1. Binge Eating Disorder (BED)

Primary Characteristics: Frequent episodes of binge eating Sense of lack of control over eating No behaviours to prevent weight gain

Suicide 2nd most common cause of death Suicide risk 18x more than same age women in population Highest when no longer “low enough” weight(like in depression when u start to get better is when they are more likely to try it Highest when older at first intervention(time to develop the illness

Eating disorders Flashcards by maria posvolsky

Most Common Eating Disorders (EDs)

Binge Eating Disorder (BED)
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)

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Binge Eating Disorder (BED)

Primary Characteristics:

Frequent episodes of binge eating
Sense of lack of control over eating
No behaviours to prevent weight gain

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Associated Behaviours

Eating for emotional comfort

Agitation(anger) during binges

Dissociate or distract during binge

Self-disgust, guilt, or depression after binge

Typically overweight/obese

Guilt-induced dieting

Intense cravings for certain foods

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Most Common Restrictive/Purging

Anorexia Nervosa
Bulimia Nervosa

Both:
* Intense, pathological fear of becoming overweight
* Pursuit of thinness (relentless, sometimes deadly)

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Anorexia Nervosa (AN)

has to do with too much control (not eating even in extreme cases)

Fear of gaining weight
Refusal to maintain normal weight
Distorted view of self/role of body in self-worth

Types
* Restricting
* Binge-eating/purging

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Associated Problems

Dietary restrictions

Eating rituals

Hoarding, concealing, discarding food

Preoccupation with food

Efforts to conceal weight loss(teachers,couches,professors that might stop)

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Medical Complications

Death
* Highest rate of death
* 10% die within 10 years of onset
* Heart arrhythmia, suicide

even when trying to get better

Kidney damage

Renal failure

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Suicide

Suicide 2nd most common cause of death

Suicide risk

18x more than same age women in population
Highest when no longer “low enough” weight(like in depression when u start to get better is when they are more likely to try it
Highest when older at first intervention(time to develop the illness

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Outcome: Prospective Study

84 patients (21 years after treatment):
* 51% fully recovered
* 21% partially recovered
* 10% still met full criteria
* 16% deceased (medical complications/suicide)

Findings:
* Relapse can still occur after recovery
* Lower BMI & less social support > poorer prognosis
* Poorer prognosis > less likely to seek treatment

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Bulimia Nervosa (BN)

more to do with lack of control (being eating)

Primary Characteristics
* Frequent episodes of binge eating
* Lack of control over eating
* Recurrent behaviour to prevent weight gain(usually normal weight)
* Distorted view of self/role of body in self-worth

Types
* Purging
* Nonpurging

anoraxia is more dedly then bulimia

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Bulimia Nervosa

Restricted eating motivated by
desire to be thin > Binging or eating
restricted foods > Vomiting, excessive
exercise, laxative use > restricted eating (again)

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Bulimia: Associated Behaviours

Preoccupation with food and/or weight

Severe self-criticism

Dietary restriction in public

Frequent bathroom visits after meals

Impulsivity
(alcohol, decisions, spending, relationships) - more impulsive then anorexia

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Medical Complications

Electrolyte imbalances

Hypokalemia (low potassium)

Damage to heart, hands, throat, teeth

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Course and Outcome

Often continued food issues after recovery

Better prognosis than anorexia(more likely to recover and less of death )

Suicide attempts 25-30% of patients
(not higher completed suicides)

70% in remission after 11-12 years

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+++Comparisons

Anorexia nervosa (binge /purge) vs Bulima

differences:
* (anorexia) low body weight/ (bulimia) averge weight
* (anorexia)distorted perception of body image / (bulimia) high concerned with body weight

similarities
* fear of weight gain
* beinge eating
* purging
* other non purging methods to avoid weight
* feeling lack of control over eating

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Age of Onset

Anorexia nervosa (ages 16-20)

Bulimia nervosa (ages 21-24)

Binge eating disorder (ages 30-50)

Body Image Dissatisfaction

Most critical element in AN & BN

Sociocultural factors:

Awareness of the thin ideal in the media

Internalization of thin ideal

Perceived pressure to be thin

Gender

Women > men 3:1

Body dissatisfaction

Men
 more muscular
 overexercise

Women
 thinner
 restricted eating

Sexual Orientation

Gay men report higher…
* Dieting frequency
* Fear of becoming fat
* Body dissatisfaction
* Belief potential partner prefers thinner than oneself

Lesbian adolescents report…
Lower body dissatisfaction
Less internalization of the thin ideal

Prevalence: Canada

canada 1 year prevelence eds (more then 15)
* eds were more prevelent in women then man

liftime prevelence(US)

anorexia
* more in women
* less prevelent then other eating disorders

bulimia
* more in women
* second bigest eating disorder

being eating disorder
* more women
* number 1 eating disorder both worldwide and the us also the biggest in man

US tends to have more then worldwide prevelence in eating disorder

Ethnicity

Attitudes > EDs
* Asian & Caucasian > African

Culture variations in focus
* Stomach bloating, ideals of self-control
* Not “fatness”

Culture-bound (Western ideals)
* Bulimia
* NOT anorexia

Diagnostic Crossover

Anorexia (R) ↔ Anorexia (B-P)

Anorexia (B-P) → Bulimia
Infrequently Bulimia → Anorexia (B-P)

Bulimia ↔ Binge Eating Disorder
Most often Binge Eating Disorder → Bulimia

Comorbidity: EDs

Depression

OCD

Substance abuse disorders

Personality disorders
-anxious avoidant disorder(anorexia and bulimia)
-cluster B like borderline disorders

Etiology: Bio

Hereditary
* Genes (which?)
* Family studies & twin studies suggest high heritability (AN, BN)
* **Body dissatisfaction & strong desire for is inhereted **

Brain abnormalities
* Frontal and temporal cortex dysfunction
-Temporal cortex – body image perception
* Hypothalamus? Lesions > lack of appetite (animals)

Etiology: Bio

**Set-point theory** * Bodies resist change * might explain body's desire to keep the body as it previously was * (like a weight when u were 10 now that you are 20) **5-HT** * **Obsessions, impulsivity, mood** * Promotes satiety(sense of fulness) * Some evidence of **low in bulimia** Too little? * **Antidepressants may help AN, BN** Too much? * **People in recovery from AN, BN have high 5-HT** metabolite (dieting to control 5-HT?) just theories

**Etiology: Psychosocial**

**Perfectionism** **Excessive self-focus** (incresed sensitivity to criticism) **Dieting** (can kickstart these disorders specially for being disorder) Cognitions * **Cognitive rigidity** * **Judge self-worth mainly by body shape and weight** **Negative emotionality**

**Etiology: Social**

**Child sexual abuse (CSA)** Family characteristics * **Intolerance of negative affect** * **Propriety, rules** * **Parent over-control** * **Poor conflict resolution skills** * **Preoccupations with thinness**

But... Cause or Result?

**Family Systems Theory** * Enmeshment (parents over envolvment) * Overprotectiveness * Rigidity * Conflict but... Cause or result? **Self-report:** reported high levels of family problems vs. **observational** no family problems we dont know but family systems improves after treatment

**Etiology: Sociocultural**

Internalized ideal Western “thinness” values

**Presentation: Psycho**

**Weight preoccupation** * **Constant worry** * **Mood dependent** -Small weight gain > depression, irritability * **Self-image dependent** to feel good **Slippery slope** Small weight gain > fear gain weight won’t stop

Treatment: Anorexia Nervosa

**Emergency procedures** to restore weight > Often hospitalization **SSRIs**(anti-depressents) **Family therapy** - very effective especially for tennagers and young adults **CBT** - less effective **Psychodynamic?** a lot of people relepse

Treatment: Psycho **(Anorexia)**

**Major treatment goal: weight gain now and long- term maintenance** **Major challenge: motivation** **Need for self-control: shift from eating to other areas** **Family lunch sessions**(very helpful) - **Changing the role of the patient with anorexia**(as sick) - **Redefining the eating problem as an interpersonal problem** - **Preventing parents from using child’s anorexia as means of avoiding conflict**

Treatment: **Bulimia**

**SSRIs** **CBT** Question standards for thinness Challenge irrational beliefs Exposure and response prevention - (negative evaluated) **IPT** - interpersonal therapy Assertiveness Mistakes ≠ catastrophes Desensitizing patient to social evaluation

Treatment: **BED**

**Medications** * SSRIs * Appetite suppressants **IPT** **CBT**

**Prevention: EDs**

**Focus** Stamina & conditioning (health) > body shape (rather then how they look/less passive) **Stop** Negative comments about body shape Peer workgroups to reduce teasing and focus on body shape evaluation