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PSY347 - Clinical 1 > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Stereotype of eating disorders

A

Young
White
Female
Thin

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2
Q

First formal diagnostic criteria. for anorexia

A

Russell (1970)

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3
Q

Anorexia was identified many centuries ago, how?

A

Miraculous saints and hunger artists

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4
Q

When and who identified bulimia?

A

Russell (1979)

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5
Q

How many percent of eating disorders are male?

A

Between 5 and 12%

Striegel-Moore et al. (1999)

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6
Q

Distribution of different eating disorders?

A

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

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7
Q

Best accepted definition of an eating disorder

A

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

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8
Q

Issues with the definition of an eating disorder…

A

Always in the eye of the beholder

Where do ballerinas, gymnasts, professional athletes fit?

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9
Q

Anorexia diagnostic criteria

A

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

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10
Q

Subtypes of anorexia

A

Restricting

Bingeing/purging

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11
Q

Bulimia diagnostic criteria

A

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

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12
Q

Why are compensatory mechanisms such as purging or laxatives dangerous?

A

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

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13
Q

What is bingeing?

A

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

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14
Q

Binge eating disorder diagnostic criteria

A

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

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15
Q

What is binge eating disorder associated with?

A

Obesity

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16
Q

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

A

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

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17
Q

Other specified feeding and eating disorders (OSFED)

A

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

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18
Q

Night eating syndrome

A

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

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19
Q

Avoidant/restrictive food intake disorder (ARFID)

A

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

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20
Q

What does ARFID replace or extend?

A

Selective or fussy eating

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21
Q

Three subtypes of ARFID

A

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

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22
Q

Why was the transdiagnostic approach thought of?

A

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

23
Q

Individuals with AN score highly on scales of _____

A

Perfectionism

Halmi et al. (2000)

24
Q

Individuals with AN score low on scaled of _____

A

Self-esteem

Karpowicz et al. (2009)

25
Q

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

A

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)

26
Q

Transdiagnostic cognitive-behavioural model

A

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

27
Q

Mechanisms in the transdiagnostic cognitive-behavioural model

A

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

28
Q

Comorbidity with other disorders

A

Relatively high levels of co-morbid conditions…

OCD 
Social anxiety 
Depressed mood 
Anxiety and impulsivity based personality disorder 
Alcohol and substance misuse
29
Q

Physical symptoms of eating disorders

A 
Cardiac complications 
Muscle weakness 
Osteoporosis 
Liver damage 
Oesophageal tearing 
Fainting 
High mortality rates
30
Q

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

A

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

31
Q

Prevalence rates in the population (Hoek, 2006)

A

AN - 0.3%
BN - 1.0%
Other cases - 2-3%

More likely in women 16-30

About 1 in 10 cases are male

32
Q

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

A

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?

33
Q

Why was there an increase in bulimia cases in 1993?

A

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

34
Q

Fiji study (Becker et al., 2011)

A

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

35
Q

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

A

People were introduced to what AN was and so they could report it

Western media may have triggered them to slim down causing AN

36
Q

Russel & Keel (2002)

A

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

37
Q

Mortality rates of AN

A

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

38
Q

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

A

Up to 21% (Birmingham et al. 2005)

39
Q

Lifetime prevalence of BN for men and women

A

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

40
Q

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

A

Individual usually presents a long time after the onset

The causal process is usually not seen

41
Q

Disadvantages in trying to find a cause for eating disorders

A

Plagued by small samples
Retrospective
Inconsistent findings

42
Q

The dopaminergic system in eating disorders

A

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

43
Q

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

A

Dopamine

Jimerson et al. (1992)

44
Q

Temporal lobe disturbance in eating disorders

A

Disturbance in the temporal lobe may result in body image problems

45
Q

Family influence on eating disorders

A

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

46
Q

The hot cross bun

A

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

47
Q

Positive reinforcement cycle

A

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

48
Q

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

A

There are increased efforts to lose/maintain weight

Purging, exercising, stricter rules

49
Q

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

A

Abstinence violations - binge-eating

Followed by even stronger efforts to control weight

50
Q

Cognitive dissonance

A

Justifies behaviours through more negative self-perception

Body image gets worse

Starvation effect kicks in

51
Q

Minnesota study

A

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

52
Q

The Dutch Hunger Winter

A

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

53
Q

Safety behaviours in eating disorders

A

Short-term - behaviours reduce anxiety
Long-term - behaviours make things worse

Suggests that eating disorders have a lot of anxiety at their heart

54
Q

Examples of safety behaviours in eating disorders

A 
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

PSY347 - Clinical 1 (9 decks)

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