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
What are the key factors to remember when treating BN?
Build a theraputic relationship: be caring and nonjudgemental, balance empathy with firmness, be positive
Build a collaborative relationship: check the patient’s perception of therapist understanding, solicit patient input in setting agenda, actively involve the patient in formulating homework assignments
What is the best way to go about food planning for BN?
- Prescribing a regular eating pattern which includes ‘taboo’ foods
- relax strictures around eating (restore a sense of control),
- make the plan flexible around relapses so there isnt a need to compensate.
- Food Diaries allow the patient to see progress
What is the best way to go about cognitive restructuring in BN?
- the thought itself should be noted down
- arguments and evidence to support the thought should be marshalled
- arguments and evidence that cast doubt on the thought should be identified
- use a mix of implication-based questioning, evidence-based questioning and alternative-based questioning
What is the RU Curve?
the Where Are You Now curve plots patient progress across 5 categories:
a) medical status (M)
b) nutritional status (N)
c) social functioning (S)
d) emotional distress (E)
e) weight status (W)
What are the biggest obstacles to acceptance of body weight and how can they be handled?
obstacles
- social pressures regarding shape and weight
- low self esteem
- perfectionism
strategies
- Education
- Therapeutic relationship
- Validation
- Cognitive restructuring
What are the DSM criteria for Binge Eating Disorder?
A. Recurrent episodes of binge eating
- Eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat
- A sense of lack of control over eating during the episode
B. The binge-eating episodes are associated with three
(or more) of the following:
- Eating much more rapidly than normal.
- Eating until feeling uncomfortably full.
- Eating large amounts when not feeling hungry.
- Eating alone because of feeling embarrassment
- Feeling disgusted with oneself, depressed, or very
guilty afterward.
C. Marked distress regarding binge eating is present
D. The binge eating occurs, at least once a week for 3 months
E. It isnt better explained by AN or BN
What is the epidemiology of BED?
Estimated global lifetime prevalence of binge eating disorder : Women 2.5% - 4.5% Men 1.0% - 3.0%. More prevalent among those seeking weight-loss treatment than in the general population: 30-40%
Comorbidities: depression (57%), anxiety (37%), substance use & personality disorders (25%), obesity
Risk Factors: May be a genetic factor (family groups), dieting, trauma, low self-esteem, low emotional regulation skills
Protective factors: family connectedness and meal sharing, emotional well-being, achievement, self control
What are the assessments for BED?
- Eating Disorder Examination (EDE), and Eating
Disorder Examination – Questionnaire (EDE-Q) - Binge Eating Scale (BES): questionnaire about cognitions and behaviours
- Bulimia Test – Revised (BULIT-R): questionnaire, good sensitivity
- Eating Attitudes Test (EAT-26): useful for detecting high risk people, includes social factors,
What are the best treatments for BED?
Psychological therapy – “first line” (CBT, IPT, DBT): aims to reduce binge eating and increase emotional regulation skills
- CBT has good outcomes in reducing binge frequency
- Average abstinence rate: post-treatment 52%, at follow-up 46%
Pharmacologic treatment (SSRIs, SNRIs): aims to treat commorbidities and reduce impulsivity
- SSRIs greater chance of remission, modest weight loss effects
- SNRIs reduced frequency and severity of binges, reduced weight
What is the CBT model for treatment of BED?
Aim: alter unhelpful thinking processes and behaviours
that maintain eating disorders by
- Cognitive restructuring to challenge unhelpful thoughts
- Addressing unhelpful behaviours such as dietary
restriction
- May address additional factors such as self-esteem,
perfectionism, interpersonal functioning, and emotion
regulation.
What is the Interpersonal Psychotherapy (IPT) model for treatment of BED?
Aim: help individuals gain insight into interpersonal
relationships in the present, early relationships, and
historical life experiences
- Does not directly address diet, cognitions related to
dietary restriction, or weight-related issues
- focus on attachment patterns, distressing emotions, and binge eating as a means of coping
What is the Dialectical behavioural therapy (DBT) model for treatment of BED?
Aim: emotion regulation and distress tolerance
- Effective in binge reduction and in lowering concerns about food and body shape
- No clear results on weight loss, depression, or
anxiety.
What are some prevention measures for BED?
education on
- media analysis (images of thinness) eg media smart
- CBT training; concsiousness of thought patterns eg student bodies program
- cognitive dissonance
