eating disorders and obesity Flashcards
what is the role of media in obsessions with food and body shape?
media
- bombards us with a ‘standard of beauty’
- makes us believe that all women should be thin
- associate beautiful people with happy lives and high moral standards
-promotes body dimension of female models, actresses, cultural icon
->became thinner over the years
10x more articles on dieting /weight management for woman rather than men
-active social media -> maintaining factor for body/eating concerns
indv w body related /eating concern , more drawn to appearance related activities -> engagement in appearance ->persistent body/eating concern
=>bidirectional , mutual reinforcement
what is aneroxia nervosa?
(an= without, orexis= appetite)
-> not always true
fear of gaining weight / becoming fat
pursuit of thinness that can be deadly
refuse to maintain normal weight
two types of aneroxia nervosa?
1) restricting type
2) binge eating /purging type
what are the psychological symptoms of aneroxia nervosa?? (7)
fear of gaining weight/fatness irritability and anxiety low self esteem preoccupation w food /weight /size impaired memory/attention/concentration denial distorted thinking styles /body image ->see things as black and white ->overgeneralisation
what are the behavioural symptoms of aneroxia nervosa?
avoidance of eating
excessive exercising
ritualistic behaviour
deceptive behaviour (storing /hiding food)
excessive fluid consumption
frequent toilet visit (laxative / vomiting)
when starved, body turn to itself to produce energy
fat burns-> muscle burns-> organs destroyed to find fuel
what is bulimia nervosa ?
(boux: ox, limes: hunger) characterised by: frequent binge eating lack of control over eating recurrent inappropriate behavior to preven weight gain
->modern disease
types of bulimia nervosa?
purging type:
vomiting
laxatives
diuretic (water pill)
non-purgin:
fasting
exercising
what is binge eating disorder?
characteristics:
episodes of binge eating
typically overweight or obese
no compensatory weight loss behaviour
->mental disorder
what type of treatment are there for anorexia nervosa?
antidepressant or other medication
family therapy
CBT
emergency, restore weight procedure
how does eating disorder in men look like?
sociocultural pressure to have toned muscular bodies body dissatisfaction (wanting a muscular upper torso)- excessive exercising underdiagnosed: stereotype for female disorders
eating disorder and it’s association with other psychopathology??
- clinical depression
- OCD
- personality disorders: impulsivity, anxiety,social isolation, depression
- ASD
- substance abuse disorder
- > increase self harm/suicide
guidelines for emergency procedure ED
person health risk due to ED, don’t consent
- only treat in inpatient setting
- compulsory treatment
child/young person at serious risk, do not consent
- ask parent or caregiver
- legal framework for compulsory treatment
-> high calcium diet (oral feeding, tube), stop exercising, bed rest
goals:
counter physio effect of starvation
weight gain
what is the target for CBT?
- encourage healthy eating/ reaching healthy body weight
- personalised treatment plan on processes that maintain eating problem
- monitoring dietary intake and association with thoughts and feelings
- cognitive restructuring includes: body image concerns, mood regulation, social skills, self-esteem, relapse
- enhance self-efficacy
model of aneroxia nervosa?
over-evaluation of weight/shape/eating
- > strict weight control
- > increased checking weight/body shape/food
- > decrease rate of weight loss
- > perceive as failure to loss weight
treatment for bulimia nervosa?
common:
antidepressant or other medication
CBT
factor in eating disorder
multi-determined:
-ED runs in families (genetic factors mixed)- susceptibility to ED inherited
- set point theory : our bodies try to maintain weight within preferred range that is genetically determined
- brain abnormalities and neurotransmitters
what is the genetic contribution for aneroxia nervosa?
strober (2002). 3 times more common among relative of aneroxia and bulimia
-> element of familial transmissibility
more closely related genetically related= more likely to have AN
MZ twin 29/50 (58%)
DZ twins 2/42 (5%)
-> strong genetic contribution, consistent with increased susceptibility
what are the neurotransmitter dysfunction in AN?
serotonin: involved in mood, obsessions, appetite regulation, impulse control
- AN have low level of 5TH metabodies
- abnormalities
dopamine: reward system
hyper sensitivity of dopamine system ->AN pathology
what is the set point theory of ED
leptin (safety hormone): reduces food intake ‘fat controller’
perturbed in AN, increased sensitivity, hypoleptinaemia is an indictor of severity of disorder
obsese poeple have increased amount of leptin-> decreased sensitivity: inability to detect brain does not respond to leptin (thus keep eating)
grehlon (hunger hormone): increase food intake, appetite stimulator
eating-> fat increase-> leptin arise-> signal body reduce intake of food
fat low-> leptin level low
what is the activity based anorexia model ??
robert : low calorie intake, limited food in combination w exercice
- > loco-motor activity increase
- > hyperactive, run more compare to animals with less food
what about the hyperactivity in AN?
40-80% show excessive activity or motor restlessness
-> difficult to control and jeopardise weight recovery
-deliberate calorie burning /weight reduction strategy
-coping strategy to suppress negative states: exercices -> anxiolytic & emotion regulation effect
- thermo-regulatory behaviour: exercice to counter hypothermia (due to restricted feeding and subsequent weight loss)
keeping patient warm: beneficial for treatment
risk factors fr anorexia nervosa
negative body shape & internalisation of thin ideal in women; rate body as heavier than ideal/ what’s attractive
what are the neurocognitive impairments in AN?
associated with OCD, perfectionism,social communicative , emotional difficulties
poor set shift (inflexible), weak central coherence, poorer global ntegration
social and emotional processes in ED?
emotional, social, communicative interpersonal difficulties (amplified with acute stress)
disordered eating= maladaptative strategy to regulate emotion, (avoidance ) reinforced when temporary reduction in anxiety
twin studies demonstrate:
- difficulty w emotion recognition
- stronger attentional bias to social threat
- positive association between social / facial threat and duration of binging ,vomiting, laxative
- emotion recognition and social attention stronger in Mz (genetic bias)
emotional and attentional bias modification training -> treatment
what are the socio cultural influences on AN
fashion magazines, media (tv) i family, peers
->idealises extreme thinnness
what are the family characteristics of AN patients?
- limited tolerance on psychological tension; poor social conflict skills
- emphasis on property/rule mindedness
- parental over direction, discouragement of autonomous
- preoccupability in desirability of thinness, dieting, physical appearance
johnson et al .2002
->low parental affection/ communication/time spent =eating and overweight problems
socio cultural risk factors for eating disorders?
westerns cultures associated ED
-thin portrayed as desirable, sign strength of character, self control, success etc…
more common in high-income asian societies
what happens in the experience exposure to televison??
look at fijan ado girls
-> attitude on body chnage drastically w tv (1995)
-> within 3 years girls that vomited to control weight from 0%-6-11%
causal link between tv/ media exposure and ED
explain how ED is culturally bound?
keel and kump (2003)
bulimia nervosa ; culturally bound (influenced by media)
anorexia nervosa ; more genetic
what is cognitive interpersonal maintenance model of anorexia nervosa?
-> cognitive, socio-emotional and interpersonal elements act together to cause and maintain
premorbid trait: OC trait, vulnerability factor, contribute to maintenance, with AN beliefs /behavior
cognitive processing style (rigidity, poor set shift, weak central coherence)underpin threats
socio-emotional impairment, difficulties in social cognition, attentional bias
family traits: high expressed emotions, criticism, hostility, overprotection=>accentuate/perpetuats problem
what is obesity?
defined by BMI (balance between heght and weight) public heath concern: -high cholesterol -hypertension -diabetes -heart disease -cancer -arthitis
not considered as eating or brain disorder
-> habit of over-eating ‘food addiction’
brain areas involved in motivation to eat, reward, inhibitory control (serotonin/dopamine) play part
what are the risk and causal factors for obesity?
risk factors:
- runs in families
- neurotransmitters& hormones (leptin=insensitive, grehlin)
- socio-cultural influences
- stress and comfort food
- > associate watching smt pleasant and eating
- > attending parties; element of food
- > becoming anxious angry or bored
- family influences:
- > behaviour: *high fat/calorie diet *overfeeding * ‘social contagiousness’ * attenuate distress
experience on rats: give access to high fat/sugar foods -> gained weight quickly ->decrease brain reward circuit ->food less rewarding=> dev. compulsive eating
treatment methods for obesity??
lifestyle modification (prevention)
medication
bariatric surgery
