Eating disorders Flashcards
What is cognitive restraint in EDs?
Intent to reduce food intake (mental effort to restrict).
Define binge eating.
Large food intake in short time with loss of control.
Two types of compensatory behaviors?
Purging (vomiting, laxatives), Non-purging (exercise, restriction).
Core features of Anorexia Nervosa?
Low weight, restriction, fear of weight gain, distorted body image.
What are the DSM-5 core diagnostic criteria for Anorexia Nervosa (AN)?
- Restriction + low body weight
- Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain.
- Disturbance in the way one’s body weight or shape is experienced ( person sees or feels their body in a distorted way), undue influence of body weight/shape on self-evaluation ( the person places excessive importance on their weight or shape when it comes to how they see themselves overall), or denial of the seriousness of the current low body weight.
What are the DSM-5 core diagnostic criteria for Bulimia Nervosa (BN)?
- Recurrent episodes of binge eating (eating an unusually large amount of food with a sense of lack of control).
- Recurrent inappropriate compensatory behaviors (e.g., vomiting, laxatives, fasting, excessive exercise) to prevent weight gain.
- The binge eating and compensatory behaviors occur at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
What is the main difference in weight status between AN and BN?
AN: Typically underweight (BMI < 17.5).
BN: Typically normal weight or overweight.
How does binge eating differ between AN and BN?
AN: Binge eating episodes may occur but are less frequent and occur alongside severe food restriction.
BN: Frequent binge eating episodes (at least once a week for 3 months) followed by compensatory behaviors.
What’s the main focus in Anorexia Nervosa (AN) versus Bulimia Nervosa (BN)?
AN: Focus on food restriction, fear of gaining weight, and distorted body image.
BN: Focus on binge eating followed by compensatory behaviors (purging, excessive exercise, etc.) to prevent weight gain.
Can a patient with binge eating behaviors meet criteria for Anorexia Nervosa?
Yes, a patient can meet criteria for AN if they are underweight and severely restrict food intake, even if they engage in binge eating behaviors.
How does Binge-Eating Disorder (BED) differ from Bulimia Nervosa?
BED involves recurrent episodes of binge eating without regular compensatory behaviors (e.g., vomiting, fasting).
The binge episodes are associated with marked distress and at least three of the following: eating more rapidly, eating until uncomfortably full, eating large amounts when not physically hungry, eating alone due to embarrassment, and feeling disgusted or guilty afterward.
Occurs at least once a week for three months.
Unlike BN, no regular compensatory behaviors are present.
Which diagnosis between AN, BM and BED requires significant distress or impairment?
Binge-Eating Disorder!
BED might not always present with visible physical health consequences like the extreme weight loss or medical complications seen in AN or BN. Therefore, the DSM-5 specifies that the presence of significant distress or impairment in functioning is essential for the diagnosis, as it captures the emotional and social impact of the disorder.
What is Avoidant/Restrictive Food Intake Disorder (ARFID)?
A disorder characterized by the avoidance or restriction of food intake, often due to a lack of interest in food, fear of consequences (e.g., choking), or sensory issues. It doesn’t involve body image concerns or an intense fear of weight gain.
What is Other Specified Feeding and Eating Disorder (OSFED)?
A category for eating disorders that don’t meet full criteria for AN, BN, or BED but still cause significant distress or impairment. Examples include atypical AN, purging Disorder, Night Eating Syndrome
What is Atypical Anorexia Nervosa (Atypical AN)?
Individuals show the core features of AN (e.g., extreme food restriction, fear of weight gain) but may have a normal or above-normal weight.
Why is Atypical Anorexia Nervosa under the category of Other Specified Feeding and Eating Disorder (OSFED)?
Atypical AN is considered a subtype of OSFED because it doesn’t meet the full criteria for AN (specifically, the weight criterion), but it still involves significant distress and impairment.
AN requires the patient to be underweight, whereas Atypical AN involves the same behaviors but without the BMI criteria being met.
What is Unspecified Feeding and Eating Disorder (USFED)?
A category used when a patient presents with symptoms of an eating disorder, but the specific type is unclear or doesn’t meet the full criteria for any recognized disorder.
What is diagnostic migration in eating disorders?
When individuals shift between eating disorder diagnoses over time (e.g., AN → BN → BED).
Lifetime prevalence of AN, BN, BED?
AN: 0.7%, BN: 1–3%, BED: 2–5%.
Gender ratio for AN, BN, BED?
AN & BN: 10 women : 1 man; BED: 2 women : 1 man.
Typical age of onset for AN, BN, BED?
AN & BN: Late adolescence to early adulthood; BED: Early to mid-adulthood.
Mortality rate for AN and BN?
AN: ~5.1%, BN: ~1.7%, BED: More research needed.
What is the SWAG stereotype?
That EDs mainly affect Skinny White Affluent Girls.
Reality check against the SWAG stereotype?
<6% of ED patients are underweight
25% of ED cases are male
Higher prevalence in sexual/gender minorities and ethnic minorities
Highest rates in multiracial and Indigenous populations
No link to high SES; food insecurity is a risk factor
How do EDs present differently in men?
Over-exercising, drive for muscularity
Focus on muscle gain, fat loss
Restriction of low-protein foods
May delay help-seeking due to stigma
What other disorders should clinicians carefully consider (whether the symptoms are better explained by another disorder, or if there’s comorbidity) when diagnosing EDs?
Body Dysmorphic Disorder, OCD, SAD, GAD, Depression, Psychosis-spectrum.
Can someone be diagnosed with both an eating disorder and body dysmorphic disorder?
Yes, they are not mutually exclusive
Why do you sometimes first have to return someone to a normal eating state to make the right diagnosis
Psychological effects of malnutrition: Low mood, anhedonia, insomnia, food preoccupation, ritualistic behaviors.
tricky to make these differential diagnosis under the effects of malnutrition
Common comorbidities in EDs?
Mood disorders, substance use, personality disorders, anxiety.
Depression prevalence in AN?
25–50% concurrent; 50–70% lifetime history. rates are even higher for BN
What are the common comorbid PD clusters associated with eating disorders?
Restricting Anorexia Nervosa (AN-R):
→ Cluster C (anxious, fearful)
↳ Includes: Avoidant PD, Dependent PD, Obsessive-Compulsive PD
Anorexia Nervosa – Binge/Purge subtype (AN-BP):
→ Cluster B (dramatic, emotional, erratic)
↳ Includes: Borderline PD, Histrionic PD, Narcissistic PD
→ and Cluster C (anxious, fearful)
Bulimia Nervosa (BN):
→ Cluster B (dramatic, emotional, erratic)
What is the estimated heritability for AN, BN, and BED?
Around 50% for all three.
Is heritability static across development?
No. Genetic influence is ~0% before puberty but rises to ~50% after puberty—ovarian hormones may play a role.
What is this an example of: The short allele of 5-HTTLPR + adverse parenting or abuse = increased drive for thinness, AN/BN symptoms.
Gene x Environment interaction
Genetic vulnerability increases ED risk only under certain environmental conditions.
What is thin ideal internalization and why is it important in eating disorders?
Thin ideal internalization is the extent to which an individual believes that thinness is the standard for beauty and self-worth. It plays a key role in the development of eating disorders by increasing body dissatisfaction, dieting behaviors, and disordered eating patterns.
It is often reinforced by media, peers, and family messages, and can become deeply ingrained, especially during adolescence.
Which one has the strongest effect on the development of eating disorder: family factors or media exposure?
Family factors has a stronger effect than exposure to media
What is this sentence an example of “do i look fat in these?”
fat talk
what is the percentage of parental fat talk directed towards the self, others, the child?
self: 74%
others: 51,5%
child: 43,6%
What are the effects of parental “fat talk” directed toward themselves vs. toward their child?
Toward the self → Associated with parental pathology (e.g., disordered eating, body dissatisfaction).
Toward the child → Associated with child pathology (e.g., low self-esteem, disordered eating behaviors).
How is teasing related to ED risk?
Teasing (especially from family + peers) increases risk for disordered eating and suicidal thoughts.
What did the Fiji study reveal?
After TV was introduced: purging increased (11.3% in 1998, 45% in 2007), and 74% felt “too fat” in 1998
What is the “abstinence violation effect”?
Also called the “f*ck it effect”—a slip in eating leads to loss of control and more disordered behavior.
idea is: fuck it, I already broke the diet
then feels guilty and fat
starts diet again
What are core psychological maintenance factors in EDs? (What keeps people in those cycles of illness.)
Perfectionism: Unrealistic standards, fear of failure.
Low self-esteem: Chronic, often untreated.
Emotion regulation: Poor coping with negative emotions, binge as escape.
Interpersonal difficulties: Social isolation, negative interactions trigger binges.
