Eating Disorders Flashcards
1
Q
What does the DSM-5’s chapter of feeding and eating disorders entail?
A
A persistent disturbance in eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.
2
Q
Define anorexia nervosa.
A
An eating disorder where the individual is significantly underweight and suffers from a fear of gaining weight and body image disturbance.
3
Q
Who proposed the term anorexia nervosa?
A
Gull.
4
Q
Who was the first to provide formal diagnostic criteria for anorexia?
A
Gerald Russell.
5
Q
Give Russell’s criteria for anorexia. (3)
A
Characteristic attitudes and behaviours, the effect on weight, and symptoms of the hormonal disturbance associated with weight loss.
6
Q
According to the DSM-5, what is the primary characteristic of anorexia?
A
A relentless pursuit of thinness resulting in weight loss substantially below a normal body weight.
7
Q
Name the two subtypes of anorexia nervosa.
A
A restricting and a binge eating/purging type.
8
Q
How is the binge eating/purging subtypes of anorexia distinct from bulimia?
A
Patients with bulimia are not underweight.
9
Q
Define bulimia nervosa.
A
An eating disorder where an individual engages in recurrent binge eating episodes and compensatory behaviours (like vomiting) designed to prevent weight gain.
10
Q
What is the Clinician Administered Staging Instrument for Anorexia Nervosa?
A
An instrument for staging anorexia nervosa based on symptomatic severity.
11
Q
Name the stages of anorexia as measured by the Clinician Administered Staging Instrument for Anorexia Nervosa. (4)
A
Stage 1 (mild illness pathology, stage 2 (moderate illness pathology), stage 3 (moderate-severe illness pathology), and stage 4 (extremely severe illness pathology).
12
Q
What is a binge-eating episode?
A
An instance of disordered eating characterised by eating an excessive amount of food, accompanied by a sense of lack of control over eating.
13
Q
Define binge-eating disorder.
A
An eating disorder where an individual engages in recurrent binge eating episodes but does not engage in compensatory behaviours designed to counteract the calorie intake.
14
Q
Who recognised binge eating disorder?
A
Spitzer.
15
Q
Give the diagnostic criteria for binge eating disorder. (8)
A
Binge eating episodes at least once weekly for three months, but not regularly engaging in inappropriate weight-control behaviours characteristic of bulimia, distress, and three of the following: eating faster than normal, eating until uncomfortably full, eating when not hungry, eating alone because of embarrassment, or feeling disgusted, guilty or depressed after eating.
16
Q
What is avoidant/restrictive food intake disorder?
A
A syndrome of children with autistic spectrum disorders and adults with swallowing or food phobias.
17
Q
Give the characteristics of avoidant/restrictive food intake disorder. (5)
A
Persistent eating disturbance so that nutritional needs are not met, underweight, deficiency in essential nutrients, dependence on enteral nutrition or medically prescribed oral supplementary feeding, and impairment in psychosocial functioning.
18
Q
Name the DSM-5’s residual categories for disturbances that do not fully meet the criteria for specified eating disorders.
A
Other specified feeding or eating disorder, and unspecified feeding or eating disorder.
19
Q
Name the five other specified feeding or eating disorder types described by the DSM-5.
A
Atypical anorexia, bulimia nervosa and binge eating disorder of low frequency and/or duration, purging disorder, and night-eating syndrome.
20
Q
Define atypical anorexia nervosa.
A
All criteria are met for anorexia, except low weight.
21
Q
Define purging disorder.
A
Purging behaviours in the absence of binge eating.
22
Q
Define night-eating syndrome.
A
Excessive eating after the evening meal or eating at night after awakening from sleep.
23
Q
When is the unspecified feeding or eating disorder category used?
A
When the feeding or eating disorder causes significant distress and impaired psychosocial functioning but there is insufficient information to specify the type of disorder.
24
Q
What is pica?
A
The eating of one or more non-food substances on a persistent basis for at least one month.
25
What is rumination disorder?
The repeated regurgitation of food which may be chewed, swallowed, or spat out for a period of at least one month.
26
Give the DSM-5's diagnostic criteria for anorexia nervosa. (5)
Significantly underweight, fear of weight gain or engaging in behaviours to prevent weight gain, body image disturbance, including self-worth being excessively influenced by weight, and a lack of concern for seriousness of weight.
27
Give the DSM-5's diagnostic criteria for bulimia nervosa.
Binge eating episodes, inappropriate weight control behaviours, self-worth is excessively influenced by weight, and binge-eating and weight control behaviours need to occur at least once a week for three months, and cannot occur at the same time as anorexia.
28
What can avoidant/restrictive food intake disorder not be explained by?
Cultural practices, another eating disorder, body image disturbance, and another medical or mental health condition.
29
Anorexia nervosa affects mainly:
Adolescent girls and young women.
30
How many times more common is anorexia in women than men?
10 times.
31
What is the mortality rate for anorexia nervosa?
5-10% of patients.
32
What are most deaths related to anorexia nervosa attributed to?
Suicide or the medical complications of starvation.
33
What percent of patients with anorexia go on to develop bulimia?
50%.
34
Give the psychological effects of starvation.
Severe depression, mood swings, irritability and outbursts of anger, compulsive behaviours, self-harming behaviours, obsessional thoughts of food and eating, hoarding food, changes in eating habits, and serious binge eating.
35
What are amphetamines?
Stimulant drugs that can produce symptoms of euphoria, self-confidence, alertness, agitation, paranoia, perceptual illusions and depression.
36
Name four disorders that are commonly comorbid with anorexia.
Substance abuse, mood disorders, anxiety disorders, and personality disorders.
37
How does anorexia affect the face and skin? (5)
Parotid and salivary gland enlargement from vomiting, dental decay, brittle hair, loss of hair, or a covering of downy hair over the body, pale skin from anaemia, and calluses on the backs of fingers from inducing vomiting.
38
How does anorexia affect bones and joints? (3)
Ankle swelling from fluid rebound after dehydration, osteopenia and fractures, and muscle weakness.
39
How does anorexia affect the endocrine system? (5)
Low sex steroid hormones, leading to absent periods, decreased libido and low testosterone, altered thyroid hormone metabolism, low blood glucose, and increased cortisol and growth hormone.
40
How does anorexia affect fluid and electrolyte levels? (4)
Dehydration, low potassium, low phosphate, and kidney failure.
41
How does anorexia affect the heart? (3)
Slow or irregular heartbeat, heart failure, or a small, weak heart.
42
How does anorexia affect the immune system? (2)
Low white cell count, and susceptibility to overwhelming bacterial infection.
43
How does anorexia affect the reproductive system? (4)
Increased risk of miscarriage, premature delivery and death of baby, and a low-weight baby with increased risk of malformations.
44
How does anorexia affect the gastric system?
Low levels of essential nutrients, inflammation of the pancreas, slow stomach emptying, constipation, diarrhoea, inflammation, tearing, scarring and ulceration of the oesophagus, stomach rupture, and liver inflammation.
45
What family predisposition is common in people with anorexia nervosa? (3)
Leanness, obsessive-compulsive disorder and mood disorders.
46
What is reduced serotonin activity associated with?
Increased appetite and decreased impulse control.
47
How may high levels of serotonin contribute to anorexia? (2)
By promoting over control and under-eating.
48
What did Bruch describe anorexia as?
A desperate struggle for a self-respecting identity.
49
How may negative affect contribute to the development of anorexia?
The individual may avoid distress by refocusing attention only on eating, shape and weight rather than broader life concerns.
50
How may negative emotions be a causal factory for anorexia?
The effect of negative emotions on body dissatisfaction.
51
What do Fairburn and Harrison believe is the most important aspect in the development of anorexia?
A dysfunctional system for evaluating self-worth.
52
Which personality trait predisposes people to developing anorexia?
Perfectionism.
53
Define perfectionism.
Striving to attain unrealistically high standards, even in the face of negative consequences.
54
Patients with anorexia nervosa report that their families were:
Characterised by higher levels of criticism and lower levels of care and affection before they developed the disorder.
55
How may family contribute to the development of an eating disorder?
Through behaviours and attitudes regarding eating, shape and weight.
56
The more frequently parent's mentioned their child's weight, the more: (3)
The child had attempted weight loss, felt less satisfied with their body, and was concerned about weight gain.
57
The more parents complained about their weight and engaged in weight loss attempts, the more likely daughters were to:
Attempt weight-loss, feel less satisfied with their bodies, and be concerned about weight gain.
58
What is believing peer approval from boys is associated with thinness associated with?
Higher body dissatisfaction and dieting in adolescent girls.
59
What is the sociocultural approach?
Theories that focus on interpersonal relationships, culture and social institutions to understand the causes of abnormality.
60
What is inpatient treatment?
Treatment where the patient is hospitalised.
61
What is day-patient treatment?
A type of treatment where individuals with psychological disorders attend the treatment setting during the day but return home at night.
62
What is outpatient treatment?
Treatment received at a hospital or clinic but where the patient is not hospitalised.
63
What is the decision regarding treatment setting determined by? (5)
The patient's level of medical and psychological functioning, the patient's preference, the therapist's recommendation, and what is available.
64
When is inpatient treatment necessary? (6)
When patients are severely underweight or losing weight rapidly, have severe medical complications, are engaging in binging, vomiting or laxative abuse that poses serious medical risks, have serious comorbid psychological problems, are not improving with outpatient or day treatment, and have an unsupportive home environment.
65
Why do people with anorexia nervosa value their disorder?
Because they see it as fulfilling important needs for them, like improving self-esteem and body image, helping them to manage distressing emotions, and communicating their distress to others.
66
Define motivation enhancement therapy.
A type of psychological treatment that aims to increase the client's motivation to change.
67
What is the first stage of CBT for anorexia? (3)
Establishing the basis of a supportive and collaborative relationship between the patient and therapist, establishing goals, and instituting a meal plan.
68
What are Garner, Vitousek and Pike's two main goals of treatment?
Normalising eating, weight and weight-control behaviours, and dealing with psychological problems like poor self-esteem, perfectionism, coping with negative emotions and interpersonal functioning.
69
When does re-feeding syndrome occur?
When rapid re-feeding overwhelms the patient's metabolic state.
70
What can rapid re-feeding cause?
Shortness of breath, physical collapse, seizures, delirium, coma, heart failure and death.
71
What happens in the second stage of CBT in the treatment of anorexia? (2)
Dysfunctional beliefs regarding food and weight are targeted, and therapy broadens to include self esteem and other issues.
72
Give three cognitive approaches that allow the patient to overcome their unrealistic beliefs.
Identifying dysfunctional thoughts, examining the evidence for and against these thoughts, and replacing any thoughts found to lack supportive evidence with more realistic beliefs.
73
What occurs in the third and final stage of CBT for anorexia?
Preparing the patient for the end of treatment and developing strategies to prevent relapse, like identifying times of vulnerability for relapse, recognising early warning signs of relapse, and ways to respond if this occurs.
74
Explain the Maudsley Model family based treatment for anorexia.
Promoting re-feeding the weight gain by encouraging patients to take responsibility for ensuring healthy eating in the home.
75
In the treatment of anorexia, which treatment is recommended for younger patients?
Family therapy.
76
Once normal weight has been achieved, what are the next stages of the Maudsley Model of family-based treatment? (3)
Establishing a new pattern of family relationships, working towards personal autonomy for the adolescent and ensuring disordered eating is no longer the focus of family interactions.
77
Why are tricyclic antidepressants avoided in the treatment of anorexia?
They may affect cardiac functioning.
78
Give some benefits of antipsychotic drugs in the treatment of anorexia.
Reducing compulsive activity and anxiety, and improving adherence to treatment in the re-feeding phase.
79
Give some disadvantages of antipsychotic drugs in the treatment of anorexia.
Metabolic and cardiovascular side effects, the patient not learning to tolerate weight gain without the assistance of medication, and patient preference.
80
What percentage of women will experience bulimia in their lifetime?
1-3%.
81
Men and women with eating disorders are generally similar in terms of: (4)
Symptoms, family histories of psychiatric disorder, family dynamics, course of the illness and response to treatment, and in the impact of eating disorder features on their functioning.
82
Give some differences between men and women with eating disorders.
Men have an older age of onset and wait longer before seeking treatment, men are more likely to use extreme exercise as a weight control method, and less frequent purging.
83
What percentage of men with eating disorders are gay?
20%.
84
When is the average onset for bulimia?
Late adolescence and young adulthood.
85
What factors result in a poorer outcome of bulimia? (3)
Childhood obesity, low self-esteem, and personality disorders.
86
What are bulimia's most dangerous physical complications?
Depletions in the electrolytes potassium, chloride and sodium, which causes electrolyte disturbances.
87
What can electrolyte disturbances result in?
Weakness, tiredness, constipation, depression, irregular heartbeats and sudden death.
88
Give some physical problems associated with bulimia.
Swollen salivary glands, severe abdominal pain, stomach rupture and death from binge-eating, tearing and ulceration is tissues in the mouth and throat, loss of normal bowel function, dental decay, fluid retention, and menstrual problems.
89
What familial characteristics predispose bulimia? (3)
Obesity, substance use and mood disorders.
90
What may reduced serotonergic function cause in bulimia?
Overeating.
91
According to the Dual Pathway Model of bulimia nervosa, there are two main factors that trigger binge eating episodes:
Dieting and negative affect.
92
Explain the Dual Pathway Model of bulimia.
Dietary restriction causes binge eating, while negative affect triggers binges when the individual attempts to reduce distressing emotions, and they act together by the self-control of the dieter becoming disrupted by negative emotions.
93
Why is motivational enhancement therapy used in the treatment of bulimia?
People with bulimia may be motivated to stop binge eating, because they find their lack of control disturbing, but are unwilling to give up the pursuit of thinness.
94
What are the main advantages of self-help approaches for bulimia? (3)
They are available to people in rural and regional areas, can provide immediate help, and reduce the amount of time needed in more intensive forms of therapy.
95
Name the six phases of Fairburn's self help manual for bulimia.
Getting started, regular eating, alternatives to binge eating, problem solving, stopping dieting, and preventing relapse.
96
What is the first stage of CBT for bulimia? (5)
Education, emphasising the self-perpetuating cycle of dieting and binge eating, eliminating weight control, following a pattern of regular eating and strategies fro avoiding binge eating.
97
What is the second stage of CBT for bulimia? (5)
Eliminating all dieting and targeting dysfunctional cognitions about eating, shape and weight, involving graded reintroduction of forbidden foods, challenging negative thoughts and replacing them, and introducing strategies for managing negative affect.
98
What is the third stage of CBT for bulimia?
Relapse prevention.
99
What is higher weight suppression?
The difference between an individual's highest weight and their current weight.
100
What is higher weight suppression associated with in bulimia?
A higher treatment drop-out rate and less symptom improvement.
101
Give some factors that predict a poorer CBT outcome in the treatment of bulimia. (4)
Comorbid borderline personality disorder and substance use disorder, lack of motivation to change, obesity, and frequent binging/purging.
102
What is the primary focus of interpersonal psychotherapy?
To help individuals identify and change current interpersonal problems that are assumed to be maintaining the eating disorder.
103
Which medications are the only ones currently used in the treatment of bulimia?
Antidepressants.
104
Why are psychological treatments preferable to medications in the treatment of bulimia? (3)
Psychological interventions are more effective, medication is associated with high dropout rates due to side effects and patient attitudes, and medication is associated with relapse.
105
Binge eating disorder affects what percent of young women?
3-5%.
106
What is the biggest physical problem for patients with binge eating disorder?
Obesity.
107
What is hypertension.
A condition where the blood supply through vessels is excessive and is a major risk factor for heart disease and stroke.
108
Give some negative health consequences of obesity.
Hypertension, type II diabetes, and cardiovascular disease.
109
Name some disorders that are commonly comorbid with binge eating disorder. (4)
Mood, anxiety, substance use, and personality disorders.
110
How is binge eating disorder similar to bulimia and anorexia?
Basing self-worth on shape and weight.
111
How is binge eating disorder different from bulimia and anorexia? (4)
Older age of onset, greater number of affected males, higher obesity rates, and lower levels of dieting.
112
Explain the role of negative affect in binge eating disorder.
People with binge eating disorder are more likely to eat in response to negative moods than those without an eating disorder.
113
How does family functioning impact the development of binge eating disorder?
Elevated levels of criticism and reduced levels of affection from parents predisposes binge eating disorder.
114
Is guided or pure self-help more effective in the treatment of binge eating disorder?
Guided.
115
Give some difference between CBT for bulimia and for binge eating disorder.
Treatments are a moderate eating plan, increasing the use of healthy weight control behaviours, and achieving greater acceptance of a larger than average body weight.
116
Is IPT more effective for bulimia or binge eating disorder patients?
Binge eating disorder, but it is only as effective as CBT.
117
Give the two differences between the results of IPT on bulimia and binge eating disorder.
IPT reduced binge eating as rapidly as CBT in binge eating patients and the proportion of patients who were no longer binge eating after treatment is higher for binge eating disorder patients.
118
What is the emphasis on in behavioural weight loss treatment?
Weight loss, with a secondary focus on binge eating.
119
Compare behavioural weight loss and CBT. Which is more effective?
BWL and CBT had the same reduction in binge eating post-treatment, though BWL resulted in more weight loss.
120
What finding conflicts with the Dual Pathway Model?
Patients that engage in dietary restriction via the BWL reduced their binge eating.
121
What have SSRIs been found to do regarding treatment of binge eating disorder?
They achieve binge eating abstinence and reduce depressive symptoms in patients.
122
Which medications have recently been found to reduce binge eating and improve weight management?
Anticonvulsants.
123
What is muscle dysmorphia?
Occurring almost exclusively in males and is characterised by excessive concern that their body is too small or not muscular enough.
124
Give the similarities between muscle dysmorphia and anorexia.
Similar levels of body image disturbance, disordered eating and compulsive exercise, and both are predicted by perfectionism, negative mood and low self-esteem.
