Eating Disorders

Question 1

Primary Characteristic in Anorexia and Bulimia Nervosa

Answer 1

all-encompassing drive to be thin

Question 2

Bulimia Nervosa: Characteristics

Answer 2

eating a large amount of food in large volumes (binge eating, out of control eating)

Followed by: purging or non-purging techniques

Question 3

BN Subtypes

Answer 3

BNP: Bulimia Nervosa Purging Type
BNNP: Bulimia Nervosa Non-Purging Type

Question 4

DSM Criteria: Bulimia Nervosa

Answer 4

Binge eating and inappropriate compensatory behaviors (once a week, for 3 months)

binge eating is charactered by
1. eating more than most people in a distinct period of time
2. lack of control while overeating.

Question 5

Consequences of Bulimia Nervosa

Answer 5

Repeated vomiting:
1. salivary gland enlargement
2. erosion of dental enamel
3.calluses on fingers or back of hands from stimulating the gag reflex

Frequent purging can disturb ethical balance of bodily fluids leading to:
cardiac arrhythmia
kidney failure

Laxative purging leading to
constipation
permanent colon damage

Question 6

Psychological Comorbidity in BN

Answer 6

other mental health disorders, most commonly anxiety and mood-related disorders

Depression after onset of BN

Alcohol use

Borderline Personality Disorder and Non-Suicidal Self Injury

Question 7

Characteristics of Anorexia Nervosa (AN)

Answer 7

strong fear of gaining weight and lose control overeating
Intense drive for thinness

Question 8

Subtypes of AN

Answer 8

ANR: Anorexia Restricting Type
restricting caloric intake

ANBP: Anorexia Binge-Eating Purging Type
binging small amounts of food, purging every time

Question 9

Criteria for Anorexia Nervosa

Answer 9

significantly low weight, less than minimally normal, or for children, less than minimally expected

fear of gaining weight or becoming fat that interferes with weight gain even when at low weight

disturbance in body image or lack of recognition of serious of current low body weight

Question 10

Health Consequences of AN

Answer 10

“Significantly low weight” is required for DSM-5-TR but it is important to note many do not seek treatment until BMI reaches approx. 16 (“severely underweight”)
Cessation of menstruation (amenorrhea), however, this does not occur for everyone, so it was dropped from the DSM-5
Dry skin, brittle hair, fragile nails
Sensitivity and intolerance of cold temperatures
Velvety skin on limbs and cheeks (lanugo)
Cardiovascular problems (low blood pressure and heart rate)
Electrolyte imbalance (low sodium and potassium)
Kidney problems
Low BMI maintained for a long duration alongside drive to restrict eating even after no longer meeting DSM criteria for AN - making it difficult to improve prognosis

Question 11

Psychological Comorbidity in Anorexia Nervosa

Answer 11

anxiety and mood disorders
Bipolar disorder, alcohol use disorder

frequent comorbidity with OCD

Question 12

Characteristics of Binge Eating Disorder

Answer 12

marked distress from binge eating
no compensatory behaviors like purging

What distinguishes people with BED from those who are overweight without BED?
Share the same concerns about shape and weight as those with AN/BN
Experience distress from binge eating

Question 13

Criteria for Binge Eating Disorder

Answer 13

recurrent episodes of binge eating
eating a lot within a specific period of time
lack of self control over eating during the episode, can’t stop won’t stop even when full, go fast fast fast

Question 14

Men are prone to what type of Eating Disorder

Answer 14

Binge Eating disorder

more so if they are gay or bisexual, even more so if they are an athlete in a sport that require weight regulation

Question 15

Women are prone to what type of Eating Disorder

Answer 15

AN + BN

BN very prevalent in sexual/gender minority groups

Question 16

Cross Cultural Considerations of Eating Disorders

Answer 16

white people
immigrants moving into western culture, risk of developing ED

Question 17

Risk Factors associated with ED, regardless of group

Answer 17

being overweight
higher social class
acculturating to western majority
Western: very body focused
other cultures less so, more face focused

Question 18

Social Causes of EDs

Answer 18

Modern Society emphasis on standards of body size seen in:
fashion styles and clothing brands
media glorifying slender bodies

Diet and Exercise culture increase
(while most people who diet don’t get ED, they are at higher risk of ED)

Question 19

Biological Factors of ED

Answer 19

being related to someone with ED = 4-5x more likely

inheritability of personality traits that are driving factors for ED
(emotional instability, poor impulse control)

low levels of serotonergic activity

Excessive exercise

Question 20

Psychological Factors in ED

Answer 20

diminished sense of personal control and self confidence

perfectionism attitudes reflected by attempts to exert control over important events in their lives
(not just perfectionism, there is week association, individual needs to think of themselves as overweight and have low self-esteem for perfectionism to play a role)

Inability to tolerate negative emotion
(binge eating to cope, leading to ED)

Question 21

Drug Treatments for EDs

Answer 21

not really effective for anorexia
mixed research support use of medication for BNP

Effectiveness is determined by a reduction in the frequency of binge eating and percentage of individuals who stop the binge-purge cycle

Antidepressants reduces purging cycles by around more than 50% (47-65%)
should be used along side psychosocial interventions

SSRIs for bulimia

Question 22

Psychosocial Treatments for EDs

Answer 22

short term CBT: targeting eating behavior and attitudes of body weight and shape

CBT-Enhanced:
focus is on transdiagnostic factors common to all EDs

semi-starvation and health-related concerns can interfere with treatment

Question 23

Psychosocial Treatments for BN

Answer 23

CBT Enhanced
teach purging bad
schedule smaller amounts of food throughout the day with minimum 3 hour intervals between meals and snacks
alter thoughts and attitudes on body shape, weight and eating
promote coping strategies to resist binge or purge

positive reductions in purging (79%) and complete cessation for 57%

family therapy good for promoting support at home

Question 24

Psychosocial Treatments for AN

Answer 24

focus on restoring weight to a point that is normal
usually difficult but also easiest part of the treatment
85% will be able to regain weight
patient unable to leave hospital until they regain their weight (big motivator)

CBT enhanced most effective
focus on marked anxiety over becoming obese and losing control of eating

Family-focused treatments can also be beneficial to address negative or ineffective communication about food or eating, to address shared views about body shape or image amongst the family, and to provide psychoeducation to multiple members in the home.

The general conclusion is that regardless of the treatment type, individuals receiving psychosocial interventions experience similar improvement in their ED symptoms.

Question 25

Psychosocial Treatments for BED

Answer 25

CBT treatments adapted from BN, works for BED

Behavioral weight-loss programs for patients with BED, such as Weight Watchers, do have some positive effect on binging but not nearly so much as CBT.
Self-help is often the first treatment offered for BED before engaging in more expensive and time-consuming therapist-led treatments.
Must consider individual factors (e.g., personal preference, accessibility, and mental health comorbidity).
CBT delivered as guided self-help was demonstrated to be more effective than a standard behavioral weight-loss program for BED.

Question 26

How to prevent eating disorders

Answer 26

Research suggests good starting points may be to focus on body shape or weight stigma by encouraging acceptance of one’s body.
Programs in adolescence that counter the effects of the media portrayals of the desirability to be thin, self-esteem enhancement, stress management, and peer relationship skills.

Question 27

Eating Disorders in Men

Answer 27

Global prevalence of eating disorders has been estimated at 2.2% for men.
Anorexia = 0.3%, Bulimia = more than 1%.

Muscular ideals encompasses a drive for muscularity and being lean.
Increased motivation to pursue rigid eating or exercise routines.
Appearance enhancing or performance drugs (anabolic steroids).
Often report “bulking and cutting.”
Muscle dysmorphia involves the perception that one’s body is lean and small, despite being large and muscular.

Risk factors for EDs in boys and men:
Identifying as gay, bisexual, asexual, transgender, or questioning.
Previous lived experience with obesity or dieting.
Professional sports or training with focus on fitness, body shape.
Obsessive or compulsive exercise.
Past experiences of bullying, adverse childhood experiences, trauma.
Comorbidity (e.g., alcohol use disorder, diagnosis with chronic illness).

Question 28

What is Pica

Answer 28

eating non-foods (grass, paper)
Stuff we do as children

Question 29

What the fuck is Rumination Disorder

Answer 29

eat
regurgitate
eat/swallow/spit

Question 30

Avoidant/Restrictive Food Intake Disorder

Answer 30

Eating disturbance, either from lack of interest, or avoid cuz it’s yucky, or concern about consequences of eating

failing to get enough nutrition and energy

significant weight loss, nutrition deficiency, dependence on supplements, marked interference with psychosocial functioning

Question 31

Other specified feeding and eating disorders

Answer 31

eating disorder that causes clinical distress, however they do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.

Atypical Anorexia Nervosa:
all of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.

Bulimia Nervosa (of low frequency and/or limited duration):
all of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.

Binge-eating disorder (of low frequency and/or limited duration):
all of the criteria for binge-eating disorder are met, except that the binge occurs, on average, less than once a week and/or for less than 3 months.

Purging disorder:
recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating.

Night eating syndrome:
Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness of recall of the eating. The night eating causes significant distress and/or impairment in functioning.