Eating Disorders Flashcards
history of AN
- Sir William Gullnamed the disorder anorexia hysterica, emphasizing what he believed to be its psychogenic origins (1868)
- later changed the name to “nervosa” to avoid confusion with hysteria
we know more about this eating disorder, historically speaking
1 or 2 per 1,000 for anorexia
- Prevalence is higher
- Chronic disorder
history of BN
first clinically described in 1979
- Historical accounts date to 1398, when “true boulimus” was described in an individual having an intense preoccupation with food and overeating at very short intervals, terminated by vomiting
1-1.5% of population
Maybe 1 or 2 per 100
Prevalence is low
- BN is more common than AN
types of Eds (including subtypes)
6 in total
2 subs
- Anorexia Nervosa
- Restricting Type
- Binge-Eating/Purging (Bulimic) Type
- Bulimia Nervosa
- Binge-Eating Disorder
- Avoidant/Restrictive Food Intake Disorder
- Other Specified Feeding or Eating Disorder
- Unspecified Feeding or Eating Disorder
DSM-5 diagnostic criteria for AN
- Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
- Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though underweight
- 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 bodyweight
SIMPLE TERMS:
Lower weight than is healthy/needed
Fearful of gaining weight
Misperceiving how you look
DSM-5 diagnostic criteria for BN
- Recurrent episodes of binge eating.
- A sense of lack of control over eating during the episode - Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other
SIMPLE TERMS:
- binge eating
- guilt
- purging
anorexia description
- Denies abnormal eating behavior
- Introverted
- Turns away food in order to cope
- Preoccupation with losing more and more weight
- Fairly rigid personality style
- Doesn’t talk about emotions easily
- Uncomfortable with pubertal changes
- Parents don’t talk about it much
bulimia description
- Recognized abnormal eating behavior
- Extroverted
- Turns to food in order to cope
- Preoccupation with attaining an “ideal” but often unrealistic weight
- Extroverted family
- Personality or substance use problems
- Weightward changes with the kid
Binge Eating Disorder
- Marked by distress regarding binge eating is present
- Binge eating occurs, on average, at least once a week for 3 months
- Not associated with BN or AN
- No purging
- Lots of shame and guilt
ARFID
Avoidant/Restrictive Food Intake Disorder
- Significant weight loss (or failure to achieve expected weight gain, or faltering growth in children)
- Significant nutritional deficiency
- Dependence on enteral feeding or oral nutritional supplements
- Marked interference with psychosocial
- Associated with autism, OCD, anxiety
- for kids
- Not common in adults
OSFED
Other Specified Feeding or Eating Disorder
- These disorders cause clinically significant distress or impairment but do not meet full criteria for any of the other ED. Examples include:
- Atypical AN (all criteria are met, except despite the significant weight loss, the individual’s weight is still within the normal range)
- BN of low frequency or duration (all criteria are met, except that the binge eating and compensatory behaviors occur less often than once a week and/or for less than 3 months)
2 subtypes of AN
- Restricting type:
fasting, introverted, decreased risk of substance abuse, family conflict is covert - Bulimic type:
binge eating or purging, more volatile, family frequently disengaged, prone to substance abuse
mortality rates with AN
Long-term follow-up studies of anorexics show death rates of over 10% after 10 years and 18-30% at 30 yr f/u – HIGHEST MORTALITY RATE rate in psychiatry
increased risks with BN
Substance use
Dangerous sexual behavior
Dangerous stealing
Criminal behavior
Shoplifting
etiology of Eating Disorders (psychosocial and biological)
- Early psychological theories proposed that anorexia represents a phobic avoidance to food and an association with the sexual tension is generated during puberty
- Biological theories focus on the role of the hypothalamus (the region concerned with the regulation of body functions, such as temperature, weight, appetite, & general homeostasis); support for this theory comes from neurotransmitter studies showing an increase in Corticotropin Releasing Factor (CRF or CRH) in the CSF of anorexic patients
- CRF is secreted by the hypothalamus in response to stress
eating disorders and genetics
Eating disorders are familial
The risk of AN among mothers and sisters of probands is estimated at 3% or about 6 times the rate among the general population
