Eating Disorders Flashcards
On Exam 3 (Apr. 22)
In addition to anorexia nervosa (AN) and bulimia nervosa (BN), what additional diagnostic categories were added in the DSM-V and why?
Binge eating disorder (BED) and Other Specified Feeding or Eating Disorder (OSFED)
Prior to this, more than half of the individuals presenting with eating concerns failed to meet criteria for AN or BN
What are the core problem behaviors of eating disorders?
A) restrictive eating
B) binge eating
C) compensatory behaviors
What cognitive features may accompany the core problem behaviors of eating disorders?
Concern about weight/shape, excessive fear of weight gain, feeling “fat” despite being a normal weight, maladaptive beliefs about eating, exercise, and weight
What are the central tenets of Fairburn’s transdiagnostic theory of eating disorders?
What do they value? What does it account for?
Overvaluation of eating, shape, and weight and their control
Accounts for the variations in eating symptomatology across the disorders
What is the primary symptom that distinguishes individuals diagnosed with AN from those diagnosed with BN or binge eating disorder (BED)?
Restriction of food intake leads to a significantly low weight that is less than minimally normal or expected
What are the other symptoms of AN?
Fear of gaining weight or becoming fat
Body-image disturbance, overconcern with weight, or lack of recognition of medical seriousness of low weight
Unwavering behavioral refusal to obtain or maintain a weight acceptable for height, age, gender, and health
Although restrictive behaviors can take many forms, which one is seen as most prominent in AN and what are some examples?
Intentional dieting that results in an unhealthy low weight
Examples may include: counting calories, spending hours planning meals, making a list of “permissible” foods, drinking too little or too much water, compulsive exercise, purging or laxative abuse
Patients with AN tend to overestimate their body size relative to their true body size. From what process is this likely the result and how is this relevant to treatment avoidance?
Results from a persistent overfocus on the body or specific parts of the body in an attempt to assess whether efforts to lose weight have succeeded
This hyperfocus on the body leads to misperceptions and denial of the seriousness of malnutrition, which is a major cause of treatment avoidance
What are some of the physical consequences of malnutrition?
Cold extremities, dry skin, hair loss, irregular menstruation (or none at all), osteoporosis (weak/brittle bones), slow growth in kids, weakening of cardiac muscles, brain shrinkage
On what critical symptom does the diagnosis of BN center?
Presence of recurrent objective binge episodes (OBEs), in which a person eats more than most others would in a similar situation and in a discrete period of time, often associated with a feeling of losing control
OBEs are then followed by compensatory behaviors such as vomiting, laxative use, fasting, or excessive exercise in an attempt to minimize the impact of the binge
What is the difference between an objective binge episode and a subjective binge episode?
Objective: overeating (3x the typical portion size) with or without loss of control
Subjective: feeling a loss of control, but a normal or small portion of food was consumed
When are binges most likely to occur and what are some common triggers for a binge?
When the individual is alone (evenings are high-risk times)
Triggers: +/- emotions, lapses in self-awareness, interpersonal difficulties, presence of tempting food, feeling that a dieting rule has been broken, body-image dissatisfaction, skipping meals, and/or getting extremely hungry
What are some physical consequences of continued binging/purging?
Fluid/electrolyte abnormalities, GI problems, menstrual irregularities, thyroid dysfunction, constipation, loss of normal colon control, dental problems, and/or scarring on the tops of hands from repeatedly inducing vomiting (Russell’s sign)
What differentiates BED from BN?
Those with BED still have OBEs, but do not partake in compensatory behaviors afterward (i.e. dieting or exercising that may occur is not excessive)
They also don’t require the display of overconcern with weight that’s needed to diagnose BN
What is interoceptive awareness and what does it have to do with eating disorders?
Interoceptive awareness is the ability to identify internal sensations
An inability to identify internal states such as appetite, hunger, and/or satiety predicts the onset of disordered eating
What factors may associate with a person’s adoption of the “thin ideal”?
What does it lead to?
Internalization of the thin ideal or feeling pressured by society to be thin is more closely related to eating pathology and body dissatisfaction (not simply the degree of media exposure)
This ideal may also be transferred via family environments
The family environment may foster eating disorders in that they fail to teach appropriate behaviors around eating; what other characteristics are common in families of eating-disordered patients?
Negative family environments (such as being chaotic, uncaring, and less expressive or cohesive) may be correlated with weight-related teasing, critical comments, or pressure to be thin
Other family risk factors: parental obesity, eating patterns, and modeling of restrictive eating
What do genetic studies indicate with respect to genetic influences on eating disorders and gender differences?
What does this finding suggest about the particular biological factors that might be implicated in the development of eating disorders in girls?
Girls: genetic influence on the development of eating disorders doesn’t manifest until during puberty
Boys: genetic effects remain the same before, during, and after puberty
Increases in genetic influences during puberty may be specific to girls because of ovarian hormones
What does “significantly low” weight mean in AN?
Less than minimally normal AND it must be the result of purposeful restriction of calories to be considered AN
What are the subtypes of AN?
Restricting: no binging or purging (weight loss accomplished through dieting, fasting, and excessive exercise)
Binge-purging: primary goal is weight loss through dieting, but these states of deprivation “get out of control” and lead to binge eating and purging
How often do binge-purge episodes occur in BN?
At least once a week for 3 months on average
What is the “thin ideal”? What does it have to do with EDs?
An obsession with thinness in a society where food is abundant
Leads to body dissatisfaction and behaviors aimed at achieving the ideal, even if maladaptive (the person begins to attach their personal value to adherence to these standards)
How is the “thin ideal” perpetuated?
Comments and actions like criticism, diet culture, glorification of slender body types, photo editing, etc.
This communicates social values
What is the problem with the theory that the thin ideal leads to body dissatisfaction?
Some people may be satisfied with their bodies even if they don’t fit the thin ideal, and others may be dissatisfied even if they fit the ideal
Not everybody with dissatisfaction develops an ED
