Eating Disorders Flashcards
prevalence of eating disorders
in the US, lifetime prevalence in increasing order for anorexia, bulimia and BED are 0.9%, 1.5% and 3.5% for women, and roughly 1/3 that in men (except men have 2.0% in BED)
- internationally, the lifetime prevalence of BED is also higher than for bulimia (1.4 vs 0.8), but see that these are lower than the US rates
- disorders both onset in late teens/early 20s (tho slightly younger for bulimia, which was also found to persist longer)
- in canada, women are also more likely to report an eating disorder than men, and the highest rates appear to be in women 15-24
do those with eating disorders get treatment?
- only a relatively small portion of those who require treatment actually seek it out in a given year, and it’s usually obtained from the general medical sector
- we also see a clear difference in hospitalization between women and men, and higher rates among young women
commonalities of anorexia and bulimia
- diagnoses share several clinical features, the most important being intense fear of being overweight
- suggested that these may be two variants of a single disorder as opposed to distinct diagnoses
- for example, co-twins of people diagnosed with anorexia are more likely than average to have bulimia
DSM criteria for anorexia
- restriction of energy intake relative to requirements, leading to significantly low body weight (in the context of age, sex, developmental trajectory and physical health); defined as weight less than minimally normal or expected
- intense fear of gaining weight or of becoming fat, or persistent behaviour that interfered with weight gain despite already being a significantly low weight
- disturbance in the experience of shape or body weight, undue influence on self-evaluation, or persistent lac of recognition of the seriousness of the current low body weight
- further diagnosed as restricting or binge eating/purging type
restricting type anorexia
- during the last 3 months, the individual hasn’t engaged in recurrent episodes of binging or purging behaviour
- subtype describes presentations in which weight loss in primarily accomplished through dieting, fasting, and/or excessive exercise
binge eating/purging type anorexia
-during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (self-induced vomiting or misuse of laxative, diuretics or enemas)
overvaluation of appearance
the tendency to link self-esteem and self-evaluation with thinness
- among ppl with acute anorexia, lower body wt is as’d with increased self esteem
- anorexics consistently overestimate their own size and choose a thin figure as being idea for them (or for others too)
development of anorexia
- typically begins in early to middle teens, often after an episode of dieting and exposure to life stress (prevalence among children and adolescents thought to be increasing)
- both men and women at risk for eating disorders are also prone to depression, panic disorder and social phobia; women were at substantially greater risk for mania, agoraphobia and substance dependence (comorbidity is high)
comorbidity of eating disorders and SUDs
- there’s a high rate of co-occurring eating disorders and SUDs
- meta analysis in spain found no link between anorexia and illicit drug use, but did find a clear link to bulimia
- canadian investigators have specifically tied to drug use to the bingeing and dieting cycle
physical changes with anorexia nervosa
- decreased blood pressure, heart rate, and bone mass
- kidney and GI problems
- dry skin, brittle nails, hair loss and laguna (fine soft hair)
- changes in hormone and electrolyte (K, Na) levels
- mild anemia
- tiredness, weakness
- cardiac arrhythmias, sudden death
- decrease in white and grey matter (with the grey loss being irreversible)
prognosis of anorexia
- 70% of patients recover, but it often takes 6-7 years and relapses are common because changing distorted values about thinness is difficult, particularly in cultures that value and therefore highly reinforce thin appearance
- death rates 10x greater than the general pop, and 2x greater than patients with other psychological disorders
mortality in eating disorders
- there’s likely to other disorder that matches the mortality risk associated with anorexia, at 5.1/1000 persons (EDNOS coming in 2nd at 3.0, then bulimia at 0.7)
- predictors of death include lower BMI, older age at first presentation for treatment, and alcohol misuse
- most common causes are from suicide or the physical complications of the illness
- anorexia associated with a 25 yr reduction in life expectancy
suicide in eating disorders
- 1/5 of deaths attributed to anorexia involve suicide
- review found that suicide rates aren’t elevated in bulimia as the are in anorexia, though people with bulimia are more likely to have suicidal ideations
bulimia nervosa
- from the greek word meaning “ox hunger”
- involves episodes of rapid consumption of large amounts of food (binge) followed by compensatory purging behaviours
- binge is defined as eating excessive amounts of food in under 2 hrs; these typically occur in secret and may be triggered by stress
- purging can be vomitting, fasting, or excessive exercise
DSM diagnosis of bulimia
- defined as eating an excessive amount of food within a defined period (usually 2hrs), and includes a sense of lack of control over the behaviour
- the bingeing and compensatory behaviours must continue at least once a weel for 3 months
- bulimia not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss