Eating Disorders Flashcards
Anorexia Nervosa
WHAT/ FACTS
- Purposeful maintenance of a significantly low body weight, intense fears of becoming overweight + has distorted views of her shape and weight
2 ways of maintenance:
1) purging after eating
2) restricting food intake
- *95% females @ around 14-25.
- High death rate
- normally starts from slightly overweight –> dieting (losing weight)
AN clinical picture - important points
- fear provides motivation
- Preoccupation w food
- distorted views
Bulimia Nervosa WHAT + FACTS
- Binges = limited period of time where a person would eat much more than most people during a similar time span. Normally in BN its 1-30 binge episodes per week.
- Followed by self blame/shame
- 15-20
- can lead to AN
- normally begins after a period of dieting (praise/ good feelings about self)
QUITE INVOLVED WITH DESIRE TO PLEASE PEOPLE
Binge eating disorder - WHAT
- Repeated binges with feeling of no control (APA, 2013)
- NO COMPENSATORY BEHAVIOUR
- 2-7% of pop have it
- Preoccupied with weight + food (like AN + BN)
- Bodily dissatisfaction & MH probs
- doesn’t nec begin with dieting**
BN - 1 binge a week; normal?
One difficulty in knowing whether you have Binge Eating Disorder is that no-one knows exactly what kind of eating constitutes a “binge”. One man’s binge may be just another man’s hearty meal.
- grand misunderstanding of how many times a week constitutes to a disorder (some websites say 3+) but DSM 5 = 1
- ED is not about choosing to eat extra-large portions, nor are people who suffer from it just “overindulging” – far from being enjoyable, binges are very distressing. -
- Sufferers find it difficult to stop during a binge even if they want to, and some people with binge eating disorder have described feeling disconnected from what they’re doing during a binge, or even struggling to remember what they’ve eaten afterwards (dissociative)
comorbidity of AN
- bipolar
- depression/anxiety
- substance abuse
- OCD
Psychodynamic theories of ED
CONTAINS A LOT OF COGNITIVE THEORIES: sensations/perceptions of control
Ego deficiency:
- distorted mother-child relationships lead to serious ego deficiencies in the child. Poor regulation of the child’s needs
- ** independence and control become problematic
- Grow up confused about their needs; gain control by controlling weight and food.
evidence around psychodynamic approach to ED? // BIOSOCIAL EXPLANATION
support:
- the same for BPD: if parents don’t teach their children how to respond accurately to their feelings or needs (internal cues) they may never learn to id hunger
- **large number of people with ED have an BPD
- ED sufferers interpret their internal cues (emotional cues inc) inaccurately — i.e. when some are anxious or upset they just think they’re hungry. Find it hard to interpret their feelings (alexithymic)
against:
?????????????????
Cognitive aetiology of ED
Deficits in their perceptions and sensations (as seen in psychodynamic). This deficit leads to broad distortions in thinking/perceptions (weight + control)
Eval of cognitive aetiology of ED
- don’t think these are the cause of ED but may be the maintenance of it
ED & depression – does depression set the stage for ED?
a) Many people with the diagnosis for an ED also qualify with a diagnosis of MDD than do in the general population
b) Close relatives of people with ED seem to have a higher rate of depressive disorders than those without ED
c) ED can be helped by anti depressant drugs used depression
* **cause or consequence???????????????
Studies of the temporal onset of EDs and depression suggest that EDs tend to precede the development of depression and that depressed mood improves with weight restoration
BUT DOES SEEM TO BE BIDIRECTIONAL; COS ALSO = Past researchers (Heatherton & Baumeister, 1991) have proposed that disordered eating is a compensatory mechanism to reduce negative mood states.
HOWEVER it is anxiety that seems to preceded ED
** both of these does increase the persistence of ED symptoms
Biological aetiology for ED
- genetic component: 70% identical twins (an>bn)
- Low serotonin in ED (linked w carb craving)
- Positive feedback (mainly in animal models) when the rat was given high fat/sugar diet –> wanting responses & then it was TAKEN AWAY –> anxiety like symptoms & compulsive seeking REGARDLESS of consequences (mainly for BED)
- hypothalamus role: weight thermostat
- it isn’t just this though –> they haven’t found genes which link together; maybe it more to do with families?
Weight thermostat - what?
- homeostatic feedback control system
in rats (easier cos no society pressure) - found there was a “metabolic propensity” for their rats to regain weight after a period of caloric restriction and subsequent weight loss, both by an increased appetite and a decrease in resting metabolic rate. - regulation of fat is more inconsistent in humans –> due to “genetic, gender, perinatal, developmental, dietary, environmental, neural, and psychosocial factors.”
Hypothalamus:
Early eating habits + genetic inheritance = help determine a person’s weight set point; when weight falls below this the lateral hypo induces hunger and slows metabolic rate and vice versa for gaining weight
SO IN DIETING - brain tries to regain weight when its lost.
SOME GAIN TOTAL CONTROL OF THERMOSTAT - AN (restriction) + BN (binging/purging)
Eval of bio ED
genetic component + identical twins IS THIS SOCIAL INFLUENCE?????
a) Adoption study – female sibling pairs; Our findings bolster those from twin studies and provide evidence of significant genetic effects on disordered eating symptoms (2009) THE ONLY ADOPTION STUDY
Weight thermostat – v accepted but v debated???
Society aetiology in ED
- Western standards make ED more likely
- Social media
- “Fat shaming” in western culture
Social media + ED
- Social networking is positively related to body image concerns and disordered eating.
- Photo-based activities are particularly salient.
- Relationships hold for both women and men.
- Internalization and appearance comparison mediate the relationship.
- Promotion of things like “thinspiration” that catches on
- interventions on social media sites: inaffective + have very low participation
- Indegenous Fiji - mass media not been around for long but ED seen an increase since its beginning
Family environment
- aspirations of thinness in families = influences onset of AN/BN
- abnormal family communication
- enmeshed family systems - involved in each others business (desire for control)
Eval of family environment + ED
(4)
what should a model include?
- No consistent research showing that this one type of family = ED; families of AN and BN vary massively
BUT contirbuting factors:
a) parental control + perfectionism: associated with ED in offspring. Fathers control predicted the most.
b) insecure attachments: trouble with the expression of feelings; muted responses + low key pattern of affective expression
c) parental attitudes: mothers w EDs impact on children (& vice versa). High amount of talk/action of dieting in families with ED
***thus, families can have an effect BUT will differ for each family
Model should include: development of obsessive, perfectionist personality –> ED, distress that leads to ED, family make up + how AN becomes consolidated as way of managing distress
Multicultural factors – race + ethnicity
- used to be a difference in ethnicities with the rate white> other minorities BUT the gap is closing
- **acculturation; Those who orient themselves more w white culture = higher ED rate
Men + ED
a) why might there be differences in the two?
- weight loss favoured by the two: males = exercise + women = dieting (w dieting often preceding ED)
- Job pressure
- Society
- There seems to be an invalid approximation of body image dissatisfaction levels in males due to the traditional focus on weight (and not muscle like men stuff with) need assessment scales for men.
- -Men also report less of a sense of being out of control during a binge than women do and that anger can trigger a binge episode, while women seem to binge in order to restrain their sense of anger
- The use of assessment tools, which places emphasis on compensatory behaviors, binge habits, attitudes about food, and emotional triggers in males, would likely improve accuracy of reporting by males, as well as lead to the development of appropriate interventions.
Muscle dysmorphia
Men
- feeling of shame
“bigorexia” - trivalised? – “something gone wrong in the brain” - ??
Treatments for AN - family therapy
what + eval
Family therapy: -Meet with a family as a whole, points out troublesome family patterns + helps them make changes (shown to be effective but don’t know why)
EVAL
Although FBT does not appear to be superior to individual treatment at end of treatment, there appear to be significant benefits at 6–12 month follow-up for adolescents suffering from eating disorders.
- needs more work on the model; not may therapists feel confident with it
- works best for early stages of ED
- less optimistic for late onset ED (adult ED)
CBT for AN/BN/BED
- included in most treatments + longer lasting changes
- needs other stuff to be effective tho
- change thoughts and behaviours.
a) cognitive –> taught different coping strategies + that they wont be judged for their weight and control abilities
b) Behavioural –> patients required to keep a diary of feelings, hunger levels and food intake + the relationship between these
Treatment for BN antidepressant
- BN are helped a lot by these drugs (AN not so much). Can help up to 40% of patients
- reduce body image and weight concerns, in addition to reducing depression and anxiety, which are commonly experienced in people who have bulimia
- bulimia have a chemical imbalance of the neurotransmitter Serotonin, which is responsible for regulating emotions, mood, and appetite; The imbalance of serotonin levels in the body can increase urges to binge and purge
