Eating Disorders Flashcards
Eating and Feeding
Feeding is one of the most fundamental behaviours for maintaining life
•crucial in development of motivated behaviours (children learning process of being hungry/when to get food - patience)
•limited availability of breast feeding = first challenge of development
•learning balance of indulgence and restraint
•eating becomes moralized (eating because of routine, rituals, and comfort)
*why it interacts with stress/other mental factors - attached meaning leading to good or bad relationship with food
Binge Eating Disorder
Recurrent episodes of binge eating: eating significantly more than most people would at once, with lack of control and 3+ of following symptoms
- Eating much faster than normal
- Eating until uncomfortably full
- Eating a lot when you aren’t even hungry
- Eating alone because you’re embarrassed of how much you’ve eaten
- Feelings of disgust at self, depression, or guilt after eating
New to DSM 5, includes having
•must have marked distress when binge eating, average of once a week for 3 months, and no dx of bulimia or anorexia (other eating disorders)
BED and Obesity
Average of 1900 calories per binge, 4800 on upper end
BED is associated with obesity
•but most people with obesity do not binge eat and you don’t need to be obese to meet criteria
•person with BED greater concern over weight/body shape than average person with obesity
•greater distress, more comorbidities, and lower quality of life than average person with obesity (more health problems)
•greater utilization of health care and greater physical health morbidity/morality than BMI matched controls
•lab: will consume more calories in lab studies
Psychological/Biological factors of BID and Prevalence
Biological factos
•some level of genetic risk (specific gene unknown)
Psychological factors
Cycle of emotions and eating
•negative emotions (depression, guilt, self - dislike)
•binge earring for comfort/emotional relief
•weight gain = further guilt over excess eating
•more negative emotions
•etc.
Prevalence
1 year: 1.6% in women, 0.8% in men
age: middle adulthood (also common in adolescent and early adulthood - trajectory)
•child/later adult onset is possible (but is likely something else)
Consistent across racial ethnic groups (in US)
Bulimia Nervosa
Bous (ox) + limos (hunger) + nervosa (nervousness/anxiety)
Recurrent binge eating and compensatory behaviours to prevent weight gain
•purging: induced vomiting (most common)
•laxatives, diuretics
•fasting
•excessive exercise
Binging AND compensatory behaviours at least once a week for 3 months
•self-evaluation influenced by body shape/weight
•not only during anorexia (can’t have both)
Common traits (not always)
•normal weight/slightly overweight
•begins with dieting to e thin, but cannot maintain diet overtime due to unrealistic goals
•lack of inhibition often due to negative emotions (stress) leads to compensatory behaviours to manage guilty start (binging)
•distressed about binging, but continuous from fear of gaining weight
•tries to conceal weight/binging and purging behaviour
Biological and psychological factors/prevalence
Biological
•some heritable risk but specific genes unknown
Psychological factors
•weight concerns/internalization of thin body ideal
•history of anxiety, depression, and neuroticism
•social anxiety, childhood obesity resulting in bullying
•history of stressful events (ex: sexual abuse)
•stress can precipitate binge eating
1 year in women: 1-1.5% (10:1 more likely in women)
Most common in early 20s
•child and later onset are more rare
Chronic or waxing weaning but symptoms often remits over time
Anorexia Nervosa
Anorexia (no appetite - misnomer) + nervosa (nervousness/anxiety)
Restriction of energy intake relative to bodily requirements (psychological not biological)
•results in significantly lower than normal body weight (body is emaciated in severe cases)
Intense fear of gaining weight/being fat and/or behaviour that interferes with weight gain (despite being underweight)
•dieting/food restriction, purging, excessive exercise
Criteria
- Distorted perception of weight/body
- Undue influence of weight/body on self evaluation
- Lack of recognition of seriousness of current low weight
Common traits
•lack of insight, will see excessive weight loss as positive
*distorted reality testing (delusion)
•many health concerns
•will try to hight emaciation from others (avoid judgment)
•amenorrhea (loss of menstruation) - no longer diagnostic criteria
Two types
1. Restricting type
•strictly limit food consumption/calories
•hardly eat at all (severe cases)
•avoids eating around people (make excuses to avoid judgment)
*fiddle with food, eat slowly, throw it away
- Binging-purging type
•similar to bulimia, but with an abnormally low body weight
•will still engage in restriction
Psychological, biological, and prevalence of Anorexia Nervosa
Biological
•some level of heritability but specific genes unknown
Psychological
•weight concerns, internalization of thin body ideal
•anxiety disorders with obsessive compulsive features
•sometimes history of child abuse
Prominent cognitive distortions about body weight/eating
•worry about becoming fat
•eating seen as disgusting/bad
•restriction seen as sign of self control/sets oneself above others
*“a truly successful person with anorexia means dying from starvation”
•restriction subtype often looked up to by other ED patients
•competition can occur between patients
•concentration cant aesthetic: some careers put pressure on thinness (models)
Prevalence
12 month in young women: 0.4% (10:1 more likely in women)
Most common in late teens
•childhood/late onset more rare
Chronic or waxing weaning course
Symptoms can remit over time (but quite serious in meantime
Health risks of eating disorders
Anorexia: 5x higher mortality risk
•severe nutrition deficiency, electrolyte imbalance leading to carting and renal issues *affects skin, hair, nails, bones/muscles
Purging
•electrolyte imbalances, GI-tract dysregulation, acidity of stomach contents, tears in throat due to induced vomiting
Binging
•obesity, tears GI tract
Suicidality
•risk of attempts elevated, risk of completion especially high in anorexia (often when cannot maintain low body weight)
Diagnostic cross-over
•patients often move from one diagnosis to another as symptoms change/over lifetime
Cross-over common between adjacent diagnosis in: binge-eating disorder, bulimia nervosa, anorexia (binging-purging type), anorexia (restricting type)
•grows from one to another
•continuum between excessive eating to restriction
General biopsychosocial factors
1. Serotonin dysregulation (most prominent in anorexia)
2. Set point of body weight (especially in bulimia)
3. Theme of control
•perfectionism: anorexia and bulimia show elevated perfectionism
•family conflict or discord: eating becomes few things person feels control over
*but reciprocal relationship
4. Moralization of indulgence vs self control and what it means to be thin (hard working) vs fat (lazy)
5. May be perpetuated by family attitudes or by other people with eating disorders (pro ana)
6. Idealization of certain body types in culture
7. Portrayals of bodies are unrealistically thin
8. Pervasive in mass media
More common in cultures that value thinness
•western/east asian
Greater exposure to Western media = greater risk of ED (ex: women in Fiji following American TV)
Eating Disorders in Men
Often focus on being muscular (not thin)
•over exercise, excessive bulking
•often in athletics with weight qualifications
Gay men are more likely to emphasize thinness
•higher risk of anorexia/bulimia than straight men (still possible in straight men)
On average, less common in men
•but more likely to be misdiagnosed, less likely to receive specialized care
•less well-described by existing diagnoses and less well understood
Treating Eating Disorders
- Medications
•antidepressants: bullimia
•antipsychotic: anorexia - CBT
•restructure negative distorted beliefs about body weight/thinness
•graudual normalization of eating habits and reduce compensatory behaviours - Managed care facility/inpatient facility (for anorexia)
- Family therapy to address problematic family dynamics
