Feeding and Eating Disorders Flashcards
1
Q
Feeding and Eating Disorders
A
- Pica
- Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder
- Anorexia Nervosa
- Bulimia Nervosa
- Binge-Eating Disorder
- Other Specified Feeding or Eating Disorder
- Unspecified Feeding or Eating Disorder
2
Q
Pica
A
- Repeated ingestion of nonfood substances
- At least 1 month
- Inappropriate to developmental level of individual
- Not part of culturally supported or socially normative practice
3
Q
Rumination Disorder
A
- Repeated regurgitation of food
- At least one month
- Not attributable to medical condition
- Doesn’t occur exclusively during anorexia, bulimia, binge-eating disorder, etc.
4
Q
Spectrum of Disordered Eating
A
- Over-eating on one side (bulimic, weight cycling, over eater, fat phobia) –> obesity
- Under-eating on other side (anorexia, fasting, chronic exerciser, fat phobia) –> starvation
- Different manifestations of a single disorder?
- Commonalities between AN and BN: food preoccupation, disturbed body perception, sexual dysfunction
5
Q
Physical/Associated Complications Related to EDs
A
- Electrolyte imbalance
- Mental slowing
- Emotional Challenges (e.g., depression)
- Pxs with thermoregulation
- Cardiac problems
- Nutritional deficiencies
- Impaired immune system
- Osteoporosis
6
Q
Anorexia Nervosa
A
- Restriction of energy intake leading to sig low body weight (less than minimally normal)
- Fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain
- Disturbance in how body weight/shape is experienced/lack of recognition of seriousness of low body weight
7
Q
Anorexia Nervosa specifiers
A
- Restricting type or binge-eating/purging type
- In partial remission/full remission
- Severity levels based on BMI
8
Q
Physical Changes in Anorexia
A
- Low blood pressure, bradycardia (slow heart rate), kidney, & gastrointestinal problems
- Dehydration, diuretic use, laxative use
- Loss of bone (osteoporosis) and muscle mass
- Brittle nails, dry skin, hair loss
- Lanugo: fine downy body hair
- Electrolyte imbalance: usually potassium and sodium; can cause tiredness, weakness, and death
- Suppression of HPA: also LH and FSH
- Loss of brain mass (gray and white)
- Tooth decay
9
Q
AN Prognosis
A
- Recovery estimates vary; up to 70%
- Mortality likely over 10%
- Recovery long process- several years
- Relapse is common
- Some damage may be permanent
10
Q
Bulimia Nervosa
A
- Recurrent binge eating episodes: “eating an amount of food that is definitely larger than what most individuals would eat in a similar period of time”
- — a sense of lack of control during episodes
- Recurrent compensatory behaviors to prevent weight gain
- Binging and purging occurs at least 1/week for 3 months
- Self-evaluation influenced by body shape and weight
11
Q
Bulimia specifiers
A
- In partial remission/in full remission
- Severity based on number of compensatory behaviors
12
Q
Bulimia Nervosa causes & info
A
- Stress and negative emotions often trigger bulimia
- Typical food choices: forbidden foods like junk food
- Likelihood of binge may increase with avoidance of craved food
- Binge: loss of control (usually shame and remorse after)
13
Q
Physical Changes in Bulimia
A
- Esophageal damage/rupture, hiatal hernia
- Stomach damage, abdominal pain
- Menstrual irregularities
- Electrolyte imbalance
- GI disturbance
- Tooth decay
14
Q
BN Prognosis
A
- about 70% recover
- about 10% remain chronically fully symptomatic
- Early intervention linked with improved outcomes
- Comorbid depression and substance abuse related to poorer prognosis
15
Q
Binge Eating Disorder
A
- Recurrent binge eating episodes
- Binge episodes are associated with 3 or more: eating more rapidly, eating until uncomfortably full, eating large amounts when not physically hungry, eating alone due to embarrassment, feeling disgusted or guilty after eating
- Distress
- Occurs at least 1/week for 3 months
16
Q
Binge Eating specifiers
A
- In partial remission/in full remission
- Severity based on number of binge episodes per week
17
Q
Controversy over Body Dysmorphic Disorder
A
- Disordered eating or BDD?
18
Q
Problems with AN/BN diagnosis
A
- Some say criteria for AN/BN too stringent
- ED NOS category was too broad
- Unclear boundaries between normal and disordered eating
- Patients may vacillate between diagnostic categories
- Differential diagnosis: medical disorders, other psychological disorders (ex- root of the problem may be below the surface such as depression)
19
Q
Eating Disorders and Genetics
A
- Family/twin studies support genetic link
- Heritability for body dissatisfaction, desire for thinness, binge eating, and weight preoccupation
- Chromosomes 1 and 10 linkage for AN
- Related to serotonin and opioid receptor abnormalities?
20
Q
Eating Disorders and Neurobiological Factors
A
- High levels of endogenous opioids: reduce pain, enhance mood, suppress appetite; released during starvation; doing these reinforce restricted eating?
- Serotonin and dopamine associated with cravings, appetite, eating behaviors; lack of serotonin regulation in bulimia and lower levels of serotonin and dopaminergic hypersensitivity in Anorexia
21
Q
Eating Disorders and Sociocultural Factors
A
- Society’s emphasis on thinness may fuel body dissatisfaction
- Dieting more prevalent, especially among women
- Body dissatisfaction/preoccupation with thinness risk factor
- Societal objectification may lead to self-objectification
22
Q
Eating Disorders and Cross Cultural Factors
A
- Found in many cultures
- Prevalence much lower before 60’s
- Religious motivations in past
- Prevalence seems lower in non-western countries
- Rates rise for non-western immigrants to Western countries once in country
- Bulimia most common industrialized, western countries
23
Q
Eating Disorders and Family Characteristics
A
- Disturbed family relationships: high levels of family conflict, low levels of support
- Attitudes about food/dieting/appearance
- Minuchin’s “psychosomatic families:” enmeshment/diffuse boundaries, overprotectiveness, rigidity, lack of conflict resolution; prevents individuation during adolescence
- —– Starvation as passive assertion, which also keeps them dependent
- —– Distract from other family difficulties?
24
Q
Eating Disorders and Child Abuse
A
- High rates of childhood sexual and physical abuse
- Abuse history not specific to eating disorders
- Emotional abuse (excessive criticism) may also be implicated
25
Q
Risk Factors for Development of EDs
A
- Childhood obesity
- Biological factors
- Family attitudes
- Peer influence
- Socio-cultural (media)
- Stressful life event
- Low self esteem
26
Q
Cognitive Behavioral View of Anorexia
A
More repressive
- Body dissatisfaction and fear of fatness
- Image distortion
- Restrictive eating, excessive exercise negatively reinforcing: reduce anxiety about weight gain
- Weight loss brings about feelings of self-control: positively reinforcing
- Criticisms from family and peers regarding weight may increase anxiety
- Mother-daughter modeling effect proposed
27
Q
Cognitive Behavioral View for Bulimia
A
More impulsive
- Weight strongly influences self-worth
- Low self-esteem
- Rigid, restrictive eating triggers lapses, which can become binges
- Stress and negative affect also trigger binges
- Disgust and fear of gaining weight lead to compensatory behavior
28
Q
Chris Fairburn’s model
A
- Importance of weight leads to body image and self-evaluation
- Body image leads to dietary restriction, purging, and excessive exercise
- Dietary restriction leads to binge eating
- Binge eating leads back to purging and excessive exercise, or self-evaluation
29
Q
Temperamental Models of ED
A
- Negative Emotionality/Behavioral Inhibition System: more fear of gaining weight in AN, more stress reactivity in BN (not as disciplined)
- Positive Emotionality/Behavioral Activation System: reward responsiveness –> approach behaviors towards food (binge)
- Constraint/Conscientiousness: low control/deliberation in bulimia, high compulsivity/self-discipline in anorexia
- Bulimia: low behavioral control, high negative emotionality, and high positive emotionality (maybe moderate self-discipline to differentiate from BED)
- Anorexia: high negative emotionality, high self-discipline (bingeing/purging subtype may be in between)
