Eating Disorders Flashcards
What is a purge?
Use of vomiting, laxatives, diuretics or enemas to eliminate calories
What is a. Binge?
- Eating a large amount within a discrete period (I.e. an amount “definitely larger than most people would eat under a similar circumstance”)
- eating is out of control during episode
What are the types of eating disorders?
- Anorexia nervosa
- Bulmia nervosa
- Binge-eating disorder
- Unspecified eating disorder
What are the diagnostic criteria of Anorexia Nervosa?
- Restriction of food that leads to a person being significantly underweight
- underweight is defined as having a body mass index under 18.5 kg/m^2 - Intense fear of gaining weight(evidenced by extreme preoccupation, frequent assessment, behaviors that interfere with weight gain etc.
- Body image disturbance(eg.g. Belief of being overweight, denying seriousness of low weight)
Behavior last Over 3 months
What is the normal. BMI range?
18.5 -24.9 kg/m^2
Give the classifications of anorexia nervosa
Mild- BMI range =17-18.49 kg/m^2
Moderate- BMI range= 16-16.99 kg/m^2
Severe- BMI range= 15-15.99
Extreme- under 15
What are the anorexia nervosa subtypes?
Based on recent behavior
- Binge-eating/purging type:
- If the person recurrently binges AND/OR purges
- Restricting type:
- The person does NOT recurrently binge or purge
- Weight loss is maintained through dieting, fasting +/- over exercising
Explain the epidemiology of anorexia nervosa
-over 90% of affected persons are females however, the prevelance data for males is scarce
- Onset: bimodal(average 17 years)
- early adolescence(12-15 years)
- late adolescence and early childhood (15-21 years)
Interests/occupation:
- Modeling, beauty competitions
- Gymnastics
- Ballet dancing
- Wrestling
What are the psychological/social factors of Anorexia Nervosa?
- cultural pressures to be thin
- Difficulty establishing autonomy from parents during adolescence ( a “control” issue)
- Perfectionist trait
- Low self-esteem
- Difficulty resolving conflicts
- Difficulty communicating negative emotions
What are the biological factors of anorexia nervosa?
- Genetic susceptibility to anorexia
- A person may inherit biochemical alterations that leads to obsessiveness
- Cultural pressures may direct the obsessiveness to body image
What are the eating rituals of someone with anorexia nervosa?
- complain of distaste for food
- Fear of eating in public
- Obsessed with food —> hoard food, collect recipes, involved in elaborate food perpetration, food related professions (waitress, cook, dietician, nutritionist)
What are the physical consequences of anorexia nervosa?
- Amenorrhea, loss of sex drive,bconstioation
- low heart rate, low blood pressure and low temperature
- hair loss
- Lanugo
- dry skin, brittle nails
Many possible medical complications: (hormone deficiency, organ failure, brain changes) with approximately 20% mortality rate
How is anorexia nervosa treatment usually initiated?
A patient is usually not self-refferred, since anorexia tends not to distress patient
Treatments is typically family initiated
How can anorexia nervosa be treated by in-patient hospitalization:
- weight gain is the immediate goal for in-patient care
- Combined with behavioral principles (e.g. operant conditioning) to encourage weight gain
- An attendant often supervises the patient to thwart attempts to lose weight
How can CBT be used to treat anorexia nervosa?
- In patient or out patient
- it is an essential component of treatment
- used to change the patient’s attitude about food and weight and learn how to break destructive eating habits
How can Pharmological therapy be used in treatment of anorexia nervosa?
-No FDA approved drug for treating anorexia
-Common off labeled drugs prescribed are:
Antidepressants (SSRI)
Appetite stimulants
-They are usually ineffective
What is the general outcome of anorexia nervosa?
- There is good short term response to in-patient treatment in a controlled environment
- Although short-term treatment may be effective, long term prognosis tends to be poor after patients are released home
What are the diagnostic criteria of bulimia nervosa?
- Recurrent binge eating
- Recurrent inappropriate compensatory behavior for binge
- purging(e.g. vomiting, laxatives, diuretics, enemas)
- Non-purging (fasting and/or excessive exercise
- The binge/inappropriate compensatory behaviors must occur more than 1 time per week fir 3 months
- Self-evaluation is unduly influenced by body shape and weight
What are the Bulimia Nervosa clarifications?
Mild- 1-3 (number of compensatory behaviors per week)
Moderate- 4-7 (number of compensatory behaviors /week
Severe- 8-13(number of compensatory behaviors/week)
Extreme- 14 or more (number of compensatory/week)
What are the features of bulimia nervosa?
There are no subtypes go bulimia nervosa
Persons typically have a BMI in the normal range or are slightly overweight
Normal BMI= 18.5 - 24.99
Give the epidemiology of Bulimia Nervosa
-More than 90% of persons with bulimia nervosa are women
Onset:
- average age of onset: 19-20 years
- After failed dieting attempts
Occupations:
- Modelling, beauty competition
- gymnastics
- ballet dancing
- wrestling
What are the psychological/social contributing factors of bulimia nervosa?
- societal pressures to bd thin +/- a means to improve self-esteem
- Strict dieting results in a broken diet and impulsivity, “all or none” eating (I.e. binging )
- fear of weight gain after binge leads to inappropriate compensatory behavior
What are the biological contributing factors of bulimia nervosa?
A person may inherit biochemical changes(low serotonin) that leads to impulse control problems
What are the physical consequences of bulimia nervosa?
- electrolyte imbalance
- irregularity in heartbeat
- consequences of excessive vomiting
What are the associated features of Bulimia Nervosa?
Consequences of excessive vomiting
-Seen in both bulimia and anorexia(subtype: bing-eating/purging)
- tooth decay
- Salivary gland inflammation “chipmunk cheeks”
- tearing of tissue in stomach and throat
How is Bulimia Nervosa treatment usually initiated and where it is usually administered?
Typically a patient initiated treatment (after several years of symptoms ) as disorder is distressful you the patient
-treatment tends to be outpatient
Contrast prognosis of bulimia and anorexia nervosa
- With greater motivation to change, prognosis is better for bulimia nervosa than anorexia nervosa
- Medical complications tend to be fewer and less severe than in anorexia, but serious events (e.g. cardiac arrests ) can occur in bullimia nervosa as a result of excessive Vomitting
How can Bullimia Nervosa be treated via psychotherapy?
- Psychotherapy
A. Cognitive: restructure patient’s thoughts about weight/food
B: Behavioral: binges gets associated with stimuli, which becomes cues for binges
Goal: Break association with stimuli, which becomes cues and binge (I.e. “extinguish” the conditioned response):
I. Identify triggering stimuli
II. Avoid stimuli and/or do another behavior when stimuli are encountered
How can bullimia nervosa be treated pharmologically?
The only FDA drug approved for bullimia nervosa are antidepressants which may be useful for impulse control, but CBT is also essenti
Describe Bulimia nervosa prognosis
- intervention soon after diagnosis has better prognosis
- having associated problems with depression or substance use has poorer prognosis
What are the diagnostic criteria of Binge-eating disorders?
- Binge eating (as per bulimia criteria)
- Binging is associated with features such as:
A. Rapid eating
B. Eating until uncomfortably full
C. Eating when not physically hungry
D. Eating alone due to shame about quantity
E. Feeling disgusted/guilty/depressed after binge
- No appropriate compensatory behavior
- The binge behavior must occur >1/week for 3 months
Give the epidemiology of Binge-eating disorder
Approximately 2% with a less skewed female bias
Give the onset and course of Binge-eating disorder
- Symptoms often start in adolescence
- chronic
- Coss-over to other eating disorder is uncommon
Give the etiology of Binge-eating disorder
- Unknown but distinct from bulimia nervosa
- In binge-eating disorder, dysfunctional dieting tends not to precede binging
- Binge during periods of stress to reduce anxiety or alleviate depressive mood
How can Binge-eating be treated?
-Cognitive-Behavioral therapy +/- antidepressants
What are the features of binge eating disorder?
Associated with obesity(BMI is more or equal to 30 kg/m^2)
-High BMI not required for a diagnosis
Obesity without binging is a distinct condition:
- Not all obese people binge eat
- There is greater distress/functional impairment in binge eating disorder than in non-bingeing obesity
- Health consequences of binge-eating disorder are similar to those of obesity
Describe sub clinical eating disorders
Many patients do not meet the criteria for either Anorexia Nervosa, Bulimia Nervosa or Binge-eating disorder but have subclinical eating disorders
The diagnosis would be called “unspecified eating disorder”
Give examples of unspecified eating disorders
- A woman with a BMI= 22kg/m2 who frequently purges but does not binge eat
Purges—> AN(binge eating/ purging subtype) or BN
Doesn’t binge eat—> not BN
Normal BMI—> not AN
- A woman with a BMI 25 kg/m2 binges and purges but only once a month
- Binge and purge—> AN(binge eating/purging subtype) or BN
-Criteria for duration: >1/week for 3 months
How does Bulimia and binge eating
Bulimia= binge-eating with inappropriate compensation
Binge eating= binge eating with inappropriate compensation
