Eating Disorders Flashcards
Eating Disorders (Defined)
- serious, life-threatening, multi-determined illnesses that require expert care
- really about patient’s thoughts that they have about food and disordered eating. It’s a spectrum of things (just because someone comes in and doesn’t look like they have an eating disorder, doesn’t meant they don’t have one.
- can serve as an expression of psychological states and needs
- evidence suggests that these illnesses are neurobiologically-based and NOT diseases of choice
-often times people have comorbidities like anxiety and stress
Epidemiology of Eating Disorders
-Up to 30 million people (all ages and genders) suffer from this
-AN has the HIGHEST MORTALITY RATE of any mental illness (1 in 5 individuals commit suicide)
Research suggests that the decreasing mortality due to AN is a result of more specialized treatment units
-23% of individuals with BN die as a result of suicide
Obesity: especially morbid obesity, is associated with an increased risk for mortality, however, net effect is difficult to quantify
- 3rd most common chronic condition in adolescent females (3-12% of adolescents experience some form of eating disorder)
- increased attention is beginning to be paid to: (minority women, males, children and older individuals [particularly pregnant women who feel they need to lose weight], LGBTQ)
- 1 out of 10 people with an eating disorder is male
- only 35% seek treatment from a facility that specializes in eating disorders
- 42% of 1st-3rd girls want to be thinner (important)
- 42% of young women with anorexia is 12x’s more likely to die rather than other women her age without anorexia
Dieting may be the gateway. You might have a genetic predisposition for an eating disorder, then you have stress (external thing going on)< try dieting and brain gets more malnourished (91% of women on college campus had attempted a diet)
-5-10% of anorexics die within 10 years
18-20% die within 20 years
50% report ever being cured
Prevalence of Eating Disorders
AN: 0.5-1% among females in late adolescence, early adulthood
BN: 1-3% among females in late adolescent/early adulthood
Subclinical ED prevalence estimates as high as 13% in population
-ED prevalence similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians in US (exception is AN, more common among non-Hispanic weights)
Most common eating disorder: BINGE EATING DISORDER
- higher proportion of males here. Have about 4 in 10 males with this disorder in particular
- 2.8% of the US adult population
Importance of Screening and Early Detection
-delay in appropriate EDO-focused treatment results in: numerous medical, psychological, and social complications (some of which, not all, are completely reversible)
Long lasting implications on development
-The longer the EDO persists, the harder it is to treat
-crude mortality rate for AN is 4-5% (higher than any other psychiatric disorder)
-costs for AN treatment and quality of life indicators: if AN progresses into adulthood-rivals that of schizophrenia
e.g. Osteoporosis is an irreversible effect of AN. We can prevent it from getting worse but we can’t get back bone mass. Debatable in adolescence because peak bone may still be developing.
Classification of Eating Disorders
AN
BN
Binge Eating Disorder (BED)
Avoidant/Restrictive Food intake Disorder (people fail to have enough nutritional intake and it may be related to a med illness like Crohn’s, can develop into a fear of food or aversion related to that pain)
Other specified feeding and eating disorders (OSFED)
Atypical AN (we see more higher weight individuals that demonstrated fear of weight gain and may lose a significant amount of weight and even though they’ve lose all this weight, they remain normal due to high starting baseline)
Subthreshold BN
Subthreshold BED
Purging Disorder (vomiting only as a mechanism to undo intake)
Night Eating Syndrome
AN Diagnostic Criteria
- restriction of energy intake relative to requirements result in in low weight
- intense fear of gaining weight or interference in gain
- disturbance in weight or shape experience, excessive influence self-evaluation, or lack of recognition of seriousness of low weight
- severity levels: goes by BMI. (Mild is >17, Moderate is 16-16.9, Severe is 15-15.9 and extreme is <15).
- sometimes we give anti-psychotics because of this deep distortion of body perception
AN (subtypes)
Restricting Type: during the current episode of AN, the person has not regularly engaged in binge-eating or purging behavior
Binge-Eating/Purging Type: during the current episode of AN, the person has regularly engaged in Binge-eating or purging behavior (i.e. Self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
- –main difference from Bulemia is that patients are almost always going to be underweight. Buliemia patients tend to be normal weight or overweight
- Amenorrhea is NO longer included in criteria
Common Clinical Presentations of AN
- intense preoccupation with thoughts of weight, shape, size and food, irrational worries about fatness
- frequently look in mirrors, focuses on appearance, likely body checks
- may hide food, spend a large amount of time cutting up food into small pieces, rearranging food on plate to eat less
- may collect recipes, cook/bake for others
- losing weight boosts self-confidence through fueling perfectionistic traits common in restricting subtype
- delayed psychosocial development and decreased interest in sex
- denial, resistance to treatment, core feelings of inadequacy and ineffectiveness (resistance common barrier to research)
Binge Eating
-can occur across the spectrum of eating disorders AND other disorders
- rapid weight loss is bad for growing children
- assessment can be difficult due to age/development. Patient must have abstract reasoning skills, perspective taking skills and ability to label emotions
- key here is the LOSS OF CONTROL. We can really see it happen across spectrums of illnesses. WE Scan see it in general developmental obesity
-often consume very high caloric, high fat items. Large volumes of foods in small amount of time. Several thousand calories at a time
Binge (definition)
1: eating, in a discrete period of time (e.g within any 2 hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
2: a sense of lack of control over eating during the episode (e.g. A feeling that one can’t stop eating or control what or how much one is eating)
Bulimia Nervosa (diagnostic criteria)
- recurrent episodes of binge eating
- recurrent inappropriate compensatory behaviors to prevent weight gain (misuse of laxatives, self-induced vomiting, diuretics, enemas, fasting, exercise
- Binge and purge episodes occur on average once per week for 3 months
- self-evaluation is unduly influenced by shape/weight
- the disturbances does not occur exclusively during episodes of AN
- categorized severity based on number of episodes of compensatory mechanisms per week (i.e. Mild average of 1-3 severe avg. of 14+)
- tend to be normal or overweight
Purging Methods:
Self-induced vomiting
Laxative abuse
Diuretic Misuse
Enemas
Common Clinical Presentation-BN
- more prevalent in females
- usually in normal weight range, can be overweight
- frequently experience weight fluctuations
- sense of losing control is significant
- abdominal pain/discomfort, self-induced emesis, sleep or social interruption usually ends bulimic episode—-feelings of guilt, depression, self-disgust follow
- have fear of not being able to stop eating voluntarily
- often fast eater
- often experience difficulties with satiety system-extreme hunger then lose control and binge, may feel full after end of normal meal
- food consumed usually high caloric and texture easy to eat quickly
- experience difficulty feeling full after end of normal meal
Binge Eating Disorder (diagnostic criteria)
- these individuals shave episodes with sense of lack of control. Don’t have a significant amount of compensatory mechanisms
- in general: it’s binge eating without other ways to undo things. Eat a lot of food when they’re not hungry. Eat alone. Feel guilty and a lot of distress
- recurrent episodes of binge eating
- binge Eating episodes are associated with at least 3:
1: Eating much more rapidly than normal
2: eating until feeling uncomfortably full
3: eating large amounts of food when not physically hungry
4: eating alone because of embarrassment
5: feeling disgusted with oneself, depressed or very guilty after overeating - marked distress regarding binge eating
- at least once a week for 3 months
- no recurrent use of inappropriate compensatory behavior
Clinical Presentation: BED
- most common eating disorder in males
- obesity, including severe obesity in 50% of patients (BMI >40), most patients/subjects with BED are overweight or obese but can be of normal weight
- 30% of individuals in weight-loss programs have BED
- 25% to 50% of patients seeking bariatric surgery have BED
- Experience many other psychiatric and physical illnesses including metabolic syndrome
- patients with BED commonly ask for help with depression or weight gain rather than binge eating per se
- BED symptoms often increase during stress
- experience body image concerns too
- these patients tend to be the most motivated. They move forward and work hard usually. Don’t see much denial as opposed to those with anorexia
BN vs. BED
BN:
- binge eating, often episodes more severe
- compensatory behavior
- over concerned with shape/weight
- once/week for 3 months
- generally in normal weight range
BED:
- binge eating
- absence of compensatory behavior
- indicators of loss of control (binge eating)
- marked distress, often with weight/shape concerns
- once/week for 3 months
- generally in overweight or obese range
