Eating Disorders Flashcards

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1
Q

Eating disorders

A
  • Epidemic in Western world
  • Prevalence has increased dangerously
  • Standards to thinness are increasingly difficult to achieve
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2
Q

EDs in the fashion industry

A
  • Several cases in the fashion industry that led to death of models
  • Some countries made it illegal for models to be below a certain body weight
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3
Q

Changes in ideal body type over time

A
  • Apply to both men and women

- Desired BMI progressively lower over time

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4
Q

Prevalence of specific EDs

A
  • Bulimia: 1%
  • Anorexia: 1%
  • Binge eating: 3%
  • Other ED: 5%
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5
Q

Key features of EDs

A
  • Body Image Disturbance

- Impairment/Distress

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6
Q

Spectrum of disorder

A

See notes

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7
Q

Body image disturbance

A
  • Overestimate actual body size
  • Unrealistically low ideal body size
  • Social comparison
  • Body dissatisfaction (can be unrelated to weight)
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8
Q

Binge eating

A
  • Eating an unusually large amount of food (1200-4000 calories in 2 hours) - but context matters, especially with the prevalence of high calorie restaurant meals!
  • Lack of control
  • Typically dessert/snack foods
  • Most likely at home, alone, at night, or after unstructured activity
  • Often in a negative mood
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9
Q

Purging behaviours

A
  • Attempts to compensate for binge eating or prevent
    weight gain
  • Can include:
    1) Fasting
    2) Self-induced vomiting
    3) Laxative misuse
    4) Diuretics (peeing it out)
    5) Excessive exercise (situation dependent and interferes with other activities; inappropriate times and settings)
    6) Enemas (injection of fluid into rectum to expel contents)
    7) Chewing/spitting out food
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10
Q

Maintaining factors of purging behaviours

A

See notes

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11
Q

Anorexia nervosa

A
  • Restriction of energy intake relative to requirements leading to significantly low weight
    AND
  • Intense fear of gaining weight or behaviors to avoid weight gain
  • Disturbance in perception of weight or influence of weight on self-evaluation
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12
Q

Types of anorexia nervosa

A
  • Restricting type: dieting, fasting, excessive exercise

- Binge/purge type: binging isn’t super often though

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13
Q

Bulimia nervosa

A
  • Binges with lack of control
  • Behaviors to prevent weight gain
  • Purging
  • Fasting
  • Occurs at least once a week (for a few months)
  • Self-evaluation unduly influenced by body shape and
    weight
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14
Q

Differences between anorexia and bulimia

A
  • Major difference between anorexia and bulimia is that bulimics aren’t significantly underweight
  • More accurate in determining their current weight
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15
Q

Calories consumed during binge vs. calories retained after purge

A
  • Women were retaining AT LEAST half of their calories if not more
  • Purging isn’t an effective way of eliminating calories
  • Ceiling of eliminating about 2000 calories and not any more
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16
Q

Binge eating disorder

A

Binges without purging, fasting

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17
Q

Pica

A
  • Eating non-edible, non-food items

- Usually in children or neurological damage

18
Q

Rumination disorder

A

Regurgitation and (possible) rechewing of food

19
Q

Avoidant/restrictive food intake disorder

A

Not eating, for a number of reasons (e.g. forgetting)

20
Q

Other specified feeding/eating disorder

A
  • Symptoms of AN or BN but not enough for either diagnosis

- Clinically significant impairment/distress

21
Q

Are eating disorders culture-bound disorders?

A
  • Differences across time: Increased rates in
    those born after 1945 than before 1945
  • Different incidence across countries: Higher rates in
    “westernized” countries (e.g. US and Netherlands vs. Curacao)
22
Q

Curacao differences by race

A
  • No cases in majority black population
  • All cases were in minority white population (most had been abroad to US or Netherlands)
  • Larger female bodies are considered more attractive in Curacao
23
Q

Sociocultural factors

A
  • Thinner beauty ideal
  • Exposure to thin ideal (e.g. magazines, TV, movies)
  • Friends’ attitudes
  • Athlete (in a sport where weight matters such as figure skating)
24
Q

What might protect people from eating disorders?

A

Sports in general, where weight doesn’t matter, might protect females from developing one

25
Q

Gender

A
  • Males comprise 10% - 25% of those with AN or BN
  • 10x risk in gay or bisexual men
  • BN more likely
  • Excessive exercise most common compensatory strategy
26
Q

Muscle dysphoria

A
  • Preoccupation with muscle size/body mass
  • Form of Body Dysmorphic Disorder = preoccupation
    with certain parts of the body; perceive parts as irregular or unattractive
  • Commonly co-occurs with eating disordered behavior
27
Q

Genetic risks for AN/BN

A
  • 56% heritability for AN

- 41% in BN

28
Q

Neural correlates in AN/BN

A
  • Reduced functioning of hypothalamus (regulates eating) in AN; altered dopamine -> change in reward
  • Low serotonin -> cravings for BN
29
Q

Psychological factors (emotions)

A

Depressive symptoms; may be a cause, consequence or correlate of eating disorders

30
Q

Types of binge eating patterns

A
  • Dieting subtype: Attempts to lose weight

- Depressive subtype: Attempts to regulate emotions; poorer prognosis

31
Q

Psychological factors (cognitive)

A
  • Primary proposed cognitive vulnerability: Overevaluation of shape or weight
  • Additional cognitive vulnerabilities: internalization of thin ideal, perfectionism, low self-esteem
32
Q

Family factors

A
  • Family dynamics: Conflict and control; messages to lose weight
  • Daughter: Perfectionist; focused on pleasing others
33
Q

Maternal eating pathology

A
  • body dissatisfaction
  • internalization of thin-ideal
  • dietary restraint
  • eating disorder symptoms
34
Q

Initial phase of anorexia treatment

A

Achieve medically stable weight

  • Calorie increase
  • Hospitalization
35
Q

Why is low weight risky?

A
  • Organ failure
  • Bradycardia (very slow heart rate)
  • Ultimately, death
36
Q

Medication (SSRIs)

A
  • No better than placebos in anorexia

- In bulimia: reduces binge/purge, abnormal eating habits still retained tho; SSRI + CBT may be better outcome

37
Q

Cognitive portion of CBT for anorexia

A
  • Psycho-education
  • Cognitive restructuring: Focused on overvaluation of
    shape and weight, perfectionism, body image
38
Q

Behavioural portion of CBT for anorexia

A
  • Meal planning and eating goals

- Rewards contingent on weight gain

39
Q

Cognitive portion of CBT for bulimia

A
  • Psycho-education
  • Cognitive restructuring
  • Monitor cognitions about binges/purges
40
Q

Behavioural portion of CBT for bulimia

A
  • Meal planning and eating goals

- Exposure to: forbidden foods, negative emotions, feeling full

41
Q

Family based therapy for adolescents with AN

A
  • Observe family meals
  • Parent becomes therapist
  • Strict expectations for eating
  • Privileges linked to eating
  • After weight gain: Transfer control back to adolescent