Eating disorders + Obesity

Question 1

Types of Feeding and Eating Disorders

Answer 1

Pica: persistent eating of non-nutritive, non-food substances
Rumination disorder
Avoidant/restrictive food intake disorder
Anorexia nervosa
Bulimia nervosa
Binge Eating disorder
Other specified feeding or eating disorder
unspecfified

Question 2

Outline bulimia nervosa

Answer 2

• binge eating (up to 4800 cals) - lack of control over eating during the episode
• recurrent inappropriate compensatory behaviour in order to prevent weight gain
• has to occur at least once a week for 3 months
  Severity is measured by compensatory behaviours:
• Mild = 1-3 per week
• Moderate = 4-7 per week
• Severe = 8-13 per week

Question 3

Prevalence and key features of bulimia

Answer 3

1% prevalence overall (1.5% women, .5% men)
Age of onset is usually 21-24 years

Most have comorbid psychological disorders (mood disorder, anxiety disorder, trauma disorder)

2 in 5 abuse substances

25-30% attempt suicide

less lethal than anorexia but twice the mortality rate found in comparably aged peers without BN.
purging methods can result in: erosion of dental enamel, mouth ulcers, electrolyte imbalance, kidney failure

Question 4

Anorexia nervosa outline

Answer 4

• restriction of energy intake resulting in weight that is less than minimally normal (adults) or expected (children)
• intense fear OR behaviour interfering with weight gain

Specifiers:
- restricting subtype / binge purge subtype
- remission
- severity (based on the bmi)

Question 5

Prevalence and associated factors for anorexia nervosa

Answer 5

Prevalence = 1% for women, .3% for men
- more common among ballet students (20%)

Age of onset: 16-20, but can occur in children

Majority are female, white, middle-upperclass

Comorbid psychological disorders (70% are depressed, sexual dysfunction)
18x more likely to die by suicide than their same aged peers

mortality rate is 5x higher than mortality rate for similarly aged women
amennorhea (loss of periods)
lanugo (fuzzy hair)
creates personality changes

Question 6

Binge eating disorder outline

Answer 6

Recurrent episodes of binge eating
Binge eating occurs on average at least 1 day a week for 3 months
No compensatory behaviour
Specifiers: remission, severity (based on # of binges)

Question 7

Prevalence and key features for binge eating disorder

Answer 7

3.5% for women, 2% for men
Higher rates in obese samples

Most are 30-50 years old

High comorbidity

concern about weight or shape, typical binge involving 1900 calories

Question 8

Explain the diagnostic crossovers between these eating disorders

Answer 8

Anorexia nervosa (restricting) <–> anorexia nervosa (binge eating / purging)

Anorexia nervosa (binge eating / purging) <-> bulimia nervosa

Bulimia nervosa <-> binge eating disorder

Question 9

What are the main clinical differences between those with anorexia and bulimia?

Answer 9

Anorexia is determined by being underweight
Bulimia is determined by number of compensatory behaviours (can be a normal weight)

Question 10

What features do anorexia and bulimia share?

Answer 10

intense fear of weight gain
higher prevalence for women
similar comorbidities

Question 11

Individuals from what diagnostic category often deny any problem exists:

Answer 11

anorexia

Question 12

What are the biological causes of eating disorders?

Answer 12

• relatives of people with eating disorders are 4-5x more likely to develop an eating disorder
• could be inherited nonspecific traits like emotional instability
• low levels of serotonergic activity often found in eating disorders

Question 13

Family factors

Answer 13

• parents with distorted perceptions of food
• perfectionistic parents
• families of individuals with anorexia are often:
  high achieving, vain, motivated to maintain harmony (poor communication), highly critical of appearance)

Question 14

Treatments

Answer 14

SSRIs might help bulimia
CBT and family therapy

Question 15

OUtline CBT plan

Answer 15

1. establish foundations of treatment (assessing severity, explain what treatment will involve, provide psychoeducation, collaborative weighing, establish a pattern of regular eating)
2. review progress ; identify barriers (review the formulation, decide whether to use the broad or focused form)
3. address the main maintaining mechanisms (over-evaluation of shape/weight/control of eating, dietary restraint, dietary restriction, being underweight)
4. maintain changes, minimise relapse

Question 16

difference between overweight and obesity

Answer 16

Overweight = bmi between 25-29
obesity = bmi 30+
(5th leading risk of death)

Question 17

Biological factors of obesity

Answer 17

genetics account for 30% of obesity cases

hormones (leptin and grehlin)
- when body fat cell decrease, leptin production decreases and food intake is stimulated, so for people who have a mutation that doesn’t produce leptin, they will have an insatiable appetite

grelin = appetite sitimulator