Eating Disorders

Question 1

General gender trends, eating disorders

Answer 1

Higher rates in females, but also prevalent in boys
Many more girls display binge/purge behaviors

Question 2

Anorexia Nervosa DSM-5 criteria

Answer 2

RID-B

1. Restriction of energy -> significantly low body weight for age and height
2. Intense fear of gaining weight/becoming fat or behavior that interferes with weight gain despite being underweight
3. Disturbance in perception of body: undue influence on weight/shape on self-evaluation, denial of seriousness of low weight

4: Binge-eating/purging for BINGE-EATING/PURGING SUBTYPE ONLY

FOR THE RESTRICTING SUBTYPE: No binges or purges

Question 3

Bulimia Nervosa DSM-5 criteria

Answer 3

1. Recurrent binge-eating (eating amounts definitely larger than common in short periods of time & sense of lack of control during episode)
2. Recurrent inappropriate compensatory behavior (induced vomiting, laxatives, excessive exercise)
3. Cycle of binge/purge happens on average WEEKLY for THREE (3) MONTHS
4. Self-evaluation is unduly influenced by body shape/weight

Not occurring exclusively with anorexia. If you have both, you are diagnosed with anorexia. Anorexia is more serious.

Question 4

Binge-eating disorder

Answer 4

Like bulimia without purging/laxatives/exercise. Loss of control

Question 5

Other eating disorders

Answer 5

Clinically specific symptoms but does not meet full criteria. POSSIBLY MOST COMMON!

Question 6

Anorexia prevalence

Answer 6

0.3 - 1% female adolescents
over 90% of diagnosed cases are female

Question 7

Anorexia course

Answer 7

Rarely begins before puberty. Late adolescence typical.

Generally chronic: less than half recover.

HIGH MORTALITY

Question 8

Anorexia mortality rate

Answer 8

5-20%. Mostly cardiac problems or suicide

Question 9

Anorexia precursor

Answer 9

Pathological dieting - don’t need to do it.

Question 10

Anorexia medical complications

Answer 10

HEART - Cardiac arrhythmia, low blood pressure and decreased heart rate.
ENERGY - Lethargy
HAIR/SKIN - Dry skin, brittle hair
TEMPERATURE - Hypothermia

Question 11

Anorexia psychological comorbidity

Answer 11

1. Depression/anxiety
2. Substance use disorder for BINGE-PURGE SUBTYPE ONLY
3. Impulse control/emotionally volatile for BINGE-PURGE SUBTYPE ONLY
4. Conformity, perfectionism, rigidity for RESTRICTING SUBTYPE ONLY

Question 12

Eating Attitudes Test

Answer 12

Screening method for E.D. Likert response scale: always, often, sometimes, rarely, never in reply to statements like “Am terrified of being overweight”, “avoid eating when hungry.”

CONS: Easy to fool

Question 13

Anorexia nervosa etiology

Answer 13

1. Genetic (heritability)
2. Neurobiological (minor role in onset but major role in maintenance. Serotonin systems disruption)
3. Family factors (overcontrolling/rigid style)
4. Psychological dimensions (avoidance of harm, low novelty-seeking, high reward dependence aka need for approval)
5. Sociocultural factors (body image ideals, culture-bound syndrome)

Popular media does not show the complexity of anorexia etiology.

Question 14

Minnesota Starvation and Rehabilitation Study

Answer 14

WW2, men who didn’t go to war – conscientious objectors, healthy young males
3 phases: baseline, starvation, rehab
Reduced caloric intake by 50%, participants lost 1/4 of baseline weight

RESULTS: Significant psychological impact
Depression, irritability, loss of concentration, social withdrawal
STARVATION REINFORCES NEGATIVE EMOTION

Question 15

Bulimia prevalence

Answer 15

Higher than anorexia
~3% girls/women for full DSM-5 criteria & another 10% report some symptoms
population diagnosed is ~90% female

Question 16

Bulimia onset

Answer 16

Later than anorexia, late adolescence into early adulthood

Question 17

Bulimia complications

Answer 17

From vomiting: erosion of tooth enamel, dehydration, swollen parotid glands, low potassium

From binges: ruptured stomach

General GI disturbances

Question 18

Bulimia comorbidity

Answer 18

Depression, anxiety, SUBSTANCE USE DISORDER

Question 19

Bulimia course

Answer 19

Better outcomes than anorexia, but mixed
Continue to show disturbed eating patterns, low self-esteem, depression even if not meeting full DSM-5 criteria anymore

POOR PROGNOSIS IF - substance use history, longer duration before treatment

Question 20

Anorexia treatment

Answer 20

Inpatient vs outpatient decision - do you need to keep them in the hospital to stabilize them?

Initial goal: restore weight
- Nutritional rehab
- ID/understand dysfunctional attitudes
- Address comorbidity psychopathology

Family therapy and CBT

Question 21

Bulimia treatment

Answer 21

ID purge triggers

Psychoeducation on harmful effects of vomiting

Normalize eating pattern and break binge-purge cycle

Sometimes: antidepressant medication

Relapse prevention: strategies for dealing w/stress

Question 22

Maudsley Method for anorexia

Answer 22

for newer adolescents
Helping parents regain control over the child

• Family oriented
• Separate disorder from the individual
  - agnostic as to cause, not assigning blame
• Gradual transfer of weight control back to the child
• Once maintaining 95% of target weight: individual therapy for issues of adolescence and/or family therapy