Eating Disorders Flashcards
Perspectives
HISTORICAL - religious orders CROSS-CULTURAL - Western "thin = attractive" ideal - ie. British TV in Fiji causing eating disorder outbreak and change of concept of "beauty"
Eating Disorder Types
ANOREXIA NERVOSA (AN) BULIMIA NERVOSA (BN) EATING DISORDER NOT OTHERWISE SPECIFIED (EDNOS) BINGE EATING DISORDER (BED) OBESITY (?)
EDT: Anorexia Nervosa
- refusal to maintain body weight (self-starvation)
- restricting VS binging/purging
- at least 15% below “normal” weight
- intense weight gain fear
- disturbance of body image
- amenorrhoea (menstruation absence)
EDT: Bulimic Nervosa
- loss of control over eating
- “normal” weight
- binging/purging cycles (ie. vomiting/laxative misuse)
- over-exercising
Management Issues
- major dilemma for clinicians
- respecting patient choice/autonomy
- patient refusing insight into self-harm caused
- enabling patient to reduce health risks
- treatments vary in invasiveness
- insufficient contextual/effectiveness research
Common Pathways to Eating Disorders
- many w/AN may develop BN
- ECKERT et al (1995); some develop BN w/o first having AN
- both usually develop in adolescence
- x10 more likely in women than men
- AN = 1% late adolescent women
- BN = 1-3% prevalence
- both probably estimates
Risks
- malnutrition effects (ie. lesser metabolism of vitamins/minerals); brittle bones (bone density reduction))
- joint disorders
- dental erosion (particularly in BN via vomit acid)
- cerebral atrophy (extreme AN)
- cognitive problems (extreme AN)
- hypothalamic function abnormalities via neurological differences/weight loss/emotional disturbance in AN
Theories
- adolescent disorder
- extreme end of “continuum of weight control issues” (60-70% of women on diets)
- may always be range of factors to various degrees
Causes
- risk factors over time include:
BIRTH/INFANCY
CHILDHOOD
ADOLESCENCE
C: Birth/Infancy Factors
- gender
- genetics
- obstetric complications
- early feeding difficulties
- high concern parenting
- neurobiology via impairments to cortical/sub-cortical structures (self-knowledge/reward/food pathways)
C: Childhood Factors
- childhood obesity
- childhood anxiety disorders
- sexual abuse/neglect
- adverse life events
- OCPD
C: Adolescent Factors
- adolescence in of itself
- body dysmorphic disorder
- high exercise levels
- dieting!!
- OCD/perfectionism
- negative self-evaluation
Cognitive/Behavioural Development
- “source of control” in life suggests function to EDs
- conflict between independence/fear of maturity
- co-existing/pre-cursive depression magnifies cognitive errors ie. guilt/shame (22-88%)
- lack of alternative control through transitions; intensified/entrenched via external food control
- deflects attention from other family issues
- media’s “aspiration for slimness” (especially AN)
- dissatisfaction w/body shape/size
- weight phobia via distorted body image
Body Image Distortion: Self VS Others
- TOVEE (2000); 204 women; 1/6 AN/BN; 5/6 healthy
- estimate body mass index; shown photos to do the same
- ED overestimated photos BMI (but control did same, just less); AN were worst
- ED rated slim photos attractive
- ED overrated own BMI
- vicious feedback loop; losing weight = downward shift in attraction perception
Compulsive Exercise
- historical; tenacious drive for physical activity
- prominent characteristic in AN, even facing severe emaciation
- BEUMON et al (1994); precedes ED onset
- CRISP et al (1980); one of last symptoms to pass
- associated w/
LENGTHIER HOSPITALISATION
HIGHER RELAPSE RISK
POOR LONG-TERM OUTCOME
Social Policy & Treatment
1997 MHA TREATMENT GUIDANCE:
- multi-disciplinary intervention emphasis for in/out patients
- avoid involuntary treatment/sectioning always (unless severe risk to self/others)
- client decisions should be MD shared
- compulsion to voluntary acting as soon as possible
- refusing treatment = symptom of it being necessary
- severe measures include:
HOSPITALISATION
FORCED FEEDING
MEDICATION
Multi-Disciplinary Approaches
PSYCHOTROPIC MEDICATION
- useful for common co-existing affective disorder
- noradrenaline/serotonin/dopamine
NUTRITIONAL COUNSELLING
- education about appropriate nutrition
FAMILY THERAPY
- helpful family changes; tackling issues (ie. EE/scapegoating)
PSYCHOTHERAPY
- ie. CBT for cognitive style/error/food beliefs; picking apart “control” theory; finding what really want to be controlled
SELF-HELP/GROUP WORK
Outcomes
AN
- 5-20% die (cardiovascular/gastrointestinal/metabolic factors)
- 25% cycle; many develop BN
- remainder gain control
- shift towards targeted brain-based interventions
BN
- good full recovery process; meds = 62% at 10y; psych = 54% at 6y
- CRISP et al (1991); 3 treatments (beh/fam/dynamic); 1y follow = good results; criticised for short follow up
- IMPROVED OVER LAST 20Y
Summary
- EDs may have most major negative heath effects of disorders
- people w/EDs can benefit from treatments (earlier the better)
- causal/maintenance factors need to be contextually seen w/unhelpful media/transitional demands placed on teens
- socio-political change/control needed on media to minimise triggering disorder factors
