Eating disorders - Articles Flashcards
Why are eating disorders (EDs) in males often underestimated? (Limbers)
- Social stigma causes males to minimize or deny symptoms.
- EDs are stereotypically seen as female disorders.
- Males are less likely to seek treatment.
When do eating disorders (EDs) typically develop in males? (Limbers)
During adolescence and young adulthood.
How does male ED symptom presentation differ from females? (Limbers)
- Less concern with shape, weight, and thinness.
- More focus on muscularity and desire to be bigger.
- Less likely to report eating due to negative emotions or loss of control.
- Less likely to use laxatives or vomiting in BN.
What is Muscle Dysmorphic Disorder? (Limbers)
A preoccupation with not being muscular enough, leading to:
* Excessive weightlifting and dieting.
* Steroid drug use.
How does sexuality impact male ED risk? (Limbers)
- Gay and bisexual men have higher rates of EDs.
- Social pressures in the LGBTQ+ community may contribute to body dissatisfaction.
What is the gold standard for assessing EDs? (Limbers)
The Eating Disorder Examination (EDE), which evaluates symptoms based on:
1. Dietary restraint
2. Eating concern
3. Shape concern
4. Weight concern
Why might self-report questionnaires be less valid for males? (Limbers)
- Overreliance on feminine ED traits (e.g., drive for thinness).
- Less recognition of muscularity concerns.
What is the Eating Disorder Assessment for Men (EDAM)? (Limbers)
A 50-item male-specific ED measure, evaluating:
* Food issues
* Weight concerns
* Exercise behaviors
* Body image concerns
* Disordered eating habits
What is the only well-established ED treatment for adolescent males? (Limbers)
Family-Based Behavioral Treatment.
What are the most established treatments for young adult males with AN, BN, or BED? (Limbers)
- Cognitive Behavioral Therapy (CBT)
- Interpersonal Psychotherapy (IPT)
- Family-Based Therapy (FBT) (potentially effective for young adults)
Why do males seek treatment less often and later than females? (Limbers)
- Lack of awareness – Males don’t always recognize ED behaviors as problematic.
- Healthcare providers may miss symptoms due to differences in male presentation.
- Higher shame and stigma associated with EDs in males.
What factors can improve ED treatment outcomes in males? (Limbers)
- Trust and comfort in therapist-patient relationships.
- Male-only treatment groups (though may also increase competitiveness).
- Awareness of the impact of competitive sports (which can perpetuate ED behaviors).
How does participation in competitive sports impact male EDs? (Limbers)
- Athletes have a higher incidence of EDs.
- Continuing to participate in sports during treatment can worsen outcomes.
What is the PRIDE Body Project and what were the outcomes? (Limbers)
A two-session intervention for gay adolescent and young adult males that includes:
* Role plays
* Verbal challenges
* Identifying barriers to resisting body image pressures
Outcomes:
Significant decreases in:
* Body dissatisfaction
* Drive for muscularity
* Self-objectification
* Bulimic symptoms
What are the lifetime prevalence rates of Anorexia Nervosa (AN) and Bulimia Nervosa (BN)? (Campbell)
- AN: 0.5%–2%, with a peak onset at 13–18 years.
- BN: 0.9%–3%, with a mortality rate of ~2%.
What is the mortality rate for Anorexia Nervosa (AN) compared to other psychiatric illnesses? (Campbell)
5%–6%, the highest mortality rate among all psychiatric disorders.
How common is EDNOS (now OSFED) in adolescents? (Campbell)
4.8% lifetime prevalence.
How does the male-to-female ratio of EDs differ in adolescents vs. adults? (Campbell)
- Adolescents: 6:1 (female to male).
- Adults: 10:1.
What role do genetics play in EDs? (Campbell)
- Relatives of ED patients have a 7–12x greater risk.
- Twin studies:
- AN heritability: 33%–84%
- BN heritability: 28%–83%
What signs may indicate an eating disorder in adolescents? (Campbell)
- Weight loss, growth stunting, or pubertal delay.
- Restrictive or abnormal eating behaviors.
- Excessive exercise or recurrent vomiting.
- Trouble gaining weight or body image concerns.
How do younger patients often present with EDs differently? (Campbell)
More atypical symptoms
* May not endorse body image concerns.
* May not engage in binge-eating or purging.
* More likely to fail to gain expected weight/height.
Which chronic illness increases ED risk in adolescents? (Campbell)
Insulin-dependent diabetes mellitus (Type 1 Diabetes).
What major change did the DSM-5 introduce in ED diagnosis? (Campbell)
- Expanded criteria for AN and BN.
- Binge-Eating Disorder (BED) is now a formal diagnosis.
What organ systems can be affected by EDs? (Campbell)
Every organ system is affected by EDs
What are common cardiac complications of EDs? (Campbell)
- Bradycardia (slow heart rate).
- Hypotension (low blood pressure).
- Arrhythmias (irregular heartbeats).
What are common gastrointestinal complications of EDs? (Campbell)
- Delayed gastric emptying.
- Constipation.
- Superior mesenteric artery syndrome.
What electrolyte disturbances are common in purging behaviors? (Campbell)
- Vomiting: Hypokalemia, hypochloremic metabolic alkalosis.
- Laxative abuse: Hyperchloremic metabolic acidosis.
What are the primary treatments for pediatric Anorexia Nervosa (AN)? (Campbell)
- Family-Based Treatment (FBT)
- Cognitive Behavioral Therapy (CBT)
- Individual therapy
What evidence-based treatment has the strongest support for adolescent AN? (Campbell)
Family-Based Treatment (FBT)
What are the 3 phases of Family-Based Treatment (FBT)? (Campbell)
- Phase I: Caregivers re-feed their child back to health.
- Phase II: Gradual return of eating control to the child.
- Phase III: Relapse prevention & treatment termination.
What are the 3 major recovery goals in ED treatment? (Campbell)
- Behavioral recovery → Normalize eating patterns & reduce rigidity.
- Psychological recovery → Improve self-esteem & social functioning.
- Physical recovery → Weight restoration, puberty progression, organ repair.
Is pharmacotherapy a first-line treatment for AN?(Campbell)
No. No strong evidence supports antidepressants (SSRIs, TCAs) or antipsychotics as first-line treatments.
Which medication is FDA-approved for Bulimia Nervosa (BN)? (Campbell)
Fluoxetine (SSRI) → Reduces binge-eating & purging in adults (uncertain in adolescents).
Are SSRIs effective in treating Binge-Eating Disorder (BED)? (Campbell)
Yes, short-term reduction in binge episodes, but not superior to CBT.
What is the core psychopathology of Bulimia Nervosa (BN)? (Wilson)
Overvaluation of body shape and weight, leading to:
* Dysfunctional dieting → Binge-eating → Purging & extreme weight-control behaviors.
What are the goals of CBT for BN? (Wilson)
- Replace dysfunctional dieting with regular, healthy eating.
- Stop purging & extreme weight-control behaviors.
- Reduce overvaluation of body shape & weight.
What are the two types of Enhanced CBT (CBT-E)? (Wilson)
- CBT-Ef (Focused CBT-E): Targets body image concerns & mood intolerance as binge/purge triggers.
- CBT-Eb (Broad CBT-E): Addresses comorbid issues like perfectionism, low self-esteem, & interpersonal difficulties.
How effective is CBT for BN compared to psychoanalytic psychotherapy? (Wilson)
- 5 months: 42% of CBT-E patients stopped binge-eating & purging (vs. 6% psychoanalytic therapy).
- 2 years: 44% of CBT-E patients in remission (vs. 15% psychoanalytic therapy).
What are predictors of better treatment outcomes in BN? (Wilson)
- Early response to CBT = better outcome.
- Longer history of ED = poorer response.
- Higher overvaluation of weight & shape = worse outcome.
What is Guided Self-Help CBT (CBTgsh) for BN? (Wilson)
- A self-help manual combined with brief therapy sessions.
- Effective compared to minimal treatment (e.g., waitlist control).
What treatment is most effective for BED? (Wilson)
CBT (including CBT-E) → 50%–70% remission rates with lasting effects.
How does CBT compare to Behavioral Weight Loss (BWL) treatment for BED? (Wilson)
- CBT is more effective for BED than BWL.
- CBT does NOT significantly impact body weight.
How does CBT compare to medication (fluoxetine) for BED? (Wilson)
- CBT alone is more effective than fluoxetine or placebo.
- CBT + medication slightly better than medication alone, but not superior to CBT alone.
What are predictors of poor treatment response in BED? (Wilson)
- Slower treatment response = poorer outcomes.
- High overvaluation of body shape & weight = more likely to relapse.
How effective is Guided Self-Help CBT (CBTgsh) for BED? (Wilson)
- CBTgsh vs. full CBT or IPT: No significant differences in remission rates.
- CBTgsh vs. Treatment-as-Usual (TAU): 35% remission in CBTgsh vs. 14% in TAU.
Why is AN difficult to treat and study? (Wilson)
- Low prevalence.
- High treatment resistance.
- Difficulty recruiting patients for studies.
What is the NICE grade for CBT in AN treatment? (Wilson)
Grade C (Limited empirical support).
Is CBT-E a promising treatment for AN? (Wilson)
Yes, studies encourage further development of CBT-E for AN.
What are the key advantages of CBT for EDs? (Wilson)
- Efficacy: Lasting short- & long-term results.
- Cost-effectiveness: CBTgsh requires fewer therapy sessions.
- Transdiagnostic application: Works across all EDs.
- Brevity: Shorter treatment is more realistic for routine care.
- Scalability: Can be expanded through self-help & digital interventions.
What is task-sharing in CBT for EDs? (Wilson)
Training less-qualified individuals (e.g., peers, coaches) to deliver aspects of treatment to expand reach.
How does culture impact CBT treatment for EDs? (Wilson)
- No significant racial/ethnic differences in outcomes.
- Cultural adaptations (e.g., family dynamics, food traditions) may improve engagement.
Why is CBT highly scalable for ED treatment? (Wilson)
- Can expand access for patients with limited mental health care.
- Includes self-help strategies & technology-based interventions.
What is Interpersonal Psychotherapy (IPT)? (Burke)
A time-limited therapy (15–20 sessions) that improves interpersonal functioning, self-esteem, and psychiatric symptoms by addressing interpersonal problem areas.
What eating disorders is IPT most effective for? (Burke)
- Bulimia Nervosa (BN)
- Binge-Eating Disorder (BED)
How does IPT explain eating disorders? (Burke)
Interpersonal problems → low self-esteem & negative affect → binge-eating behaviors.
What are the four interpersonal problem areas addressed in IPT? (Burke)
- Interpersonal deficits (social isolation, unsatisfying relationships).
- Interpersonal role disputes (conflicts in relationships).
- Role transitions (difficulty adapting to life changes).
- Grief (loss of a person or relationship).
What are the three phases of IPT? (Burke)
- Initial phase (sessions 1–5) – Identify problem areas & set treatment goals.
- Intermediate phase (8–10 sessions) – Work on interpersonal issues related to ED.
- Termination phase (4–5 sessions) – Review progress & plan for relapse prevention.
What is the purpose of the interpersonal inventory in IPT? (Burke)
A detailed assessment of current relationships, social functioning, & relationship expectations to identify the primary problem area.
How does IPT address grief as an interpersonal issue? (Burke)
- Helps facilitate mourning.
- Encourages the development of new activities & relationships.
- Prevents idealization of lost relationships.
How does IPT address role transitions? (Burke)
- Helps mourn & accept the loss of an old role.
- Restores self-esteem by developing mastery in a new role.
How does IPT address interpersonal role disputes? (Burke)
- Identifies the stage of the dispute.
- Modifies faulty communication to resolve conflict.
How does IPT address interpersonal deficits? (Burke)
- Helps improve social skills.
- Encourages new relationship formation.
- Reviews past significant relationships to understand difficulties.
What therapeutic strategies maximize IPT effectiveness? (Burke)
- Warm, supportive, active stance.
- Focusing on goals during each session.
- Making connections between ED behaviors & interpersonal problems.
- Redirecting discussions to main interpersonal issues.
- Using general therapeutic techniques (e.g., clarification, communication analysis).
What is discussed during the termination phase of IPT? (Burke)
- Reviewing progress made in therapy.
- Discussing relapse triggers & prevention strategies.
- Addressing grief related to ending treatment.
How does IPT compare to CBT for Bulimia Nervosa (BN)? (Burke)
- IPT is effective but has a slower response time than CBT.
- More research needed on different racial/ethnic groups.
How does IPT compare to CBT for Binge-Eating Disorder (BED)? (Burke)
- IPT is effective for BED, with long-term improvements.
- A good alternative to CBT, especially in group therapy settings.
Is IPT effective for Anorexia Nervosa (AN)? (Burke)
- Limited evidence for AN.
- Best used in maintenance & relapse prevention, not weight restoration.
How is IPT used for obesity prevention? (Burke)
- Prevents excess weight gain in adolescent girls.
- Most effective for those with social problems & anxiety.
What is the main goal of IPT for EDs? (Burke)
To improve interpersonal functioning, which in turn reduces eating disorder symptoms.
Are medications the primary treatment for eating disorders? (Davis)
No, medications are supplementary to therapy, primarily for Bulimia Nervosa (BN) & Binge-Eating Disorder (BED).
What is the first-line medication for BN? (Davis)
Fluoxetine (SSRI) – Effective in reducing binge-purge episodes, even without comorbid depression.
Why are SSRIs preferred over TCAs for BN? (Davis)
- Fewer severe side effects.
- Safer in overdose cases.
- More tolerable for patients.
What are the risks of SSRIs in younger populations? (Davis)
Increased risk of suicidality in adolescents.
How does Topiramate (antiepileptic) help in BN? (Davis)
- Reduces binge-eating & purging.
- Improves psychological symptoms.
- May cause weight loss as a side effect.
Do medications for BED consistently reduce weight? (Davis)
No, they reduce binge-eating frequency but do not consistently lead to weight loss.
How do antidepressants help in BED? (Davis)
- Reduce binge frequency.
- Do not significantly impact weight loss.
What weight-loss medication is used for BED? (Davis)
Orlistat (lipase inhibitor) – Reduces weight, but not binge frequency.
What stimulant medication is effective for BED? (Davis)
Lisdexamfetamine (LDX) – Reduces binges, weight, BMI, & triglycerides.
What are the risks of LDX in BED? (Davis)
Increased heart rate & blood pressure – Requires monitoring.
Is chromium effective for BED? (Davis)
No, it has no impact on binge-eating frequency, weight, or mood symptoms.
Why is pharmacotherapy not effective as a primary treatment for AN? (Davis)
- Undernutrition complicates medication response.
- Weight & psychological symptoms do not improve with antidepressants.
Which antipsychotic medication shows promise in AN? (Davis)
Olanzapine (2nd generation antipsychotic) – Leads to modest weight gain & improves obsessionality.
Should Olanzapine be used alone for AN? (Davis)
No, it should be combined with behavioral interventions.
How does D-cycloserine relate to AN treatment? (Davis)
- Mixed results in treating AN.
- Used in exposure therapy for food phobia.
What is Dronabinol and how does it affect AN? (Davis)
- Synthetic cannabinoid used for appetite stimulation.
- Causes weight gain but also increased physical activity.
Why is bone density treatment complex in AN? (Davis)
- Hormone replacement can mask hypothalamic dysfunction.
- Transdermal hormone therapy shows potential benefits.
What are the most effective medications for each eating disorder? (Davis)
- BN: Fluoxetine (SSRI).
- BED: Lisdexamfetamine (LDX), Topiramate.
- AN: Olanzapine (SGA) (modest effect).
What is the primary conclusion regarding medication for EDs? (Davis)
- BN & BED respond well to medication.
- AN has limited pharmacotherapy options – behavioral treatment is primary.
- More research needed, especially for AN.
Why is compulsory treatment considered for Anorexia Nervosa (AN)? (Elzakkers)
- AN has a high mortality rate.
- Many patients are resistant to treatment due to fear of weight gain.
- Non-compliance poses a life-threatening risk.
What are the four key questions addressed in this review on compulsory treatment for AN? (Elzakkers)
- How often is compulsory treatment used in AN?
- What are the outcomes of compulsory treatment?
- What factors lead to compulsory treatment?
- What are patient perspectives on compulsory treatment?
How was compulsory treatment defined in this review? (Elzakkers)
Treatment involving a formal legal measure, requiring patients to undergo care against their will.
What were the characteristics of the compulsory treatment group? (Elzakkers)
- More severe AN symptoms.
- More comorbidities (e.g., depression, anxiety).
- Longer illness duration.
- More prior hospital admissions.
How did hospital stays compare between compulsory and voluntary patients? (Elzakkers)
- Longer hospital stays for compulsory patients.
- Similar discharge weights between groups.
Did compulsory treatment damage the therapeutic relationship? (Elzakkers)
No, most compulsorily treated patients remained voluntarily in treatment afterward.
What were the long-term effects of compulsory treatment for AN? (Elzakkers)
- Higher 5-year mortality for compulsory group (12.7% vs. 2.6% in voluntary group), likely due to initial severity.
- Adolescents showed better outcomes after 1 year, including:
- More regular menstrual cycles.
- Fewer readmissions.
- Better overall functioning.
What are the risk factors for compulsory treatment in AN? (Elzakkers)
- More prior AN admissions.
- More psychiatric comorbidities.
- Lower BMI (more severe malnutrition).
How do AN patients view compulsory treatment? (Elzakkers)
- Nearly half acknowledged its necessity within two weeks.
- Many felt grateful in hindsight for life-saving intervention.
- Some believed that at very low weights, they couldn’t make rational decisions.
- Some favored early compulsory treatment, while others feared it might deter patients from seeking help.
What controversies exist around compulsory treatment for AN? (Elzakkers)
- Balancing patient autonomy vs. life-saving intervention.
- Ethical concerns regarding forcing treatment.
- Fear that it may discourage voluntary treatment-seeking.
What is the main conclusion regarding compulsory treatment for AN? (Elzakkers)
- Severe symptoms increase the need for compulsory treatment.
- Short-term outcomes are similar to voluntary treatment.
- About half of patients later accept the need for treatment.
- Ethical debates persist, emphasizing the need for careful consideration.
Why is anorexia nervosa considered a challenging and resistant disorder? (Vitousek et al., 1998)
- Patients use denial, deception, and rationalization to protect their symptoms.
- They do not voluntarily seek treatment and are often pressured by family or friends.
- Even when they seek help, the focus is usually on other issues (e.g., depression, anxiety) rather than low weight.
- Compliance with treatment may be a defensive strategy rather than genuine cooperation.
How do individuals with anorexia nervosa actively resist treatment? (Vitousek et al., 1998)
- Denial: Refusing to acknowledge their low weight or the risks.
- Manipulation: Hiding weight loss, wearing baggy clothes, or consuming excessive water before weigh-ins.
- Deflection: Avoiding discussions about food or weight and diverting focus to external concerns.
- Superficial Compliance: Appearing to follow treatment while secretly restricting food or over-exercising.
Why is weight gain and eating more perceived as a threat in anorexia nervosa? (Vitousek et al., 1998)
- Thinness is equated with self-control, discipline, and moral superiority.
- Fear of losing their identity as someone who is “different” from others struggling with weight.
- Food restriction serves multiple purposes, including avoiding adult responsibilities and reducing anxiety.
- Their eating behaviors feel like the solution, not the problem.
How is denial in anorexia nervosa different from substance abuse? (Vitousek et al., 1998)
- People with alcoholism deny that they are alcoholics but do not view alcoholism as desirable.
- People with anorexia take pride in their disorder, seeing it as an achievement rather than an illness.
- Some individuals deliberately resist treatment because they believe they are stronger than others who “give in” to eating.
What happens when an anorexic individual starts questioning their disorder? (Vitousek et al., 1998)
- They may feel trapped—they no longer believe in thinness as the solution but still fear change.
- They experience ambivalence, wanting to recover but also fearing weight gain.
- Starvation impairs rational thinking, making it harder to assess their beliefs critically.
How does motivation for change differ in bulimia vs. anorexia? (Vitousek et al., 1998)
- Both disorders share fear of fat, distorted body image, and the belief that weight determines self-worth.
- Bulimics are more likely to be distressed by their symptoms and desire recovery.
- Anorexics often see their disorder as a “success”, while bulimics feel out of control.
- Many transition between anorexia and bulimia over time.
What are key therapist attitudes when treating eating disorders? (Vitousek et al., 1998)
- Empathy and Validation
- Acknowledge that thinness and control feel essential to the patient.
- Recognize that symptoms serve a purpose, even if they are harmful.
- Avoid power struggles over eating and weight.
- Understanding Resistance
- Patients do not see weight gain as recovery but as loss of control.
- Resistance is normal and expected, not defiance.
- Acknowledging the Difficulty of Change
- Change is frightening for the patient.
- Expect setbacks and ambivalence.
Why is the Socratic method effective for eating disorders? (Vitousek et al., 1998)
- Instead of telling patients what to do, it helps them discover solutions themselves.
- Avoids power struggles by guiding the client to challenge their own beliefs.
- Encourages critical thinking about weight, control, and identity.
What are key therapist strategies in the Socratic approach? (Vitousek et al., 1998)
- Use the client’s language – Reflect their own words back to them.
- Respect their individuality – Anorexics resist being “ordinary,” so emphasize individual choices.
- Be collaborative – Work together rather than forcing solutions.
- Be honest – Address contradictions between beliefs and behaviors.
- Be patient – Change takes time and repetition.
Why is psychoeducation important in eating disorder therapy? (Vitousek et al., 1998)
- Corrects distorted beliefs about food, weight, and health.
- Helps patients understand the consequences of their behaviors.
- Needs to be repeated multiple times before patients integrate the information.
Why is an experimental approach useful for anorexia treatment? (Vitousek et al., 1998)
- Many anorexics fear weight gain is permanent.
- Emphasizing temporary changes reduces anxiety.
- Patients should be encouraged to test changes and assess results themselves.
What is the functional approach in eating disorder therapy? (Vitousek et al., 1998)
Instead of debating what is “right” or “wrong,” focus on how behaviors affect their life.
Example:
Therapist: “What do you like about being underweight?”
Client: “I feel in control.”
Therapist: “Does being underweight really give you control over your life?”
Why is philosophical exploration important in eating disorder treatment? (Vitousek et al., 1998)
- Many anorexics see thinness as a moral or aesthetic ideal.
- Therapy should challenge beliefs about self-worth beyond body size.
- Helps patients develop a new sense of purpose beyond eating control.
