Exam 3 Flashcards
Anorexia Nervosa (characteristics; medical consequences)
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health (less than minimally normal/expected) (based on WHO BMI)
Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain
Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight
Two Types:
Restricting type: During the last 3 months has not regularly engaged in binge-eating or purging.
Binge-eating/purging type: During the last 3 months has regularly engaged in binge-eating or purging
Potential psychological problems: Depression, anxiety, low self-esteem, sleep disturbances, Substance abuse, Obsessive-compulsive patterns and perfectionism (similar to OCD, but different reasonings)
Potential Medical Complications (Partial List): Amenorrhea, Death from heart arrhythmias, kidney damage, gray matter brain shrinkage, brittle hair and nails, dry skin, yellowish skin from liver damage, etc.
Bulimia nervosa (characteristics; medical consequences)
Recurrent episodes of binge eating characterized by both:
1. Eating in a discrete period of time (e.g., within any 2-hour period), an amount of food definitely larger than what most individuals would eat in a similar period of time under similar circumstances
2. A sense of lack of control during the episode
Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
Bulimia can lead to damage to hands, throat, and teeth
Binge Eating Disorder
Binge eating episodes (at least 1/week) characterized by both:
1. Eating in a discrete period of time an amount of food definitely larger than what most individuals would eat in a similar period of time;
2.A sense of lack of control during the episodes
Binge eating episodes are associated with 3≥ of the following:
Eating much more rapidly than normal.
Eating until feeling uncomfortably full.
Eating large amounts of food when not physically hungry.
Eating alone because of feeling embarrassed.
Feeling disgusted with oneself, depressed, or very guilty afterwards.
Atypical anorexia nervosa
all the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range
Since speed of weight loss is related to medical complications, individuals with atypical anorexia nervosa who lose a lot of weight rapidly by engaging in extreme weight control behaviors can be at high risk of medical complications
Biological factors in eating disorders (e.g., parts of the hypothalamus, set-point theory)
The set-point theory is related to homeostasis. The theory posits that the human body has a predetermined weight or fat mass set-point range. Various compensatory physiological mechanisms maintain that set point and resist deviation from it.
The hypothalamus controls eating and other body maintenance functions; * Damaged ventromedial hypothalamus * Signals of satiety no longer received
Starvation causes a release of endorphins
* Decision making about food switches to a less logical part of
the brain. * Hyperactivity in AN due in attempt to stay warm further
decreases weight
Serotonin: Low in anorexia, Normal in bulimia, Both show higher levels than control women during recovery
Dopamine: Imbalance may explain lack of pleasure from food and other typical comforts.
Minuchin’s views on family systems in eating disorders
Enmeshed family patterns (overinvolvement; overconcern)
Treatments for anorexia nervosa; challenges
- Emergency procedures to restore weight * Antidepressants or other medications
- Family therapy
- Cognitive-behavioral therapy
Emergency procedures: Severe AN may require emergency
hospitalization and: * intravenous feeding. * Nasogastric tube feeding may be used temporarily when medical
stability and/or body weight continue to decline despite refeeding
efforts. Major disadvantage of using forced feeding for patients with EDs is they may become distrustful of the medical establishment and uncooperative with further treatment.
Medications: Antidepressants sometimes used; no evidence effective.
Treatment with antipsychotic medications may be beneficial.
Family therapy: treatment of choice for adolescents with anorexia. In
randomized controlled trials where patients are treated with family therapy for one year, after five years have 75%–90% of patients show full recovery
Medications to treat bulimia
Antidepressants
Cognitive-behavioral therapy
For BN antidepressants can binge frequency; improve mood and
preoccupation with shape and weight
Most effective treatment is cognitive-behavioral therapy.
* Behavioral elements:
* focus on meal planning, nutritional education, and ending binge/ purge cycles by teaching to eat small amounts more frequently. * Exposure and response prevention. In this situation a client
with bulimia would be exposed him to situations that usually
cause binge episodes and then prevented from binge eating.
* The cognitive element is aimed at changing the cognitions and
behaviors that initiate or perpetuate a binge cycle.
Gender and eating disorders (e.g., different prevalence of)
Female internalized ideal, * 94% of teen girls and 64% of boys have experienced body
shaming
Boys and men account for 10-25% of all cases of Eds
Check one note for prevalence
Orthorexia (general characteristics)
“Fixation on righteous eating” * Not in DSM * Food choices severely restricted * Obsession with purity of diet (not weight)
Gender differences in alcohol tolerance
Women have less dehydrogenase (less mass to dilute alc. as well) in the stomach, become more intoxicated than men on equal doses of alcohol (even if both male and female are same size, women will get drunk faster with the same amount)
Physiological effects of alcohol
Irreversible liver damage—cirrhosis (liver is overworked and could mean liver replacement)
Damage to the heart and immune system (could lead to strokes and heart attacks)
Major nutritional problems
Korsakoff’s syndrome (Person can be delusional, also known as wet brain syndrome, damage isn’t always reversible)
Biological Processes: * Increases GABA activity at key sites in the brain * Decreases glucose levels (low energy) * Motor impairment * Cerebellum
Delirium tremens (DTs)
When a heavy drinker suddenly stops or significantly reduces their alcohol intake may experience delirium tremens (DT)
DTs usually starts two to five days after the last drink * Lasts 3-6 days * 5-25% with DTs die from seizures, heart failure, and other complications
Opioids (risks and treatments)
Most immediate danger is overdose * Impure drugs * Dirty needles and other equipment can spread infection
Medical uses of opioids
Suppresses the sensation of pain * Euphoria * CNS depressant
