eating disorders Flashcards
DSM-5 eating disorder category definition
characterised by persistent disturbance of eating / eating-related behaviour, altering consumption / absorption of food, & significantly impacting physical health pr psychosocial functioning
ICD-11 feeding and eating disorder category definition
abnormal eating or feeding behaviours not explained by another health condition that are not developmentally appropriate or culturally sanctioned
feeding vs eating disorder
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
DSM-5 & ICD-11 listed eating (& ‘feeding’) disroders
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)
present cultural context
(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)
ED lifetime prevalences for AN, BN, & BED among women, according to DSM-5
anorexia = 1.7%, bulimia = 0.8%, BED = 2.3%
incidence among models & dancers
3x increased risk of suffering an ED
ED lifetime prevalence for AN, BN, & BED among men in USA
anorexia = 0.3%, bulimia = 0.5%, BED = 2%
challenges (2) of diagnosing anorexia nervosa
(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)
anorexia nervosa diagnostic criteria (1, 2a, 2b, 2c; 3a, 3b)
(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
anorexia nervosa restrictive subtype criteria
weight loss accomplished mostly thought dieting, fasting, & excessive exercise; no episodes of binge eating / purging
anorexia nervosa binge-eating/purging subtype criteria
recurrent episodes of binge eating / purging behaviour, e.g. self-induced vomiting, misuse of laxatives, diuretics, enemas
(1) physical & (2) psychological anorexia nervosa associated factors
physical: amenorrhea, lanugo, thinning hair, hormonal alterations
psychological: obsessive preoccupation w/ food, depressive / social withdrawal, irritability, inflexible thinking, excessive energy/activity levels
anorexia vs bulimia - differential diagnosis
body weight is normal or above normal w/ bulimia due to absence of restrictive food intake
anorexia vs major depressive disorder - differential diagnosis
no persistent desire to lose weight / persistent fear of gaining weight w/ MDD diagnosis
anorexia vs social anxiety disorder - differential diagnosis
social anxiety does not only comprise anxiety when observed eating
anorexia vs OCD - differential diagnosis
OCD does not always/only comprise obsessive thoughts & rumination around food
bulimia nervosa diagnostic criteria (6)
(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
(1) physical & (2) psychological bulimia nervosa associated factors
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
binge eating disorder criteria (8)
(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
(1) physical & (2) psychological associated factors of binge eating disorder
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
binge eating disorder vs bulimia - differential diagnosis
compensatory behaviour w/ bulimia absent in BED
binge eating disorder vs obesity - differential diagnosis
obesity is associated w/ lover over-evaluation of body weight / size & lower rates of psychiatric comorbidity
binge eating disorder vs bipolar & depressive disorders - differential diagnosis
both diagnoses are possible, but bipolar & depressive disorders are not necessarily associated w/ loss of control
binge eating disorder vs borderline personality disorder - differential diagnosis
binge eating is a common symptom of borderline personality disorder but both diagnoses only apply if criteria for both are met
biological factors associated w/ anorexia nervosa (4)
(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
biological factors associated w/ bulimia nervosa (2)
(1) lower response to serotonin, possibly linked w/ anxious temperament
(2) genetic component suggested by twin studies
aetiology of eating disorders - individual factors (7)
(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
abstinence violation effect
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aetiology of eating disorders - family & peer influences (2)
(1) modelling effect, esp. from mothers, of preoccupation w/ physical appearance, food, or food intake (2) peer criticism over weight appearance or food intake
aetiology of eating disorders - sociocultural factors (3)
(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
objectification theory & relevance to ED development
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
psychodynamic perspective of EDs
fluctuations between over eating & food refusal are viewed as a manifestation of ambivalence of the child towards the mother, & unresolved conflicts therein (Freud)
