eating disorders Flashcards
when did eating disorders appear in the DSM?
1980
- one subcategory of disorders beginning in childhood or adolescence
- in DSM-4 anorexia + bulimia formed a distinct category
prevalence of eating disorders in US (2001 + 2003)
anorexia: W 0.9%, M 0.3%
-bulimia: W 1.5%, M 0.5%
- binge eating disorder W 3.5%, M2.0%
gender bias – overwhelming , W overrepresent
international prevalence
- lifetime prevalence of binge eating : 1.4%
bulimia 0.8% - disorders were similar in terms of age of onset, but earlier for bulimia
- bulimia has longer persistence
canadian prevalence of eating disorders
0.5% of 15yoa+
W > M
15-24 yoa: 1.5% reported eating disorder
1.7% had eating attitude problem
prevalence of treatment for eating disorder?
few ppl who require treatment, sought it.
- treatment obtained from general medical sector
commonalities of anorexia and bulimia
- intense fear of being overweight
- may be variants of a single disorder
DSM criteria for Anorexia
- restriction of energy intake relative to requirements, leading to significantly low body weight
- intense fear of gaining weight/fat or behaviour that interferes with weight gain even tho being of low weight
- disturbance in the way in which one’s body weight/shape is experienced. undue influence of body weight/shape on self-evaluation or persistent lack of recognition of the seriousness of the current low body weight
define low body weight?
weight that is less than minimally normal
or less than that minimally expected
define anorexia (word) - define nervosa
loss of appetite
N: due to emotional reasons
two categories of anorexia
restricting type: during last 3 months, no binge eating or purging. weight loss thru dieting, fasting, exercise
binge-eating/purging type: during last 3 months, engaged in recurrent episodes of binge eating or purging behaviour
how is self-esteem related to anorexia?
anorexia nervose closely link self-esteem with maintaining thinness.
= over-evaluation of appearance
- lower body weight = increased self-esteem
development of anorexia nervosa
- early/middle teens
- often after episode of dieting and exposure to life stress.
- prevalence is increasing
- co-morbidity is high
what disorders are often co-morbid with anorexia nervosa
depression, panic disorder, social phobia, W especially at risk for: mania, agoraphobia, substance dependence
co-morbidity of subs abuse and eating disorders study
no link btw drug use + anorexia
- but clear link found between bulimia and drug use.
physical changes with AN
decrease bp, hr, bone mass
- hair, nail, skin issues
- tired, weak, anemia
- cardiac arrhythmias
- decrease in brain size (grey change = irreversible)
prognosis of AN
70% recover, may take 6-7 years
- relapses common because changing thoughts is hard.
- death rates 10x > than gen.pop
- 2x > than other psych disorders
mortality in eating disorders
A: 5.1/1000 deaths
other eating disorders: 3/1000 deaths
– death often from physical complications or suicide.
- 25 year reduction in life expectancy
predictors of death
- lower BMI
- older age at first presentation
- alcohol misuse
suicide rates in eating disorders
suicide not elevated in bulimia like they are in AN
- bulimia more likely to have suicide ideation
- 1/5 anorexia deaths = suicide
define bulimia (Word)
ox hunger
what is bulimia
episodes of rapid consumption of large amount of food, followed by compensatory behaviours
binge occurs? triggered by?
occurs in secret
- triggered by stress.
DSM-5 criteria for binge eating
- eating excessive amound of food within defined period
- sense of lack of control over behaviour
- at least once a week for 3 months
- extreme weight loss? is anorexia, binge-purge type
characteristics of binging
- preceded by poorer than average social experiences, self-concepts, moods
- stressors that involve negative social interactions may elicit binge
- high interpersonal sensitivity, increases in self-criticism
- contil uncomfortably full
- followed by deterioration in self-concept, mood state, social perception
loss of control in binge or bulimia
- loss of control over the amount of food being consumed
- ashamed of binge + conceal them
- akin to dissociative state.
bulimia + fear of gaining weight as essential diagnostic criterion
- covers what clinicians + researchers view as core psychopathology
- makes diagnosis more restrictive
- makes syndrome more closely resemble AN
what is fat talk
focus on fear of becoming fat
negative appraisals of the self for being fat
- female friends talk turns disparaging their bodies to each other
- seen as more likeable if engaged in fat talk
- reflects highly defensive + negative sense of self
development of bulimia
- age + study
- late adolescence, early adulthood.
- can be earlier, so intervening before they meet the criteria is important
- extreme body dissatisfaction found in g5 kids.
- as bmi increases, body satisfaction decreases
development of bulimia
- triggers?
- recovery?
often overweight before onset, binge eating often starts during a dieting episode
70% recover, 10% remain fully symptomatic
diagnostic crossover in eating disorders
some with anorexia develop bulemia + vice versa
features of bulimia nervosa
- K+ depletion, change in electrolytes
- diarrhea
- irregularities in heart beat
- tearing of tissue in stomach + throat
- loss of dental enamel
- swollen salivary glands
DSM criteria for binge eating disorder
recurrent binges, lack of control, distress about binging
- 3+ : eating rapidly, uncomfortably full, eating alone due to embarrassment, eating large amounts of food when not hungry, feeling disgusted, depressed or guilty.
diff from anorexia by absence of weight loss
diff from bulimia by absence of compensatory behaviour
binge eating treatment response + prevalence?
- more responsive to treatment than AN or BN.
- 1/25 women
risk factors in binge eating disorder
- linked to?
- childhood obesity
- comments about being overweight
- low self-concept
- depression
- sexual/physical abuse
impaired work/social functioning, depression, low self-estem, subs abuse + dissatisfaction with body
life-term duration of BED?
- 4 years
- greater than AN (5.9 years) and BN (5.8 years)
role of genetics in eating disorders
- relatives of women with AN are 4x more likely to have AN
- twin studies suggest genetic influence. identical twin > fraternal concordance
- dissatisfaction with body appears to be heritable.
the brain + eating disorders
- areas important?
hypothal : regulat hunger, eating.
= lesion: lose weight, no appetite.
PVN: implicated
cortisol: as result of self-starvation, has consequences
problem with biological explanation - brain?
animal hypothalamic lesions =/= anorexic behaviour
- body-image disturbance, fear of becoming fat, high interest in food is DIFF than animal model.
endogenous opioids and eating disorders
- hypothesis of endorphins + bulimia
- starvation ^ endorphin = euphoric state
- excessive exercise ^ endorphins
- low endorphin in bulimia promotes craving, eating = reward + reinforcement
NT + eating disorders
5-ht is low
- E
- may be due to genetic polymorphisms, influenced by environment/parenting style
what are socio-cultural variables
standards set for ideal body have changes thru history
- progression toward increasing thinness as the ideal.
- playboys become thinner: now leveled off and possibly reversing.
socio-cultural variables: barbie
promotion of unrealistic images affects F >M
- increase bust 12”, reduce waist 10”, grow over 7 ft in height
- barbies expose to unrealistic body images
do socio-cultural variables apply to men?
yes, hyper-mesomorphic lean + muscular body ideal provides pressure + dissatisfaction that underscores problems in body image, eating behaviours + problems in health + well-being
what is the scarlett o’hara effect?
theory that women respond to socio-cultural pressures by eating lightly in an attempt to project images of femininity
prevalence of obesity/overweight?
altho cultural standards + pressures to be thin increase, more ppl are overweight + obese.
- 20-30% are overweight
- evolutionary tendency to eat to excess to store energy in bodies for time when food may be less plentiful
children + overweight
- prevalence?
- 31% of young women (g6-10) thought they were fat. increased with age
1/10 young girls had maladaptive eating attitudes
number of dieters from 1950 to 1999
M: 7->29%
F: 14-> 44%
impact of media on body image + dissatisfaction
- increased eating disorder symptoms assoc with increased exposure to fashion magazines, and not assoc with TV viewed
- however, soap operas were associated with drive for thinness
cultural view of fat
negative connotations: unsuccessful, little self-control, less smart, lazy
automatic bias towards thinner ppl. perpetuated by thin + obese.
pro-ana websites?
glorify starvation + reinforce irrational beliefs about the importance of thinness + perceived rewards of being thin
- some people find tips to become more anorexic.
- equated thinness with happiness
what is activity anorexia
pursuit of fitness rather than pursuit of thinness
- loss of appetite when engaged in physical activity (dancers, gymnasts)
two interrelated motivational factors account for activity anorexia
- food deprivation reinforces effectiveness of physical activity
- physical activity decreases reinforcement effectiveness of food
gender influences in eating disorders
W more heavily influenced by cultural ideas of thinness than M.
- W more concerned about thinness, diets = more vulnerable
- appearance pressure may be increasing in young males
cross-cultural studies
more common in industrialized society
- more common in western culture
cog-behave views on eating disorders
- fear of fatness + body-image disturbace are motivating factors = weight loss reinforces.
- behaviours to achieve thinness (-) reinforced by reduction of anxiety about becoming fat
- (+) reinforced by sense of mastery
effects on cognition when exposed to media
- fashion model exposure can instill (-) moods in young women, esp those vulnerable
what is thinspiration effect
chronic dieters feel thinner when looking at images of thin ppl
= reinforces dieting. distress when not able to attain body image standards
timing of binging
- after diets are broken
- purging: element of fear
- anorexia w/o binge-purge type = more preoccupied and fearful of weight gain
characteristics of families
high levels of conflict in family reported. not causal tho.
why is there a need for observational studies of families?
- parents weren’t different btw kids w ED and control
2. eating attitudes closely related to perceived parental characteristics than to actual parental characteristics
childhood abuse + ed
- sexual abuse higher in those with ED, esp BN
- 25% of ED have past sexual abuse = psychological disturbance
studies with poor ethics
- hunger and malnutrition in 40’s-50’s
- unethical, controlled experiments, lack of consent of Northern Cree ppl.
- deny food + nutrients to study them.
personalities of those with ed
- AN: perfectionist, shy, compliant
- BN: histrionic features, affective instability + outgoing social disposition
- AN + BN: high in neuroticism and anxiety, narcissism, low in self-esteem, score high in traditionalism
narcissism + treatment of ed
- grandiose ego, highly sensitive tho
- defensive “poor me” style predicts treatment drop out
3 types of perfectionism
- self-oriented (high standards for self)
- other-oriented (high standards for others )
- socially prescribed perfectionism (perception that high standards are being imposed on you by others)
who has elevated self-oriented perfectionism?
weight-restored and underweight anorexics
+ excessive exercise anorexics
who has higher socially prescribed perfectionism?
underweight anorexics
what is perfectionistic self-presentation
individuals try to create image of perfection + highly focused on minimizing mistakes they make in front of other people
unsure what causal role is
treatment of eating disorders
- tricky because they deny they have a problem
- dentist often spots key indicator: erosion of teeth enamel
- hospitalization may be required : weight restoration is goal
relapse rates of ED
- more likely when?
high - 41% in one study
- when: binge-purge anorexia subtype; had more OCD-like checking behaviours; lower motivation to recover
medication as treatment for ed?
fluoxetine: prozac, alleviate the anxiety of bulimia. but no benefits following weight restoration, not consistently effective.
- none found to be effective in AN
psych treatment of AN
goal 1: gain weight to avoid medical complications. operant-conditioning therapy. get things as they eat = reward
goal 2: long-term maintenance of weight gain
CBT treatment of AN
good + prevented relapse. also interpersonal therapy was effective
- treatment of choice for bn + bed.
- family therapy may be better for AN
Family therapy
for AN
- many participants were functioning well 3 months after therapy.
- best for early onset + short history of it
cbt for bn
question society’s standards
- uncover and change beliefs
- see that normal weight can be maintained
- high calorie + snacking doesnt need to trigger binge-purge
- alter all-or-nothing thinking
- taught assertion skills to help cope
treating body image disturbance
- cbt is best
- half of the clients relapse tho
- predictors: less initial motivation for change, higher preoccupation with food + eating
lower rates of recovery in who?
- ppl with other psych disorders
- ppl with negative slef-efficacy judgements about ability to recover
prevention of ED
- best way?
aim at high risk participants
- interactive program
- multiple sessions
- only females + 15+ yoa
