Eating disorders Flashcards
Definition of eating disorders
A persistent disturbance of eating behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning (Fairburn & Walsh, 2002)
Problems with the definition of eating disorders
- Cultural issues
- Exercisers, models and gymnasts
- Is it purely about weight
- Gender, age, ethnicity
- Avoidance/restrictive food intake disorder
Anorexia nervosa
- Persistent restriction of energy intake leading to significantly low body weight (what is minimally expected for age, sex, etc)
- An intense fear of gaining weight or becoming facts or persistent behaviour that interferes with weight gain
- Disturbance in the way ones body weight or shape is experienced
- Undue influence of body shape and weight on self evaluation
- Persistent lack of recognition of the seriousness of the current low body weight
Subtypes:
- Restricting
- Binge eating/purging
Critical thoughts about definitions of Anorexia
People differ in their set point for weights (so is BMI useful?)
Various suggestions over the years
Athletes tend to count as overweight (more muscle)
Ballerinas and gymnasts are sanctioned to be underweight
Bulimia nervosa
- Recurrent episodes of binge eating (eating in a discrete period of time more than people would in a similar period)
- Recurrent inappropriate compensatory behaviour in order to prevent weight gain (self induced vomiting, misuse of laxatives)
- Binges and compensatory behaviours both occur on average and at least once a week for 3 months
- Self evaluation unduly influenced by body shape/weight
- Does not occur exclusively during episodes of anorexia nervosa
Critical thoughts about Bulimia nervosa
Quite an overlap with AN so how can you clearly distinguish between them
What is a binge?
Subjective (loss of control) or objective (loss of control + excessive intake)
What counts as excessive
Binge eating disorder
- Recurrent episodes of binge eating (eating more in a period that another person would ; lack of control)
- Episodes associated with 3 or more (Eating more rapidly ; eating until feeling uncomfortably full ; eating large amounts of food when not feeling physically hungry ; eating alone because of feeling embarrassed ; feeling disgusted, depressed or guilty after)
- Marked distress
- Bingeing at least once a week for 3 months
- No purging of compensatory behaviours
Critical thoughts about binge eating
Recent formal diagnosed (still some debates about definitions)
Same issues as so bulimia nervosa
Need to understand the motivation for bringing in this category (genuine destress and need for treatment and access to insurance money for clinicians as a way of treating obese people)
Other Specified Feeding and Eating Disorders (OSFED)
Known as atypical cases
Present with many of the symptoms of other disorders but do not meet the full criteria for diagnosis
- Atypical anorexia nervosa (Despite weight loss, their weight is in the normal range)
- Atypical bulimia nervosa (low frequency or limited duration)
- Atypical binge eating disorder (low frequency)
- Purging disorder
- Night eating disorder
Avoidant/restrictive food intake disorder
Normally found in children
- Disturbance in eating or feeding (Substantial weight loss/lack of weight gain)
- Absence of typical beliefs about food
- Replacing and extending what was called selective eating
3 Subtypes :
- Sensory-based avoidance
- Lack of interest
- Food associated with fear evoking stimuli
Incidence and prevalence
Incidence = number of new cases in a set window of time
Prevalence = Number of current cases (point prevalence) or number of people who have the problem over the past year (annual prevalence)
Hard to calculate incidence so we focus of prevalence
Prevalence rates
Most focus on the young female population
Lifetime prevalence rates up to :
- Anorexia nervosa= 4% of women, 0.3% of men (van Eeden et al., 2021)
- Bulimia nervosa = 3% of women, 1% of men (van Eeden et al., 2021)
- Binge eating disorder= 2.8% of women, 1% of men (Galmiche et al., 2019)
Problems with looking at medical records
Only tell us how many cases were spotted, not how many there were
GPs are not the best at spotting cases
Spike could be because of more awareness being raised (Currin et al, 2005)
Impact of westernisation
Related to increasing identification and prevalence
Curacao study
Showing more cases among non-whites in recent years - Hoek (2006)
Fiji study (Becker et al, 2011)
A clear link to western media
Both TV and social network based exposure
Theories of causation
- Sociocultural factors
- Neurobiological factors
