Eating disorders Flashcards
Define Cognitive restraint, dietary restraint, binge eating and compensatory behaviors
Cognitive restraint→ intent to reduce food consumption
Dietary Restriction→ Actual decrease in energy intake
- amount of food OR what kind of food
Binge Eating→ consuming objectively large amount of food in discrete period of time
- feeling of loss of control
Compensatory Behaviors
- Purging→ physically removes food (vomiting, laxatives, diuretics
- Non-purging→ counteract the ingestion of food indirectly (restriction, compensatory exercise)
What are the DSM-5 criteria to be diagnosed with Anorexia Nervosa?
Diagnosis
- Weight→ BMI < 17.5
- Dietary restrictions need to be present
- Typically present→ body dissatisfaction, weight concerns, undue influence of weight/ shape on self-esteem
- Specifier→ sometimes binge eating, purging and excessive exercise
Are eating disorders ego syntonic or dystonic?
Usually very ego syntonic→ forced into treatment because think that are doing the right thing
- restrictions and compensatory behaviours feel god for them most of the time
What are the DSM-5 criteria to be diagnosed with Bulimia Nervosa?
Diagnosis
- Binge eating
- Compensatory behaviours (1 per week for 3 months)
- undue influence of weight/ shape on self-esteem (not low weight usually)
- Typically present→ body dissatisfaction, weight concerns, undue influence of weight/ shape on self-esteem
—>both Anorexia and bulimia do not require significant distress for diagnosis
What are the DSM-5 criteria to be diagnosed with Binge Eating Disorder (BED)?
Binge eating without compensatory behaviours
Diagnosis
- Binge eating (eating more rapidly, until uncomfortably full, large amounts when not hungry, eating alone due to embarrassement and feeling guilty after
- absence of compensatory behaviors
- MUST have significant distress
- Sometimes present: body dissatisfaction, weight concerns, dietary restrictions
What are the different residual diagnostic categories of eating disorders?
Avoidant/ restrictive food intake disorder (ARFID)→ important weight loss but not motivated by weight concern
- need to be psychological
- could be because of sensory sensitivity
Other Specified Feeding and Eating Disorder (OSFED)
- Subthreshold AN, BN, BED
- Atypical AN→ not below weight threshold
- Purging Disorder
- Night Eating Syndrome
Unspecified Feeding and Eating Disorder (USFED)
—>30-50% of treatment seeking individuals have OSFED and USFED
What is the epidemiology of the 3 main eating disorders?
Anorexia
- prevalence-> 0.7% (atypical->2.8%)
-gender-> 10F:1M
-age-> late adolescence
-mortality-> 5.1%
BN
-prevalence-> 1-3%
- gender-> 10F:1M
-age-> late teen- early adulthood
-mortality-> 1.7%
BED
-prevalence-> 2-5%
-gender-> 2F:1M
-age-> early-mid adulthood
Demographics→ stereotype with Skinny White Affluent Girls (SWAG)
- Underweight = < 6% of ED population
- Males = 25% of ED population
- Sexual and gender minorities have higher ED prevalence
- Ethnic minority populations have high rates of EDs
- Multiracial individuals + Indigenous have highest rates of EDs
- No relationship between high SES and EDs→ but food insecurity more associated with Bulimia nervosa and BED
How do eating disorders present themselves in men?
Eating Disorders in men
- men with Eds more likely to over-exercise, want to gain muscles and loose fat
- Restriction of low-protein foods
- Prioritizing eating more meals over other tasks
- Eating beyond feeling full
- more secretive due to stigma→ delayed help-seeking
What are some potential differential diagnosis of EDs?
Body Dysmorphic Disorder→ extreme obsession about perceived defects in appearance
- no eating pathology
OCD→ often comorbid with EDs, especially AN-restrictive
Anxiety disorders
Depression
Psychosis-spectrum disorders→ reduced energy intake can cause hallucinations
Hard to determine because some effects of malnutrition are
- low mood
- anhedonia
- insomnia
- preoccupation and rituals related to food
What are the comorbidity rates for EDs?
Depression
- AN: 25-50% concurrent Depression
- AN: 50-70% lifetime hx Depression
- BN: even higher
PDs also common
- 50-70%
- Restricting AN- Cluster C
- AN-BP- both B and C
- BN– cluster B
Anxiety
- OCD and social phobia
- PTSD only for BN and BED
What are the genetic risks of EDs?
Heritability
For AN, BN and BED→ 50%
- increased familial risks→ family members 4x more likely to have EDs
BUT heritability is not static→ change over development
- 0% genetic contribution before puberty
- 50% emerges after puberty for girls-> might show effect of estrogen
What is a gene x environment interactions that could contribute to EDs?
Short allele of serotonin 5-HTTLPR
- also link with agression and depression
- elevated risk for EDs
- interact with parenting style AND abuse history
—>interaction between polymorphism and environment increase likelihood of EDs
—>non specific biomarkers
—>adverse effects of genes on mental health only expressed under certain environmental conditions
What were the results of the study looking at family factors in EDs and Fat talk?
Family Factors→ many ideals about food come from it
- criticisms or fat talk has powerful influences on development of disordered eating
- more than media exposure
- also maybe worse at teaching their kids to build self-esteem
Fat talk→ making discouraged comment about weight, body comparisons, judgment about other bodies
- study examined frequency of parental fat talk towards others, oneself and the child
- very common in all families
- self→ 74% were doing it (associated with parental psychology)
- others→ 51.5%
- child→ 43.6 (associated with child psychopathology)
What were the results of the study looking at peers influence on EDs and suicidal thoughts?
Underwieght and overweight kids were the more teased
- then associated with thoughts of suicide in young adulthood
- teased by peers-> 36%
- teased at home-> 43%
-both-> 51%
What did the Fiji study show about media influence on EDs?
Media→ Fiji Study
- In 1995→ No television, no EDs
- In 1998 (western media introduced)→ 11.3% adolescent girls report at least 1 purging behaviour; 74% feel « too fat»
- In 2007→ 45% report at least 1 purging behaviour in the past month
What is the Abstinence violation effect?
once make little mistake, everything goes away
- then feel guilty and start over
-coercive cycle
What is the Dual Pathway Model of EDs?
Sociocultural pressures AND Thin-ideal internalization–>Body dissatisfaction–>Negative affect AND restrained eating –> Eating disorders
What are the main maintenance factors of EDs?
Perfectionism→ High standards, fear of failure, self-criticism
Low self-esteem→ Omnipresent and unconditional
- treatment obstacle→ can think that do not deserve to get better
Emotion regulation→ Negative mood intolerable,
- binge trigger
- do not tolerate negative affect and could do anything to make it goes away
Interpersonal difficulties→ Isolation, negative interactions precede binges
What is Fairburn’s trans-diagnostic theory of EDs?
Variations in eating symptomatology are all expressions of overvaluation of eating, shape and weight
- should be the focus of treatment
What are physical consequences of AN?
Blood flow to periphery is decreased
dry skin and hair fall
menstruation stops
calcium lost-> osteoporosis (irreversible)
low heart rate, blood pressure and possible death
brain shrinkage
What is the course for AN. BN and BED?
AN
-rapid respond to treatment is good predictor of course
-1/3 have chronic course
BN
- only 6% seek treatment
- average length of illness with treatment is 5years
-50% recover but high relapse rates
What are risks factors of EDs?
Body dissatisfaction
Dieting-> unsuccessfull dieting seems to be more problematic
Interoceptive awareness-> feeling fo satiety
Weight
Family and childhood abuse
