Eating Disorders Flashcards
Historical Differences between AN and BN
AN: hysteria was changed to nervosa to avoid confusions; anorexia means “lack of appetite”; preoccupation with body weight and shape
BN: first clinically described in 1979; “true boulimus” means an individual having an intense preoccupation with food and over eating at very short intervals, terminated by vomiting; the word bulimia derives from Greek meaning “ravenous hunger”
DSM-5 Criteria
AN- Self-induced weight loss resulting in body weight less than 85% expected. Intense fear of gaining weight or becoming fat; fundamental disturbance in the way in which one perceives his or her body weight or shape; Endocrine changes resulting in amenorrhea and a lack of sexual interest, virulence, and potency in males
BN: recurrent episodes of binge eating; repeated compensatory behaviors in an effort to counteract weight gain, such as vomiting, misusing laxatives, diuretics, enemas, other medications, fasting, or excessive exercising (2x a week for 3 months); one’s self-evaluation is overly influenced by body weight and shape.
Subtypes of AN and BN
AN: 2 major subtypes:
Restricting Type: fasting, introverted, decreased risk of SUDS, family conflict is covert
Bulimic Type: binge eating or purging, more volatile, family frequently disengaged, prone to SUDS
One type of Bulimia
Anorexia vs. Bulimia
AN: denies abnormal eating behavior, introverted, turns away from food to cope, preoccupation with losing more and more weight.
BN: recognizes abnormal eating behavior; extroverted; turns to food in order to cope; preoccupation with attaining an “ideal” but often unrealistic weight.
Mortality rates with AN
50% of deaths due to complication of anorexia, 25% die by suicide, and 25% die of unrelated causes.
Long-tern follow-up studies of anorexics show death rates of over 10% after 10 years and 18-30% at 30 yr f/u
Increased Risks associated with BN
Increased risk of Depression, anxiety d/o, and personality d/o
30%–substance users
Etiology of Eating Disorders
Psychosocial
Phobic avoidance of food and association with sexual tensions generated during puberty.
Psychodynamic formulations–oral impregnation.
Social theories–importance of conforming to American beauty, ideals of youth, and slimness.
Modern psychological theories–avoidant of maturational challenges; antithesis of puberty. There is profound self-loathing.
Biological Theory
Role of hypothalamus (concerned with regulation of body functions)–increase in Corticotropic releasing factor in CSF, which is released with stress. This leads to reduction in food intake, feeding time/episodes. There is the occurrence of amenorrhea before weight loss–20%. Leptin (satiety hormone) are low. There is a decrease in sex hormones. Vomiting leads to increase in DA levels–reinforces/rewards the vomiting behavior.
c. Bulimia-connected to serotonin→ prozac works really well.
Familial transmission/ genetics
Eating disorders are familial.
Risk of AN among mother and sisters of probands is estimated at 3% or 6x the rate among the general population.
Twins–2.6 times more likely to have a diagnosis of BN. 90% for AN and 83% for BN.
Nearly all women in Western Society diet at some point in adolescence or young adulthood, yet few than 1% develop AN.
Comobidities
Anoretics face an increased risk of depression, anxiety disorder, and personality disorder.
Bulimics face an increased risk of depression, anxiety disorder,
Methods of Purging
Misuse of laxatives/diuretics
Self-induced vomiting
Exercises excessively
Health Consequences of AN and BN
Hypothermia Dependent edema Anemia Impaired renal function Bradycardia Hypotension Cardiac arrhythmias Lanugo Osteoporosis Brain atrophy Hormonal abnormalities Amenorrhea Lethargy Constipation
BN Calluses on dorsal surface of hands from vomiting Dental caries from corrosion Esophageal erosion Enlarged parotid glands Hypotension Hypokalemia Lanugo Hypocalcemia Hypochloridemia Electrolyte disturbances Metabolic alkalosis Serum transaminase- increase reflecting fatty degeneration of liver Lethargy Seizures
Risk Factors for BN and AN
BN: dieting, puberty, transitions, various jobs, anorexia, impulsivity, and anxiety.
AN: puberty, perfectionistic personality, family history affective, OCD, and anxiety disorder, impaired family interactions, stressful life events.
a. Genetics
b. Family history
c. Stressful adjustments
d. Prognostic indictors: supportive family, treatment, acute onset, younger age.
i. Poor: more than 5 years without getting treatment, lots of stressors, and transitions.
Prognostic Indicators
BN: younger age of onset, and higher social class
AN: age of onset is better because families can mandate treatment, bulimic/purging symptoms lead to a worse prognosis, chronicity of illness (.6 years with little treatment benefit), lowest weight achieved, repeated hospitalizations, and poor social functioning
Incidence/ Prevalence and chronicity
PR of anorexia is .4% and incidence is <.1%
a. Incidence- number of cases in time
b. Prevalence- total number of cases overall.
c. Low incidence but high prevalence= chronic.
Course and Outcome of Eating Disorders
Anorexia: those who improve may continue to display characteristics of the illness, such as distorted body image. Fewer than 25% have a good psychological outcome.
Poor outcome is generally associated with a longer duration of the illness, older age of onset, prior psych hospitalizations, poor premorbid adjustment, and comorbid personality disorder.
50% achieve normal weight by f/u and 10% are overweight
1/3 of anorexics have a normal diet on f/u; while, 1/2 avoid high-calorie foods, and up to 1/2 display bulimic behaviors.
Menstruation returns in about 40-90% but usually only after 90% ideal body weight returns.
Psychosocial impairment are typical at f/u, including educational, vocational, psychological, social, and sexual problems.
20-30% of restricting anorexics eventually develop binge eating within the first 5 years of onset.
Bulimia: prognosis is better than Anorexia; 50% recover, 25% improve but still suffer symptoms, and 25% remain chronically ill.
Mortality rate due to BN is 1-6% after many years of follow up
After 10 years 2/3 to 3/4 of bulimics are in at least partial recovery.
