Eating Disorders

Question 1

Stereotype of eating disorders

Answer 1

Young
White
Female
Thin

Question 2

First formal diagnostic criteria. for anorexia

Answer 2

Russell (1970)

Question 3

Anorexia was identified many centuries ago, how?

Answer 3

Miraculous saints and hunger artists

Question 4

When and who identified bulimia?

Answer 4

Russell (1979)

Question 5

How many percent of eating disorders are male?

Answer 5

Between 5 and 12%

Striegel-Moore et al. (1999)

Question 6

Distribution of different eating disorders?

Answer 6

Fairburn & Harrison (2003)
Anorexia nervosa = 15%
Bulimia nervosa = 35%
Eating disorder not otherwise specified = 50%

Question 7

Best accepted definition of an eating disorder

Answer 7

A persistent disturbance of eating behaviour or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning (Fairburn & Walsh, 2002)

Question 8

Issues with the definition of an eating disorder…

Answer 8

Always in the eye of the beholder

Where do ballerinas, gymnasts, professional athletes fit?

Question 9

Anorexia diagnostic criteria

Answer 9

Persistent restriction of energy intake leading to significantly low body weight in context of age, sex, development, physical health

Either an intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain

Disturbance in the way one’s body weight or shape is experienced, or undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight

Question 10

Subtypes of anorexia

Answer 10

Restricting

Bingeing/purging

Question 11

Bulimia diagnostic criteria

Answer 11

Recurrent episodes of binge eating

Recurrent, inappropriate compensatory behaviour in order to prevent weight gain

Binges and compensatory behaviours both occur, on average, at least once a week for 3 months

Self-evaluation unduly influenced by body shape/weight

Disturbance does not occur exclusively during episodes of anorexia nervosa

Question 12

Why are compensatory mechanisms such as purging or laxatives dangerous?

Answer 12

They drive down the body’s level of potassium which is important in all neural functions
Can cause heart attacks etc

Question 13

What is bingeing?

Answer 13

Eating, in a discrete period of time, more than most people would eat during a similar period of time under similar circumstances

A sense of lack of control over eating during the period

Question 14

Binge eating disorder diagnostic criteria

Answer 14

Recurrent episodes of binge eating

Episodes associated with three or more of the following
Eating more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed of very guilty after

Marked distress regarding binge eating

Bingeing at least once a week for 3 months

No purging or compensatory behaviour

Question 15

What is binge eating disorder associated with?

Answer 15

Obesity

Question 16

Why did it take so long to recognise binge eating as a disorder?

Answer 16

People have negative connotations of obese people
Only came into diagnostic criteria due to American insurance policies - clinicians wanted to see patients but there was no insurance for obese people and therefore they made the diagnostic criteria to be able to see them

Question 17

Other specified feeding and eating disorders (OSFED)

Answer 17

Presents with many of the symptoms of other eating disorders, but doesn’t meet all of them so can’t be fully diagnosed

Atypical anorexia nervosa

Bulimia nervosa of low frequency or limited duration

Binge-eating disorder of low frequency or limited duration

Purging disorder

Night eating syndrome

Question 18

Night eating syndrome

Answer 18

Tend to avoid food in the first half of the day

Eat in second half of the day but not enough

Half wake up in the middle of the night because they are so hungry and raid the fridge without realising

Question 19

Avoidant/restrictive food intake disorder (ARFID)

Answer 19

Disturbance in eating or feeding
Leads to substantial weight loss or gain
Nutritional deficiency
Dependent on supplements

Absence of typical beliefs about food or fear of weight gain

Question 20

What does ARFID replace or extend?

Answer 20

Selective or fussy eating

Question 21

Three subtypes of ARFID

Answer 21

Sensory-based avoidance
Refuses food based on smell, colour, texture, brand

Lack of interest
In consuming the food or tolerating it nearby

Food associated with fear-evoking stimuli
Developed through a learned history e.g. choked on something as a child and so avoid it now

Question 22

Why was the transdiagnostic approach thought of?

Answer 22

Diagnosis of specific eating disorders does not do what it should
40-50% of cases do not fit neatly into diagnosis
EDNOS are the largest group
Many fail to stay in one diagnosis
Therefore a transdiagnostic approach was thought of

Question 23

Individuals with AN score highly on scales of _____

Answer 23

Perfectionism

Halmi et al. (2000)

Question 24

Individuals with AN score low on scaled of _____

Answer 24

Self-esteem

Karpowicz et al. (2009)

Question 25

Difference in AN diagnosis from DSM-IV to DSM-V

Answer 25

The requirement for females to present with amenorrhea Amenorrhea is not a good predictor of AN as there are no reported difference between women with AN who do and do not menstruate (Watson & Anderson, 2003)

Question 26

Transdiagnostic cognitive-behavioural model

Answer 26

Fairburn (2008) A model of eating disorders that argues that a dysfunctional system of self-evaluation is central to the maintenance of all eating disorders, and that self-worth is defined in terms of control over eating, weight and shape, which in turn leads to dietary restriction

Question 27

Mechanisms in the transdiagnostic cognitive-behavioural model

Answer 27

Low self-esteem - Motivates people to achieve in the domain of weight and shape of body Clinical perfectionism - Projects achievement in dietary restraint as an important goal Interpersonal problems - May lead to people controlling their weight in order to facilitate interpersonal problems Mood intolerance - Encourages binge eating and purging as a way of coping with negative mood states

Question 28

Comorbidity with other disorders

Answer 28

Relatively high levels of co-morbid conditions... ``` OCD Social anxiety Depressed mood Anxiety and impulsivity based personality disorder Alcohol and substance misuse ```

Question 29

Physical symptoms of eating disorders

Answer 29

``` Cardiac complications Muscle weakness Osteoporosis Liver damage Oesophageal tearing Fainting High mortality rates ```

Question 30

Why is there more of a focus on prevalence than incidence?

Answer 30

It is unclear when a lot of eating disorders start and so incidence rates are hard to ascertain

Question 31

Prevalence rates in the population (Hoek, 2006)

Answer 31

AN - 0.3% BN - 1.0% Other cases - 2-3% More likely in women 16-30 About 1 in 10 cases are male

Question 32

GP case identification 1988-2000 (Currin et al., 2005)

Answer 32

Relatively stable number of cases in recent years One increase in identification in 1993 Increase in identification relative to pre-70s - due to better education on the topic?

Question 33

Why was there an increase in bulimia cases in 1993?

Answer 33

Princess Diana announced that she had BN More people thought it was ok to have the condition More GPs had heard of the condition and so were able to diagnose it

Question 34

Fiji study (Becker et al., 2011)

Answer 34

Clear link between Westernised media and AN No reported cases of AN until TV was introduced to one half of the island AN cases on this half went up in the next year When TV was introduced to the other half of the island the same thing happened

Question 35

Explanation of the Fiji Study (Becker et al., 2011)

Answer 35

People were introduced to what AN was and so they could report it Western media may have triggered them to slim down causing AN

Question 36

Russel & Keel (2002)

Answer 36

Homosexual men have increased rates of eating disorder diagnosis, and increased scores on ratings of body image concerns than heterosexual men

Question 37

Mortality rates of AN

Answer 37

5% per decade (Smink et al., 2012)

Question 38

How many individuals with AN die as a result of the disorder?

Answer 38

Up to 21% (Birmingham et al. 2005)

Question 39

Lifetime prevalence of BN for men and women

Answer 39

Women = 1.5% Men = Between 0.1% and 0.5% (Hudson et al., 2007)

Question 40

Why is it difficult to develop theories for the causation of an eating disorder?

Answer 40

Individual usually presents a long time after the onset The causal process is usually not seen

Question 41

Disadvantages in trying to find a cause for eating disorders

Answer 41

Plagued by small samples Retrospective Inconsistent findings

Question 42

The dopaminergic system in eating disorders

Answer 42

The dopaminergic system is involved in the regulation of body weight, eating behaviour and the reward system (Volkow et al., 2004) These systems are compromised in individuals with an eating disorder

Question 43

Individuals prone to binge eating may exhibit low levels of ______ release

Answer 43

Dopamine | Jimerson et al. (1992)

Question 44

Temporal lobe disturbance in eating disorders

Answer 44

Disturbance in the temporal lobe may result in body image problems

Question 45

Family influence on eating disorders

Answer 45

Over half of the families in which an individual develops an eating disorder place a strong emphasis on weight and shape (Haworth-Hoeppner, 2000)

Question 46

The hot cross bun

Answer 46

Framework for understanding the maintenance of eating disorders Padesky & Mooney (1990) Cognitions, behaviour, physiology and emotions are all linked Cognitions - I am going to keep gaining weight Behaviour - Avoid food Physiology - Starvation, serotonin disturbance, autonomic function Emotions - Anxiety develops which causes need for more control

Question 47

Positive reinforcement cycle

Answer 47

When weight is being lost this results in positive emotions and reinforces the behaviour Gives a sense of control and achievement, often when there has been a lack of such feelings in the past

Question 48

What happens when the positive feelings shift to anxiety about loss of control?

Answer 48

There are increased efforts to lose/maintain weight Purging, exercising, stricter rules

Question 49

What happens when a person senses they have lost control of their eating?

Answer 49

Abstinence violations - binge-eating Followed by even stronger efforts to control weight

Question 50

Cognitive dissonance

Answer 50

Justifies behaviours through more negative self-perception Body image gets worse Starvation effect kicks in

Question 51

Minnesota study

Answer 51

Keys (1950) Results of starvation Emotional instability drives the binge eating Cognitive narrowing (can't get the bigger picture of the harm it is doing) Social isolation results Behaviour changes

Question 52

The Dutch Hunger Winter

Answer 52

Showed the effects of starvation in a naturalistic environment Children of mothers who were pregnant during the famine had an increased incidence of schizophrenia or schizotypal personality

Question 53

Safety behaviours in eating disorders

Answer 53

Short-term - behaviours reduce anxiety Long-term - behaviours make things worse Suggests that eating disorders have a lot of anxiety at their heart

Question 54

Examples of safety behaviours in eating disorders

Answer 54

``` Reduce fear of weight gain and manage emotional states by... Restriction Vomiting Exercise Laxative use ``` Managing emotional states by... Binge eating Body related safety behaviours... Body avoidance Body comparison Body checking