Eating Disorders Flashcards
Body dissatisfaction
Feeling negatively about physical appearance, spikes beginning at puberty in girls, increase in dieting and desire to lose weight, characteristic of and predictor of eating disorders
Main eating disorders in DSM 5
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
Core features of eating disorders
Over or under control of eating behaviors
Self-esteem tied to physical appearance
Anorexia + bulimia nervosa similarities
Emerge during transition: puberty to adolescence or adolescence to emerging adulthood
95% cases in ages 11-25
4-5x more common in females
Bulimia Nervosa DSM
Recurrent episodes of binge eating and
Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives/diuretics/other meds, fasting, or excessive exercise
Binge eating and inappropriate compensatory behaviors both occur on average at least once a week for 3 months
Self-evaluation is unduly influenced by body shape and weight
Disturbance does not occur exclusively during episodes of anorexia nervosa
Binge eating DSM definition
An episode of binge eating is characterized by both of:
- Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode (feeling that one can’t stop or control eating)
No set amount of food, context is critical
Why does BN emerge in adolescent girls?
Intense societal focus on female physical appearance as girls mature physically
Many adolescent girls have difficulty adjusting to societal focus, coupled with rapid changes in body shape and weight that begin at puberty
Media and body image
Amount of media exposure predicts levels of body dissatisfaction and eating disorders
Viewing media images of think models in lab is linked with immediate increases in body dissatisfaction and changes in food choices
Nadroga, Fiji
Remote island, didn’t get regular exposure to Western mass media/satellite television until 1995
Quasi-experimental design, compare life for girls growing up in Fiji before and after exposure to mass media- naturalistic study
128 adolescent girls assessed in 1995 and 1998
Prevalence of dieting rose 0-69%, purging 0-12%, feeling too fast 0-75%, girls with television sets in their homes were 3x more likely to report clinically significant levels of body dissatisfaction - proxy for exposure
Girls directly attributed these feelings and behaviors to the exposure
Causal link between media and body dissatisfaction
Eating disorders across cultures
- Disproportionately more prevalent in North America, W Europe, Japan
- In these cultures, wealth correlates inversely with weight
- In other cultures, wealth correlates positively with weight, larger figures considered signs of beauty and success
Eating disorders in the US
- Prevalence risen as image of ideal woman has increasingly emphasized thinness
- More common among young women in fields that emphasize thinness
- More common among middle and upper class Americans of all racial and ethnic backgrounds
Objectification
Perceiving another person as an object or commodity, without consideration of personality or dignity
Objectification in adolescence in girls
Constant physical scrutiny of female bodies has numerous consequences, discrimination, diminished attributions of agency and intelligence
Objectification frequently begins at puberty
Objectification theory
For women, having a reproductively mature body results in physical scrutiny
based on physical appearance and creates a set of psychological risks, including disordered eating, that stem from the social experience of being evaluated based on physical appearance
Self-objectification
Girls and women are socialized to internalize the observer’s view of themselves as important indicators of their worth and value
Important bc self-concept that is excessively tied to physical appearance is a key nomothetic feature of disordered eating
Objectification cognition
We use different cognitive processes to perceive visual stimuli as human or non-human
Configural processing
Involved in recognizing a visual stimulus as a person, involves perceiving relations among the different parts of a stimulus
Analytic processing
Recognizing a visual stimulus as an object, doesn’t take into account spatial relationships of different parts of the stimulus
Inversion effect
Accuracy of recall and recognition is inverted versus not
Analytic processing isn’t affected by inversion
Configural processing is subject to inversion effect, harder to recognize people when they are upside down
Testing “literal objectification”
Showed people in bathing suits, then upside down, asked if you’ve seen them before (also did memory test with upright images)
Upright images- same amount of recognized images
Upside down- big drop in accuracy for men, not for women
So difference in analytical/configural processing depending on gender, A for women, C for men
Perceive sexualized images of women diff than men
People recognized male pics better when they were upright- inversion effect, indicating configural processing
No difference in recall for female pictures regardless of image orientation, indicated they used analytic processing consistent with perceiving objects
Male + female participants had these cognitive processes
Another core feature of all eating disorders
Difficulties with interoceptive awareness
Interoceptive awareness
Recognition of internal physical cues- hunger, cold, pain
Interoceptive awareness and eating disorders
People with poor interoceptive awareness are more likely to develop disordered eating 1-4 years later
Poor interoceptive awareness also explains why people who self-objectify have more symptoms of disordered eating: the more people view themselves from an external perspective, the more they seem to lose touch with their own internal sensations, including feeling hungry or full
High levels of self-obj, high levels of disordered eating, interoceptive awareness explains why these things are related
Binge eating disorder versus AN + BN
Not more common in females
Emerges throughout lifespan, not primarily during adolescence
Binge eating disorder DSM
Recurrent episodes of binge eating
Binge-eating episodes associated with 3+ of:
- Eating much more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present
Binge eating occurs on average at least once a week for 3 months
Binge eating NOT associated with recurrent used of inappropriate compensatory behavior as in BN and doesn’t occur exclusively during course of BN or AN
Two common antecedents of a binge
Hunger
Emotional distress
Binge trajectory
Someone hungry or upset, then binge, then feel immediately better, later feel intense guilt and shame, in bulimia then restrict diet and other compensatory behaviors- not in BED, starts over
Intervention for BN and BED
CBT first line treatment
Other supported treatments are interpersonal psychotherapy and SSRIs
CBT for BN and BED
Emphasize self-monitoring of food intake and emotions to improve interoceptive awareness
Regular eating schedule- 3 meals, 3 snacks: causes an immediate change
Reducing distorted perceptions of weight, educate clients on functions of binge, finding other ways to comfort
CBT for BN and BED- results
Works very quickly, 70% show significant changes in 3 weeks, 80% show complete remission after treatment, 75% of those in remission maintain these gains a year later
Body dissatisfaction over lifespan
Dramatic declines in body dissatisfaction, drive for thinness, dieting, and disordered eating symptoms in women in the 20 years after college graduation
Miraculous Maids
Young women who restricted food intake as a larger practice of devotion and ascetism
Catherine of Siena, 1347-1380
Difference between AN and other eating disorders
Core symptoms of BN and BED are associated with shame- binge and compensatory behaviors
Core symptoms of AN are associated with pride
Anorexia Nervosa DSM
Restriction of energy intake relative to requirements (limited intake of food and nutrients), leading to a significantly low body weight in the context of age, sex, developmental trajectory, or physical health. Significantly low weight is defined as a weight that is less than minimally normal or less than that that minimally expected
Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Two Subtypes of Anorexia
Binge-Eating/Purging Type: During the last 3 months, engaged in recurrent episodes of binge eating or purging behaviors
Restricting Type: During last 3 months, has not engaged in recurrent episodes of binge eating or purging. Presentations in which weight loss is accomplished primarily through dieting, fasting, or excessive exercise/
Differences between AN B/P type and BN
Weight of the individual
Frequency of binge/purge- more often in BN
More distinctions between AN and other EDs
AN- unusually low body weight, recurrent B/P in last 3 months
BN/BED- not unusually low body weight, binge/compensatory behaviors weekly for last 3 months
AN Prevalence + Outcomes
Low, 1% or less
Lack of nutrients can affect organs, mortality rate highest of any clinical disorder, 5-15%
Biological basis of AN
Dysregulated levels of serotonin and dopamine in cerebrospinal fluid
SSRIs sometimes used to target behavioral symptoms but limited success
Serotonin is involved in regulating how much we eat and whether we feel full/hungry
Gene that regulates levels of serotonin seems to be involved in AN
Anorexia + treatment problem
Very high rates of relapse- 1/3 of people who have symptom remission relapse in 6 months
50% relapse overall
Even after eating stabilizes and behavioral improvement, people with histories of AN tend to maintain severely disordered cognitions about food and weight
Anorexia treatment biologically
People continue to show abnormal levels of dopamine and serotonin even after participation in successful treatment with stabilized weight and eating
Might explain rates of relapse and persistence of disordered cognition
Also low serotonin linked with personality traits associated with perfectionism, guilt, preference for order; also traits common in anxiety disorders
AN hypothesis
For some people, AN is a manifestation of an anxiety disorder
Societal emphasis on thin body ideal combined with pubertal weight gain leads girls to channel their anxiety into restrictive eating
Developmental support for AN/anxiety research
70% of people with AN have lifetime histories of anxiety disorders
In 2/3 of cases, anxiety disorders precede anorexia onset
Anxiety disorders persist after AN symptoms stabilized
AN + Anxiety trajectory
Childhood anxiety disorder, then puberty: weight gain, changes in gender roles and social environment add to this anxiety producing AN and comorbid anxiety disorder, then treatment for AN stabilizes weight but anxiety disorder persists
LeGrange’s AN perspective
Family patterns don’t cause AN, certain types of families are not more consistently associated with EDs than others
Involving family in treatment is preferred unless extreme parental psychopathology
Reversal of previous treatment- taking child away from parents to treat them
Maudsley System for Treating EDs
Core feature: Parents are in charge of “refeeding” the child
Views family as best chance for recovery instead of source/exacerbation- as was historically believed
About more than just food, whole family system
Maudsley Effectiveness
2x as many teens who do Maudsley show full symptom remission compared to individual treatment, maintain gains at one year follow up, also improves comborbid conditions that aren’t the focus of treatment
But even Maudsley is only 40% full remission in many studies
Maudsley research
Still newish, published treatment protocol is not yet 20 years old
8 RCTs, partial remission is 75%- seems to work better than anything else
Next steps are figuring out adaptations to make it work better, some families need more time
Maudsley alternatives
Not great ones right now
In addition to nutrition support and stuff- Reduced Environmental Stimulation Therapy (REST)- for interoceptive awareness
Can be done at any age
Float in a shallow, warm pool w salt, for an hour, air and water set to match body temp- effortless, decreases awareness of body motion and position
Goal is to reduce awareness of anything not your own body, minimize external feedback so interoceptive signals become more obvious
REST RCT
People in residential AN treatment, 8 sessions
Body dissatisfaction- stays same for control, decrease for REST
Same with state anxiety
Something about floating makes people feel good! But not much change from week to week, people look incrementally better with each session but not much change over time- for both body satisfaction and state anxiety
