EDs (wk 7)

Question 1

describe 3 EDs added to the DSM 5

Answer 1

-pica: persistent eating of nonnutritive, nonfood substances

-rumination disorder: repeated regurgitation of food (may be re-chewed, re-swallowed, or spit out)

-avoidant/restrictive food intake disorder: an eating disturbance manifested by failure to meet nutritional and/or energy needs

Question 2

compare the 2 subtypes of AN

Answer 2

-restricting: extremely low body weights attained through dieting, sometimes excessive exercise

-binge-eating/purging: not only engage in dieting/exercise, but also in binge eating and/or purging behaviors

Question 3

what are the symptoms of AN?

Answer 3

-Low body weight (calculated by BMI)

-fear of weight gain, OR behavior that interferes w weight gain

-Body image disturbance, shape / weight based self esteem, or denial of seriousness

Question 4

what is the lifetime prevalence of AN for women? when is the typical onset? what is the mortality rate?

Answer 4

-lifetime prevalence for women 0.5%

-typical onset 14-18yrs

-mortality rate over 10%

Question 5

describe purging

Answer 5

-purging: behaviors in order to achieve/maintain weight loss, eg self-induced vomiting, laxative abuse, abuse of enemas/diuretics

Question 6

what are the subtypes of BN?

Answer 6

-purging (vomiting, laxatives, diuretics)

-non-purging (excessive exercise, fasting)

Question 7

what are the symptoms of BN?

Answer 7

-binge eating with compensatory behavior
-Shape + weight based self esteem
-Does not meet criteria for AN

Question 8

differentiate BN from AN

Answer 8

-weight is not part of criteria – indivs typically within the normal weight range

Question 9

what is the lifetime prevalence of BN for women? when is the typical onset?

Answer 9

-life time prevalence for women 1-3%

-typical onset late adolescence, early adulthood

Question 10

what are the criteria for binge eating?

Answer 10

-objectively large* amount of food AND loss of control

-“objectively large”: depends on context (eg m/f, age)
-rough guideline: equivalent to 2 full meals

Question 11

what is the diagnostic criteria for Binge Eating Disorder?

Answer 11

A. Recurrent binge eating

B. Assoc w min 3:
-eating much more rapidly than normal
-eating until uncomfortably full
-eating large amounts of food when not physically hungry
-eating alone bc embarrassed
-feeling disgusted w oneself, depressed, or v guilty afterward

C. Distress regarding binge eating
D. Binge eating occurs AL once/wk for 3mos
E. No compensatory behaviors

Question 12

what is the 12 month prevalence of BED among women and men? in which group of people is it prevalent among? what is the prevalence among ethnic groups for women?

Answer 12

-12mo prevalence women (1.6%) + men (0.8%)
-prevalent among indivs seeking weight-loss treatment
-comparable prevalence across ethnic groups for women

Question 13

what are the 5 disorders found under OSFED?

Answer 13

1. Sub-threshold AN
2. Sub-threshold BN
3. Purging disorder - compensatory behavior in normal body weight indiv after eating small amts of food
4. Sub-threshold BED
5. Night eating syndrome - binge eating when waking up at night

-in other cases the features of an ED combine in a diff way than in one of the 3 disorders

Question 14

there is recognition of fluidity between diagnoses for someone w ED’s behavior to change over time. why does differentiating matter?

Answer 14

-suicidality - AN higher rate of completed suicide; BN higher rate of self-injurious behavior
-empirically supported treatments diff for diff disorders

Question 15

how do ED behavioral symptoms present across gender? what issues are unique to men with EDs?

Answer 15

-behavioral symptom presentation v similar across genders
-biggest diff is in body image: muscularity might be more important than losing weight

-more psychiatric comorbidity + impairments in social fnxing among males w ED

Question 16

what are 5 causes for EDs? (sociocultural, personality/indiv, family factors, adverse events, maturational issues, peer environment)

Answer 16

-sociocultural theories: EDs are a result of pressure on women in Western society to achieve an ultra-slim body

-personality/indiv factors: perfectionism, obsessiveness, low self esteem, depression assoc w greater risk

-family factors: parental modeling (of dieting behaviors) + criticism, genetics (50%)

-adverse events: esp childhood sexual abuse; traumatic events can have negative impacts on self esteem, body image, sense of control

-maturational issues: puberty (women move away from thin ideal female figure), onset of dating + sexuality (which appears to be more stressful for young women)

-peer environment: peer groups characterized by high levels of disordered eating

Question 17

what are treatment options for BN?

Answer 17

-CBT: supported for use w adults (and to a much lesser extent adolescents) w BN

-has been treated w antidepressants; this is inferior to CBT

Question 18

what are strengths and weaknesses of inpatient treatment?

Answer 18

-helpful for symptom ↓, often necessary for medial stabilization
-high rates of relapse

Question 19

what does research say about Family Based Treatment for AN and BN?

Answer 19

-only treatment w empirical support for adolescents w AN
-most supported treatment for adolescents w BN

Question 20

what are the 5 fundamental principles of FBT?

Answer 20

1.parents are NOT to blame for the ED
2. parents are in the best position to care for their child; parents know their child the best and love them the most.
3. re-feeding mimics an inpatient ED unit
4. ED is a disease, separate from the individual (medical model)
5. therapist as coach to parents

Question 21

describe the structure of an FBT session

Answer 21

1. meet individually w patient: take weight, assess binge/purge episodes for the week
   -discuss whether patient has any concerns they would like to address in family session
   -purpose: build alliance, provide support to patient
2. family session
   -review weight + ED symptoms for the week (sets tone for session)
   -problem solve re: how to normalize eating in the next week

Question 22

describe the 3 stages of FBT

Answer 22

1. Refeeding: parents in charge of refeeding / normalizing patterns of eating
   -treatment involves coaching parents on how to do this (eg if your child had cancer would you allow them to not adhere to treatment?)
2. Gradually ctrl over eating is returned to the adolescent – with careful monitoring
3. Issues related to healthy adolescent development, model problem solving, and termination
   -adolescent autonomy
   -Appropriate family boundaries
   -parents prepare/make plan for adolescents leaving home

Question 23

describe the family meal that occurs during FBT: when does it occur? what happens and what is the goal?

Answer 23

-stage 1, second session

-parents instructed to bring a meal that will help to re-nourish their starved child

-goal: support the parents in having their child begin to eat more than they wish to

-intervention begins when patient decides they’re done. Therapist coaches parents in having their child eat more than they wish

Question 24

what are 5 features of the family meal?

Answer 24

-parent decides how much child should eat + take action
-parents must be on “the same page, word, letter” regarding how much child needs to eat (eg “half of your sandwich, “four more bites” etc)
-sit on either side of child
-authoritative style: “we understand how hard this is for you, but your father and I need you to eat the rest of your sandwich”
-consistent, repetitive, warm

Question 25

how does the chronicity of an ED affect the outcome?

Answer 25

-a shorter duration of illness seems to be related to a better outcome