Eating Disorders

Question 1

Most Common Forms of Eating Disorders and Commonalities Between Them

Answer 1

• Most common forms
- Anorexia nervosa
- Bulimia nervosa
• Central to both disorders
- Intense and pathological fear of becoming overweight and fat
- Pursuit of thinness that is relentless and sometimes deadly

Question 2

Anorexia

Answer 2

• Characterized by
- A fear of gaining weight
- A refusal to maintain a normal weight and adequate nutrition
• Types:
- Restricting type
- Binge-eating/purging type
• Distorted thoughts and values are typical
• Members of some groups or professions, such as ballet dancers and models, are at greater risk

Question 3

Bulimia

Answer 3

• Characteristics
- Frequent episodes of binge eating
- Recurrent inappropriate behavior to prevent weight gain i.e. purging or excessive exercise
- self-evaluation is undly influenced by body shape and weight
- Normal weight or slightly overweight
- fear of gaining weight, becoming fat
- over concerned with weight
- binge eating and purging
- use of non-purging methods to avoid weight gain
- feeling of lack of control over eating
• Typically begins with restricted eating motivated by the desire to be slender. Over time, however, the early resolve to restrict gradually erodes, and the person starts to eat “forbidden foods” or any food available
• Purging type
- Vomiting
- Laxatives
- Diuretics
• Non-purging type
- Fasting
- Exercise

Question 4

Binge-Eating Disorders

Answer 4

• Characteristics
- Frequent episodes of binge eating
- Typically overweight or obese
- No compensatory weight loss behaviors
• New disorder in DSM-5
• No compensation for binging behavior
• Less dietary restrictions than with bulimia
• Not surrounded by the fear of gaining weight/being fat

Question 5

Age of Onset and Gender Differences

Answer 5

• Anorexia nervosa is most likely to develop in 15- to 19-year-olds
• Bulimia nervosa is most likely to develop in women ages 20-24
• Three females for every male with an eating disorder
- Underreporting of eating disorders in men and misdiagnosis makes gender comparison difficult
• Pathological patterns of eating date back several centuries but did not attract much attention until the 1970s and 1980s
• For men, body dissatisfaction often involves a wish to be more muscular. Over-exercising as a means of weight control is also more common in men. As a result, men are less likely to recognize that they have an eating disorder, are more likely to be misdiagnosed when they do, and are less likely to receive specialist treatment

Question 6

Prevalence of Eating Disorders

Answer 6

• U.S. lifetime prevalence of binge eating disorder is around 3.5% in women and 2% in men
• U.S. lifetime prevalence of anorexia nervosa is around .9% in women and .3% in men
• U.S. lifetime prevalence of bulimia is around 1.5% in women and .5% in men
• Prevalence of binge eating disorder higher in obese people
• Risk has increased in 1900s

Question 7

Medical Complications of Eating Disorders

Answer 7

• Anorexia can lead to
- Death from heart arrhythmias
- Kidney damage
- Renal failure
• Bulimia can lead to
- Electrolyte imbalances
- Hypokalemia (low potassium)
- Damage to hands, throat, and teeth

Overall, Eating Disorders Effect The Entire Body

Question 8

Course and Outcome

Answer 8

• Suicide risk is high among anorexics (1 in 5 deaths)
• Long-term prognosis for bulimia is relatively good compared to anorexia
• Anorexia
- After 21 years:
> 51% fully recovered
> 21% partially recovered
> 10% not recovered
> 16% no longer alive
• Bulimia
- 70% in remission after 11 to 12 years
• Binge eating
- 60% in remission after 6 years
• Löwe and colleagues (2001) looked at the clinical outcomes of patients with anorexia nervosa 21 years after they had first sought treatment
• Many who recover will still have food issues

Question 9

Long-Term Stability of Eating Disorders

Answer 9

• People with eating disorders often later develop other eating disorders

• “Diagnostic crossover” common among subtypes of anorexia
• Uncommon between binge-eating disorder and anorexia

Question 10

Association of Eating Disorders with Other Forms of Psychopathology

Answer 10

• Eating disorders associated with following disorders:
- Clinical depression
- Obsessive-compulsive disorder
- Substance abuse disorders
- Various personality disorders
> can even exacerbate personality disturbances
- Self-Harming

Question 11

Eating Disorders Across Cultures

Answer 11

• Eating disorders are becoming a problem worldwide

* Attitudes that lead to eating disorders are more common in whites and Asians than African Americans

Question 12

Biological Factors

Answer 12

• The tendency to develop an eating disorder runs in families
• Whether this is due to genetic influence has yet to be determined
- personality traits (i.e. perfectionism)
- susceptibility
• Set-point theory (the idea that our bodies resist marked variation) may play a role
• Damage to the frontal and temporal cortex linked with anorexia and sometimes bulimia
• Serotonin levels may play a role (also play a role in mood, explains comorbidity)

Question 13

Sociocultural Factors

Answer 13

• Sociocultural influences such as fashion magazines idealize extreme thinness
• Women often internalize the thin ideal
• Western values toward thinness (e.g., as reflected in American TV) may have influenced non-Western cultures toward disordered attitudes toward eating

Question 14

Family Influences

Answer 14

• Families of anorexics characteristics:

• Limited tolerance of disharmonious affect or psychological tension
• Emphasis on propriety and rule-mindedness
• Parental over-direction of child or subtle discouragement of autonomous strivings
• Poor skills in conflict resolution
• Preoccupations regarding desirability of thinness, dieting, and good physical appearance

Question 15

Individual Risk Factors

Answer 15

• Gender (female)
• Age (adolescence)
• Binge-eating disorder onsets after adolescence and more common in men than women
• Internalization of thin ideal
• Perfectionism
• Negative body image
• Dieting
• Negative emotionality
• Childhood sexual abuse (debatable)

Question 16

Treatment of Eating Disorders

Answer 16

• Treatment can be challenging because patients are often conflicted about getting well
• Approximately 17% of patients with severe eating disorders have to be committed to hospitals against their will
• Hospitalization can lead to competitive pressure to be more anorexic than fellow patients

Question 17

Treatment of Anorexia

Answer 17

• Emergency procedures to restore weight
• Antidepressants or other medications
• Family therapy
• Cognitive-behavioral therapy

Question 18

Treatment of Bulimia and Binge-Eating Disorder

Answer 18

• Antidepressants or other medications

* Cognitive-behavioral therapy

Question 19

Obesity

Answer 19

• Defined by body mass index
• In the U.S., 1/3 of adults are obese
• Increased significantly in last 30 years
• Linked with many health problems
• Demographic and behavioral factors
- Sex (male except for African American women)
- Race or ethnicity (minorities)
- Socioeconomic status (low)
• From a diagnostic perspective, obesity is not an eating disorder
• Many clinicians regard the central problem as compulsive food consumption or a “food addiction”

Question 20

Risk of Causal Factors of Obesity

Answer 20

• Risk factors
- Genetic inheritance
> more likely or less likely to gain weight
- Hormones involved in appetite and weight regulation
- Sociocultural influences
- Family influences
- Stress and “comfort food”
• Minorities are at especially high risk for obesity. Obesity rates are highest (50%) in black women. Low income is associated with obesity for women, but higher income is associated with obesity in black and Mexican American men.

Question 21

Obesity and Genes

Answer 21

• Genes that may have helped our ancestors survive famine may now contribute to obesity
• A genetic mutation has been specifically linked to binge eating

Question 22

Hormones Involved in Appetite and Weight Regulation

Answer 22

• Leptin—a hormone produced by fat cells that acts to reduce food intake
- An inability to produce leptin can lead to obesity
• Grehlin—a hormone produced by the stomach that stimulates appetite
- High levels of grehlin can lead to obesity

Question 23

Obesity and Sociocultural Influences

Answer 23

• Time pressure can cause poor eating and exercise habits
• Restaurant portions are relatively large in the U.S.
• Immigrants to the U.S. have lower rates of obesity for first 10 years but increase in BMI later

Question 24

Obesity and Family Influences

Answer 24

• Family behavior patterns
- High-fat, high-calorie diet
- Eating to alleviate distress or show love
- Overfeeding infants and young children can predispose them to obesity
- Obesity can be “socially contagious” among those in close relationships
• Children whose mothers smoked during pregnancy or whose mothers gained a lot of weight during the pregnancy are also at a higher risk of being overweight at age 3
• People who are obese have markedly more adipose cells than people of normal weight

Question 25

Stress and Comfort Food

Answer 25

• Comfort foods
• Foods high in fat and carbohydrates
• Stimuli or conditions and cues 
- Watching TV
- Watching movies
- Attending parties
- Becoming anxious, angry, or bored
• Certain stimuli or conditions can serve as cues to eat, especially for obese people

Question 26

Circular Pattern of Obesity

Answer 26

• Pathways to binge eating
• Social pressure to conform to the thin ideal
• Depression
• Low self-esteem

Question 27

Treatment of Obesity

Answer 27

• Lifestyle modifications
- Low-calorie diet, exercise, and behavioral intervention
• Medications
- Meridia, Xenical
• Bariatric Surgery
- Reduces capacity of stomach or shortens intestine

Question 28

Prevention of Obesity

Answer 28

• Three simple steps 
- Eat three fewer bites of food at meals
- Walk or take stairs more often
- Sleep more
• Once people become obese, it is difficult for them to lose weight and maintain their new low weight
- Therefore, prevention is important

Question 29

Eating Disorder (definition)

Answer 29

Disorders of food ingestion, regurgitation, or attitude that affect health and well-being, such as anorexia, bulimia, or binge eating.

Question 30

Anorexia Nervosa - The Restricting Type

Answer 30

• body weight markedly low
• fear of gaining weight, becoming fat
• distorted body image
• feeling of control over eating

Question 31

Anorexia Nervosa - The Binge-Eating/Purging Type

Answer 31

• body weight markedly low
• fear of gaining weight, becoming fat
• distorted body image
• binge eating and purging
• use of non-purging methods to avoid weight gain
• feeling of lack of control over eating during binges

Question 32

Binge

Answer 32

An out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances.

Question 33

Purge

Answer 33

Purging refers to the removal of food from the body by such means as self-induced vomiting or misuse of laxatives, diuretics, and enemas.
• Belief that the hallmark of a truly successful person with anorexia nervosa was death from starvation, and that patients who were able to accomplish this should somehow be revered
• Ballet dancers are at an especially high risk for eating disorders

Question 34

Anorexia or Bulimia?

Answer 34

• If the person who binges or purges also meets criteria for anorexia nervosa, the diagnosis is anorexia nervosa (binge-eating/purging type) and not bulimia nervosa.

Question 35

The binge-eating episodes are associated with three (or more) of the following:

Answer 35

• Eating much more rapidly than normal.
• Eating until feeling uncomfortably full.
• Eating large amounts of food when not feeling physically hungry.
• Eating alone because of feeling embarrassed by how much one is eating.
• Feeling disgusted with oneself, depressed, or very guilty afterward.

Question 36

Eating Disorder Not Otherwise Specified

Answer 36

A diagnostic category reserved for disorders of eating that do not meet criteria for any other specific eating disorder.

Question 37

Diagnostic Crossover

Answer 37

• Between the two subtypes of anorexia (restricting and binge-purging) especially common
• Shifts from anorexia to bulimia in 1/3
• If someone with anorexia (binge-purge subtype) gains weight, the diagnosis will change to bulimia to reflect this fact, even though there may not be a big clinical change in the illness itself.
• Crossovers from the restricting subtype of anorexia into binge-eating disorder do not seem to occur at all.
• Diagnostic crossover from bulimia into binge-eating disorder occurs in about 10.9 percent of cases

Question 38

Meta-Analysis

Answer 38

A statistical method used to combine the results of a number of similar research studies. The data from each separate study are transformed into a common metric called the effect size. Doing this allows data from the various studies to be combined and then analyzed
• has shown that eating disorders (attitudes and behaviours) are significantly more prevalence in whites than non-whites
• exposure to Western views of appearance (especially through media) has been shown to influence other cultures

Question 39

Hypothalamus

Answer 39

Key structure at the base of the brain; important in emotion and motivation
• Possible that the lateral hypothalamus acts as a site that integrates information relevant for regulating food intake.
- overeating and suppressing eating in response to fear

Question 40

Set Point

Answer 40

The tendency of our bodies to resist efforts to bring about a marked change (increase or decrease) in weight (i.e. hunger)
• People with anorexia may think about food constantly and make intense efforts to suppress their increasing hunger
- chronic dieting may well enhance the likelihood that a person will encounter periods of seemingly irresistible impulses to gorge on large amounts of high-calorie food
• Patients with bulimia, hunger-driven impulses may escalate into uncontrollable binge eating.

Question 41

Serotonin

Answer 41

A neurotransmitter from the indolamine class that is synthesized from the amino acid tryptophan.
Also referred to as 5-HT (5hydroxytryptamine), this neurotransmitter is thought to be involved in a wide range of psychopathological conditions.
• Modulates appetite and feeding behavior
• Some researchers have concluded that eating disorders involve a disruption in the serotonergic system
• People with anorexia have low levels of 5-HIAA, which is a major metabolite of serotonin.
- May be because they are eating so little food.
• Levels of major metabolite in serotonin (5-HIAA) normal in people with bulimia
• After recovery, both of these patient groups have higher levels of 5-HIAA (than control); they also have higher levels than they had when they were in the ill state
• People with serotonin overactivity may use dieting as a way to regulate this by decreasing the amount of tryptophan that is available to make serotonin
• Change in the serotonin system will have implications for other neurotransmitter systems too

Question 42

Perfectionism

Answer 42

The need to get things exactly right. A personality trait that may increase risk for the development of eating disorders, perhaps because perfectionistic people may be more likely to idealize thinness.

Question 43

Negative Affect

Answer 43

The experience of an emotional state characterized by negative emotions. Such negative emotions might include anger, anxiety, irritability, and sadness.
• causal risk factor for body dissatisfaction
• have the potential to make people feel even worse about themselves.
• predictive of a high risk for later developing an eating disorder
• evidence suggests it may work to maintain binge eating
• in the very short term, eating provides much needed comfort.
- binge eating, a distraction from negative feelings
• childhood sexual abuse has been implicated in the development of eating disorders

Question 44

BMI

Answer 44

An estimation of total body fat calculated as body weight in kilograms divided by height (in meters) squared.
• below 18.5 are considered underweight;
• 18.5 to 24.9 is considered normal;
• 25.0 to 29.9 is overweight;
• obesity is defined as having a BMI above 30.
• BMI above 40 or being more than 100 pounds overweight is called morbid obesity.

Question 45

Weight Stigma

Answer 45

• A powerful source of this is the media, which perpetuates weight-based stereotypes and often depicts overweight or obese people in a very negative light.
- Compared to thin television characters, those who are overweight or obese are more likely to be shown when eating, are less likely to be depicted as being involved in romantic relationships, and are more likely to be the target of derisive comments
• Weight bias is even found in health care professionals who may blame obese patients for being overweight and having weight-related health problems
• The idea that we can simply decide to control our weight by eating less and exercising more does not always fit with the scientific facts.

Question 46

Prader-Willi syndrome

Answer 46

Prader–Willi syndrome have chromosomal abnormalities that create many problems, one of which is very high levels of grehlin. Sufferers are extremely obese and often die before age 30 from obesity-related causes.
• Extreme, may result in food having to be locked away from them to prevent binge eating
• Illustrates how the biological drive to eat can be so powerful that willpower is no match

Question 47

Obesity and Negativity Cycle

Answer 47

• Cycle A: Social pressure to be thin – body dissatisfaction – dieting - diet failure – binge eating – social pressure to be thin
• Cycle B: negative emotions – binge eating – weight gain – negative emotions

Question 48

Obesity and Negativity Cycle

Answer 48

• Cycle A: Social pressure to be thin – body dissatisfaction – dieting - diet failure – binge eating – social pressure to be thin
• Cycle B: negative emotions – binge eating – weight gain – negative emotions