Eating disorders Flashcards
How many calories does the brain need to keep going?
500
Why is it important to heat up anorexics?
Because being cold —> shiver —> lose more weight
What is anorexia nervosa often comorbid with?
Severe depression, OCD, OCPD, anxiety
AN causes _________ of the brain
pseudoatrophy
In the metabolic system, AN can cause __________ and ____________
hypothermia, dehydration
AN can make your __________ irregular
heartbeat
AN can suppress __________ development, causing you to become very ___________
red blood cells, tired
AN causes your ________ to crash, which means…
white blood cells, you’re not protected from bacterial infections
What are olanzopine and seroquel used for in anorexic patients?
To quell anxiety when they are given food, not specifically for AN
According to biggest study on EDs: In the early years after onset, the odds of recovering from ___ were greater than ___ but over time the probabilities of recovery shifted to favour ___.
AN, BN, BN
BN group had _____ the rate of recovery at 10-14 years than the AN group
three times
If you don’t recover from AN as an adolescent, you are risking…
permanent changes to your brain
What is refeeding syndrome?
potentially fatal shift of fluids and electrolytes that occurs when refeeding a malnourished patient.
Phosphate is needed to keep your heart going, when starved your phosphates become depleted. But if you eat too much too quickly your phosphate levels can get too high and you can die
What happens to anorexic’s brain if you give them a Krispy Kreme doughnut?
Their amygdala and hippocampus will light up > extreme fear response
How does the anorexic’s brain react when looking at others vs looking at themselves?
Their brain lights up normally when looking at someone else, but there is no activation when they are looking at themselves - the thought of looking at themselves is so terrifying that the brain shuts down
We think AN is related to an area of the brain called the __________. Anorexics’ _______ underperform
insula
Weak central coherence refers to…
the cognitive style where is a bias towards local or detail-focused processing accompanied by difficulties in the integrative processing of information
- ass. with autism spectrum disorders
AN patients have difficulty with set-shifting. What is it?
the ability to move back and forth between multiple tasks, operations and mental sets
- anorexics cannot change their strategy
The average duration of AN is…
7 years
Binge eating episodes are characterised by a _________ over eating
lack of control
Compensatory behaviours in BN include…
self-induced vomiting, misuse of laxatives, diuretics, fasting, excessive exercise
For BN: The binge eating and inappropriate compensatory behaviours occur on average at least ___________ for ___ months
once a week, 3
The severity specifiers for BN are based on _____.
frequency of inappropriate compensatory behaviours Mild = 1-3 Moderate = 4-7 Severe = 8-13 Extreme = 14+
BN is much easier to treat without comorbidity. What is BN often comorbid with?
Substance abuse, depression, personality disorders esp. BPD, anxiety disorders
The gold standard for assessing EDs is the…
Eating Disorders Examination (EDE)
The EDE includes 4 subscales:
Restraint
Weight concern
Shape concern
Eating concern
CBT-E (CBT for BN) usually lasts for ___ and is conducted in __ stages
20 weeks, 3 stages
What are the aims of Stage 1 of CBT-E?
- establish a sound therapeutic relationship
- educate patient about cognitive view of BN, explain need for both behaviour and cognitive change
- establish regular weekly weighing
- educate patient on body weight regulation, dieting adverse effects, physical consequences of binge eating, vomiting and laxative misuse
- reduce frequency of binging behaviour by introducing a pattern of regular eating and alternative behaviour
- reduce secrecy and enlist cooperation of friends and family
What are the aims of Stage 2 of CBT-E?
- tackle dieting
- enhance problem-solving skills
- address concerns about shape and weight
- address other cognitive distortions
What happens during Stage 3 of CBT-E?
- 3 interviews at 2-week intervals - ensure progress is maintained
- relapse prevention
- awareness of vulnerability factors
- how to deal with setbacks
It’s important to include _________ food into meal plans so that it doesn’t trigger binging
forbidden
The Keys study / the Minnesota starvation study showed that..
If you starve humans for too long, you lose control over food intake
The most important part of treatment for bulimia is …
the Daily Food Record
Some patients report a ________ during or following a binge episode
dissociative quality
What constitutes the difference between a subjective and objective binge?
Some people feel they are bingeing when they do not have objectively large amounts of food - if loss of control is present, this constitutes a subjective binge episode
Criterion B of BED states that the binge-eating episodes are associated with at least three of the following:
- 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 about how much they are eating
- Feeling disgusted with yourself, depressed or very guilty following a binge episode
In BED, Binge eating needs to occur _____ for at least _________
• once a week, 3 months
Specifier of severity in BED is based on the number of number of binge episodes per week.
- Mild: 1-3
- Moderate: 4-7
- Severe: 8-13
- Extreme: 14+
BED typically begins during -
early adulthood
What are the risk factors for BED?
- runs in families - suggests genetic influences
- Dieting is the greatest risk factor
Trauma, low self esteem, body dissatisfaction, negative emotionality, overevaluation of the importance of weight and shape, difficulty regulating emotional states, parental substance abuse
What are some triggers for binge eating?
- negative affect
- interpersonal stressors
- dietary restraint
- boredom
Is BED similar to other EDs in terms of comorbidity?
Yes, depression, anxiety are most common
substance abuse and PDs around 25% comorbid with BED
BED patients with current psychiatric comorbidity reported….
earlier age of first diet and higher ‘lifetime high BMI’
The Binge Eating Scale (BES) was developed to…
assess binge eating severity in obese patients
The Bulimia Test Revised (BULIT-R) was designed to….
assess the presence of bulimic symptoms. It has good sensitivity and specificity for BED
Why would you probably not use the Eating Attitudes Test - 26 to assess for BED?
- ok as a screening tool to determine at risk individuals
* but a bit dated (1982)
What is first-line treatment for BED?
- CBT - BED actually do want to work with you and get better, therefore CBT works
- If they don’t have access to a therapist, give them the Fairburn book with therapist contact
What are the other psychological treatments for BED?
- IPT - developed for depression, moderate effects
* DBT - deals with impulse control
What is Vyvanse and how does it work?
Pharmacological treatment specifically developed for BED
○ not yet approved in Australia, but used in US/Canada
○ it reduces the craving to eat
○ a slow-acting Ritalin
○ shown promising results
Compare CBT and Vyvanse?
- CBT helps stop binging, but doesn’t help you lose weight, unlike Vyvanse
- CBT increases ability to deal with negative affect, teaches you to deal with a hiccup
- Problem with Vyvanse is that you have to come off it - but the urge to binge will come back
- No trial has combined the two treatments yet
What is the average abstinence rate post-treatment?
52%
What is the average cessation rate at follow-up?
46%
Components of CBT for BED?
- cognitive restructuring to challenge unhelpful negative thoughts and beliefs about the importance of shape, weight, eating and their control for defining one’s self worth
- address unhelpful behaviours such as dietary restriction that may then lead to a binge cycle
- may address additional factors such as self-esteem, perfectionism, interpersonal functions, and emotional regulation
The Cognitive-Behavioural Model of BED assumes a variety of interlinked factors:
- low self-esteem; self-worth based on eating habits, weight, shape and the ability to control these
- extreme concerns about shape and weight
- bi-directional binge eating and strict dieting
- negative affect binge eating
What is the aim of IPT for BED?
- help patients gain insight into interpersonal relationships in the present, early relationships and historical life experiences
- explore interpersonal relations, attachment patterns, distressing emotions, and binge eating as a means of coping (how they interlink)
IPT for BED does not…
directly address diet, cognitions related to dietary restriction, or weight-related issues
What are the aims and effects of DBT for BED?
- Aim: improve emotion regulation and distress tolerance
- effective in binge reduction and lowering concerns about food and body shape
- no clear results on weight loss, depression, anxiety
Are antidepressants useful for BED?
• Moderately, helps patients with their depression and anxiety symptoms
not enough info on long-term gains
How is anorexia nervosa (binge-purge) subtype distinct from bulimia nervosa?
BN patients are not underweight
In order to be diagnosed with BED does there need to be a disturbance of body image or overvaluation of weight or shape?
no
Pica refers to
the eating of one or more non-food substances on a persistent basis for at least one month
Rumination disorder refers to
the repeated regurgitation of food
AN patients who engage in ____________ behaviours, have been ill for a ___________ period of time or have symptoms of ________ tend to have a poorer outcome.
binge eating and purging
longer
OCPD
Reduced serotonin activity has been found to be associated with increased ______________ and decreased _________________________
appetite
impulse control
What is leptin?
a hormone that results in decreased food intake and weight
Findings have shown that leptin abnormalities are likely to be a ____________ of AN.
consequence
_____________ is a personality trait that predisposes an individual to developing AN.
perfectionism
Motivational Enhancement Therapy (MET) for An aims to help patients
increase their motivation to change so that they are more able to engage in treatment and make a lasting recovery
Particularly for those patients who have some motivation to change, ________ is often seen as the treatment of choice.
CBT
What happens in the first stage for CBT for AN?
- establishing a supportive and collaborative relationship between patient and therapist
- instituting a meal
- goals of therapy are established in a collaborative manner
.The second stage of CBT for AN begins after…
some degree of weight gain is underway
The Maudsley Model of family-based treatment begins with…
promoting re-feeding and weight gain by encouraging parents to take responsibility for ensuring healthy eating in the home
Poorer outcomes of BN are reported when there is…
a history of childhood obesity, low self-esteem, personality disorder
A familial predisposition to __________, and family histories of ________ and ______________ are common in BN patients.
obesity
substance use
mood disorders
According to the Dual Pathway Model of BN, there are two main factors that trigger binge eating episodes:
dieting and negative affect
BN: Vicious cycle in which _____________ increases the likelihood of further negative ________________ and mood, thereby triggering more binge eating.
binge eating
social interactions
Higher levels of motivation at pre-treatment predicted…
a better treatment response
A proportion of patients with BN respond well to ______________
guided self-help
The one possible exception to the superiority of CBT compared to other psychological treatments for Bulimia is…
IPT
Study has found that CBT results in a more ____ improvement than IPT.
rapid
Evidence has shown that _____ are more effective than placebo in reducing binge eating and mood disturbance.
Antidepressants
Individuals with BED are more likely to eat in response to _____ compared to those without an eating disorder who are matched for weight.
Negative mood states
One Premorbid factor that applies to all EDs is ________.
poorer family functioning
