Eating Disorders Flashcards
What is the history of Anorexia Nervosa?
It used to be called the ‘green sickness’ has been noticed for hundreds of years
Treatment circa 1930 considered the condition treatable and hysterical. It shouldn’t be left untreated and forcing the patient to eat is often necessary. It required patience and specially trained nurses. Anorexia must be treated before other problems
What are the DSM criteria for Anorexia Nervosa?
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significant low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on selfevaluation, or persistent lack of recognition of the seriousness of the current low body weight
Restricting type: No binge/purge behaviour last 3 months
Binge/Purge type: Binge/purge behaviour last 3 months
How is the severity of AN measured?
In terms of body weight (Mild: BMI ≥ 17, Moderate: BMI 16 – 16.99, Severe: BMI 15 – 15.99, Extreme: BMI
What are the medical manifestations of AN?
AN can effect almost all areas of health including:
- Neurological: e.g. pseudoatrophy of the brain
- Metabolic: e.g. hypothermia, dehydration
- Cardiovascular: e.g. hypotension, bradycardia, -prolonged Qt interval, arrhythmia
- Haematological: e.g. iron deficiency anemia
- Renal: e.g. acute and chronic renal failure
- Endocrine: e.g. amenorrhoea
- Musculosketal: e.g. osteopenia, stress fractures
- Gastroenterlogical: e.g. delay gastric emptying, severe
constipation
- Immunological: e.g. more severe bacterial infections
What is Re-feeding syndrome?
Refeeding syndrome describes a potentially fatal shift of fluid and electrolytes that occurs when refeeding a malnourished patient. Serious consequences of refeeding syndrome include: • Cardiac or respiratory failure • Gastrointestinal problems • Delirium • Death
How does body shape perception factor into AN?
Brains of anorexia nervosa patients process self images differently from non-self-images: An fMRI Study
AN patients process non-self images in a similar manner to controls though with increased involvement of the limbic system
Self images engage the attentional and self- referencing system with suppression of perceptual processing.
What are central coherence and set shifting?
Weak central coherence refers to the cognitive style where there is a bias towards local or detail-focused processing accompanied by difficulties in the integrative processing of information and is characteristically associated with autism spectrum disorders.
Set-shifting is the ability to move back and forth between multiple tasks, operations or mental sets and is a major component of executive functioning
What are the characteristics and risk factors for anorexia?
Anorexia lasts on average 7 years, and has 32x the likelihood of successful suicide attempts
Risk Factors; Highly heritable with strong neurobiological component,
What are the greatest difficulties in the research and treatment of AN?
- Insufficient sample sizes
- Recruitment difficulties
- Placebo controls
Non-compliance; anorexia is egosynctonic and patients rarely have the desire to get better
What are the common treatment options for anorexia?
Family Based Therapy (FBT): can be very effective if caught early on in the illness
Cognitive Behaviour Therapy (CBT): has about 50% success, not studied as well as in other disorders
Interpersonal Psychotherapy (IPT)
Dialectical Behaviour Therapy (DBT)
Motivational Enhancement Therapy (MET)
What are the DSM criteria for Bulimia Nervosa?
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat
- A sense of lack of control over eating during the
episode
B. Recurrent inappropriate compensatory behaviors
in order to prevent weight gain
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
How is the severity of BN measured?
In terms of frequency of binge/purge episodes (Mild: 1–3 pw, Moderate: 4–7 pw, Severe: 8–13 pw, Extreme: 14+ pw)
What are the epidemiology and comorbidities of BN?
Occurs primarily in women, covaries with dieting
comorbidities: substance abuse, depression, suicidality, personality disorders, anxiety disorders
How can BN be assessed?
Eating Disorders Inventory - 3 (assessment of the behavioural and psychological dimensions characteristic of eating disorders)
Eating Disorders Examination (semi-structured interview, good reliability): 4 subscales - restraint, shape concern, eating concern, weight concern
What does CBT-E for BN involve?
usually lasts 20 weeks, semi-structured, problem-oriented, concerned with present and future (rather
than past)
3 stages of treatment
- Stage 1: theraputic relationship and education, reduction in frequency of episodes, introduction of support systems
- Stage 2: building skills, addressing cognitions on shape and weight,
- Stage 3: fortnightly meetings, prevention of relapse, maintenance of skills, management of setbacks & vulnerability factors
