eating disorders Flashcards
what are the three eating disorders
anorexia nervosa, bulimia nervosa, binge eating disorder
What are the symptoms of anorexia
starvation, refusal to maintain normal body weight
- fear of gaining weight
what are the two types of anorexia
Purge type : throws up and uses weight control methods to lower weight
Restricted type: Doesnt eat
(Walters and Kendler, 1994).
Ten times more females than males are afflicted by the disorder
(Lask and Bryant- Waugh, 2000)
Increase in early onset anorexia in girls between 8 and 13 years of age
(TOzzi, Sullivan, Fear, McKenzie and Bulik, 2003).
Onset following stressful llife event, such as leaving home
DSM5 prevalence anorexia
the 12 month prevalence rate for anorexia among young females to be 0.4% with female to male 10:1.
Lifetime prevalence for is 0.8% with peak onset 19-20 years. (Stice, Marti and Rohde, 2013).
What are the main features of bulimia
The main features of which ae recurrent episodes of binge eating followed by periods of purging or fasting.
Fear of weight gain. Distroted perception of body weight.
Binge eating: Often more than a normal persons daily intake in one sitting.
Recurrent compensatory behaviours to prevent weight gain. Vomitting is the most common form of purging and occurs in 80-90% of those who present for treatment.
Not usually overweight compared to the norm for their height (Gordan 2001). Do not become underweight as a result of purging.
Onset of bulimia
Onset of late adolescence, early adulthood 16-20 (Stice, Marti and Rhode, 2013) persisting for several years.
90% female (gotestam and Agras, 1995).
Frequently triggered by concerns about body weight and shape, origins in period of dieting
binges
Binge eating suggests a loss of control over their eating patterns. Embarrassement means binges are usually done in secret with foods which are easy to consume ( Sweets, cakes, bread).
Often planned in advance, and can be triggered by periods of depression.
Shisslak, Pazda and Crago, 1990)
High levels of self disgust, low self esteem, feelings of inadequacy and high levels of depression
Less physical symptoms than anorexia:
Permanent loss of dental enamel as a result of vomiting and in some cases swollen parotid glands can produce a puffy face appearance.
Prevalence of bulimia
Lifetime prevalence in women is 1-3% (gotdon, 2001) in men the prevalence is much lower (10 tims lower). Increase in diagnosis around 1996 could be due to Princess Dianas battle in the 1990s.
Much fewer cases of bulimia in women who hace not been exposed to western ideals and influences (Keel and Klump, 2003).
(Keel and Klump, 2003).
No bulimia in people with no exposure to western ideals
Binge eating disorder:
Eating disorder characterised by recurrent episodes of binge eating without the purging or fasting associated with bulimia.
- Tend to be overweight.
- History of failed attempts to diet.
(Napolitano and Himes, 2011). Binge eating disorder
Found in children and common in adolescents and college
Associated with high levels of major depression, impaired work and social functioning, low self esteem and dissatisfaction with body shape (Streigel moore et al., 2001).
(Stice, Marti and Rhode, 2013). Prevalence of binge eating disorder
Lifetime prevalence is 3% and peak age onset is around 16-20 years
weight loss treatment and binge eating
The disorder can be as high as 30% among individuals seeing weight loss treatment (Dingemans, Bruna and Van Fruth, 2002).
binge eating women : men
Only 1 and a half times higher in women than men (Stice, Telch and Risvi, 2000)
lifetime prev of anorexia
0.4%
Anorexia comorbid with
depression and ocd
bulimia prevalence
between 1-3%
bulimia comorbid with
Bulimia is comorbid with depression, BPD and substance abuse.
Cultural and demographic differences in eating disorders
May present a direct risk factor (Miller and Pumariega, 2001).
Keel and Klump (2003) found no evidence of cases of bulimia in individuals without exposure to Western ideals and concluded there is no form of bulimia that is not related to the weight concerns generated from exposure to western cultural ideals. When individuals from non western cultures present sypmotoms of bulimia they have usually been exposed.
African American women are less likely than white women to have an eating disorder (Lovejoy, 2001).
Demographic factors within cultures
Females are 10 times more likely to develop an eating disorder than males (Streigel moore, 1997)
Idealisation of female body weight by the media (Harrison, 2001).
Significantly higher in homosexual males (Strong, Williamson, Netemeyer and Geer, 2000) reflecting greater importance on male physical appearance.
The Aetiology of eating disorders.
Biology
Genetic: 1st degree relatives significantly more likely to develop disorder than relatves of a group of females who have never been diagnosed (Strober et al., 2000)
40-60% (trace et al., 2013)
Also important to understand interactions with pparents (Baker, Mitchell, Neale and Kendler, 2010).
Genes: Serotonin- appetite regulation. Food reward sensitivity- dopamine and weight regulation (opiod receptors) Trace, Baker, Penas lledo and bulik, 2013).
BUT
Plagued by underpowered sample sizes and failed replications. Sulivan, Daley and Donovan, 2012)
Aetiology: Neurobiological
Lateral hypothalamus: Lesions to the lateral hypothalamus result in self starvation similar to anorexia (Hoebel and Teitelbaum, 1966). However, lack of hunger is not central to anorexia, they are usually very hungry even though theyre starving themselves.
Self starvation and maintaining a low body weight may be reinforced by endogenous opiods- the body releases during starvation to reduce pain sensation (Hardy and Waller, 1988)
Sociocultural influences Aetiology
Media influences, body dissatisfaction and dieting. Media portray extreme thinness in women. Results in media influence. Exposure related to a drive for thinness in young adolescent girls. Tiggermann and Pickering (1996) found that body dissatisfaction and a drive for thinness was significantly associated with watching certain types of TV show that portrayed idealized female images.
Boody dissatisfaction is directly correlated with the amount of time young females spend reading magaazines that expose them to idealized female body shapes (Tiggermann, 2003).
Eating fashions: Individuals with an eating disorder are more likely to have been vegetarian (52% vs. 12%. (Bardone- Cone et al., 2012).
Media influences lead to body dissatisfaction defined as the gap between ones actual and ideal weight and shape (Polivy and Herman, 2002).
Peer influences Aetiology
A study of adolescent school girls Eisenberg et al., 2005) found that the use of unhealthy weight control behaviours were significantly influenced by dieting behaviour of close friends .
However, it is possible that they become friends due to their shared concerns rather than develop.
Familial Factors: Aetiology
Family systems theory: dysfunctional family structure which reinforce disordered eating.
Enmeshment: Parents are intrusive, overly involved (Minuchin, 1978)
Overprotective: overly concerned with parenting and with welfare (Shoebridge and Gowers, 2000)
Rigidity: maintain status quo within family.
Lack of conflict resolution: Avoid conflict or in a continual state of conflict.
Mothers eating pattern, critical of daughters success.
However, Policy and Herman (2002) point out that most of the studies are retrospective and correlational in nature and so do not implu causation.
Experential factors: Aetiology
Rastam and Gillberg (1992) 14% of anorexia sufferers 0% healthy had suffered a negative life experience 3 months prior to the onset.
Childhood sexual abuse: anorexia and bulimia but not in binge eating disorders. (Johnson, Cohen Kasen, Smailes and Brook, 2002).
BUT risk factor for lots of disorders (Chou, 2012).
Bulimia only in the case of BPd (Kin et al., 2000) as a control method.
Psychological and dispositional factors
Individuals who develop eating disorders have personality and dispositional characteristics.
- Perfectionism
- Shyness
- Neuroticism
- Low self esteem
- High introspective awareness
- Negative or depressed affect- depression
- Dependence and non assertiveness
Herman, Polivy, Lank and Heatheron, 1987 those with bulimia try to alleviate negative mood by eating. Suggesting negative mood might be a cause rather than just a symptom.
Perfectionism Predictor of bulimic symotoms in women who perceive themselves as overweight
Transdiagnostic models of eating disorders
This model 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 restraint.
Model includes low self esteem. Clinical perfectionism, interpersonal problems, mood intolerance.
Lampard, Byrne, Mclean and Fursland (2011) found that low self esteem was associated with overevaluation of weight and shape which in turn was associated with dietary restraint and interpersonal difficulties.
how much variance in genetic
50%
Napolitano and Himes (2011)
binge eating disorder is common in adolescents and college students
Crispy (1973)
stereotype womans problem
Streigel Moore (1997)
10 times more women than men have ED.
Strong (2000)
Significantly higher in homosexual males
Lovejoy (2001)
AA significantly less likely than white females
