eating disorders Flashcards
1
Q
prevalence of eating disorders during the COVID-19 pandemic
A
- Diagnostic incidence was 15.3% higher in 2020
compared with previous years - Steady increase throughout 2020
- The increase occurred solely in females between
10-19 years old. - Primarily anorexia nervosa
2
Q
eating disorders * In DSM-IV
A
- AN and BN formed distinct categories reflecting the increased
attention they had received from clinicians and researchers. - Eating Disorder - Not Otherwise Specified (EDNOS)
3
Q
eating disorders In DSM-5
A
- BED is distinct category
- Removed EDNOS and
replaced it with more
specific categories
4
Q
EDNOS from DSM-4 to DSM-5
A
- DSM-5 dropped the EDNOS description for new designations.
- Unspecified Feeding Or Eating Disorder
- can be used for any condition that causes clinically significant
distress or impairment but does not meet diagnostic thresholds. - can be used when there is insufficient information such as in
hospital emergency room situations. - The other broad category is “other specified feeding or eating
disorder.” - applies to atypical, mixed, or subthreshold conditions.
- includes a variety of conditions, including subthreshold BN and
subthreshold BED. - includes night eating syndrome, which is a repetitive tendency to
wake up and eat during the night and then get quite upset about it. - includes purging disorder - this is a form of bulimia that involves self
induced vomiting or laxative use at least once a week for a minimum
of six months in the absence of binge eating
5
Q
anorexia nervosa
A
- The term AN is a misnomer because most patients do
not lose their appetite or interest in food – they
become preoccupied with food. - Essential feature is that the individual refuses to
maintain a minimally normal body weight, is intensely
afraid of gaining weight, and exhibits a significant
disturbance in the perception of the shape or size of
her/his body.
6
Q
thinness and self esteem in AN
A
- The self-esteem of people with AN is closely linked to
maintaining thinness. The tendency to link self-esteem and
self-evaluation with thinness is known as over-evaluation of
appearance. - Among people with acute AN, lower body weight is
associated with increased self-esteem. - Individuals with anorexia nervosa overestimate their own
body size and choose a thin figure as their ideal
7
Q
Development of and Comorbidity in AN
A
- Typically begins in the early to middle teenage years,
often after an episode of dieting and exposure to life
stress. - The prevalence of anorexia among children and adolescents is
increasing. - Comorbidity is high.
- Men and women at risk for eating disorders are also prone to
depression, panic disorder, and social phobia (Gadalla, 2008). - Women were at substantially greater risk for mania,
agoraphobia, and substance dependence. - Substance use disorders
8
Q
AN and death rates
A
- AN death rates are
- 10x greater than general population
- 2x greater than patients with other psychological disorders
- Longitudinal investigation found mortality rate for AN is
5x higher than the rate for the general population
(Fichter & Quadflieg, 2016). - There is no other disorder that matches the mortality
risk inherent in AN
9
Q
bulimia nervosa
A
- Involves…
- episodes of rapid consumption of a large amount of food
(binge) accompanied by a lack of self-control - followed by compensatory behaviours (purging).
- Binge = eating excessive amount of food in < 2 hours
- Typically occur in secret
- May be triggered by stress
- Purge = vomiting, fasting, or excessive exercise
10
Q
characteristics of binge eating
A
- Binge episodes tend to be preceded by poorer than average
social experiences, self-concepts, and moods. - Stressors that involve negative social interactions may be
particularly potent elicitors of binges. - People with BN have high levels of interpersonal sensitivity, as
reflected in large increases in self-criticism following negative
social interactions. - Continues until the person is uncomfortably full (Grilo,
Shiffman, & Carter-Campbell, 1994). - Binge episodes are often followed by deterioration in self-
concept, mood state, and social perception
11
Q
Fat Talk: BN and Fear of Gaining Weight
A
- The focus on fear of becoming fat and negative
appraisals of the self for being fat are the focus of
research on a phenomenon known as fat talk. - Fat talk refers to the tendency for friends, particularly female
friends, to take turns disparaging their bodies to each other. - Both average weight and overweight target people were seen
as more likeable if they were depicted engaging in fat talk
(Barwick et al., 2012). - Fat talk seems to reflect a highly defensive and negative
sense of self
12
Q
Development of and comorbidity of BN
A
- Bulimia nervosa typically begins in late adolescence or
early adulthood. - Extreme body dissatisfaction was found among 7–8% of
both girls and boys in Nova Scotia. - these children were only in Grade 5
- The data suggests that children particularly at risk can be
identified at a fairly young age (Austin, Haines, & Veugelers,
2009). - Many people with BN are somewhat overweight before
the onset of the disorder and the binge eating often starts
during a dieting episode.
13
Q
Commonalities in AN and BN
A
- The diagnoses of AN and BN share several clinical features:
- Intense fear of being overweight
- Self-evaluation is unduly influenced by body/shape weight
- There are some indications that these may not be distinct
diagnoses but may be two variants of a single disorder. - Co-twins of people diagnosed with anorexia nervosa, for
example, are themselves more likely than average to have
bulimia nervosa (Walters & Kendler, 1994). - Temporal studies also identify diagnostic crossover.
- More than 18% with AN eventually develop BN, while
approximately 7% of those with BN eventually develop AN (see
Keel, Brown, Holland, & Bodell, 2012). 24
14
Q
Binge Eating Disorder
A
- BED is linked with impaired work and social functioning,
depression, low self-esteem, substance abuse, and
dissatisfaction with body shape (Spitzer et al., 1993;
Striegel-Moore et al., 1998). - Risk factors for developing BED include:
- childhood obesity,
- critical comments regarding being overweight,
- low self-concept,
- depression, and
- childhood physical or sexual abuse
15
Q
Biological Factors in EDs
A
- Genetics
- Little research on genes
- AN and BN run in families
- Overvaluation of appearance and body dissatisfaction appear
to be heritable (twin studies) - The brain: Hypothalamus
- Regulates hunger and eating.
- Lesions in animals shows that they lose weight and have no
appetite - Regulates hormones that are abnormal in people with AN
(e.g., cortisol). These abnormalities may result from
starvation and return to normal with weight gain
16
Q
Endogenous Opiods and EDs
A
- Endogenous opioids are substances produced by the body
that reduce pain sensations, enhance mood, and suppress
appetite, at least among those with low body weight. - Starvation may increase the levels of endogenous opioids,
resulting in a positively reinforcing euphoric state (Marrazzi &
Luby, 1986) - Excessive exercise would increase opioids and thus be reinforcing
(Davis, 1996; Epling & Pierce, 1992).
17
Q
Hardy and Waller (1988) hypothesized that
A
bulimia is
mediated by low levels of endogenous opioids, which are
thought to promote craving; a euphoric state is then
produced by the ingestion of food, thus reinforcing
bingeing
18
Q
Perceptions of Children Being
Overweight
A
- An Ontario study found that among more than 2,000 girls aged
10 to 14, 29.3% were dieting and 1 in 10 had maladaptive
eating attitudes, suggesting the presence of an eating disorder
(McVey, Tweed, & Blackmore, 2004
19
Q
The thinspiration effect
A
- Chronic dieters actually feel thinner after looking at idealized images of
the thin body and this motivates them to diet (Mills, Polivy, Herman, &
Tiggemann, 2002). - This can begin a process of dieting that can ultimately lead to distress
among dieters unable to attain unrealistic body-image standards
20
Q
Psychodynamic Views of eating disorders
A
- Most propose that the core cause lies in disturbed
parent–child relationships and agree that certain core
personality traits, such as low self-esteem and
perfectionism, are found among individuals with eating
disorders. - Psychodynamic theories propose that the symptoms of
an eating disorder fulfill some need, such as the need
to increase one’s sense of personal effectiveness (the
person succeeds in maintaining a strict diet) or to avoid
growing up sexually (by being very thin, the person
does not achieve the usual female shape)
21
Q
Childhood Sexual Abuse and EDs
A
- Some studies have indicated that self-reports of childhood sexual abuse
are higher than normal among people with eating disorders, especially
those with bulimia nervosa
Physical abuse and sexual abuse were significant predictors of having an
eating disorder
22
Q
Personality Factors and EDs
A
- Meta-analysis studies demonstrate:
- six personality factors were linked consistently with EDs– avoidance
motivation, lower extraversion and self-directedness, neuroticism,
perfectionism, and sensitivity to social reward - People with AN and BN are high in neuroticism and anxiety and
low in self-esteem (Bulik et al., 2000). - People with AN or BN also score high on a measure of
traditionalism, indicating strong endorsement of family and
social standards
23
Q
Perfectionism and EDs
A
- Weight-restored and underweight people with AN had
elevated scores on self-oriented perfectionism. - Underweight people with AN had higher scores on socially
prescribed perfectionism. - People with AN who engage in excessive exercise are
distinguished by remarkably high levels of self-oriented
perfectionism
24
Q
Hewitt and Flett (1991b) created a multidimensional
perfectionism scale that assesses:
A
- self-oriented perfectionism (setting high standards for oneself)
- other-oriented perfectionism (setting high standards for others)
- Socially prescribed perfectionism (the perception that high
standards are imposed on the self by others
25
Treatment of EDs
* It is often difficult to get a person with an eating disorder into
treatment because the person typically denies that he or she has a
problem.
* The majority of people with eating disorders, up to 90% of them, are not in
treatment (Fairburn et al., 1996) and those who are in treatment are often
resentful.
* Some people with bulimia only wind up in treatment because their
dentist has spotted one key indicator: the erosion of teeth enamel as a
result of the stomach acid coming into contact with the teeth during
vomiting.
* Hospitalization is required frequently to treat people with anorexia so
that their ingestion of food can be gradually increased and carefully
monitored.
* Weight loss can be so severe that intravenous feeding is necessary to save the
person’s life.
* Weight restoration is the immediate primary goal in the treatment of anorexia
26
Psychological Treatment Of BN
* The cognitive-behavioural therapy (CBT) approach of Fairburn
(1985; Fairburn, Marcus, & Wilson, 1993) is the best validated
and current standard for the treatment of bulimia.
* In Fairburn’s therapy, the client is encouraged to question
society’s standards for physical attractiveness
27
Treatment for Eating Disorders:
Research on the CBT Approach
Limitations of Treatment Effectiveness
* At least half of the eating disorder clients treated in some
CBT controlled studies do not recover.
* May be that significant numbers of the patients in these
studies have psychological disorders in addition to eating
disorders, such as borderline personality disorder,
depression, anxiety, and marital distress (Wilson, 1995).
* Another possibility: individuals who begin with negative
self-efficacy judgments about their ability to recover are
more treatment resistant and take longer to recover
28
Relapse Rates of ED
* High rate of relapse in the treatment of eating disorder.
* A recent study of 100 anorexia nervosa patients in Toronto who
were treated successfully found that 41% of them relapsed
during the one-year follow-up period
Carter et al. (2012) found in their study that relapse was
more likely for those clients who:
* Binge-purge anorexia subtype
* Had more OCD-like checking behaviours.
* Lower motivation to recover predicted subsequent relapse
