eating disorders

Question 1

Social media and body dissatisfaction

Answer 1

• Social Media Exposure is linked to weight dissatisfaction, drive for thinness, increased internalisation of thin ideals, and body surveillance.
• using social media, feel pressure to lose weight, look more attractive or muscular, and to change their appearance.
• Correlations were found between Instagram and concerns with body image

oWebsites that are ‘pro-ana’ (short for anorexia) or ‘pro-mia’ (short for bulimia) and other ‘thinspiration’ websites, blogs and Instagram profiles are dangerous online communities that promote and exacerbate eating-disorder symptoms and behaviours.

Question 2

thinspiration study

Answer 2

• randomly assigned healthy women to view either pro-eating disorder, other health-related or tourist websites
  o Women completed food diaries for one week before and one week after viewing these websites.
  o Women assigned to the pro-eating disorder website condition restricted their eating more the following week than did the women assigned to the other website conditions.
  o viewing these websites causes unhealthful changes in eating behaviour.

Question 3

ED and FB use

Answer 3

• investigate the relationship between internet exposure (e.g., use of Facebook) and body image concerns.
• Time spent online was significantly associated with body image (drive for thinness, greater body image concerns, having more Facebook friends was significantly related to greater body image concerns)
• correlational design, which does not allow for any causal conclusions as to whether using Facebook will lead to greater body image concerns.

Question 4

gender influences

Answer 4

• ED more common in women than in men,
• Western cultural advocates thinness more for women
• objectification of women’s bodies –> leads to “self objectify” –> shame of their own bodies
• ‘nice’ varies dramatically over time (during 20th and early 21st century)
• Women’s body are public property  damaging
• Body dissatisfaction (overweight; exposure to societal “norms” in media) are risk factors for eating disorders.
• Dieting is now more common
   (1950 vs. 1999: Men - 7% - 29%; women - 14% - 44%)
• Eating disorders often preceded by periods of dieting

Question 5

cultural influences

Answer 5

• fear of being fat associated with Western culture only
• Obese females were rated as more attractive by Ugandan students compared to British Students.
• BN more common in industrialized countries.
• As countries develop westernized cultures, incidence of BN increases.

Ethnic Influences

• AN 8 times greater in Caucasian versus African American women.
• White women and Hispanic women greater body dissatisfaction than African American women.
• Evidence that eating disorders more prevalent in white women.
• As countries develop and become more urbanize AN rates increase.

Question 6

Does stereotyping overweight individuals lead to a fear of feeling “fat”?

Answer 6

• Obese people viewed as less smart, lonely, shy, and greedy for affection of others
• Obese people viewed by health professionals as lazy, stupid and worthless
• Multiple studies show “fat shaming” is associated with greater weight gain

Question 7

DSM 3 features required for diagnosis anorexia nervosa

Answer 7

1. Restriction of energy intake leading to significantly low body weight; person weighs much less than is considered normal
2. Intense fear of gaining weight and being fat or behaviour that interferes with gaining weight.
3. Distorted body image or sense of body shape. believe that they are overweight and that certain parts of their bodies (abdomen, hips and thighs, are too fat)

severity based on BMI

Question 8

Two subtypes of anorexia

Answer 8

• The restricting type, weight loss is achieved by severely limiting food intake
• the binge-eating/purging type a person also regularly engages in binge eating and purging behaviour.

Question 9

amenorrhoea

Answer 9

Prior to the DSM-5, amenorrhoea (loss of menstrual period) was one of the diagnostic criteria but removed  many reasons why periods stop

Question 10

BMI

Answer 10

kg / height (metres squared).
- healthy BMI is between 18.5 and 25.

17 and lower= bad
BMI cut-offs may vary from country to country;
- some Asian countries (e.g., Japan, Singapore and Hong Kong) have introduced lower cut-offs for public health actions due to higher risks for cardiovascular diseases at substantial lower BMIs.

BMI values lower than 18.5 are consistently used to indicate underweight. In addition,

Question 11

prevalence of AN

Answer 11

Prevalence
begins in the early to middle teenage years, often after an episode of dieting and the occurrence of life stress.

o ‘Westernisation’ of (thin) beauty ideals has led to increasing rates of anorexia nervosa in some Asian countries (e.g., Hong Kong, Japan)
o Anorexia nervosa is at least 10 times more frequent in women than in men
o frequently comorbid with depression, obsessive–compulsive disorder, specific phobias, panic disorder and various personality disorders
o Mortality rates for individuals with anorexia nervosa are high; suicide rates are also high with one in five individuals with anorexia nervosa who died committing suicide

Question 12

Bullimia Nervosa DSM

Answer 12

1. Recurrent episodes of binge eating
   • In 2 hours food intake beyond normal
   • Lack of control over eating during the period
2. Recurrent inappropriate compensatory behaviour to prevent weight gain.
   • Vomiting/laxatives/diuretics/excessive exercise
3. Symptoms at least once a week for 3 months
4. Self evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during periods of Anorexia Nervosa.

People with Bulimia are usually normal weight –
separates them from people with anorexia

Question 13

prevalence of BM

Answer 13

Typically found in older adolescents/ young women.
 90% of cases are female
 Low incidence : 1-2% of the population

Comorbidity
 Death/Suicide rates are high but lower than with Anorexia Nervosa
 Frequent purging can –> electrolyte imbalance/ depletion
 Frequent vomiting –> severe dental problems (ph balance destroyed – excess
acidic gastric secretions destroy enamel on teeth).
 About 70% recover.
 Depends on stage of disorder where intervention begins.
Comorbid with depression, anxiety disorders, substance use, conduct disorder and personality disorders

Severity ratings
New severity ratings in the DSM-5 are based on the number of compensatory behaviours in a week

Question 14

binge eating as having two characteristics.

Answer 14

a) eating an excessive amount of food, that is, much more than most people would eat, within a short period of time (e.g., two hours).
b) Second, it involves a feeling of losing control overeating (i.e., not being able to stop).

a. Bulimia nervosa is not diagnosed if the binge eating and purging occur only in the context of anorexia nervosa and its extreme weight loss
b. The key difference between anorexia nervosa and bulimia nervosa is weight loss: people with ¬anorexia nervosa lose a tremendous amount of weight, whereas people with bulimia nervosa do not.

Question 15

Binge eating disorder

Answer 15

• first included as a diagnosis in DSM-5 (it was considered a diagnosis in need of further study in DSM-IV-TR).

1. Recurrent episodes of binge eating
   - food intake in 2hours
   - Lack of control
2. The Binge eating episodes are associated
   with 3 or more of the following:
    Eating more rapidly than normal
    Eating until uncomfortably full
    Eating large amounts when not hungry
    Eating alone because of embarrassment
    Feeling disgusted/guilty/upset afterwards
3. Marked distress regarding binge eating
   episode
4. Binge eating occurs 1/wk for > 3mths
5. NO compensatory behaviour.

• different from anorexia nervosa by the absence of weight loss and from bulimia nervosa by the absence of compensatory behaviours (i.e., purging, fasting or excessive exercise).
• Severity ratings : # binge-eating episodes per week.
• Many have a history of dieting;
• comorbid with mood disorders, anxiety disorders, ADHD, conduct disorder and substance use disorders
• Binge-eating disorder is more prevalent than either anorexia nervosa or bulimia nervosa

Question 16

factors leading to BED

Answer 16

 Negative weight comments
 Childhood obesity
 Depression
 Childhood abuse

Question 17

Physical consequences of binge-eating disorder

Answer 17

• increased risk of type 2 diabetes, cardiovascular problems, chronic back pain and headaches,
• sleep problems, anxiety, depression, irritable bowel syndrome and
• for women, early onset of menstruation

Question 18

neurobiological factors for ed

Answer 18

hypothalamus = regulating hunger and eating

• (cortisol) which regulated by the hypothalamus, is different in people with anorexia nervosa. (result of starvation as cortisol levels return to normal after weight gain)

Question 19

Endogenous opioids:

Answer 19

substances produced by the body that reduce pain sensations, enhance mood and suppress appetite, and are also released during starvation.

o Starvation increases the levels of endogenous opioids, resulting in a positively reinforced mood state

o excessive exercise increased opioids and thus reinforcing.
o bulimia nervosa = low levels of the endogenous opioid beta-endorphin
Animal studies have shown that binge eating leads to changes in the opioid system but not that changes in the opioid system lead to more binge eating.

Question 20

serotonin

Answer 20

• binge-eating episodes may result from serotonin deficit (not feeling full ever)
• food intake restrictions interfere with serotonin system.
• AN and BN ↓ serotonin metabolites
  o people in recovery from AN continue to have lower serotonin activity  (may be a trait-related disturbance rather than a symptom of malnutrition)

o antidepressant drugs can increase serotonin activity (SSRI)
o Serotonin, more likely linked to the comorbid depression often found in anorexia nervosa and bulimia nervosa.

Question 21

Dopamine

Answer 21

• dopamine is linked to the pleasurable aspects of food that compel an animal to seek food
• dietary restraint = exhibited greater dopamine activity in the dorsal striatum area of the brain during the presentation of food.
• thus people who restrain their eating may be more sensitive to food cues, (dopamine signals the salience of particular stimuli)

Question 22

DAT dopamine transporter study

Answer 22

• women with either anorexia nervosa or bulimia nervosa had greater expression of the dopamine transporter gene DAT
• gene is ‘turned on’, as it interacts with different aspects of the environment.
• found that women with either eating disorder exhibited less expression of another dopamine gene called DRD2.

Question 23

Environmental Factors

Answer 23

 Early menarche
 Stress in mothers during pregnancy
 Premature birth and birth complications

Question 24

Psychodynamic Factors

Answer 24

• Underlying thought = core cause is disturbed parent-child relationship.
• Children raised as ineffectual develop behaviour to gain competence, respect and
  effectiveness (Bruch, 1980)

Failure to develop sense of self because of conflicting mother-daughter relationship
 Food symbol of relationship
 Binging/Purging is the conflict

A young person trying to resist puberty?
• Early puberty a risk factor
• Denial of sexuality (especially with previous abuse)
• Electra Complex, resolution of which ends in identification with mother

Question 25

Appearance Comparisons

Answer 25

 Compare one’s body with others
 Appearance comparisons highlight perceived inadequacies due to upward nature
 Selective both for the attribute about themselves on which they
compare, and for the target with whom they choose to compare
 Comparing oneself on features that are not liked
 Select “better” people with whom to compare, e.g., people who have
the desired quality

Question 26

Anorexia nervosa

Cognitive–behavioural theories

Answer 26

• fear of weight gain and body-image disturbance as the motivating factors that powerfully reinforce weight loss.
• onset followed a period of weight loss and dieting.
• Behaviours that achieve or maintain thinness are negatively reinforced by the reduction of anxiety about gaining weight as well as positively reinforced by comments from others
• Dieting and weight loss may also be positively reinforced by the sense of mastery or self-control they create

Question 27

low positive emotion differentiation.

Answer 27

• ED individuals experience positive emotion, even though they may not distinguish among different positive emotional states all that well

o they may experience a positive emotion such as pride very intensely after losing weight or by avoiding eating a piece of cake at a party.
o This becomes indistinguishable from happiness or success and is referred to as low positive emotion differentiation.

Question 28

Personality and sociocultural variables

Answer 28

• perfectionism and a sense of personal inadequacy may lead a person to become especially concerned with his or her appearance, making dieting a potent reinforcer.
• strong drive for thinness

Question 29

outcomes of anorexia nervosa

Answer 29

Physical:
 Blood pressure & Heart rate slow significantly.
 Kidney and GI problems
 Bone mass reduced significantly,
 Skin dries.
 Neurological impairments.
 Reduction of important electrolytes
 Endorphins may be released (may act as reinforcers for disordered behaviours in relation to eating)

Psychological:
 Patient is no longer rational, personality changes

Co-morbidity (OCD, depression, panic, personality disorders)

Question 30

Cognitive behaviour of BN

Answer 30

o Negative affect + stress + low positive affect predicts binge eating
o Stress and negative effect are relived by purging
o When restrained from purging, people with bulimia show ↑ anxiety and skin conductance when eating

Question 31

Appearance Comparisons: Treatment

Strategies

Answer 31

 Increase awareness - understand impact
 Reduce frequency of comparisons
 Facilitate a change in the balance between upward and downward comparisons
 Alter negative affective outcomes of comparisons

Question 32

Treatment of Eating Disorders

Psychological Intervention BN

Answer 32

• CBT most valid and current gold-standard
• Cognition – i.e. challenge perception of “thin”
• Behaviour – i.e. being taught assertiveness skills
• 20 to 40 sessions needed.

Question 33

Treatment of Eating Disorders
Psychological Intervention
AN

Answer 33

1) Hospitalization immediate weight gain
2) Operant conditioning to achieve healthy weight

• CBT + Hospitalization = ↓ of anorexic symptoms after 1yr

• Family Based therapy
• Lunch meetings to
1. Change patient role of person with anorexia nervosa
2. Redefine issue as an interpersonal issue (not personal)
3. Prevent parents using the disorder to prevent conflict

individual therapies, cognitive–behavioural therapy (CBT)
BT focuses primarily on the maintaining processes of anorexia nervosa by directly challenging cognitions and patterns of thinking (e.g., cognitive biases such as ‘People only like thin women!’).

Question 34

Binge Eating Disorder treatment

Answer 34

Binge Eating Disorder
• CBT and IPT most effective
• More work required!

Question 35

Anti-Depressants

Answer 35

• ↓ binge eating and vomiting in BN compared to placebo.
• ↓ depression and distorted view toward eating.
  • Problem = drop-out rate. 1/3 of women dropped out of study (side effects)
  • Relapse when medication withdrawn
  • AN does not respond well to anti depressant medication

Question 36

refeeding syndrome

Answer 36

a dangerous and sometimes fatal metabolic disturbance (e.g., due to very low levels of potassium, phosphate and magnesium).

Thus, start with low doses of nutrition, increasing slowly over time while constantly monitoring the patient’s electrolyte levels. Beyond the immediate medical stabilisation of a patient

Question 37

family therapy

Answer 37

Family therapy is another form of psychological treatment for anorexia nervosa and is based on the notion that interactions among members of the patient’s family can play a role in treating the disorder

Question 38

CBT with bullimia nervosa

Answer 38

• encouraged to question society’s standards for physical attractiveness.
• normal body weight can be maintained without severe dieting and that unrealistic restriction of food intake can often trigger binge eating.
• Altering this all-or-nothing thinking can help people begin to eat more moderately.
• Patients also learn assertiveness skills, which help them cope with unreasonable demands placed on them by others, as well as more satisfying ways of relating to people.

Question 39

CBT and Binge eating disorder

Answer 39

CBT and Binge eating disorder

• The intervention targets restraint as well as binge eating  emphasising self-monitoring, self-control and problem solving.
• Treatment gains from CBT appear to last long-term while IPT seems to be as effective as CBT and seems to have slightly better long-term outcomes than CBT
• Both CBT and IPT are more effective than behavioural weight-loss programs, which are often used to treat obesity
• CBT and IPT reduce binge eating (but not necessarily weight), whereas behavioural weight-loss programs may promote weight loss but do not curb binge eating.

Question 40

preventative interventions

Answer 40

• Psychoeducational approaches. The focus is on educating children and adolescents about eating disorders in order to prevent them from developing the symptoms.
• Deemphasising sociocultural influences. The focus here is on helping children and adolescents resist or reject sociocultural pressures to be thin.
• Risk factor approach. The focus here is on identifying people with known risk factors for developing eating disorders (e.g., weight and body-image concern, dietary restraint) and intervening to alter these factors.

Question 41

social media caused eating disorders??

Answer 41

NO, they are not a modern invention

Ancient Egyptian tomb painting depicting noble self
inducing vomiting

Anorexia a century ago was replication of Christian
saints being nourished by the holy spirit