, happiness and success.
How might eating disorders be prevented?
Before implementing a prevention program, it is necessary to target specific behaviours to change. Early concern about being overweight was the most powerful predictor for later symptoms. Girls who scored high on weight concern scale were at substantial risk for developing serious symptoms compared to girls who scored lower.
In 1996, Killen and colleagues evaluated a prevention program on girls age 11 to 13. Half the girls were put on the intervention program, and the other half were not. The program emphasized that female weight gain after puberty is normal and that excessive caloric restriction could cause increased gain. Although intervention had relatively little effect on the treatment group compared to the control group, it significantly reduced weight concerns for those girls at high risk for developing eating disorders. Hence the most cost-effective preventive approach would be to carefully screen girls who are at high risk for developing eating disorders and to apply the program selectively to them. This finding is further confirmed by Stice and colleagues after reviewing a prevention program that selected girls 15 or over. The program showed that focusing on eliminating an exaggerated focus on body shape or weight and encouraging acceptance of one’s body stood the base chance of success.
These preventive programs can also be delivered over internet. ‘Student bodies program’ developed by Winzelberg and colleagues (1998) have showed significant improvement in body image and a decrease in drive for thinness. This program was interactive software featured both visual and audio components, as well we online self-monitoring journals and behaviour change assignments administered each week. Participants were contacted by email and encouraged to get back on track if missing assignments.
