Eating disorders 1 Flashcards
balance between hunger and satiety =
homeostasis
what are the internal causes of hunger and satiety?
genetics
learning
social learning
what are the external causes of hunger and satiety?
social pressures
food industry
toxic environment
a persistent disturbance of eating behaviour or behaviour intended to control weight, which significantly impairs physical health/psychological functioning =
eating disorder
only ___% of cases are underweight as majority of people with eating disorders are not identifiable by being skinny
15
BMI =
weight (Kg) / Height in m2
what is the healthy range of BMI?
19-25 (varies with factors such as ethnicity)
why is BMI not a very meaningful measure for young people?
young people are growing over time so we use expected weight for height and this is adjusted for age
what is the BMI of someone overweight?
over 25
what is the BMI for an obese person?
over 30
why do athletes have a higher BMI?
muscle weighs more than fat
persistent restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, disturbance in body experience =
anorexia nervosa
what are the subtypes of anorexia?
restricting
binge-eating/purging
which is the worst subtype of anorexia?
binge-eating > more worried about suicide
explain the critical thoughts of why weight is not a definite indicator of anorexia
some people have naturally low BMI and don’t put on weight easily despite eating lots, ballerinas encouraged to be underweight (social sanctioning), lots of variation, BMI needs to be adjusted for specific ethnic groups, most cases won’t show extreme weight loss at the start, might be starvation for other reasons
recurrent episodes of binge eating of eating more in a short period than people would normally in a similar period =
Bulimia nervosa
what are some of the recurrent inappropriate behaviours in order to prevent weight gain (bulimia)?
self induced vomiting misuse of laxatives diuretics other medications fasting excessive exercise
how many times does binges and behaviours have to occur for the diagnostic criteria of bulimia?
1 x a week for 3 months = DSM-5
DSM-4 = 2 x a week
recurrent episodes of over eating, sense of lack of control, eat more rapidly and large amounts when not hungry, eating alone, feelings of disgust/depression/guilt =
binge eating disorder
does binge eating disorder have any purging or compensatory behaviours?
no
which disorder is the most common?
binge eating disorder
how often does binge eating disorder have to occur in the diagnostic criteria?
1 x a week for 3 months
what does OSFED stand for?
other specified feeding and eating disorders
present with many symptoms of other eating disorders but don’t meet full criteria for diagnosis =
atypical cases
why were OSFEDs introduced?
lots of people don’t fit neatly into diagnosis with eating disorders but would still benefit from help
what are some disorders that fit under OSFED?
atypical anorexia nervosa atypical bulimia nervosa atypical binge eating disorder purging disorder night eating syndrome
despite significant weight loss, the individuals weight is within or above the normal range =
atypical anorexia nervosa
what makes bulimia nervosa and binge eating disorder atypical?
lower frequency and/or duration
what does ARFID stand for?
Avoidant/Restrictive Food Intake Disorder
who is mainly affected by ARFID?
children and young people
what are some of the signs of ARFID?
disturbance in eating substantial weight loss nutritional deficiency dependence on supplements absence of typical food beliefs anxiety induced fussy eating
what are the 3 subtypes of ARFID?
- sensory based avoidance
- food associated with fear evoking stimuli
- lack of interest (in consuming or tolerating nearby)
refuses food intake based on smell, colour, texture, presentation = which subtype of ARFID?
sensory based avoidance
Fairburn et al (2003) found that __-__% of cases don’t fit neatly into diagnosis and _______ cases are the largest single group
40-50, atypical
what are some problems with diagnosis of eating disorders?
many fail to stay in 1 diagnosis e.g. patients with anorexia develop bulimia, doesn’t indicate best treatment
(consequently there is a shift from rigid diagnoses = trans diagnostic model)
what do the underlying biological causes and consequences of eating disorders means we have to consider?
comorbid psychological problems
what are some comorbid psychological problems that arise with eating disorders?
anxiety disorders
depressed mood
personality disorder
alcohol/substance use
why is alcohol use a higher risk and used more over substance use?
has a higher nutritional load so can replace food and keep you going throughout the day
what are problems arise that lead to higher mortality rates?
cardiac complications muscular failure osteoporosis liver damage oesophageal tearing fainting
number of new cases in a period of time =
incidence
number of current cases =
point prevalence
number of cases who have had the problem over the past year =
annual prevalence
what factors make it hard to calculate incidence so we focus on prevalence instead?
slow onset
secrecy
slow diagnosis
which disorder gets the most attention despite having the lowest prevalence rate?
anorexia (0.3%) then bulimia (1%) then other cases (2-3%)
when looking at more vulnerable groups prevalence rate _______
increases
what are the proposed sociocultural and neurobiological factors as causes of eating disorders?
early parenting abuse bullying emotional invalidation childhood obesity parental mood/eating childhood anxiety
what are some of the limitations with studies and causal evidence for eating disorders?
aren’t many cases in population and need a large sample size
lack of longitudinal data
selective sampling
risk of selective memory
risk of misinterpreting associations
doesn’t infer causation
what are cognitive patterns that maintain an eating disorder? (theories of maintenance)
low self esteem
negative self attribution
perfectionism
(each of these have a self maintaining cycle)
what are the 2 central belief systems?
broken cognitive link between eating and weight, overevaluation
explain the ‘broken cognitive link’ theory
most of us believe our eating and weight will balance out naturally whereas people with eating disorders have broken cognition believing whatever they eat will cause weight to shoot up. this drives restriction > bingeing > gaining weight > restricting
explain overvaluation as theory of maintenance
believe appearance and weight define them as being acceptable people, only good enough if in control of body (especially women)
what are the safety behaviours that calm patients down when feeling anxious?
binge eating restricting body avoidance/checking exercise purging
what is the long term consequence of safety behaviours?
feel worse so do behaviour again to calm us > forms vicious cycle
what is the biggest maintaining and triggering emotion for eating problems?
anxiety (particularly in relation to safety behaviours)
how do perceptual factors play a part in eating disorders?
perceive themselves 25-30% larger than they are, overestimate size
what is thought shape fusion?
when we see food we already feel larger in size before eating it
what are the steps a clinician would use to formulate an eating disorder by increasing the chances of a binge?
starve a person for period of time > make them feel distressed > expose them to lots of food > disinhibit (get person drunk)
