eating disorders

Question 1

DSM-5 eating disorder category definition

Answer 1

characterised by persistent disturbance of eating / eating-related behaviour, altering consumption / absorption of food, & significantly impacting physical health pr psychosocial functioning

Question 2

ICD-11 feeding and eating disorder category definition

Answer 2

abnormal eating or feeding behaviours not explained by another health condition that are not developmentally appropriate or culturally sanctioned

Question 3

feeding vs eating disorder

Answer 3

feeding disorder: behavioural disturbances not related to body weight / shape concerns, e.g. eating non-edible substances (pica)

eating disorder: abnormal eating behaviours & preoccupation w/ food; prominent body weight / shape concerns

Question 4

DSM-5 & ICD-11 listed eating (& ‘feeding’) disroders

Answer 4

anorexia nervosa, bulimia nervosa, binge eating disorder, pica, avoidant-restrictive food intake disorder (ARFID), other specified eating or feeding disorder, rumination disorder (specific to DSM)

Question 5

present cultural context

Answer 5

(1) ‘thinspiration’ & ‘pro-ana’ subcultures exist in person & online (2) media promotes body ideals (3) cultural obsession w/ food (ex: food shows like British Bake-Off, eating challenges/competitions)

Question 6

ED lifetime prevalences for AN, BN, & BED among women, according to DSM-5

Answer 6

anorexia = 1.7%, bulimia = 0.8%, BED = 2.3%

Question 7

incidence among models & dancers

Answer 7

3x increased risk of suffering an ED

Question 8

ED lifetime prevalence for AN, BN, & BED among men in USA

Answer 8

anorexia = 0.3%, bulimia = 0.5%, BED = 2%

Question 9

challenges (2) of diagnosing anorexia nervosa

Answer 9

(1) overlap of symptoms can make it difficult to correctly diagnose (2) frequent subclinical presentation of symptoms (clinically significant eatings disorders that do not fully satisfy diagnostic criteria)

Question 10

anorexia nervosa diagnostic criteria (1, 2a, 2b, 2c; 3a, 3b)

Answer 10

(1) persistent restriction of energy intake leading to significantly low body weight
(2) disturbance of 1 of the following: (a) the way one’s body/shape is experienced, (b) undue influence of body shape/weight on self evaluation, (c) persistent lack of recognition of seriousness of current low body weight
(3) either (a) intense fear of gaining weight / becoming fat, or (b) persistent behaviours that interfere w/ weight gain

Question 11

anorexia nervosa restrictive subtype criteria

Answer 11

weight loss accomplished mostly thought dieting, fasting, & excessive exercise; no episodes of binge eating / purging

Question 12

anorexia nervosa binge-eating/purging subtype criteria

Answer 12

recurrent episodes of binge eating / purging behaviour, e.g. self-induced vomiting, misuse of laxatives, diuretics, enemas

Question 13

(1) physical & (2) psychological anorexia nervosa associated factors

Answer 13

physical: amenorrhea, lanugo, thinning hair, hormonal alterations
psychological: obsessive preoccupation w/ food, depressive / social withdrawal, irritability, inflexible thinking, excessive energy/activity levels

Question 14

anorexia vs bulimia - differential diagnosis

Answer 14

body weight is normal or above normal w/ bulimia due to absence of restrictive food intake

Question 15

anorexia vs major depressive disorder - differential diagnosis

Answer 15

no persistent desire to lose weight / persistent fear of gaining weight w/ MDD diagnosis

Question 16

anorexia vs social anxiety disorder - differential diagnosis

Answer 16

social anxiety does not only comprise anxiety when observed eating

Question 17

anorexia vs OCD - differential diagnosis

Answer 17

OCD does not always/only comprise obsessive thoughts & rumination around food

Question 18

bulimia nervosa diagnostic criteria (6)

Answer 18

(1) eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time & under similar circumstances
(2) a sense of lack of control over eating during the episode
(3) recurrent inappropriate compensatory behaviour in order to prevent weight gain (self-induced vomiting, misuse of laxatives, diuretics, enemas)
(4) binge eating & inappropriate compensatory behaviour occurring on average at least once a week for 3 months
(5) self evaluation unduly influenced by body weight / shape
(6) disturbances do not occur exclusively during episodes of anorexia nervosa as diagnoses are mutually exclusive

Question 19

(1) physical & (2) psychological bulimia nervosa associated factors

Answer 19

physical: body weight at or above normal, menstrual irregularities or amenorrhea, lacerations of backs of hands or corrosion of teeth if purging
psychological: strong preoccupation with weight, social withdrawal, low self-esteem, depression w/ elevated risk of suicide

Question 20

binge eating disorder criteria (8)

Answer 20

(1) recurrent episodes of binge eating occurring on average at least once a week for 3 months, with (2) eating faster than normal (3) eating until uncomfortably full (4) eating large amounts of food when not hungry (5) eating alone due to embarrassment (6) feeling disgusted w/ oneself, depressed, or very guilty afterward (7) marked distress regarding BED (8) binge eating not associated w/ inappropriate compensatory behaviours as in bulimia or anorexia binge-eating subtype

Question 21

(1) physical & (2) psychological associated factors of binge eating disorder

Answer 21

physical: any body weight; not the same as obesity
psychological: social role adjustment problems, lower quality of life, functional impairment, subjective distress & comorbidity compared to obese people

Question 22

binge eating disorder vs bulimia - differential diagnosis

Answer 22

compensatory behaviour w/ bulimia absent in BED

Question 23

binge eating disorder vs obesity - differential diagnosis

Answer 23

obesity is associated w/ lover over-evaluation of body weight / size & lower rates of psychiatric comorbidity

Question 24

binge eating disorder vs bipolar & depressive disorders - differential diagnosis

Answer 24

both diagnoses are possible, but bipolar & depressive disorders are not necessarily associated w/ loss of control

Question 25

binge eating disorder vs borderline personality disorder - differential diagnosis

Answer 25

binge eating is a common symptom of borderline personality disorder but both diagnoses only apply if criteria for both are met

Question 26

biological factors associated w/ anorexia nervosa (4)

Answer 26

(1) low activity in frontal lobes, associated w/ behaviour regulation, & amygdala, associated w/ fear & strong emotions
(2) loss of grey & white matter in the brain
(3) abnormalities in serotonin receptors before/after development of disorder & lower response to serotonin, possibly linked w/ anxious temperament
(4) genetic component suggested by twin studies

Question 27

biological factors associated w/ bulimia nervosa (2)

Answer 27

(1) lower response to serotonin, possibly linked w/ anxious temperament
(2) genetic component suggested by twin studies

Question 28

aetiology of eating disorders - individual factors (7)

Answer 28

(1) thoughts/feelings about food & dieting (2) dissatisfaction w/ body (3) negative self evaluation (4) perfectionism (5) abstinence violation effect (6) comorbid disorders incl. depression & anxiety (7) using avoidance coping mechanisms

Question 29

abstinence violation effect

Answer 29

…

Question 30

aetiology of eating disorders - family & peer influences (2)

Answer 30

(1) modelling effect, esp. from mothers, of preoccupation w/ physical appearance, food, or food intake (2) peer criticism over weight appearance or food intake

Question 31

aetiology of eating disorders - sociocultural factors (3)

Answer 31

(1) manipulation of images used to convey idealised bodies, esp. in women’s fashion/beauty industry (2) higher ED prevalence in western industrialised cultures (3) a combination of a cultural ideal of thinness, repeated media exposure to this ideal, and subsequent assimilation of the ideal

Question 32

objectification theory & relevance to ED development

Answer 32

suggests that women, particularly, learn to view their bodies as commodities subject to the male gaze; the more this happens, the more they come to see themselves from others’ point of view & will strive to conform to ideals so as to be positively evaluated (body monitoring) - this increases vulnerability to developing an ED

Question 33

psychodynamic perspective of EDs

Answer 33

fluctuations between over eating & food refusal are viewed as a manifestation of ambivalence of the child towards the mother, & unresolved conflicts therein (Freud)