Eating Disorders Flashcards
DSM-IV ED Diagnoses
- anorexia nervosa
- bulimia nervosa, more common than the former, less than EDNOS
- EDNOS (other not-specified)
Solution to Problems of Classifying Eating Disorders in DSM-IV
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
DSM-IV Definition of Anorexia Nervosa
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
Which Criteria Remained for DSM-5 Anorexia Nervosa
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
DSM-5 Differences to Anorexia
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
Comorbidity and Mortality in Anorexia
- One of the most severe
- Highest mortality rate, around 20%
- High comorbidity with depression, risk of suicide
DSM-IV Bulimia Nervosa
- 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
DSM-IV Subtypes of Bulimia Nervosa
Purging
- Expelling stuff from body
Nonpurging
- Compensating without expelling
Which Criteria Remained for Bulimia Nervosa in the DSM-5
Size of binge?
- Large binges have a more severe condition
Frequency of binge?
- Not so much
Differences in DSM-5 Bulimia Nervosa
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)
DSM-5 Binge Eating Disorder
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
Types of Prevalence Statistics
- Point prevalence (at any given point)
- Lifetime prevalence
- Incidence (new cases)
OSFED (Other Specified Feeding and Eating Disorders)
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
Purging Disorder
Not dependent on the amount of food taken, could be minimal food still causing throw up
Night Eating Syndrome
75% of their calories after the evening meal
Causes of Eating Disorders
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
Tripartite Influence Model
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
Eating Disorders and Gender Differences
Men less likely to develop EDs overall
- But presentation is similar to women
Muscle dysmorphia
- Extreme drive to bulk up
Eating Disorders and Cultural Factors
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
Eating Disorders and Psychological Factors
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
Eating Disorders and Genetic Risk Factors
- 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
Eating Disorders and Neuroendocrine Dysfunction Risk Factors
- Hunger controlled by hypothalamus
- Low levels of serotonin linked to impulsivity and binge eating
- Abnormalities might be caused by starvation/binge-purge
Biological Treatment of Eating Disorders
- 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
CBT for Bulimia Nervosa
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
IPT for Bulimia Nervosa
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
Effectiveness of CBT and IPT in treating Bulimia Nervosa
60% recovered posttreatment to 6 years (CBT), IPT worked more rapidly, but years after, results are similar
Maudsley Approach to Family Based Therapy in Treating for Anorexia Nervosa
- 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)
CBT for Anorexia Nervosa
- Longer treatment
- Less effective in AN
- ⅓ of patients recover
