Eating Disorders Flashcards
Define eating disorders
Characterized by severe disruptions in eating behavior affect physical, psychological, and social functioning
Define anorexia nervosa
- Intense fear of gaining weight
- Distorted body image
- Body weight is below normal
Why is amenorrhea not required for diagnosis of anorexia nervosa?
- Men can get diagnosed for anorexia nervosa
- You do not need to have a period/experienced puberty to get anorexia
When is anorexia usually first diagnosed?
Adolescence or adulthood
What is anorexia triggered by?
Dieting and stress
How many times are women more likely to be diagnosed with anorexia than men?
10x
What mental disorders is anorexia comorbid with in women?
Depression, OCD, phobias, panic, and alcoholism
What is anorexia comorbid with in men?
Substance dependence, mood disorders, or schizophrenia
Does anorexia have the highest mortality rate among all psychological disorders?
Yes - suicide rates are high with death rates 10x higher than the general population
What are some physical changes associated with anorexia?
- Blood pressure and heart rate decrease
- Kidney issues
- Loss of bone mass
- Brittle nails, dry skin, hair loss
- Lanugo (soft hair)
- Depletion of sodium and potassium electrolytes
(can cause tiredness, weakness, and death)
What are the three medical sequelae or consequences of anorexia nervosa? (Give examples for each)
- Health complications
- irregular heartbeat
- hypotension (low blood pressure)
- electrolyte imbalances
- infertility - Hospitalizations
- involuntary hospitalizations - Death
- 5-8% die from complications
How many people eventually recover from anorexia? and how long does this take? are relapses common?
35-60% but less than 50% fully recover: 6-7 years: yes
What is a common cognitive distortion that people in the US with anorexia have?
They have a hard to modify distorted view of self especially in a culture that values thinness
What is the comorbidity rate between anorexia and body dysmorphic disorder?
It is not high because body dysmorphic disorder is focused on one feature of the body
Define bulimia nervosa
Uncontrollable eating binges followed by compensatory behavior to prevent weight gain
What are compensatory behaviors?
Purging, vomiting, fasting, excessive exercise
What is the time period of bulimia nervosa for it to be diagnosed?
At least one a week for 3 months
What are typical food choices for binges?
Cakes, cookies, chips
What does avoiding craved food do for binge?
It increases the likelihood of a binge?
What happens to a person during a binge and after it?
They dissociate or loss awareness during it and then feel shameful and remorseful afterwards
What is the onset age of bulimia nervosa?
Late adolescence or early adulthood
What percent of women have bulimia nervosa?
90%
What causes bulimia nervosa?
The person is overweight and they start to diet
What is bulimia nervosa comorbid with?
Depression, panic disorders, anxiety, substance abuse
How do the suicide rates of bulimia nervosa compare to the general population and anorexia nervosa?
They are higher than the general population but are much lower than in anorexia
What does the BMI/weight look like in people with bulimia nervosa?
Normal BMI or are overweight
What are the three medical sequelae/consequences of bulimia nervosa?
- Health complications
- unstable weight
- electrolyte weight
- dental problems
- cardiac problems - Hospitalization
- Death
- arise from complications
- mortality rate of 4%
What is the recovery rate of bulimia nervosa?
75%
What does the recovery rate look like in bulimia nervosa?
What does recovery look like though? No longer purge but still binge?
What percent of people remain fully symptomatic?
10-20%
When are poorer outcomes of bulimia nervosa predicted?
When depression and substance abuses are comorbid
What helps improving outcomes of bulimia nervosa?
Early interventions
What is binge eating disorder caused by?
Obesity and history of dieting
Do all obese people meet criteria for binge eating disorder? If not, what makes people qualify?
No (2-25% of obese people qualify) – must report binge eating episodes and a feeling of loss control over eating to qualify
What are risk factors of binge-eating disorder?
Childhood obesity, early childhood weight loss attempts, being taunted about your weight, low-self concept, depression, childhood physical or sexual abuse
What percent of people recover from binge-eating disorder?
About 60%
What eating disorder is the most common and lasts the longest of the three disorders?
Binge-eating disorder – lasts 14.4 years
Compare the body weight of anorexia nervosa, bulimia, and binge eating disorders
AN: Low
BN: Normal or overweight
BED: Usually overweight or obese
Compare the fear of weight gain of anorexia nervosa, bulimia, and binge eating disorders
AN: Yes
BN: Yes
BED: No
Compare the body image of anorexia nervosa, bulimia, and binge eating disorders
AN: Distorted
BN: Overconcerned with weight
BED: May be unhappy with weight
Compare the binge eating of anorexia nervosa, bulimia, and binge eating disorders
AN: Maybe
BN: Yes
BED: Yes
Compare the purging of anorexia nervosa, bulimia, and binge eating disorders
AN: Maybe
BN: Yes
BED: Yes
Compare the use of non purging methods to avoid weight gain for anorexia nervosa, bulimia, and binge eating disorders
AN: Yes
BN: Yes
BED: No
Describe the rates of the three eating disorders in men
Anorexia - 5%
Bulimia - 20%
Binge eating - 50%
Describe the rates of the three eating disorders in women
Women:
Anorexia - 95%
Bulimia - 80%
Binge eating -50%
What percent of men and women receive treatment for binge eating disorders?
50%
Compare the prevalence of anorexia and bulimia
AN: 0.5%-2%
BN: 1-3%
Compare the sex ratio of anorexia and bulimia
AN: 10-20 –> females to males
BN: 10:1 –> females to males
Compare the personality traits of anorexia and bulimia
AN: Greater harm avoidance, persistence, conscientiousness, perfectionism
BN: Greater novelty seeking, negative emotionality, social insecurity, feelings of ineffectiveness, stress reactivity
Compare the associated clinical features of anorexia and bulimia
AN: Compulsivity, overcontrol
BN: Affective dysregulation, impulsivity, undercontrol
What are the two main difference between Binge eating disorder and Anorexia?
- Absence of weight loss in binge eating disorder
2. Absence of compensatory behaviors in binge eating disorders
What are biological factors of bulimia?
- Genetic factors
- Disturbances in serotonergic and noradrenergic systems
What are psychological factors of bulimia?
- Negative self evaluation, low self-esteem
- Rigid cognitive style, all or nothing thinking
What are social factors of bulimia?
- Cultural norms, emphasis on thinness as the ideal body shape
- Certain sports equate body size with ability to succeed
If you have bulimia how many times more likely would your sibling be diagnosed?
7-20 times
What do mood disturbances do to a person with bulimia?
They are more prone to developing mood disorders such as depression and anxiety
Why are women more vulnerable to eating disorders?
The perceptions we have of ourselves are more interpersonal
What do family and twin studies support in eating disorders?
A genetic link
What two eating disorders have a monozygotic concordance rate?
Anorexia and weight
What behaviors are heritable in eating disorders?
Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation
What receptors function abnormally in patients with anorexia?
Serotonin
What is serotonin related to in people with eating disorders?
Satiety
What do people with anorexia and bulimia have low levels of?
Serotonin metabolites
What causes low levels of serotonin metabolites of people with anorexia and bulimia?
Under active 5HT in anorexia and 5HT deficit in bulimia prevents sense of satiety
What are effective medications for eating disorders? What is a reason for this?
Antidepressants that increase serotonin perhaps because major depressive disorder is comorbid with eating disorders
What feelings is dopamine related to?
Pleasure and motivation
What do patients with anorexia and people with eating disorders feel more positive and rewarded by seeing?
When viewing pictures of severely underweight women
What behaviors are negatively reinforcing and why?
Restrictive eating a and excessive exercise are negatively reinforcing because reduce anxiety about weight gain
What behaviors are positively reinforcing?
Feelings of self control brought about by weight loss
What lead to excessive concerns a about weight?
Perfectionism and personal inadequacy
What can environmental factors can lead to the diagnosis of anorexia?
Criticism from family and peers
How is self-worth influenced in people with bulimia?
It is strongly influenced by weight and have low self esteem
What does rigid restrictive eating trigger in bulimia?
It triggers lapses which can become binges while eating many “off-limit” foods
How do people feel after binging?
Disgust with oneself and fear of gaining weight lead to compensatory behavior
What how does purging make people feel short term compared to long term?
Reduces anxiety about weight gain and then negative feelings about purging lead to lower self esteem which triggers further binges
What triggers binges?
Stress and negative affect
What scale measures dieting and overeating especially for bulimia?
Restraint Scale
Talk through the schematic of cognitive behavior theory of bulimia nervosa
Low self esteem–> dieting to feel better about oneself –> food intake is restricted too severely –> diet is broken –> binge –> compensatory behaviors to reduce fear of weight gain
What does American society value in men compared to women?
Thinness in women and muscularity in men
What has often preceded onset of an eating disorder in women?
Dieting
What also predicts eating disorders in relation to sociocultural factors?
Body dissatisfaction and preoccupation with thinness
What factors play a role in unrealistic expectations for body image?
- Societal objectification of women
- Unrealistic media portrayals
- Overweight individuals are seen as lesser
What factors are associated with decreased eating disorder symptoms?
Aging and changes in life roles (having a life partner or having children)
In other cultures how is higher weight viewed?
It is a sign of fertility and healthiness
As countries become more like Western cultures …
Eating disorders increase
In what societies is bulimia more common?
Industrialized societies
Name the seven diathesis factors in the diathesis-stress model for eating disorders
- Genetic factors
- 5HT dysregulation
- DA dysregulation
- Negative self evaluation
- All or nothing thinking
- Cognitive style
- Perfectionism
Name the seven diathesis stress factors in the diathesis-stress model for eating disorders
- Family interactions
- Puberty
- Bullying
- Hospitalization
- Transitions, college
- Trauma
- Divorce
What are mediating factors for eating disorder?
Age, opportunity, peers, environment, culture, treatment history
What is the diathesis for vulnerability with anorexia nervosa?
- Are you genetically related to someone who has anorexia?
- Do you have dopamingergic dysregulation?
- Are you young?
- ## Are you being bullied?
What personality characteristics impact eating?
Perfectionism, lack of interoceptive awareness, and negative affect predicted disordered eating
If you have anorexia what does hunger feel like?
Nothing - you have lost perception of it
What do people with eating disorders report higher rates of?
Childhood sexual and physical abuse
Are reports of abuse specific to eating disorders?
No - the presence of abuse could be too general of a variable
What are three ways anorexia nervosa can be treated?
- Hospitalization
- Medications
- Serotonin-enhancing medications - Psychological treatments
- Family therapy
- Psychodynamic psychotherapy
- Cognitive-behavioral therapy
What can antidepressants such as prozac and SSRIs promote?
Weight gain
Where is treatment for bulimia typically offered?
Eating disorder clinic
What are the immediate goals of treatment for bulimia?
- Eliminate binge: purge patterns
- Establish good eating habits
- Eliminate the underlying cause of bulimic patterns
- Eat as much as 6 times per day
What are three types of treatment for people with bulimia? * go over the graph with someone
A. Psychological treatments - Cognitive behavioral therapy (CBT) - Interpersonal therapy (IPT) - Dialect behavior therapy (DBT or BT) B. Medications + Inpatient Treatment Program - SSRIs C. Medications + Self Help Manual - SSRIs
What does CBT teach for people with binge-eating disorder?
Teaches restrained eating through self-monitoring, self-control, and problem solving skills
Is CBT more effective than medication?
Yes
What is equally as effective as CBT?
IPT
What do behavioral weight-loss programs do?
- They may promote weight loss
- Do not curb binge eating
How are eating disorders prevented today? List 3
- Psychoeducational approaches
- Educate early about the dangers of eating disorders - De-emphasize sociocultural influences
- Dissonance reduction intervention to deeemphasize sociocultural factors - Risk-factor approach
- Healthy weight intervention to develop healthy weight and exercise programs
