Eating disorders

Question 1

Define eating disorders

Answer 1

Disorders involving a definite disturbance of eating habits &/or weight control which results in physical &/or psychosocial functioning impairments

Question 2

Given the different sub-types of eating disorder, how might we best distinguish between anorexia nervosa and bulimia nervosa?

Answer 2

Anorexia is a more extreme version of bulimia in as much as anorexia diagnosis requires you to be clinically under-weight

Question 3

What are the 4 main symptoms of anorexia nervosa?

Answer 3

1) Refusal to maintain weight at/above the minimally normal weight for your age/height, 2) Intense fear of gaining weight, 3) Body image disturbance & 4) Amenorrhea (absence of 3 consecutive menstrual cycles)

Question 4

What are the 4 main symptoms of bulimia nervosa?

Answer 4

1) Recurrent binge eating which is perceived to be uncontrollable, 2) inappropriate compensatory behaviour (vomiting, laxatives & excessive exercise), 3)…twice per week for 3 months & 4) self-evaluation which is unduly influenced by body shape & weight

Question 5

What are the 2 types of anorexia?

Answer 5

Restricting type vs. binge eating/purging type (done to comfort the worries of friends or family)

Question 6

What are the 2 types of bulimia?

Answer 6

Purging type vs. non-purging type

Question 7

What are eating disorders NOS?

Answer 7

(Not Otherwise Specified) Atypical eating disorders which are clinically significant but do not conform to the diagnostic criteria of AN nor BN

Question 8

What is binge eating disorder?

Answer 8

Recurrent episodes of over-eating in the absence of weight control behaviours = strong overlap with obesity = patients are often in their 40s and 25% are male

Question 9

ED (Eating Disorder) patients commonly move between diagnostic criteria e.g….

Answer 9

Many anorexia sufferers become bulimia sufferers with time whereas few bulimia sufferers become anorexia sufferers. There is also a lot of movement out of anorexia & bulimia into atypical EDs and then diagnostic escape!

Question 10

Anorexia and bulimia sufferers often share 4 demographic characteristics. They are…

Answer 10

Mostly female (90%), adolescents (young adults for bulimia), predominantly from western societies and mainly caucasian

Question 11

Name 3 demographic differences between anorexia and bulimia

Answer 11

1) A: possible excess in high social classes vs. B: even distribution across social class, 2) 0.7% vs. 1-2% prevalence, Possible vs. likely increase in incidence across the generations (= secular change)

Question 12

The ideal girl, as measured in terms of front cover models, had a BMI (weight/height squared) of ___ in 1991 where…

Answer 12

15.6 where < 18.5 is underweight and > 25 is overweight (Nichter, 1991)

Question 13

There has been a change in the “thin ideal” across the generations. Wiseman (1992) found that Playboy models had an average weight of __% of the population average in 1989 compared to __% in 1959

Answer 13

82.5% from 91%

Question 14

Sypeck (2003) found that the number of glamour magazine front covers displaying ___ ___ ___ increased a lot from 1985 to 2000

Answer 14

Full body shots

Question 15

The shift in ED onset from adolescence to adulthood may reflect…

Answer 15

The inclusion of older women who conform to the thin ideal in TV programmes e.g. Desperate Housewives & Sex in the City

Question 16

The much higher incidence rate of EDs amongst females relative to males may reflect the finding that…The gender drive for muscle vs. fat may be a confounding variable here

Answer 16

Females believe that their current weight is much greater than 1) what they believe males would find most attractive, 2) what they deem most attractive & 3) their ideal weight…in that order. In contrast, males believe that their current, ideal & most attractive weight are the same, though what they believe females would deem most attractive is a little lower

Question 17

Do EDs originate with health conscious behaviours in adolescence?

Answer 17

Yes they may: 50% of girls begin dieting between the ages of 8 and 11 and 42% of girls diet because they “feel fat”

Question 18

A problem with questionnaires on dieting is the…

Answer 18

Definition of dieting which may include items all the way from cutting down on food intake to eating more healthily

Question 19

Glamour models, Playboy models and Sex in the City suggest that EDs are culture-bound. Give 3 pieces of evidence which differentiate between anorexia and bulimia in answering this question

Answer 19

1) There have been secular (generational) increases in BN but not in AN, 2) AN (not linked to the thin ideal) but not BN has occurred in other historical contexts & 3) AN (not linked to the thin ideal) occurs in non-western cultures but whether BN does depends on that culture’s exposure to western TV

Question 20

What do the 3 pieces of evidence re: AN vs. BN and whether they are culture-bound suggest?

Answer 20

That BN is linked to the thin ideal and is therefore culture bound. AN is not linked to the thin ideal and hence is not culture bound

Question 21

Can the thin ideal completely explain the incidence of EDs? Why? (3 reasons)

Answer 21

No, because 1) whilst the environmental pressure for thinness is immense, EDs are rare, suggesting that IDs in psychobiological vulnerability to pressures play a role & 2) There are historical & non-western incidents of AN where thinness was/is not prized & 3) EDs show such stereotypic symptoms, age-of-onset & developmental trajectories

Question 22

Name 2 challenges which psychobiological research into EDs faces

Answer 22

1) Psychobiological factors may only be state factors (i.e. associated with the ED rather than being present prior to symptom onset) e.g. products of starvation & 2) or state factors of comorbid anxiety or depression. Conc) Correlates may not be causal

Question 23

The following hormones regulate body weight and appetite: grehlin, peptide YY, cholecystokinin (CCK), leptin & insulin. Group them into 3 categories

Answer 23

1) Short duration, meal-related satiety signals (act rapidly to initiate/terminate meals): grehlin, CCK. 2) Intermediate acting hormones which inhibit eating between meals: peptide YY. 2) LT regulators which act slowly to decrease appetite & keep body fat stores stable: leptin & insulin

Question 24

Acute ANervosa is characterised by hypo___

Answer 24

Hypoleptinaemia i.e. a lack of leptin = heightened appetite = binge eating

Question 25

Leptin depletion is a ___ factor not a ___ factor of anorexia which contributes to clinical physical symptoms such as…(2 things)

Answer 25

State factor, not a trait factor. 1) Amenorrhea (missing menstrual cycles) & 2) Decreased bone mineral density

Question 26

Whilst low levels of leptin may simply be a state factor (consequence of anorexia), they may still serve to perpetuate or maintain the disorder by encouraging…(2 related things)

Answer 26

Excessive exercise and physical restlessness

Question 27

It has been found that restricting the feeding schedules of mice whilst giving them free access to a running wheel causes them to…(2 things)

Answer 27

Run 10km/day & run themselves to death. In fact, giving them access to a running wheel causes them to consume even less of the food = a vicious cycle

Question 28

As far as leptin is concerned, it is believed that…(link food restriction, physical hyperactivity, decreases in leptin & prevention of further weight gain)

Answer 28

Food restriction causes 1) physical hyperactivity & 2) decreases in leptin. 1) & 2) encourage each other. All 3 factors prevent further weight gain

Question 29

Rats administered with leptin make ___ revolutions of the running wheel

Answer 29

Fewer

Question 30

Hormones have their effect by influencing the ___. Leptin seems to ___ on recovery

Answer 30

Hypothalamus. Normalise

Question 31

Serotonin is implicated in EDs. It is argued that ___ disturbance of 5HT transmission is…

Answer 31

Premorbid (prior to experiencing the disorder). Modulated by restricted eating or binging, which are interpreted as ways of correcting serotonin dysfunction

Question 32

Serotonin dysfunction had been linked to 3 factors which are also important in EDs. What are these?

Answer 32

1) Abnormal mood & emotional processing, 2) Appetite dysregulation & 3) Impulsive/compulsive/obsessional behaviour

Question 33

Psychological factors play a role in EDs. BN & AN patients have more -ve thoughts whilst a), b) & c), though the difference to normal controls is not significant for _ _ in c)

Answer 33

a) Eating a chocolate mint e.g. I have no self-control, b) Being weighed e.g. I’m getting fatter and fatter & c) Looking at themselves in the mirror. AN

Question 34

EDs are characterised by biased cognitions but do these cognitive distortions affect perception or just memory?

Answer 34

Shafran (2002) asked Pps to adjust a projected life-size image of themselves so that it matched a) exactly what they saw in the mirror & b) what they would like to see in the mirror. ED patients overestimated their own weight (by 17%) & were less satisfied with it

Question 35

Shafran (2007) used the visual dot probe task to measure ED patients’ biased attention towards/away from different stimuli. What was found?

Answer 35

Compared to controls, patients showed an attentional bias away from (avoidance of) +ve eating stimuli & a bias towards -ve eating stimuli & neutral weight stimuli (e.g. weighing scales)

Question 36

Shafran (2007) also tested anxiety patients - why?

Answer 36

To ensure that the ED patients’ results could not simply be explained in terms of comorbid anxiety

Question 37

How do we know whether attentional, thought-based and perceptual biases are a cause or effect of EDs?

Answer 37

Pps who are semi-starved shows signs of fixating on food in daily life to a much greater extent than prior to semi-starvation (Kalm, 2005)

Question 38

Why was the semi-starvation study carried out? How much weight did the average Pp lose? What other symptoms did semi-starvation induce?

Answer 38

To investigate the problem of re-feeding civilians after they had been semi-starved during the war. 25%. Extreme weakness, irritability, fatigue & amnesia

Question 39

___ism has been linked to AN. What is ___ism?

Answer 39

Perfectionism = compulsive striving towards unattainable goals, having impossibly high standards & basing your own worth entirely on achievement

Question 40

___ive traits are thought to be associated with BN. Does the evidence support this view?

Answer 40

Impulsive traits. Yes in self-report and by the finding that BN patients show more self-harm & alcohol & substance abuse. No in terms of their performance on neuropsychological tests of cognitive control

Question 41

What two pieces of evidence suggest that AN/BN are associated with altered functioning of the reward system?

Answer 41

1) EDs share clinical characteristics with & have high incidence rates of substance abuse & addition, 2) Dopamine anomalies are implicated in EDs

Question 42

Distinguish between the malfunctioning reward systems of AN patients & BN patients. Individuals with BN may be…(a personality trait), where as individuals with AN may be…

Answer 42

BN: hedonic (they find food rewarding) which would explain approach behaviours (e.g. overeating). AN: anhedonic (find food unrewarding) which would explain compensatory behaviours (e.g. excessive exercise). It has been found that the more excessively AN patients exercise the more anhedonic they tend to be (Davis, 2002)

Question 43

What 2 pieces of evidence does Wagner (2007) present to suggest that at the neural level AN patients show abnormal reward processing?

Answer 43

1) AN Pps showed reduced activity in the insula, ACC & striatal regions during blind administration of sucrose vs. water. 2) Pleasantness ratings are +vely correlated with ACC, striatum & insula activity in controls but not in AN

Question 44

What 3 mechanisms are proposed by Fairburn (1998) to account for the “need to control” in reinforcing self-worth in EDs?

Answer 44

1) Dietary restriction enhances their sense of being in control, 2) Starvation reinforces dietary restrictions by threatening perceived self-control & 3) Avoidance of mirror checking results in the absence of feedback, perceived failure of control & more dieting

Question 45

At the same time the more you lose weight the more difficult it becomes to lose more weight & so to reassert/demonstrate self-control. Therefore, to treat EDs we must break…& boost…

Answer 45

The link between perceived self-worth & amount of self-control. Self-worth