Eating Disorders Flashcards
Where in HiTOP model?
Internalizing
-Eating Pathology
Key symptoms
Binge Eating
- Consuming an objectively large
amount of food
- In a discrete (short) period of time
- With a feeling of loss of contro
Compensatory Behaviors:
mainly to relieve emotions, don’t actually undo the effects of eating (even if think so)
*Purging
-Physically removes food
– Vomiting
– Laxatives
– Diuretics
*Non-Purging
- Counteract the ingestion of
food indirectly
– Restriction
– Compensatory exercise
Weight/ Shape Concern
*A relationship with one’s
weight/ shape characterized by:
-Body dissatisfaction
-Preoccupation with weight/
shape
-Over-valuation of weight/ shape
*Weight/ and or shape play an
excessively important role in
determining self-worth
DSM Diagnoses (Categorical Approach)
Anorexia Nervosa (AN)
*A term introduced in 1873 by Sir William Gull
*Anorexia means absence of appetite
*Anorexia Nervosa is the dx
*Cases/ phenomena have been described for centuries
Bulimia Nervosa (BN)
*More recent; 1979 (Gerald Russell)
*Descriptions of binge-eating go back further
Nervosa = anxious
Binge Eating Disorder (BED)
Anorexia Nervosa
Anorexia Nervosa (AN)
*Core features:
*Weight (usually, BMI < 17.5)
-BMI = Body mass index (ratio of weight to height)… very flawed
*Dietary restrictions
*Typically present: body
dissatisfaction, weight concerns,
undue influence of weight/
shape on self-esteem
*Sometimes present: binge
eating, purging, excessive
exercise
Not looking at if subjectively distressed
Anorexia subtypes:
Restrictive only or binge-purge subtypes
Atypical anorexia (newer category): All the behaviours but not abnormally low BMI
Men less likely to be diagnosed with anorexia because bmi very flawed
Don’t necessarily believe they need to eat more
Think others are the problem
Cognitive distortions
Often involuntary hospitalization
Force-fed
“You are not anorexia”
Starving = more cognitive problems… leads to more cognitive distortions
Bulimia Nervosa (BN)
Core features:
*Binge eating
*Compensatory behaviors
*Undue influence of weight/
shape on self-esteem
Typically present: body
dissatisfaction, weight concerns,
dietary restrictions
*Significant distress or
impairment?
-Not looking at if subjectively distressed
At least once a week for 3 months
Not necessarily purging, can also be restriction
Can be more normal weight
Binge Eating Disorder (BED)
Core features:
*Binge eating
* (absence of compensatory
behaviors)
Sometimes present: body
dissatisfaction, weight concerns,
dietary restrictions
*MUST have significant distress (unlike AN and BN)
(see graph of differences between AN, BN and BED)
Residual diagnostic categories
- Avoidant/ restrictive food intake disorder (ARFID):
-Not explained by lack of food in culture
-Usually unrelated to shape or weight concerns
-Often in kids
-Often childhood and infancy
-More common than anorexia
-More prevalent in boys
Other Specified Feeding and Eating Disorder (OSFED):
* Subthreshold AN, BN, BED
* Atypical AN
* Purging Disorder
* Night Eating Syndrome
- Unspecified Feeding and Eating Disorder (USFED)
30-50% of treatment-seeking individuals
OSFED/USFED
Diagnostic Migration
Likely to meet criteria for another disorder at another point in time
(see the details in graph)
Bulimia, binge eating= more externalizing
Anorexia nervosa = more internalizing
But lots of diagnostic migrations? (going from one disorder to another)
SO what does that say about categorical conceptualizations?
Epidemiology
Ex: women in Montréal, 1501 women randomly recruited
4.1% frequent binge eating
8.7% frequent compensatory behaviours
1.1% regular purging behaviours
0%AN, 0.6%BN, 2.8%BED, 0.6%purging disorder, 14.9% residual OSEFED-type category
Prevalence
AN: 0.7%
BN: 1-3%
BED: 2-5%
Gender ratio
AN: 10 women: 1 man
BN: 10 women: 1 man
BED: 2 women: 1 man
Age of onset
AN: late adolescence
BN: late adolescence-early adulthood
BED: early-mid adulthood
Mortality
AN: 5.1%
BN: 1.7%
BED: more research needed
Causes of death: Malnourishment
but also suicide
Stereotype: Skinny White Affluent Girls (SWAG)
* Underweight = < 6% of ED population
* Males = 25% of ED population
* Sexual and gender minorities have higher ED prevalence
* Ethnic minority populations have high rates of EDs
- Multiracial individuals + Indigenous have highestrates of EDs
* No relationship between high SES and EDs
- But there is an association with food insecurity
So SWAG simply not true
Differential Diagnosis
* Body Dysmorphic Disorder
* Obsessive Compulsive Disorder
* Anxiety disorders (esp. SAD, GAD)
* Depression
* Psychosis-spectrum disorders
Some effects of malnutrition:
* Low mood
* Anhedonia
* Insomnia
* Preoccupation and rituals related to food
Comorbidities
*Extensive
- Mood, substance, PDs, anxiety
*Depression
- AN: 25-50% concurrent Depression
- AN: 50-70% lifetime hx Depression
- BN: even higher
*PDs also common
* 50-70%
- Restricting AN- Cluster C
- AN-BP- both B and C
- BN– cluster B
Etiology: Heritability
*AN, BN, BED: mean ~50%
*Disordered eating symptoms:
~50%
*Increased familial risk
-e.g., AN: Family members have
4x the risk
*Heritability not static over
development
-0% genetic contribution before
puberty
- ~50% emerges after puberty
- Ovarian hormones?
Gene X Environment Interactions
*Short allele of 5-HTTLPR
*Parenting style
-Short allele interacts with
parenting style: Control/intrusive, critical, underinvolved
*Abuse history
-> AN, BN symptoms, drive for thinness
Etiology: Sociocultural factors
Appearance ideals across time
Men often present differently
Muscle dysphoria
Exercise as compensatory behaviour
Men often go undetected, screeners made for women
*Fat talk – Self, Family, Peers
-Fat talk directed to child associated with eating disorders
- Examination of frequency of parental “ fat talk” (toward the self, the
child, and others)
- Associations between parental “fat talk” and child eating behaviours
Family:
*Parental “fat talk” directed toward:
-Self: 74%
-Others: 51.5%
-Child: 43.6 %
*Toward the self: Associated with parental pathology
*Toward the child: Associated with child pathology
Peers:
* Teasing someone
about their
weight
* The idea that it is
ok to do so
* Implying that weight is
tied to character (lazy,
undisciplined, etc.)
Teasing linked with thoughts of suicide (see graphs)
Media:
Fiji Study
*In 1995 : No television, no EDs
*In 1998 : 11.3% adolescent girls report at least 1 purging behaviour; 74% feel « too fat»
*In 2007 : 45% report at least 1 purging behaviour in the
past month
*But natural experiment, no random assignment. Still, this is persuasive temporal evidence
*Introduction to Western body ideals associated with rise of Eds
Dual Pathway Model:
Never just a single pathway
Ex: sociocultural pressures + thin-ideal internalization leads to body dissatisfaction which can lead to a negative affect and restrained eating which can lead to eating disorders
Etiology: Psychological factors
Abstinence violation effect,
or the “f*ck it” effect:
Start diet and restrict food… feelings of hunger… eat “forbidden” foods… overeat since already “broke” diet (“Already ruined, so might as well go all out”)… feel guilty and fat… (starts over again)
-Differences between lapse, relapse, collapse
Maintenance factors:
Maintenance factors are risk factors and lead to worse course and maintain the illness
*Perfectionism
-High standards, fear of failure, self-criticism
*Low self-esteem
-Omnipresent and unconditional, treatment obstacle
–Omnipresent and Unconditional = feel bad about everything, not just your weight
*Emotion regulation
-Negative mood intolerable, binge trigger
–Negative urgency (need to act to stop bad feeling)
*Interpersonal difficulties
-Isolation, negative interactions precede binges
–Withdraw even further from social interactions because often revolve around food (eating out)
