Eating Disorders

Question 1

Anorexia Nervosa: DSM-5

Answer 1

Eating disorder in which the individual is significantly below a body weight that is normal for their age and height
Suffers from a fear a gaining weight
Body image disturbance, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Question 2

Bulimia Nervosa: DSM-5

Answer 2

Recurrent episodes of binge eating.
Eating large amounts of food in a discrete amount of time (within 2 hours).
Sense of lack of control over eating during an episode.
Recurrent inappropriate compensatory behaviour to prevent weight gain (purging).
The binge eating and compensatory behaviours both occur, on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 3

Binge eating disorder

Answer 3

Eating disorder in which the individual engages in recurrent binge eating episodes but does not engage in compensatory behaviours designed to counteract the caloric intake.

Question 4

Avoidant/restrictive food intake disorder (ARFID)

Answer 4

A persistent eating disturbance associated with failure to meet nutritional/energy needs.
Cannot he explained by cultural practices, another eating disorder, body image disturbance and/or another medical or mental health condition.
Eg children with autism or adults with food or swallowing phobias.

Question 5

Other specified feeding or eating disorder (OSFED)

Answer 5

Disturbances of eating that do not meet criteria for anorexia nervosa, bulimia nervosa, binge eating disorder or avoidant/restrictive food intake disorder.
Eg atypical anorexia where person is not underweight
Bulimia and binge eating disorder of low frequency and/or limited duration
Night eating syndrome
Purging disorder

Question 6

Unspecified feeding or eating disorder

Answer 6

Symptoms characteristic of an eating disorder causing significant impairment or distress that do not meet full criteria for another eating disorder.

Question 7

Pica

Answer 7

Persistent eating of non-food substances

Question 8

Rumination disorder

Answer 8

Repeated regurgitation of food, which may then be re-chewed, re-swallowed, or spat out.

Question 9

Prevalence of anorexia

Answer 9

Affects mainly adolescent girls and young women.
10 times more common in females.
0.9% of women had experienced it at some time in their life
>1% had it currently

Question 10

Age of onset of anorexia

Answer 10

Usually in early to late adolescence.

Pre-pubertal onset is not uncommon.

Question 11

Course of anorexia

Answer 11

Mortality rate is among the highest of all psychiatric disorders (5-10% of patients die per decade) due to deaths from medical complications of starvation and suicide.
Recovery is lengthy and many fail to fully recover.
47% recover after 4-10 years.
32.4% improve but still experience some symptoms.
19.7% remain chronically ill.
About 50% of patients go on to develop another eating disorder eg bulimia

Question 12

Associated psychological and medical problems

Answer 12

Medical and psychological complications of starvation (see table pg. 243)
Comorbid with mood disorders (Eg depression), anxiety disorders, substance use disorders, and personality disorders.

Question 13

Aetiology of anorexia: biological factors

Answer 13

Moderate heritability

Genetic and environmental factors have a different causal role for different aspects of the disorder.

Question 14

Aetiology of anorexia: Psychological factors

Answer 14

Low self-esteem (I’m better if I’m thin)
Negative affect (eg guilt, anxiety, anger, shame). Attempt to avoid emotional distress by focusing on weight and food.
Negative emotions, body dissatisfaction.
Dysfunctional thinking (cognition) about eating, shape and weight. Eg base self-worth on thinness, if not thin then must be lazy, weak, incompetent.
Perfectionism (personality trait).

Question 15

Aetiology of anorexia: social factors

Answer 15

High levels of criticism from family.
Parents who comment on their child’s weight increase likelihood of child developing anorexia.
Parents model bad eating behaviours/attitudes.
Peer approval (have to look thin to get attention from boys)
Peer groups in which eating, shape, and weight cancers are high.
Sociocultural - emphasis on thinness in media

Question 16

Treatment of anorexia

Answer 16

Motivational enhancement therapy
CBT
Family therapy
Pharmacological approaches (not really any good medications)

Question 17

Motivational enhancement therapy (MET) - anorexia

Answer 17

Aims to help patients increase their motivation to change so that they are more able to engage in treatment and make a lasting recovery.

Question 18

CBT - anorexia

Answer 18

Stage 1: establishing the basis for a supportive and collaborative relationship between the patient and therapist, and instituting a meal plan.
Stage 2: once some degree of weight gain is underway, dysfunctional beliefs regarding food and weight are targeted. Also focus therapy on wider issues (eg self-esteem, perfectionism etc).
Stage 3: preparing patient for end of treatment and developing strategies to prevent relapse.

Question 19

Family therapy - anorexia

Answer 19

Treatment of choice for younger patients.
Encourage parents to take responsibility for ensuring healthy eating in the home.
Establish new pattern of family relationships - ensure disordered eating is no longer the focus of family interactions.

Question 20

Prevalence of bulimia nervosa

Answer 20

Affects primarily females.
1-3% of women will experience it at some point in their lives.
0.1-0.3% of men will experience it.
20% of males with an eating disorder are homosexual.

Question 21

Age of onset and course of bulimia nervosa

Answer 21

Later age of onset than anorexia, emerging in late adolescence and young adulthood.
Symptoms can become chronic for some individuals.
Estimated 50% still having it after 10 years.

Question 22

Associated medical and psychological problems with bulimia

Answer 22

Problems related to purging behaviours.
Most dangerous is depletion of electrolytes of potassium, chloride and sodium.
Results in weakness, tiredness, constipation, depression, irregular heartbeats and sudden death.
See pg 257 for more medical problems.

Question 23

Aetiology of bulimia nervosa: biological factors

Answer 23

Moderate heritability
Familial predisposition to obesity, and family history of substance use and mood disorders are common in bulimia patients.

Question 24

Aetiology of bulimia: psychological factors

Answer 24

Two main factors: dieting and negative affect.
Dietary restrictions may precipice binge eating, due to intense states of hunger which results in loss of control over eating.
Individuals may try to reduce distressing emotions through the comfort and distractions provided by binge eating.
Vicious cycle: dieting and eating exacerbating each other. Binge eating triggers renewed attempts at dieting due to anxiety over weight gain.

Question 25

Aetiology of bulimia: social factors

Answer 25

Social and cultural factors that encourage dieting or result in negative effect will cause bulimia.
Eg teasing about weight, lower levels of care and affection from family.

Question 26

Treatment of bulimia nervosa

Answer 26

Motivational enhancement therapy 
CBT
Self-help approaches
Interpersonal psychotherapy (IPT)
Pharmacological (antidepressants)

Question 27

Self-help approaches - bulimia

Answer 27

Patients provided with a self-help manual and work through it alone or with a therapist (better results).
Available for people living in rural and regional areas.
Reduce time and cost of treatment.

Question 28

CBT - bulimia

Answer 28

Stage 1: educate patient about bulimia nervosa and emphasis the self-perpetuating cycle of dieting and binge eating. Goal is to eliminate dieting and other weight control methods and promote a regular eating pattern.
Stage 2: once regular pattern of eating is achieved, all dieting is eliminated and dysfunctional cognitions regarding eating, shape and weight are targeted.
Stage 3: focus on relapse prevention.

Question 29

Interpersonal psychotherapy (IPT) - bulimia

Answer 29

Help individuals identify and change any current interpersonal problems (help with negative affect).

Question 30

Prevalence of binge eating disorder

Answer 30

Affects approx 3-5% of young women.

Two-thirds are female.

Question 31

Age of onset of binge eating disorder

Answer 31

Age of onset is unknown, but best estimates are that it initially occurs in late adolescence and young adulthood.
Most patients are in the young or middle-age adult years.

Question 32

Course of binge eating disorder

Answer 32

Subject to much debate.
Some argue it’s a short-term condition that tends to spontaneously resolve.
Some argue the disorder typically persists over years.
Research suggests individuals experience temporary remission of their symptoms but the disorder then reoccurs.

Question 33

Associated medical and psychological problems

Answer 33

Most prominent problem is overweight or obesity.
Rate of obesity is as high as 65% among individuals with binge eating disorder.
Increased risk of developing hypertension, type 2 diabetes, and cardiovascular disease.
Mood disorders, anxiety disorders, substance use disorders, and personality disorders are common comorbidities.

Question 34

Aetiology of binge eating disorders: biological factors

Answer 34

Preliminary support for moderate heritability.

Question 35

Aetiology of binge eating disorder: psychological factors

Answer 35

Dieting and negative affect, like bulimia.
Dieting has less causal importance.
Stronger support for role of negative affect in binge eating disorder.

Question 36

Aetiology of binge eating disorder: social factors

Answer 36

Poor family functioning, including elevated levels of criticism, and reduced levels of affection from parents.
Obesity stigma - social rejection from peers results in negative emotions and overeating.

Question 37

Treatment of binge eating disorder

Answer 37

Similar approaches as bulimia nervosa
Self-help approaches
CBT
Interpersonal psychotherapy 
Behavioural weight loss (BWL)
Pharmacological approaches

Question 38

CBT - binge eating disorder

Answer 38

Similar to treatment of bulimia.
Targets of treatment are a moderate eating plan, increasing the use of healthy weight-control behaviours (eg regular, moderate exercise), and achieving greater acceptance of a larger than average body weight.

Question 39

Behavioural weight loss (BWL) - binge eating disorder

Answer 39

Focus is mainly on weight loss, with a secondary focus on binge eating.
Patients are encouraged to alter behaviours that result in weight loss (restrict caloric intake and increase physical activity).

Question 40

Limitations of current treatment approaches

Answer 40

Lack of research on treatment for anorexia.
CBT still has much room for improvement in treating bulimia.
Separating eating disorders and obesity (people go in for treatment for obesity and eating disorder might be missed).
Most suffers are not accessing available treatment and some professionals are not adept at identifying and treating eating disorders.