Eating disorders Flashcards

Question

How is AN maintained? (8)

Answer 1

Sufferers deny having a problem *As AN develops in severity the following pattern typically manifests *Various measures of body weight (& loss) are taken, often several times daily *Complex rituals may evolve around these measures *Weight loss results in profound (but short lived) satisfaction *Increasingly punitive measures are taken if weight loss is not observed (purging, further dietary restriction) *Highly stylised rituals may evolve around eating and the types of food eaten may become extremely restricted *Social avoidance occurs (although not in the early stages where weight loss may be reinforced by friends and family) *Investment is gradually withdrawn from all other activities until pursuit of further weight loss becomes the only meaningful goal

Answer 2

–Some have suggested that the process of weight loss itself may become physically addictive –Indeed there is evidence of heightened b-endorphin levels in AN –This addiction model suggests that the person may experience *An affective high (from endogenous opioids) -problems with this version due to inconsistent data on the role of endorphins in AN *An avoidance of dysphoria (by avoiding eating) *A reduction in anxiety/stress (from not eating tryptophan the precursor for serotonin, thus lowering abnormally high serotonin levels)

Answer 3

*As noted earlier there is a 5-10% lifetime mortality rate *Approximately 50% never fully recover and experience repeated periods of recovery and then relapse (of varying severity) *Treatment –The first goal is refeeding which usually takes place in hospital (2000-4000Kcal/day) under strict supervision –This is usually combined with some form of on-going psychotherapy (various) –Additional treatments include the use of certain anti-depressants but these are only effective after refeeding and may assist in preventing relapse

Answer 4

*Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following: –Eating in a discrete period of time (a 2 hour block) an amount of food larger than what most people would eat under similar circumstances –A sense of lack of control (a feeling that one can’t stop eating) *Recurrent inappropriate compensatory behaviour to avoid weight gain (e.g., laxatives, diuretics, fasting or excessive exercise) *Binge eating and inappropriate compensatory behaviours both occur, on average, at least once per week for 3 months *Self-evaluation unduly influenced by body weight and shape *Occurs independently of any episodes of AN

Answer 5

–Lifetime prevalence is 1-3% in women –Predominantly a female disorder with 1 male case to every 10 female –BN typically develops in late adolescence or early adulthood –BN is most common in the same cultural and social groups as AN

Answer 6

–Benign relative to AN and includes *Dental erosion *Swelling of the parotid glands (with characteristic ‘Chipmunk’face) *Electrolyte abnormalities *Rare complications from oseophageal tear/gastric rupture

Answer 7

*Predisposing factors –A history of AN *Some studies suggest 20-30% of people with BN met the criteria for AN earlier in their lives *May share certain common genetic traits with AN –Childhood and parental obesity –A history of dieting (prior to onset -in many cases) –Family environment *Critical comments about weight during adolescence *Sexual abuse -incidence is higher than for controls, but this is true for all psychiatric disorders (as with AN) –Higher rates of anxiety and depression -75% life time risk -(and in family members too) –Higher rates of personality disorders, substance abuse and self harming, which along with traits of impulsivity may combine towards self-harm behaviour such as BN *Instigation –One possible model of how BN may get started has been suggested *The person diets *They are preoccupied with their weight (cultural influence) *They discover (from media, friend, teammate) a method for ‘quick weight loss’(typically vomiting or laxatives) *This is then coupled with the discovery that palatable food may be eaten without consequences *As the condition develops perceived control over eating and purging is gradually lost *Frequency and duration of binges increases *The range of triggers increases –Dysphoria -which it may temporarily relieve –Certain foods (sight or smell) *Binged foods are highly idiosyncratic and binges can vary from intakes of 700-10000+Kcal

Answer 8

*The development of BN is accompanied by various physiological changes related to abnormal satiety *Enlarged gastric capacity »Water filled balloon into stomach *Delayed gastric emptying »General digestive slowing throughout GI tract *Reduced gastric elasticity »Disturbed sensation of gastric fullness *Impaired CCK release »Correlates with diminished subjective post-meal satiety *Reduced vagal information flow »Associated with increased pain threshold observed in BN *Abnormal serotonergic function & serum leptin levels *All of these changes are perhaps adaptations to binges, although some maybe predispositions -it is hard to tell as prospective studies are rare

Answer 9

*50% appear to make a full recovery *30% experience occasional relapse *20% exhibit chronic BN

Answer 10

–This is usually a combination of CBT (4-6M) and antidepressants which together appear quite successful *CBT identifies cues to bingeing and how to deal with them *Antidepressants work even if the patient is not depressed –BN is far more easily treated than AN