Eating Disorders Flashcards
Eating disorders
- Epidemic in Western world
- Prevalence has increased dangerously
- Standards to thinness are increasingly difficult to achieve
EDs in the fashion industry
- 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
Changes in ideal body type over time
- Apply to both men and women
- Desired BMI progressively lower over time
Prevalence of specific EDs
- Bulimia: 1%
- Anorexia: 1%
- Binge eating: 3%
- Other ED: 5%
Key features of EDs
- Body Image Disturbance
- Impairment/Distress
Spectrum of disorder
See notes
Body image disturbance
- Overestimate actual body size
- Unrealistically low ideal body size
- Social comparison
- Body dissatisfaction (can be unrelated to weight)
Binge eating
- 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
Purging behaviours
- 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
Maintaining factors of purging behaviours
See notes
Anorexia nervosa
- 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
Types of anorexia nervosa
- Restricting type: dieting, fasting, excessive exercise
- Binge/purge type: binging isn’t super often though
Bulimia nervosa
- 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
Differences between anorexia and bulimia
- Major difference between anorexia and bulimia is that bulimics aren’t significantly underweight
- More accurate in determining their current weight
Calories consumed during binge vs. calories retained after purge
- 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
Binge eating disorder
Binges without purging, fasting
Pica
- Eating non-edible, non-food items
- Usually in children or neurological damage
Rumination disorder
Regurgitation and (possible) rechewing of food
Avoidant/restrictive food intake disorder
Not eating, for a number of reasons (e.g. forgetting)
Other specified feeding/eating disorder
- Symptoms of AN or BN but not enough for either diagnosis
- Clinically significant impairment/distress
Are eating disorders culture-bound disorders?
- 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)
Curacao differences by race
- 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
Sociocultural factors
- 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)
What might protect people from eating disorders?
Sports in general, where weight doesn’t matter, might protect females from developing one
Gender
- 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
Muscle dysphoria
- 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
Genetic risks for AN/BN
- 56% heritability for AN
- 41% in BN
Neural correlates in AN/BN
- Reduced functioning of hypothalamus (regulates eating) in AN; altered dopamine -> change in reward
- Low serotonin -> cravings for BN
Psychological factors (emotions)
Depressive symptoms; may be a cause, consequence or correlate of eating disorders
Types of binge eating patterns
- Dieting subtype: Attempts to lose weight
- Depressive subtype: Attempts to regulate emotions; poorer prognosis
Psychological factors (cognitive)
- Primary proposed cognitive vulnerability: Overevaluation of shape or weight
- Additional cognitive vulnerabilities: internalization of thin ideal, perfectionism, low self-esteem
Family factors
- Family dynamics: Conflict and control; messages to lose weight
- Daughter: Perfectionist; focused on pleasing others
Maternal eating pathology
- body dissatisfaction
- internalization of thin-ideal
- dietary restraint
- eating disorder symptoms
Initial phase of anorexia treatment
Achieve medically stable weight
- Calorie increase
- Hospitalization
Why is low weight risky?
- Organ failure
- Bradycardia (very slow heart rate)
- Ultimately, death
Medication (SSRIs)
- No better than placebos in anorexia
- In bulimia: reduces binge/purge, abnormal eating habits still retained tho; SSRI + CBT may be better outcome
Cognitive portion of CBT for anorexia
- Psycho-education
- Cognitive restructuring: Focused on overvaluation of
shape and weight, perfectionism, body image
Behavioural portion of CBT for anorexia
- Meal planning and eating goals
- Rewards contingent on weight gain
Cognitive portion of CBT for bulimia
- Psycho-education
- Cognitive restructuring
- Monitor cognitions about binges/purges
Behavioural portion of CBT for bulimia
- Meal planning and eating goals
- Exposure to: forbidden foods, negative emotions, feeling full
Family based therapy for adolescents with AN
- Observe family meals
- Parent becomes therapist
- Strict expectations for eating
- Privileges linked to eating
- After weight gain: Transfer control back to adolescent
