Eating Disorders Flashcards
How are eating disorders diagnosed?
DSM-5 ‘Feeding and Eating Disorders’
These are conditions which entail ‘a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning’
As well as anorexia nervosa, bulimia nervosa and binge eating disorder, includes Avoidant/restrictive food intake disorder (ARFID), Binge Eating Disorder and other disorders of eating and feeding
How is Anorexia Nervosa diagnosed?
DSM-5 defines anorexia nervosa as characterised by a relentless drive for thinness resulting in a body weight less than 85 per cent of that expected
Also, several cognitive distortions related to body image disturbance
Fear of gaining weight or persistent behaviour to avoid gaining weight
Restricting and binge eating/purging subtypes
How is Bulimia Nervosa diagnosed?
DSM-5defines bulimia nervosa as characterised by episodes of binge eating and weight-control behaviours
Weight-control behaviour scan include fasting, excessive exercise, or purging (vomiting, misuse of laxatives, diuretics or enemas)
Self-worth is excessively influenced by shape and weight
Individuals who meet the criteria for bulimia nervosa but are significantly underweight will be diagnosed solely with anorexia nervosa
How is Binge-Eating Disorder diagnosed?
DSM-5has included binge eating disorder as a category in its own right
Characterised by binge eating at least once a week for at least three months accompanied by marked distress by this behaviour
No weight-control behaviours
How is Avoidant/restrictive food intake disorder (ARFID) Diagnosed?
A persistent eating disturbance such that energy and/or nutritional needs are not met
No disturbance of body image or weight/shape concern
Who does Anorexia mainly affect?
Adolescent girls and young women
What are Biological Factors of Anorexia Nervosa?
Moderate genetic heritability
Interaction between genetic factors and the environment
May have abnormally high levels of serotonin activity
May have abnormal function of neuroendocrine (hormonal) systems involved in the regulation of hunger and fullness
Possible abnormalities in the structure and function of the brain
What are key Psychological Factors Anorexia Nervosa?
Low self-esteem
Negative affect—e.g., anxiety, guilt, anger, shame
Negative emotions and mood Dysfunctional thinking—particularly for evaluating self-worth
Perfectionism—unrealistically high standards
What are Social Factors of Anorexia Nervosa?
Family factors: Individuals with anorexia report higher levels of criticism and lower levels of care and affection from parents–Parents may influence their children through direct comments and modelling
Peer group pressure and cultural values play a role: Seeking peer approval –Cultures that place a high value on the control of eating, shape and weight
Concerning rise in pro-anorexia websites: ‘Thinspiration’
How is Anorexia Nervosa treated?
Motivational enhancement therapy (MET) aims to increase motivation to change
Cognitive behaviourtherapy (CBT) targets dysfunctional beliefs about weight and food –Particularly useful for those who are motivated to change
Family therapy is considered a treatment of choice for younger patients –The Maudsley model
Pharmacological approaches–Antidepressants, including SSRIs and TCAs
What is the lifetime prevalence of Bulimia?
1–3 per cent lifetime prevalence
What are Biological Factors of Bulimia Nervosa?
Moderate genetic heritability
Potential role of reduced serotonergic function
Familial predisposition to obesity, substance use and mood disorders
Epigenetic factors may also be occurring: Exposure to maternal stress, Under/over nutrition in utero
What are key Psychological Factors of Bulimia Nervosa?
Dual pathway model—binge eating episodes triggered by dietary restriction, negative affect or both. Binge eating in turn results in increased dieting and negative affect which increases the likelihood of further binge eating.
What are key Social Factors of Bulimia Nervosa?
Individuals with bulimia nervosa report higher levels of critical comments about their eating, shape and weight
Individuals with bulimia nervosa report a history of poor family functioning compared to healthy individuals
Negative interpersonal interactions may trigger binge eating
How is Bulimia Nervosa treated?
Motivation enhancement therapy: May be motivated to stop binge eating but unwilling to give up pursuit of unrealistic and unhealthy levels of thinness
Self-help approaches Good for those who are motivated, Manualised and based on CBT techniques
Cognitive behaviour therapy (CBT)
Interpersonal psychotherapy (IPT): Help individuals identify and change interpersonal problems that are assumed to be maintaining the eating disorder
Pharmacological approaches–Antidepressants
What is the lifetime prevalence of Binge Eating Disorder?
Lifetime prevalence rate is approx. 3–5 per cent
What are key Biological Factors of Binge Eating?
Moderate genetic heritability
May entail dysfunction in the serotonin system
Possible role of hormonal disturbances
What are key Psychological Factors of Binge Eating?
Dual-pathway model may also explain binge eating episodes in binge eating disorder
Emotional eating is associated with binge eating disorder–More likely to eat in response to negative mood states
High percentage of individuals report experiencing major depression in the period before they developed the disorder
What are key Social Factors of Binge Eating?
Poorer family functioning: Elevated levels of criticism, Reduced levels of affection
Obesity stigma: Negative attitudes and behaviours of others towards obese individuals
How is Binge Eating Disorder treatmed?
Self-help approaches–Self-help may be a useful first step, Guided self-help most useful approach
Cognitive behaviour therapy (CBT)
Interpersonal psychotherapy (IPT)
Behavioural weight loss (BWL): Focus on weight loss, secondary focus on binge eating
Pharmacological approaches: SSRIs, Anticonvulsants, with some adverse effects
What are current challenges and controversies surrounding eating disorders?
Lack of research on treatment for anorexia nervosa
Cognitive behaviour therapy is the most effective treatment for bulimia nervosa but there is room for improvement
Most sufferers are not accessing available treatments
Many health professionals mistakenly believe that treatment for bulimia nervosa is very difficult
Many health professional may lack expertise in delivering effective interventions
Approaches to eating disorders and obesity need to be integrated
Some patients require involuntary treatment
DSM-5classifies muscle dysmorphia as a type of body dysmorphic disorder. Some have suggested it should be classified as an eating disorder
Prevention approaches to eating disorders have failed to reduce eating disorder symptoms
What is the lifetime prevalence of Anorexia?
0.9 per cent
What is the mortality rate of Anorexia?
5–10 per cent. The highest of all psychiatric disorders
What is the age of onset for Anorexia?
Usually early to late adolescence (earlier than other eating disorders)
