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Assessment, Personality and Psychopathology > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

DSM-IV ED Diagnoses

A
  • anorexia nervosa
  • bulimia nervosa, more common than the former, less than EDNOS
  • EDNOS (other not-specified)
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2
Q

Solution to Problems of Classifying Eating Disorders in DSM-IV

A

Change existing diagnostic criteria

  • Relax criteria for existing disorders so that EDNOS population would constitute as being in those categories
  • Finding specific symptoms and making a new classification
  • Binge Eating Disorder for example
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3
Q

DSM-IV Definition of Anorexia Nervosa

A

Refusal to maintain minimally normal body weight

  • Doesn’t say how this may occur
  • Minimally normal body weight also wasn’t specified
  • Below 85% of the expected weight, BMI of 17.5 (arbitrary choice)
  • Intense fear of becoming fat
  • Disturbance of body perception, affective component, i feel instead i see myself as
  • Amenorrhea

Subtypes:

  • Restricting type
  • Binge-eating/purging type
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4
Q

Which Criteria Remained for DSM-5 Anorexia Nervosa

A

Weight criteria?

  • Variability in how people defined the weight parameters
  • The specific weight didn’t seem to play a role in how well they were
  • Don’t keep

Fear of fat?

  • Cultural differences
  • Keep

Amenorrhea?

  • Only applicable to women
  • Physiological byproduct of being at a low weight
  • Don’t keep
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5
Q

DSM-5 Differences to Anorexia

A

Weight criteria?

  • Variability in how people defined the weight parameters
  • The specific weight didn’t seem to play a role in how well they were
    Dont keep

Fear of fat?
- Consider cultural differences

  • More generally though, keep

Amenorrhea (absence of menstruation)?

  • Only applicable to women
  • Physiological byproduct of being at a low weight
  • Therefore, don’t keep
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6
Q

Comorbidity and Mortality in Anorexia

A
  • One of the most severe
  • Highest mortality rate, around 20%
  • High comorbidity with depression, risk of suicide
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7
Q

DSM-IV Bulimia Nervosa

A
  • Binge eating
  • Large amount in discrete period of time, in comparison to expected amount
  • Lack of control over eating (if there was control then it would be over eating, if there was some control but not a lot it would be a subjective binge)
  • Inappropriate compensatory behaviours, not always about self-induced vomiting
  • Binge and compensatory behaviours 2x per week for 3 months
  • Self-evaluation influenced by weight/shape
  • Framed differently than anorexia
  • Does not occur exclusively during episodes of AN
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8
Q

DSM-IV Subtypes of Bulimia Nervosa

A

Purging

  • Expelling stuff from body

Nonpurging

  • Compensating without expelling
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9
Q

Which Criteria Remained for Bulimia Nervosa in the DSM-5

A

Size of binge?

  • Large binges have a more severe condition

Frequency of binge?

  • Not so much
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10
Q

Differences in DSM-5 Bulimia Nervosa

A

Kept binge eating, and the lack of control over eating, compensatory behaviours

from minimum of 2x per week to 1x per week, introduction of a severity indicator, the frequency is less important

size of binge is now considered (larger binges indicate a more severe condition)

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11
Q

DSM-5 Binge Eating Disorder

A

Binge episodes

  • Eating large amount in discrete period
  • Experience a lack of control over eating

Binge eating associated with

  • Eating much more rapidly than normal
  • Eating until uncomfortably full
  • Eating large amounts of food when not hungry
  • Eating alone because of embarrassment
  • Feeling disgusted, depressed or guilty after eating

Distress about binge eating, binge eating 1x per week for 3 months, binge eating not associated with compensatory behaviours

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12
Q

Types of Prevalence Statistics

A
  • Point prevalence (at any given point)
  • Lifetime prevalence
  • Incidence (new cases)
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13
Q

OSFED (Other Specified Feeding and Eating Disorders)

A

Do not meet criteria for any specific Eating Disorder

  • Do not meet full criteria for AN, BN. or BED

Includes Purging Disorder, Night Eating Syndrome, Avoidant and Restrictive Food Intake Disorder

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14
Q

Purging Disorder

A

Not dependent on the amount of food taken, could be minimal food still causing throw up

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15
Q

Night Eating Syndrome

A

75% of their calories after the evening meal

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16
Q

Causes of Eating Disorders

A

Social factors

  • Expectation of thinness
  • Idea that there is little effort required for “ideal body”

Social comparison

  • Upward comparison
  • Downward comparison

media

peer influences

  • Social group encourages a particular body type
  • Teasing based on weight

family pressure

  • Mothers’ (or parents) own weight concerns
  • Comments about weight
17
Q

Tripartite Influence Model

A

https://www.google.com/search?sca_esv=ecacba330ca1712d&rlz=1C1UEAD_enAU1083AU1083&sxsrf=ADLYWIKE-9Oq2n95iTl8A7UWRFpxCy71vA:1732417820273&q=tripartite+influence+model&udm=2&fbs=AEQNm0Aa4sjWe7Rqy32pFwRj0UkWd8nbOJfsBGGB5IQQO6L3J7pRxUp2pI1mXV9fBsfh39Jw_Y7pXPv6W9UjIXzt09-Y-RVsUQytO3H9U9unQ4zjSmyc1am7RU9IOaZeZLN-vxqOLRVgtOkNIBInceOOInHD1Vy8A8dMZkK6qsEDDgBo37uamqwPID1ktpoxri6hURFY-RftoYl5J3cAxl4SOYvmGkrX6Q&sa=X&sqi=2&ved=2ahUKEwiyo56m__OJAxUjTGwGHRRLId8QtKgLegQIDhAB&biw=1039&bih=495&dpr=1.35#vhid=lmz774TECybjYM&vssid=mosaic

18
Q

Eating Disorders and Gender Differences

A

Men less likely to develop EDs overall

  • But presentation is similar to women

Muscle dysmorphia

  • Extreme drive to bulk up
19
Q

Eating Disorders and Cultural Factors

A

African americans, hispanic americans

  • Less likely to internalise thin-ideal body

Chinese cultures

  • Non-fat-phobic AN

Developing nations

  • Emphasis on larger body size
  • Same idea in western cultures, but flipped on its head
20
Q

Eating Disorders and Psychological Factors

A

Problem related to the “self”

  • Low self-esteem
  • Unstable identity

Perfectionism

  • May be an attempt to exert control in an uncontrollable environment

Difficulty tolerating negative emotion

  • Escape theory - temporary relief
21
Q

Eating Disorders and Genetic Risk Factors

A
  • Relatives of ED patients 5x higher risk

Hard to separate family influence from genetic influence specifically

  • But MZ twins have higher concordance than DZ twins
  • What’s being inherited is less clear, might inherit perfectionism, affective instability
22
Q

Eating Disorders and Neuroendocrine Dysfunction Risk Factors

A
  • Hunger controlled by hypothalamus
  • Low levels of serotonin linked to impulsivity and binge eating
  • Abnormalities might be caused by starvation/binge-purge
23
Q

Biological Treatment of Eating Disorders

A
  • Not greatly successful alone

SSRIs for bulimia

  • Depression comorbidity
  • Low levels of SSRIs that are too low to treat depression still helps binge eating component, suggesting that it does play a role in the ED itself

Less clear for anorexia

  • Used atypical antipsychotics for some time
  • Thought process was that some of the symptoms were distorted from reality
  • Side effect, that they promote weight gain
  • Not popular recently
24
Q

CBT for Bulimia Nervosa

A

Spread out over 20 weeks, 4 or 5 months of treatment

  • Early stages (twice a week), middle (once a week), later (less frequent)

Stage 1

  • Present CB model to the patient
  • Work on it collaboratively
  • Behavioural strategies to stabilise eating
  • E.g 3 meals, 2 snacks

Stage 2

  • Eliminate dieting (fears around eating specific foods)
  • Strategies to modify cognitions, attitudes, and beliefs

Stage 3

  • Maintenance and relapse prevention
25
Q

IPT for Bulimia Nervosa

A

Manualised treatment: this is what each session looks like

  • Focus on interpersonal relationships

Focal areas

  • Interpersonal disputes (an active conflict)
  • Role transition
  • Grief (over a dead human)
  • Interpersonal deficits
  • No focus on eating disorder symptoms
26
Q

Effectiveness of CBT and IPT in treating Bulimia Nervosa

A

60% recovered posttreatment to 6 years (CBT), IPT worked more rapidly, but years after, results are similar

27
Q

Maudsley Approach to Family Based Therapy in Treating for Anorexia Nervosa

A
  • the first goal is weight restoration
  • 15-20 sessions over a year

Outpatient treatment with parents in key role (parental coaching)

  • Phase 1: restore weight (at home)
  • Phase 2: give control of eating back to child
  • Phase 3: establishing healthy adolescent identity (away from stunted socioemotional development)
28
Q

CBT for Anorexia Nervosa

A
  • Longer treatment
  • Less effective in AN
  • ⅓ of patients recover

Assessment, Personality and Psychopathology (18 decks)

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