Feeding and Eating Disorders Flashcards
Feeding & Eating Disorders
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorders
Anorexia Nervousa
persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, & physical health)
anosgnosia
lack of insight
Anorexia Nervosa thoughts
- either an intense fear of gaining weight or becoming fat, or PERSISTENT behavior that interferes with weight gain
- disturbance in the way ones body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Two subtypes of Anorexia Nervosa
-Restricting type
-binge-eating/purging type
(can bounce between the two)
Restricting type
lose weight by cutting out sweets and fattening snacks, eventually restricting nearly all food
-show almost no variability in diet
Binge-eating/purging type
lose weight by vomiting after meals, abusing laxatives or diuretics
like those with bulimia nervosa, people with this subtype may engage in eating binges
Additional Signs/ Symptoms of Anorexia
Avoid eating with others Unusual eating habits, rituals “I’m just trying to be healthy” Extreme self-discipline in other areas of life Food as expression of autonomy (can't force ppl to eat- I am the boss of me) Compulsive exercise Isolation from friends/family OCD, depression and substance use often comorbid alcohol
Physiological Symptoms of Anorexia
Heart Muscle Shrinkage
Amenorrhea (loss of 3 menestrual cycles)
Dry skin, sallow complexion
Brittle hair, nails, purple nail beds
Sensitivity to/intolerance of cold
Lanugo
Low blood pressure/heart rate (slow &irregular hr)
Lanugo
peach fuzz around torso or jawline (body’s bid for thermoregulation)
blood pressure
65-75bpm is normal
anorexics can get as low 30 bpm
athletes can get to 45 bpm
The clinical picture of anorexia nervosa
Despite their dietary restrictions, people
with anorexia nervosa are extremely
preoccupied with food
–This includes thinking and reading about food
and planning for meals
–It may be the result of food deprivation, as
evidenced by the famous 1940s “starvation
study” with conscientious objectors
Anorexia Nervosa quote
The mind may make the body sick, but only the body can help the mind be well again
(like talking to a drunk and telling them to stop drinking) it’s all about weight restoration
AN Stats
Prevalence: up to 1% of adolescent girls/young women -- About 90%–95% cases female -- Bimodal onset; ages 12-18 --May be overweight initially --Highest mortality rate of any DSM disorder: ~ 10-20% (depending on study) --1:5 of those deaths are from suicide
Rates of Recovery
--1/3 recover after initial episode --1/3 fluctuate with recovery and relapse -- 1/3 suffer chronic deterioration
Bulimia Nervosa
Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges: -- Bouts of uncontrolled overeating during a limited period of time --Eat objectively more than most people would/could eat in a similar period
Which disorder has the highest mortality rate?
Anorexia Nervosa
but BN are more likely to self report/objective and are insightful
What does bimodal mean?
two peaks– early puberty can be a risk factor or transitions like going to college
DSM-5 Signs/ Symptoms of Bulimia Nervosa
Binge/compensatory behaviors >1/week
for at least 3 months
what is a binge?
a) eat large quantity in 2 hours , and
b) loss of control
what is compensatory behavior?
(DSM5 removes subtypes)
a) purging – vomiting, laxative, diuretics
b) non-purging – exercise, fasting
– Do not meet weight criteria for AN
–Self-Evaluation unduly influenced by body
size, shape, and weight
Binge episodes
People with bulimia nervosa may have between 1 and 30 binge episodes per week
Binges are often carried out in secret
–Binges involve eating massive amounts of food very rapidly with little chewing
–Usually sweet, high-calorie foods with soft texture
–Binge-eating food consumption can be as many as 10,000 calories per binge episode
Compensatory behaviors
Attempt to compensate for and “undo” the caloric effects
–Vomiting: fails to prevent the absorption of half the calories consumed during a binge & repeated vomiting affects the ability to feel satiated –>greater hunger and bingeing
Most people fall within 10% of normal weight
Other signs & symptoms of bulimia
Mood swings Fear of being fat Shame/guilt Eats in secret hoards food Alcohol/substance abuse common Anxiety disorders common Depression seems to follow BN -hard to treat
Physiological effects of BN
Salivary and/or lymph gland enlargement Irregular menstrual cycle (about 1/2) Corrosion of teeth(top teeth) Dehydration, weakness, fatigue Bleeding, infection of throat Electrolyte imbalance: cardiac arrhythmia,seizures, coma renal failure Colon damage from laxative abuse Raspy voice Digestive/intestinal problems Muscle spasms and headaches
can you be comordid with BN & AN?
No you cannot
BN Stats
~90%–95% of bulimia nervosa cases occur in females
–Peak age of onset is between 15 and 21 years
–Symptoms may last for several years with
periodic letup
–In minority populations, risk higher with
higher degree of acculturation, social class
acculuration
how much you culture to where you are —> western standards
what are judge sports?
diving, ballet, cheerleading
Research suggests that bingeing often occurs after…
strict dieting
Study of binge-eating behavior in a low calorie
weight loss program found that 62%
of patients reported binge-eating episodes
during treatment
Bulimia Prognosis
33% remit every year --But another 33% relapse into full criteria --Adolescent-onset better prognosis than adult-onset --Death-rate = 1%
BN vs. AN similarities
! Onset after a period of dieting ! Fear of becoming obese ! Drive to become thin ! Preoccupation with food, weight, appearance ! Feelings of anxiety, depression, obsessiveness, perfectionism ! Substance abuse ! Distorted body perception ! Disturbed attitudes toward eating
BN vs. AN differences
People with BN = more worried about
pleasing others, being attractive to others,
and having intimate relationships
! People with bulimia nervosa tend to have
libido/sex life.
! Approximately half of women with bulimia
nervosa experience amenorrhea vs. almost
all women with anorexia nervosa
Binge Eating Disorder
Binge eating without compensatory behavior
! Between 2 and 7% of the population display binge eating disorder
! Eating large amounts of food
! Eating rapidly during binge episodes
! Large amounts of food when not physically hungry
! Eating alone because embarrassed about how much one is eating
! Feeling disgusted with oneself, depressed, or guilty when overeating
! Feeling that your eating behavior is out of control
! Frequently eating alone
! Hoarding food
! Hiding empty food containers
! Feeling depressed, disgusted or upset about your eating
Note: Most obese people do not have BED
Overvaluation Shape/Weight
Current specifiers are severity based on number of binge episodes per week ! Overvaluation of shape/weight is associated with significantly elevated eating disorder pathology and psychological distress. ! Predicts treatment outcome
Binge Eating Disorders… Fun fact
1 in 4 survey participants secretly create concoctions.
-no difference in concocting susceptibility between sexes or ethnicities
food concoting
making unusual good mixtures (mashed potatoes with Oreo cookies, frozen vegetables mixed with mayonnaise, and chips with lemon, pork rinds, Italian dressing and salt)
Binge Eating Disorder vs. Obesity ***
Runs in families (not a simple familial variation of obesity).
! Males, older age, and a later age of onset.
! Greater concerns about shape and weight, higher likelihood
of psychiatric comorbidity in the form of mood disorders and
anxiety disorders.
! Lower quality of life than obesity.
! More positive response to specialty treatments than to
generic behavioral weight loss treatments.
! clinical utility of the BED diagnosis in terms of treatment
selection; for example, antidepressant medication is useful in the treatment of BED, but is not generally useful in the
treatment of obesity.
Etiology of Eating Disorders
genetic family dynamics societal, cultural biological media factors individual temperament (impulsive)
Risk Factors for EDs
! Perfectionism for AN ! Early Puberty ! Failed attempts to lose weight ! Antecedent illness with weight loss ! Discovery that purging, fasting or exercising can compensate for binging ! Athletics ! Beginning a diet ! Family history of eating disorder, substance abuse or mood disorder
Biological factors
Genetics
! Lifetime risk: 10X higher if family member has
eating disorder
• MZ twins with anorexia: 70% (DZ:20%)
• MZ twins with bulimia: 23% (DZ: 9%)
! Increased risk if family hx of: anxiety,
depression, or alcohol dependence
! Serotonin Imbalance
! Anorexia Nervosa: Elevated 5-HTP; abnormal
5HTP (2a) receptor
! Bulimia Nervosa: Depleted 5-HTP
Cognitive/Behavioral Explanations
Eating Disorders seem to be propelled primarily through cognitive distortions
–Control (out of control?)
–Belief that popularity and self-esteem are
determined by weight and body shape
Behavioral explanations:
–Observational learning
–Operant conditioning
Family Environments
–Lack communication skills? Low support?
–High pressure, driven, concerned about
appearance
–Discomfort handling conflict, tolerating/
discussing emotions
(family harmony when Jane was sick/malnourished)
Societal Factors
–Media Influence
–54% of men and 75% of women are unhappy with their physical
appearance and wish that their bodies were different
–Most fashion models are thinner than 98% of American women
–Peer group norms
–Athletic team norms
–Degree of adopting western standards of beauty
What causes Eating Disorders? Multicultural Factors: Gender Differences
–Males account for only 5% to 10% of all
cases of eating disorders
–The reasons for this striking difference are not entirely clear, but Western society’s double standard is, at the very least, one reason
–A second reason may be the different
methods of weight loss favored:
–Men are more likely to exercise
–Women more often diet
“It’s just as hard to be Ken as it is to be Barbie”
Body Image and the Media
Average American woman 5’4”,140 lbs --Average American model 5’11”, 117 lbs --80% American women dissatisfied with their appearance -->50% of high school girls want smaller hips, thighs, and/or waists
The Role of Dieting
--95% of eating disorders start with diets --Dietary restraint leads to preoccupation with food --Food restriction interferes with serotonin
Dieting in Anorexia
Weight lossreinforcing --Symptoms may provide relief from family conflicts/ other stressors
Dieting in BN
two parts: restriction and then binge eating
Restriction becomes
Binge eating
Malnutrition lowers serotonin levels: depression
and triggers binge behavior
–Bingeing may reduce stress/anxiety
Binge eating becomes
Purging
Increased endorphins reinforces vomiting
–Purging provides psychological relief
How are eating disorders treated?
–Eating disorder treatments have two main
goals:
-Correct dangerous eating patterns
-Address broader psychological and situational
factors that have led to, and are maintaining,
the eating problem
—This often requires the participation of family and
friends
Treatment of Eating Disorders
Multidisciplinary Team Approach: ! Individual therapist ! Group therapist ! Physician ! Nutritionist ! Psychiatrist
Treatment for Anorexia Nervosa
Hospitalization
- Weight gain (recover from malnourishment)
-Necessary weight gain is often achieved in 8 to 12 weeks
- Address dysfunctional anxious cognitions
about becoming obese, losing control of
eating, thinness as marker of self-worth
- Family therapy
-Maudsley Method
- Intuitive Eating
AN Treatment
No evidence-based psychotherapy for
Anorexia Nervosa in adults
– No evidence-based pharmacologic
treatments
Treatment for Bulimia
Immediate aims: • Eliminate binge-purge patterns • Establish good eating habits • Eliminate the underlying cause of bulimic patterns Medications: SSRIs --- May enhance psychological treatment --- No long-term efficacy --- Cognitive-Behavior Therapy --- Develop normal patterns of eating --- Self-monitoring --- Address perfectionism and maladaptive thoughts --- Develop alternative coping strategies
Appetite Awareness Training
Appetite Awareness ! Become aware of your appetite signals ! Become aware of other triggers to eat besides hunger/fullness ****Practice starting at moderate hunger and stopping at moderate fullness
Treatments for BN more so
• Left untreated, bulimia nervosa can last
for years
• Treatment provides immediate,
significant improvement in about 40% of
cases
• An additional 40% show moderate response
• Follow-up studies suggest that 10 years
after treatment about 75% of patients
have fully or partially recovered
interesting thing about binges
every eating disorder we have involves a binge
Planning to eat can prevent
binge eating behavior in part
Diet Binge Purge cycle
Rules/Dieting»_space; Slips, breaks rule»_space; AVE (Abstinence Violation Effect)»_space;Binge»_space; Guilt/Shame»_space;(Purging)»_space;Renewed Resolve
Abstinence Violation Effect
I blew it, fuck it
where one cig becomes the whole pack
Fear of becoming obese-Why?
Different because heart disease runs in the family to there are social reasons
Anorexics have a nigh need for perfectionism
perfectionism
chronic state of stress because nothing is perfect
what is the difference between BN people and AN people?
BN=people pleasers
AN=more isolation, less nourished, shut down sex drive to survive
BED
is largely behavioral
great deal of shame
severity
mild, moderate, severe depends NOT on how many binge episodes but how much they value appearance body size& shape
out of body experience
can be seen in AN
operant conditioning role
purging feels good after uncomfortable fullness
-getting asked out on dates during bingeing and purging»_space;what is level of confidence
FDA approved
there are no FDA approved meds
highest eating pathology
sport: Jockeys (horse racing)
Timeframe
AN been around since the beginning BN more culturally bound
Psychological Factors
Personality -perfectionism -obsessive compulsiveness -emotional instability -harm avoidance -persistence, low novelty seeking (AN) -impulsivity sensation seeking (BN) Poor Self Image
orthorexia
obsession with nutrition
An integrative model
Restriction of Eating
Group therapy on eating disorders
group therapy great for BN depends on AN
when people start eating and they get gassy and start bloating
“I’m allergic”
Wrong just reintroducing after restricting it
weight restoration
main idea for AN cause it will increase insight–must go slowly
refeeding syndrome
blood sugar & insulin secretion, electrical activity, could lead to seizures, really sick, ruptured stomach, could be deadly
residential facilitates
have the highest relapse once they leave
Maudsley method
is effective for young (15 years and younger) where the therapist goes in with the family
SSRI medications
are like a volume knob
Do you have food rules or do food rules have you?
Her daughter when given the choice between a cookie and an apple she will listen to her body because she hasn’t been exposed to society standards
Food monitoring
get away from it, “ how do you feel”-Eating in the green
-appetite cues are disturbed from binging and purging
