eating disorders - definitions Flashcards
define eating disorder
“a persistent disturbance of eating behaviour or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning”
issues with the definition of eating disorders (4)
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
younger cases of eating disorders (2)
feeding disorders
avoidant/restrictive food intake disorder
companies which determine what an eating disorder is (2)
DSM-5
ICD - international classification of disease - this follows DSM
incorrect stereotypes of eating disorders
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
BMI as a measure
* healthy rage
* in young people
* overweight categories
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)
issues of using BMI with treatments
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
anorexia nervosa - diagnostic criteria (5)
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
subtypes of anorexia nervosa (2)
restricting
binge-eating/purging
issues with anorexia nervosa diagnosis (6)
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
difficulty spotting those with anorexia
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
bulimia nervosa - diagnostic criteria (4)
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
issues with bulimia nervosa diagnosis (3)
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
binge-eating disorder diagnostic criteria
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
issues with BED diagnosis
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
OSFED diagnostic criteria
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
OSFED - atypical disorders (5)
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)
ARFID diagnostics: who, what (4) and common treatment type
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
ARFID subtypes (3)
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
issues with diagnoses of EDs (5)
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
comorbidity of EDs with other psychological problems (4)
anxiety - OCD, social anxiety
depressed
personality disorder - anxiety and impulsivity based
alcohol and substance use - alcohol as higher risk
reasons for high mortality with EDs (6)
cardiac complications
muscular weakness (including cardiac failure)
osteoporosis
liver damage
oesophageal tearing
fainting
epidemiology - incidence and prevalence - which is used with EDs most
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
prevalence of different disorders (4)
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
issues using prevalence
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
impact of westernisation on EDs
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?
proposed causal factors of EDs (2)
sociocultural factors
neurobiological factors
sociocultural factors of EDs (5) - strength of evidence (4)
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
neurobiological factors of EDs (3) + issue with these
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
maintenance of EDs - why look at this
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
cognitive patterns of ED maintenance (3)
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
cognitive central belief systems (2)
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
cognitive maintenance of EDs - safety behaviours
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
emotional factors of ED maintenance
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
perceptual factors of ED maintenance
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
social factors of ED maintenance
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”
formulating behaviours - binges
triggers and setting conditions
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
formulating cases with EDs
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
models of formulating ED cases (2)
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
