Eating Disorders Flashcards
What does the DSM-5 mention as the 4 primary categories of eating disorder?
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
- OSFED - other specified feeding and eating disorders
Why is the language used to talk about eating disorders so crucial?
You should never comment about the body of a patient with an eating disorder
What are the 2 main features of anorexia nervosa?
- active maintenance of low body weight
2. extreme shape and weight concern
What is the weight and BMI like of someone with anorexia nervosa?
In adolescents and children, weight is less than 85% of their expected weight
Or they will have a BMI of 17 or less
What is restricting anorexia?
This involves eating very little on a daily basis
What are the 2 types of binge in binge/purging anorexia?
Objective binges - this would be recognised as a binge by a healthy person
Subjective binge - involves an anorexic person eating something they hadn’t planned
What is the main age of onset of anorexia nervosa?
What percentage of people this age present with it?
Age of onset peaks at 15 and 18 years
0.5% of girls aged 15-18 present with anorexia nervosa
What percentage of anorexia nervosa cases are seen in females?
95%
What are the severe physiological and psychological effects underlying anorexia nervosa?
- starvation affects all organ systems and organs begin to shrink
- cognitive impairment may occur due to shrinkage of the brain
What are the behavioural signs of anorexia relating to body image and behaviour?
- obsessive behaviour
- not being truthful about how much weight they have lost
- underestimate the severity of the problem
- pre-occupation with body weight
- distorted perception of body shape/weight
- fear of fatness or pursuit of thinness
What are the psychological behavioural signs of anorexia nervosa?
- rigidity in thinking
- setting high standards and being a perfectionist
- social withdrawal and isolation
- depression and anxiety
- compromise of educational and employment plans
What are the behavioural signs of anorexia nervosa relating to food and diet?
- strict dieting
- excessive calorie counting
- hiding food
- eating only low calorie food
- missing meals
- avoid eating with others
- cutting food into tiny pieces to make it less obvious they have eaten little
What are the other behavioural signs of anorexia nervosa?
- vomiting or misusing laxatives (purging)
- taking appetite suppressants (diet pills)
- telling lies about what they have eaten, pretending they have already eaten
- finding it difficult to think of anything other than food
Why is is difficult to diagnose an eating disorder?
Normally a few of the behavioural signs are observed, but it is very difficult to actually identify an eating disorder
What is the affect of anorexia nervosa on the stomach?
The stomach shrinks due to starvation
It begins to physically hurt after only eating a small amount
What are the physical signs of anorexia nervosa that affect mood?
- getting irritable and moody
- difficulty concentrating
- difficulty sleeping and tiredness
- feeling dizzy
What are the physical signs or anorexia nervosa that can be visibly noticed?
- severe weight loss
- constipation and bloating
- growth of downy hair on the body
- hair falls out
- swelling of the feet, hands or face
What are the physical signs of anorexia nervosa that cannot be visibly noticed?
- stomach pains
- feeling cold/having a low body temperature
- low blood pressure
- periods stop or are irregular
- weakness/loss of muscle strength
What was the Minnesota experiment?
The calorific intake of men was halved, and they had no previous experience of eating disorders
What behaviour was shown by the men in the Minnesota experiment?
They became preoccupied with food
Some developed bulimic responses, some would hide food and eat secretly and some would take hours to eat meals
What happened to the men in the Minnesota experiment, once they had access to food?
They ate continuously but continued to binge even after they reached their optimal weight
How does an individual with bulimia nervosa feel about their condition?
They feel very out of control of their condition
What behaviour is observed in bulimia nervosa?
- recurrent binge eating, where large amounts of food are eaten very quickly
- compensatory behaviour (e.g. vomiting, fasting)
- there is an extreme shape and weight concern
What must the binge frequency be for someone to have bulimia nervosa?
At least once a week for 3 months
What is the normal age of onset for bulimia nervosa?
What % of people this age are affected?
The age of onset tends to be late adolescence to young adulthood
It affects 1-3% of girls aged 18-25 years old
What percentage of people with bulimia nervosa are female?
Why might this figure not be accurate?
95% of people with bulimia nervosa are female
Men are less likely to prevent with symptoms
What is the major risk associated with purging and why does it occur
high risk of cardiac arrest
potassium is lost through purging, which helps muscles to work including heart muscle
What are the behavioural signs of bulimia nervosa related to how the person feels?
- mood swings
- associated with depression, low self-esteem, misuse of alcohol and self-harm
- feeling anxious and tense
- feeling a loss of control over eating
- feelings of guilt after binging and purging
What are the behavioural signs of bulimia nervosa relating to binging?
- they disappear soon after eating
- they purge after binging using vomiting, laxatives, diuretics, over-exercising or fasting
- they are preoccupied with thoughts of food, and organise their life around eating and purging
What are the other behavioural signs of bulimia nervosa?
- distorted perception of body shape or weight
2. being secretive about their bulimic episodes
How may people with anorexia nervosa and bulimia nervosa look different in appearance?
Someone with bulimia nervosa tends to be more of a healthy body weight
Why should doctors be careful to prescribe laxatives to bulimic patients?
The bowel becomes sluggish in a state of famine, leading to constipation
There is a risk that patients may abuse them
What is the typical pattern of food behaviour in someone with bulimia nervosa?
There tends to be periods of restriction
These are followed by periods of binging and compensatory behaviours
What are the physical signs of bulimia nervosa that are visibly noticeable?
- swelling of hands and feet
- amenorrhea (periods stop or are irregular)
- regular changes in weight
- bloating and constipation
- excessive exercising
- enlarged salivary glands
What are the physical signs of bulimia nervosa that are not visibly noticeable?
- electrolyte abnormalities/imbalance
- gastric problems
- stomach pain
- fatigue and lethargy
What are the physical signs of bulimia nervosa that are only visible to the patient?
- vomiting
2. misuse of laxatives and diuretics
What is binge eating disorder?
Recurrent binge eating without the compensatory behaviour
Large amounts of food are eaten very quickly, showing a loss of self-control
What is the binge frequency in binge eating disorder?
It is usually once a week for at least 3 months
What 3 factors do all eating disorders have in common?
- behaviour is always centred around food
- there are core beliefs and associated concerns about body weight and shape
- high levels of distress
What is meant by the transdiagnostic view of eating disorders?
There are shared clinical features of eating disorders, and patients tend to move over into another disorder over time
Why is the transdiagnostic view used?
There is a lot of variation within the behaviour of eating disorder patients, where they exhibit the behaviour of another eating disorder
What 4 domains must be treated in order for someone with an eating disorder to recover?
- severe (clinical) perfectionism
- low self-esteem
- intense mood states that are very irregular
- interpersonal difficulties (e.g. avoidance of social situations due to social anxiety)
What are the 2 stages of disordered eating?
- it may be a single, short crisis
2. this may then develop into a chronic, intractable disorder
What group of people tend to recover from a single, short crisis?
What is required for recovery?
Recovery is more likely in adolescents who are offered appropriate help quickly
There is little evidence of spontaneous recovery
Why should disordered eating try to be stopped in the ‘single, short crisis’ stage?
If it develops into a chronic disorder, this is much more difficult to treat and takes much longer
What is the definition of behaviour relating to disordered eating?
It is the way in which people cope with stresses in their life
Why might someone stop eating?
- when external events feel outside of personal control
e. g. after an argument - to influence others
e. g. showing feelings of distress, defiance, anger
Why might someone begin binge eating and purging?
To regulate negative emotional states
What 5 factors make a young person more likely to develop an eating disorder?
- mental health problems
- family history
- perfectionism
- history of significant dieting
- being part of a sport or activity where there is an emphasis on appearance
What are the 2 types of risk factors that contribute to developing an eating disorder?
- Body dissatisfaction risk factors (specific)
2. Self-regulatory risk factors (non-specific)
What are 3 categories of specific risk factors?
What do they result in?
Contextual, physical, developmental
They lead to:
- negative body image
- weight preoccupation
- dieting
What are 3 categories of non-specific risk factors?
What do they result in?
parental psychopathology/insensitivity, trauma, temperamental/biological predispositions
They lead to:
- low self-esteem
- affective dysregulation
- insecure attachment
What is an example of a physical aspect that influences disordered eating?
Coming from a family with larger/smaller BMIs means that you are more likely to follow this trend
What did Patton’s cohort study show about how dieting is linked to eating disorders?
Dieting is a predictive factor for eating disorders
It is linked, even though it is not causative
How does cult of image affect eating disorder prevalence?
Magazine media invites and exploits social comparisons in relation to appearance
Why are adolescents often vulnerable to eating disorders?
During adolescence, there is a focus on developing your own identity
Identity becomes bound to external appearance
What are food behaviours like in adolescents?
There are high levels of shape/weight concern, especially in girls
This is acted out through food - dieting, skipping meals, vegetarianism, etc.
How does peer impression management influence food behaviours in adolescents?
Peer impression management involves socially normative dieting and conforming to social norms
How does mood tend to improve in patients with anorexia?
Their mood improves as their weight increases
During day-to-day eating, mood is improved by eating good tasting, high energy food
How are cravings triggered in someone with an eating disorder?
Cravings tend to be triggered by a negative mood
usually particular food groups are completely cut out of the diet by someone with an eating disorder
How is behaviour affected by consumption of regular meals?
There is an improvement of mood when regular meals are consumed
What other factors can trigger the behaviour related with eating disorders?
Many external events
e.g. binging and restricting is used to manage negative emotional states
What is the first step in getting someone to manage their eating disorder behaviours?
Getting people to understand their emotions and why they are feeling a particular way
If they can manage their emotions, they are more likely to be able to manage their behaviour
What are the 3 stages involved in treatment of an eating disorder?
- weight management
- psychological therapies
- relapse prevention
What is the initial focus of eating disorder treatment during the weight management stage?
Not usually weight gain, but ensuring that the patient doesn’t lose anymore weight
What are examples of psychological therapies that are used to treat eating disorders?
- family based therapy (used for children)
- Cognitive behavioural therapy
- Guided self help
When is guided self help often used as a treatment?
It is the most effective treatment for bulimia nervosa and binge eating disorder
