eating disorders - definitions

Question 1

define eating disorder

Answer 1

“a persistent disturbance of eating behaviour or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning”

Question 2

issues with the definition of eating disorders (4)

Answer 2

in the eye of the beholder

do models and gymnasts and ballerinas fit this?
* maybe not cos their goal isn’t to become thin but to achieve a sporting goal

not just about weight

gender, age, and ethnicity

Question 3

younger cases of eating disorders (2)

Answer 3

feeding disorders
avoidant/restrictive food intake disorder

Question 4

companies which determine what an eating disorder is (2)

Answer 4

DSM-5
ICD - international classification of disease - this follows DSM

Question 5

incorrect stereotypes of eating disorders

Answer 5

only thin, white, young women
* only 15% with eating disorders are underweight - majority is normal weight

age, gender, and ethnicity doesn’t mean they don’t have an ED

Question 6

BMI as a measure
* healthy rage
* in young people
* overweight categories

Answer 6

19-25 = healthy range (varies with ethnicity)

BMI is not meaningful in younger people - adjusted for age using expected weight for height:
<85% = underweight
< 70% = dangerously underweight

overweight = BMI > 25
obese = BMI > 30 (more levels within this e.g. morbidly obese > 40)

Question 7

issues of using BMI with treatments

Answer 7

can be used as a barrier to treatment - only when it is really bad
but many people with ED are healthy weight and so resources aren’t given to them

Question 8

anorexia nervosa - diagnostic criteria (5)

Answer 8

persistent restriction of energy intake leading to significantly low body weight
* in context of age, sex, developmental trajectory, and physical health

either fear of gaining weight and becoming fat or persistent behaviour that interferes with weight gain

any of these:
* disturbance in way ones body weight or shape is experienced (body dysmorphia)
* undue influence of body shape and weight on self-evaluation
* persistent lack of recognition of seriousness of current low body weight

Question 9

subtypes of anorexia nervosa (2)

Answer 9

restricting
binge-eating/purging

Question 10

issues with anorexia nervosa diagnosis (6)

Answer 10

early stages might not be thin enough for intervention

athletes therefore defined as overweight due to muscle weight

ballerinas and gymnasts defined as underweight due to their sport

people differ in set point for weight - so BMI isn’t very useful

definitions related to BMI are arbitrary - they’ve changed over the years

self reported height and weight

Question 11

difficulty spotting those with anorexia

Answer 11

better at spotting extreme examples
* especially seeing before/after states
* where BMI is lower than 17.5 it is easy to spot

however starvation could be due to other reasons - lack of resources

Question 12

bulimia nervosa - diagnostic criteria (4)

Answer 12

recurrent episodes of binge eating (eating more than most people would in a discrete period of time under similar circumstances)
* with a lack of control over eating during the episode

recurrent inappropriate compensatory behaviour in order to prevent weight gain
* self-induced vomiting, laxative/diuretics misuse, fasting, excessive exercise

binges and compensatory behaviours occur on average at least once a week for 3 months

self-evaluation is unduly influenced by body shape/weight
* does not occur exclusively during episodes of anorexia nervosa

Question 13

issues with bulimia nervosa diagnosis (3)

Answer 13

defining what a binge is
* subjective = loss of control
* objective = loss of control + excessive intake
* excessive intake = over 2000kcal in one go

defining compensatory behaviours
* vomiting isn’t always self-induced
* is exercise for health or to control weight

how often do these need to happen
* 1x week for 3 months - but this is ever changing too with new criteria

Question 14

binge-eating disorder diagnostic criteria

Answer 14

recurrent episodes of binge eating
* eating in a set time period more than most people would under similar circumstances
* lack of control over eating in this episode

episodes have 3 or more of the following:
* more rapid eating
* eating till feeling uncomfortably full
* eating lots when not hungry
* eating alone from embarrassment
* feeling disgusted, depressed, or guilty

marked distress regarding binge eating
at least 1x week for 3 months
no purging/compensatory behaviours

Question 15

issues with BED diagnosis

Answer 15

recent formal diagnosis - only 2013 with DSM-5 → so still debating levels for diagnosis

need to understand motivation for making this a category in DSM-5

distress and need for treatment

or for insurance money for clinicians as a way to treat lots of obese patients

BED patients can have trouble accessing services - prioritising anorexia over BED, viewed as higher risk - more immediate whilst BED causes premature deaths

Question 16

OSFED diagnostic criteria

Answer 16

other specified feeding and eating disorders

atypical cases

present with many symptoms of other EDs but not full criteria for diagnosis

introduced due to:
* people with issues needing help
* insurance industry would only pay out on diagnosed cases

Question 17

OSFED - atypical disorders (5)

Answer 17

atypical anorexia nervosa
* weight loss but within or above normal range

atypical bulimia nervosa
* low frequency and limited duration

atypical binge-eating disorder
* low frequency and limited duration

purging disorder

night eating syndrome (eat at night whilst semi-conscious and don’t remember it the next day)

Question 18

ARFID diagnostics: who, what (4) and common treatment type

Answer 18

avoidant/restrictive food intake disorder
primarily in children and young people

• disturbance in eating or feeding
• substantial weight loss/lack of weight gain
• nutritional deficiency - therefore dependence on supplements
• absence of beliefs about food or fear of weight gain - more focus on feeding than eating consequences

treatments are primarily behavioural - focused on anxiety and exposure to food

Question 19

ARFID subtypes (3)

Answer 19

sensory-based avoidance
* refuse intake based on smell, texture, colour, brand, presentation

lack of interest
* in consuming or tolerating food

food associated with fear-evoking stimuli
* developed from learned history

Question 20

issues with diagnoses of EDs (5)

Answer 20

diagnosis of EDs doesn’t do what it should do
* 40-50% don’t fit into main diagnoses
* OFSED is largest group - all atypical
* many fail to stay in one diagnosis
* diagnosis doesn’t indicate best treatment

therefore shift away from rigid diagnosis → move towards transdiagnostic model

Question 21

comorbidity of EDs with other psychological problems (4)

Answer 21

anxiety - OCD, social anxiety

depressed

personality disorder - anxiety and impulsivity based

alcohol and substance use - alcohol as higher risk

Question 22

reasons for high mortality with EDs (6)

Answer 22

cardiac complications

muscular weakness (including cardiac failure)

osteoporosis

liver damage

oesophageal tearing

fainting

Question 23

epidemiology - incidence and prevalence - which is used with EDs most

Answer 23

incidence = number of new cases in set window of time

prevalence = number of current cases or people who have had it in the last year

slow onset + secrecy + slow diagnosis = hard to calculate incidence

so focus on prevalence

Question 24

prevalence of different disorders (4)

Answer 24

lifetime prevalence rates:

anorexia nervosa = 4% women, 0.3% men

bulimia nervosa = 3% women, 1% men

binge eating disorder = 2.8% women, 1% men

indication that OFSED has highest lifetime prevalence

western cultures = binge eating disorder up to 6.1% women and 0.7% men

Question 25

issues using prevalence

Answer 25

can’t rely on medical records
* make assumptions about who would have eating disorders → GPs do this too
* only can measure those with diagnosis not how many which aren’t caught
* most focus on young women (14-30 years)

increase in numbers doesn’t mean actual increase in cases but just increase in diagnosis rates → more awareness

Question 26

impact of westernisation on EDs

Answer 26

westernisation = increasing identification and prevalence of EDs

more cases amongst non-whites in recent years

study in Fiji → linked introduction of western media and EDs

why - body image and control issues?

Question 27

proposed causal factors of EDs (2)

Answer 27

sociocultural factors
neurobiological factors

Question 28

sociocultural factors of EDs (5) - strength of evidence (4)

Answer 28

early parenting, abuse, bullying, emotional invalidation, childhood obesity etc.

weak causal evidence:
* lack longitudinal data
* selective sampling
* risk of selective memory
* misinterpretation of associations - does chaotic lifestyle cause ED vice versa

Question 29

neurobiological factors of EDs (3) + issue with these

Answer 29

hypotheses are more common than actual evidence

genetics
* some evidence from twin studies
* unknown which genes are responsible → directly or do they increase risk e.g. perfectionism or serotonin mechanisms that predispose impulsivity or compulsivity

hypothalamic damage - prevents hunger
* but anorexia patients report being hungry

starvation effects go away when the person eats
* mood and cognitive deficits, social isolation, behavioural inactivation

issue of causality
* does biology cause ED or ED cause changed biology

Question 30

maintenance of EDs - why look at this

Answer 30

related to treatments → idea of interrupting maintenance mechanisms to stop disorder

can start in many ways - limited ways of maintaining it

if we can’t identify causes can look at maintenance mechanisms instead

Question 31

cognitive patterns of ED maintenance (3)

Answer 31

low self-esteem
negative self-attribution
perfectionism

each have a self maintaining cycle = low self-esteem → don’t look for good parts of yourself → don’t see the positives → feeds into low self-esteem

Question 32

cognitive central belief systems (2)

Answer 32

broken cognitive link between eating and weight
* drives restriction, then binging, then weight gain in a cycle
* strong cognitive dissonance

overvaluation of appearance and weight
* used to define self as being acceptable person

Question 33

cognitive maintenance of EDs - safety behaviours

Answer 33

behaviours which calm temporarily when anxious
* binge-eating, restricting, body avoidance/checking, exercise, purging
* can make you feel more in control short term

have long-term consequences
* feel worse so start these behaviours again
* forms a cycle

Question 34

emotional factors of ED maintenance

Answer 34

anxiety - triggers and maintains emotion for EDs
* related to safety behaviours

impacts other emotions
* anger, loneliness, boredom
* causality goes both ways with these

depression as a consequence not cause → serotonin deficits following lack of eating

Question 35

perceptual factors of ED maintenance

Answer 35

those with ED overestimate body size by 25-30%

misperceive our weight - thought-shape fusion when we see food
* idea thinking about eating is as bad as eating

Question 36

social factors of ED maintenance

Answer 36

social pressure to be thin or muscular

worsening body image as a result of being exposed to images on social media

images based on criticism and self-comparison to

“thinspiration”

Question 37

formulating behaviours - binges
triggers and setting conditions

Answer 37

done with individual to normalise what they eat when they binge-eat
* identifies risks

triggers of binging
* emotional distress
* availability of food/cue exposure

setting conditions
* teach better ways to deal with emotions and cope around food
* starvation
* disinhibition/permissive cognitions

Question 38

formulating cases with EDs

Answer 38

way of understanding functions of ED - not diagnostic process

allows for individual differences in history and potential causal/maintaining factors

assumes core functions and processes that underpin most cases

Question 39

models of formulating ED cases (2)

Answer 39

ABC model
* antecedent → behaviour → consequence
* focus on feedback loops that maintain the problem

models have different levels of evidence and complexity → too complex means it isn’t easily implemented

Slade (1982) model
* central role of control
* stress is one of the maintenance elements
* food becomes more critical later in model but other cognitions and behaviours cause it earlier