Eating Disorders Flashcards
DSM-V
AN
- significantly reduced calorie intake (BMI
Keele et al (2010)
AN
- prevalence of 0.4%
- 10:1 - F:M
- early onset in middle teens following a stressful life event
- normally goes undetected for the first five years
+ have strict rules, have a sense of control, positive sense of self and wellbeing
– if rules are broken, it can cause stress and panic
– whole world revolves around routine, and cannot have a normal life
– isolation, loneliness, lack of awareness about risky behaviour
– want to stay alive, but cannot give up risky behaviour
BN
- prevalence of BN = 1-3% females, 0.1-0.3% males (9:1 - F:M)
- 75% remission 20 years after diagnosis
- comorbidity - 36-63% major depression
+ excitement of binge eating, but a feeling of sadness and disgust after, out of control, therapy is aimed at gaining control
The Diana effect
- increase in mid 1990’s in BN diagnoses
- more people coming forward and saying they have BN because Diana came out as bulimic
- AN rate has always been lower than BN
Pomeroy et al (2002)
- consequential medical problems with AN and BN
- bloated
- poor sleep
- sensitivity to cold
- osteoporosis
- dry skin
- swelling of glands
Keele and Klump (2003)
- more variably and heritability for BN cross culturally than AN
Fairburn and Harrison (2003)
- migration across disorders e.g. those who are AN are likely to become BN… BUT BN rarely become AN
Historically
- was apparent in early times
- not just a cultural construct
- ideology for people to be smaller
- maybe thinking you’re closer to God by staring yourself - irrational beliefs
Hoek
- normally Westen countries
- white people
- female (90%)
- young adults and adolescents
- AN (high social class)
- BN (even distribution of social class)
- AN (0.7% in teenagers)
- BN (1-2% in 16-35 year old females)
- BUT not everyone comes to clinical services and there is little evidence on atypical disorders
Trace et al (2013)
- genetics
- twin studies (40-60%) but a small sample
Treasure and Holland
- 55-5% = AN —> MZ vs. DZ
- 35-5% = BN —> MZ vs. DZ
BUT
Bulick
- 80% of variance was genetic for BN
- shared environment and learned behaviour
Molecular genetics
- serotonin and polymorphism - occurs in different forms
- genetic variation in a population
- suggests that depending on how much serotonin is in your brain varies with the severity of eating disorder
- BUT Gorwood couldn’t confirm this hypothesis
Fairburn - molecular genetics
- ignores other factors e.g. anxiety, low self esteem, SES, cultural norms
Socio cultural factors
- media reliance
- BMI - playboy
- food and eating fashions - e.g. very popular to be vegan
- negative attitudes towards obesity
- gap between actual and ideal weight
Hill (1998)
- familial factors
- psychiatric problems in family
- excessively criticise daughters appearance
Raffi et al (2000)
- experiential factors
- more premorbid life stressors
- BUT retrospective and correlational
- childhood sexual abuse contributed to BN, but only with BPD
- control
Lampard er al (2013)
- low self esteem correlated with an overvaluation of shape, interpersonal life difficulties
- perfectionism - BN
- negative mood
Fairburn - CBT
- restriction over food means that you have more control
- social withdrawal
- irrational thoughts
- CBT mostly for those with BN
- family therapy is mostly for those with AN
Fairburn - CBT effectiveness
- 20 sessions over 5 months for BN
- worked
- and BN drugs were also good
- BUT there is a paucity of research with AN
Negatives of assessment
- lying (e.g. patients putting weights in clothes to look as though they have gained weight - huge amounts of deception, but need to trust client)
- emotional well being must be taken into account once the initial weight gain has been looked at
Serpell (1999)
- patient writes down what they like and dislike about their anorexia
- for example, may say that likes the feeling of control and feeling skinny, but doesn’t like how you have to lie, and how you feel sad about your image
NICE Guidelines (2004)
- meal planning
- cognitive restoration of dysfunctional beliefs
- devleop prevention methods and cognitive restructuring
Wilson and Pike (2001)
antidepressants are better than placebos
Stice et al (1994)
- 238 female undergraduates - direct effect on the media
- changes are important
- work with vulnerable populations
- very common in girls in school, helps to reduce media pressure to be thin and reduce peer pressure
- ‘The Body Project’ - 6 sessions - most effective when it is interactive
Brown and Ogden (2003)
- parents share ideals with children
- food consumption and thoughts
- a positive parental role model is better
- therefore, therapy should target parental views. e.g. do not call child fat, do not use negative language
Dare et al (2001)
- psychological therapies for adults with AN - 84 patients
- 4 groups: psychanalytic therapy, 7 months cognitive analytic therapy, family therapy, low contact
- all patients improved
- BUT need to look at candidates which are most appropriate for therapy
- motivation is vital. 90% of patients do not seek treatment due to the challenges associated with it
Future research
- could look more at prevention and more about awareness before it gets to be seriously harmful e.g. withdrawn personality, seem shady at meal times, an obsession with food and counting calories etc.
