Final Flashcards
1
Q
How does the eating pathology category challenge HiTOP conceptualization and categories?
A
- Bulimia and binge eating have more externalizing features
- Anorexia has more internalizing features
2
Q
What are the key symptoms of eating disorders?
A
- Cognitive Restraint
- Dietary Restriction
- Binge Eating
- Compensatory Behaviours (purging & non-purging)
- Weight/Shape Concern
3
Q
Describe cognitive restraint in eating disorders
A
Cognitive effort focused on the intent to reduce the amount of food consumption
4
Q
Describe dietary restriction in eating disorders
A
- Actual decrease in energy intake
- Changing the frequency, quantity or types of food
- Ex: amount of food eaten and/or what foods are eaten
5
Q
Describe binge eating in eating disorders
A
- Consuming an objectively large amount of food
- In a discrete (short) period of time
- With a feeling of loss of control (person wants to stop eating but can’t)
6
Q
Describe compensatory behaviours in eating disorders
A
Purging:
- Attempt to physically remove food from system
- Ex: self-induced vomiting, consuming laxatives, diuretics
- These behaviours provide people with temporary relief (relieve negative affect)
- These are ineffective at reducing the calories
- These behaviours can have detrimental effects on health overtime
Non-Purging:
- Counteract the ingestion of food indirectly
- These function primarily to reduce the emotions linked with food
- Ex: restriction (after eating a lot, engaging in restriction of consumption to make up for it), compensatory exercise
7
Q
What are some examples of the detrimental effects that purging behaviours can have on health overtime?
A
- Vomiting can lead to dental problems, oesophageal problems, high GI problems
- Laxatives overuse is associated with lower GI problems
- Diuretics linked with very low levels of electrolytes
8
Q
Describe weight/shape concern in eating disorders
A
- A relationship with one’s weight/shape characterized by:
- Body dissatisfaction
- Preoccupation with weight/shape
- Over-valuation of weight/shape
- Weight and/or shape play an excessively important role in determining self-worth
9
Q
Describe Anorexia Nervosa (AN)
A
- Term introduced in 1873 by Sir William Gull -> older concept
- Anorexia means absence of appetite
- Anorexia Nervosa means anxious nervous absence of appetite
- Anorexia Nervosa is the diagnosis
- Cases/phenomena have been described for centuries
- Typically present: body dissatisfaction, weight concerns, undue influence of weight/shape on self-esteem
- Sometimes present: binge eating, purging, excessive exercise
- Extreme/intense fear of gaining any weight and often altered perception of shape of body
- Sub-types of either restrictive only (someone who only engages in restrictive eating) or binge-purge
- Atypical anorexia (when all of these behaviours are present but no BMI issues)
- Men are less likely to be diagnosed with AN because of high muscle mass
- There’s often denial about having a problem -> this makes treatment complicated
10
Q
Describe Bulimia Nervosa (BN)
A
- More recent: 1979 (Gerald Russell)
- Noticed patients that used a pattern of binge eating followed by self-induced vomiting
- Descriptions of binge-eating go back further
- Typically present: body dissatisfaction, weight concerns, dietary restrictions
- People with BN unlike with AN are more typically a normal weight or slightly overweight
- Severity of BN is based on frequency and severity of compensatory behaviours
11
Q
What are the DSM diagnoses of eating disorders
A
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Both BN and AN don’t require significant distress or impairment for diagnosis
12
Q
What are the core features of Anorexia Nervosa (AN)?
A
- Weight that’s significantly lower than expected for height and age (usually, BMI < 17.5)
- Dietary restrictions
13
Q
What are the core features of Bulimia Nervosa (BN)?
A
- Binge eating
- Compensatory behaviors
- Undue influence of weight/shape on self-esteem
14
Q
What are the core features of Binge Eating Disorder (BED)?
A
- Binge eating (binge episodes with purging or other compensatory behaviours)
- Absence of compensatory behaviors
15
Q
Describe Binge Eating Disorder (BED)
A
- Binge episodes with engaging in purging or other compensatory behaviours
- Usually in normal or overweight weight range
- Severity based on frequency and amount of binge episodes
- Sometimes present: body dissatisfaction, weight concerns, dietary restrictions
- Must have significant distress
16
Q
Describe Avoidant/ restrictive food intake disorder (ARFID)
A
○ Failure to meet energy needs accompanied by significant weight loss
○ Significant nutritious deficiency
○ Can’t be explained by lack of food or culture
○ Food is available and they’re choosing not to consume it
○ Atypical -> seems to not be related to weight or shape of body
17
Q
What are the residual diagnostic categories for eating disorders?
A
- Avoidant/ restrictive food intake disorder (ARFID)
- Other Specified Feeding and Eating Disorder (OSFED)
- Unspecified Feeding and Eating Disorder (USFED)
18
Q
Describe Other Specified Feeding and Eating Disorder (OSFED)
A
- Subthreshold AN, BN, BED
- Atypical AN
- Purging Disorder (engaging in purging without binges)
- Night Eating Syndrome (eating a lot at night)
19
Q
What percentage of treatment-seeking individuals with eating disorders meet criteria for OSFED/USFED?
A
Between 30-50%
20
Q
Describe the diagnostic migration of eating disorders
A
- Individuals who meet criteria for one eating disorder at one point in time are very likely to meet criteria for another eating disorder at another point in time
- AN-restricting subtype (AN-R) and AN-binge-purge subtype (AN-BP) often migrate with each other
- AN-binge-purge subtype (AN-BP) and BN often migrate with each other
- BN and BED often migrate with each other
21
Q
What are the statistics for the eating pathology among women in Montreal?
A
- 8.7% frequent compensatory behaviours
- 4.1% frequent binge eating (objective)
- 1.1% regular purging behaviours
- 14.9% residual, OSFED-type category
- 0% AN
- 0.6% BN
- 3.8% BED
- 0.6% purging disorder
22
Q
Describe AN epidemiology
A
- Prevalence: 0.7% (rare)
- Gender ratio: 10 women:1 men
- Age of onset: late adolescence
- Mortality: 5.1%
23
Q
Describe BN epidemiology
A
- Prevalence: 1-3%
- Gender ratio: 10 women:1 men
- Age of onset: late adolescence - early adulthood
- Mortality: 1.7%
24
Q
Describe BED epidemiology
A
- Prevalence: 2-5%
- Gender ratio: 2 women:1 men
- Age of onset: early - mid adulthood
- Mortality: more research needed
25
Which eating disorder is more prevalent in boys and has an onset in infancy?
* ARFID
* Much less common for onset in adulthood
26
Describe the SWAG stereotype for the epidemiology of eating disorders
- Skinny White Affluent Girls (SWAG)
* Underweight = < 6% of ED population
* Males = 25% of ED population -> likely because of different presentations in males
* Sexual and gender minorities have higher ED prevalence
* Ethnic minority populations have high rates of EDs
* Multiracial individuals + Indigenous have highest rates of EDs
* No relationship between high SES and EDs -> but there is an association with food insecurity
27
What are some common differential diagnoses with eating disorders?
* Body Dysmorphic Disorder (people have a distorted sense of their body)
* Obsessive Compulsive Disorder (ritualistic and obsessive thoughts present in eating disorders followed by compulsions to undo the thoughts)
* Anxiety disorders (esp. SAD, GAD)
* Depression
* Psychosis-spectrum disorders
28
What are some effects of malnutrition?
* Low mood
* Anhedonia
* Insomnia
* Preoccupation and rituals related to food
29
What are some extensive comorbidities with eating disorders?
- Mood disorders
- Substance disorders
- Personality disorders
- Anxiety disorders
30
Describe the comorbidity between eating disorders and depression
* AN: 25-50% concurrent Depression
* AN: 50-70% lifetime hx Depression
* BN: even higher
31
Describe the comorbidity between eating disorders and personality disorders
- Commonly comorbid -> 50-70%
* Restricting AN and Cluster C Personality Disorders
* AN-BP and clusters B and C
* BN and cluster B
32
Describe the heritability of eating disorders
* AN, BN, BED: mean ~50%
* Twin and adoption studies have found moderate to high heritability in AN, BN, and BED
* Disordered eating symptoms: ~50%
* Increased familial risk
* Ex: AN -> family members have 4x the risk
* Heritability not static over development
* 0% genetic contribution before puberty
* ~50% emerges after puberty
* To what extent are ovarian hormones contributing -> concordant changes in eating patterns across the menstrual cycle
33
What are some Gene X Environment Interactions we see with eating disorders?
* Short allele of 5-HTTLPR
* Parenting style
* Short allele has been found to interact with parenting styles (ex: parents who are very critical, under involved)
* Abuse history
- These lead to AN, BN symptoms, drive for thinness
34
What's the dominant body ideal in North America?
- Thin ideal
- Degree to which a person buys into this ideal or believes that being thin is better
- Photoshop -> even thin women were photoshopped into physically impossible thin bodies
- Thin-ideal internalization
35
How do eating disorders present in men/boys?
○ They present differently
○ Ex: muscle dysmorphia
○ Focus on gaining the right muscle mass
○ Men more likely to use exercise as a compensatory behaviour instead of purging
○ When binging, men report less of a sense of loss of control
36
What are some sociocultural pathways for eating disorders?
* Appearance ideals
* Fat talk – Self, Family, Peers
* Weight stigma/bullying
* Media – Fiji Study
37
What's fat talk?
- Disparaging comments about body image and eating habits
- Can be comments about own weight/eating habits or some else's weight
38
Describe Lydecker et al. (2018) study on parental fat talk
* Examination of frequency of parental “fat talk” (toward the self, the child, and others)
* Associations between parental “fat talk” and child eating behaviours
Findings:
* Parental “fat talk” directed toward: Self (74%), Others (51.5%) and Child (43.6%)
* Toward the self: associated with parental pathology
* Toward the child: associated with child pathology -> child "fat talk" was most strongly associated with all child eating and weight problems
39
Describe the impact of peers and weight stigma
* Teasing someone about their weight
* General idea that it's ok to do so
* Implying that weight is tied to character (lazy, undisciplined, etc.)
* Weight stigma has a big impact on pathology
40
Describe the study on weight stigma in high school
* Study of people ~20 yrs old and what they experienced in high school
* 11% reported frequent weight teasing in high school
* Those in overweight category were much more likely to be teased
41
Describe the relationship between teasing about weight and thoughts of suicide
- Not teased = 25% have thoughts of suicide
- Teased by peers = 36% have thoughts of suicide
- Teased at home = 43% have thoughts of suicide
- Teased by both = 51% have thoughts of suicide
42
Describe Becker et al. (2004) Fiji Study
* Idea that media exposure is linked to disordered eating or thin idealization
* In 1995 televisions were introduced in Fiji
* In 1995: no television, no EDs
* In 1998 : 11.3% adolescent girls report at least 1 purging behaviour, 74% feel "too fat"
* In 2007: 45% report at least 1 purging behaviour in the past month, rates of formal eating disorders also increased
* Persuasive temporal correlational evidence that introduction to western ideals and media is associated with disordered eating
43
Describe Stice (2001) Dual Pathway Model
- Sociocultural pressures and Thin-ideal internalization both lead to Body dissatisfaction
- Body dissatisfaction leads to Negative affect and/or Restrained eating
- Negative affect and Restrained eating both lead to Eating disorders
44
Body dissatisfaction is considered the norm among who?
Women
45
Describe the Abstinence violation effect or the “f*ck it” effect for eating pathology
* Also used in substance use disorders -> substance use effect
- Eating pathology cycle
- Start diet and restrict food (when restricting calories, the body rebels to stay alive)
- Feelings of hunger (crave high calorie foods)
- Eat “forbidden” foods
- Overeat - already “broke” diet (binge episode)
- Feel guilty and fat
- Start the diet again and heavily restrict food again (cycle restarts)
46
What are some maintenance factors for eating disorders?
* Perfectionism
* Low self-esteem
* Emotion regulation
* Interpersonal difficulties
47
Describe perfectionism as a maintenance factor for eating disorders
* High standards
* Fear of failure
* Self-criticism
* Well-established maintenance factor for people with eating disorders
* People with perfectionism features tend to have a more severe course
48
Describe low self-esteem as a maintenance factor for eating disorders
* Omnipresent
* Unconditional
* Treatment obstacle -> people hate themselves so it's hard to motivate them to make changes
* Don't just feel bad about weight but also feel bad about everything
49
Describe emotion regulation as a maintenance factor for eating disorders
* Negative mood intolerable -> can't tolerate high negative affect (need to do something about it)
- Binge trigger
- This has been associated with binge episodes and NSSI
50
Describe interpersonal difficulties as a maintenance factor for eating disorders
* Isolation, loneliness and other forms of stress can trigger the onset of disorders
* Negative interactions precede binges -> common trigger and predictor of binge episodes
* Having strict rituals around food makes it harder to engage with social fabric they're within
51
What's psychotherapy?
- Process in which a professionally-trained therapist systematically uses techniques derived from psychological principles to relieve another person’s psychological distress or promote growth
- Uses evidence-based treatment
52
What are the major schools of psychotherapy?
* Psychodynamic
* CBT
* Humanistic-experiential
* Integrative/eclectic
* All of these schools have their own evidence-base behind them
53
How do we establish efficacy?
* For a drug to reach markets, pharmaceutical companies have to first show that the drugs are effective
* Efficacy: drug does what you think it's going to do
* Efficacy for therapies is typically established through RCTs -> RCTs can tell us whether a treatment has a beneficial effect
54
What are RCTs?
- Where you get a large group of people with a disorder and put them either in a group with an already established treatment, in a waitlist group, and in a group with a new treatment
* Empirically supported therapy
* Can tell us whether a treatment has a beneficial effect, BUT
* Issues:
* Wait-list control for people who are acutely ill?
* With therapy, it's possible that different therapists are giving different doses to therapy or giving special ingredients that we may not see in RCTs
* Patients enrolled in RCTs are usually relatively uncomplicated cases (ex: single dx -> people with psychosis, severe suicidal ideation, etc. are usually excluded)
* Highly controlled treatments
55
What's the effectiveness of a treatment?
- Whether a treatment shows that it's effective outside of highly controlled laboratory setting
- Does it represent real-world conditions?
56
Describe Empirically Supported Therapies
* Gold-Standard: having gone through empirically supported therapy that meets criteria for designation as an empirically supported therapy
* Evidence-Based Practice = the integration of the best available research and clinical expertise within the context of patient characteristics, culture, values, and treatment preferences
* APA and CPA require training programs to train in evidence-based practices
* Having this structure can be beneficial for treatment
* Ideally not strict reliance on a single therapy
57
Why do people argue against the criteria for designation as an empirically supported therapy?
They argue this approach devalues the perspectives of people in the field
58
What are the 3 Waves of Behaviour Therapy?
* 1st Wave: Classic behaviour therapies
* 2nd Wave: Incorporation of cognitions
* 3rd Wave: New Ideas and approaches
59
Describe the first wave of behaviour therapy
* Classic behaviour therapies
* Built on classical and operant conditioning
* Systematic desensitization
* Focus is on behaviours, not thoughts
60
Describe the second wave of behaviour therapy
* Incorporation of cognitions
* Rise of mainline Cognitive-Behavioral Therapy
61
Describe the third wave of behaviour therapy
* New ideas and approaches
* Acceptance and Commitment Therapy
* Mindfulness-based Cognitive Therapy
* Dialectical Behavior Therapy
* People who established all of these will typically say these are a variation on CBT
62
What are exposure therapies?
- Strict behavioural therapies
- Idea that if someone has a fear of something, you will expose them to their fear so they can habituate to the feared object
- Exposure therapy allows one to ride the anxiety wave multiple times until they habituate
63
How is anxiety like a wave?
* Anxiety is like a wave -> riding the anxiety wave
* Anxiety has to peak at some point -> it isn't rising forever, you rise to the peak and then go down
* However, when people feel their anxiety rising, they'll engage in avoidance behaviours -> leads to them not experiencing the natural peak
64
Describe the vicious cycle of anxiety
- Begin exposure
- Exposure (anxiety climbing/rising)
- Before panic peak, individual engages in avoidance behaviour to escape anxiety
- Anxiety quickly drops
- Individual fails to habituate
- Anxiety trigger returns
- Cycle restarts
65
Describe the outcome of repeated exposure with anxiety
With continuous exposure and habituation/anxiety coasting, the anxiety wave becomes smaller and smaller leading to a mastery of anxiety
66
Describe In Vivo Exposure
* Systematic desensitization through exposure to feared situations or locations, in order to produce extinction of the fear response
* Imaginal exposure used if the patient cannot be directly exposed to the feared stimuli
* Used to be flooding procedure (ex: if someone is scared of snakes, you would put them in a pool of snakes)
* Now commonly use graduated exposure therapy
67
Describe Graduated exposure therapy
○ Build a fear hierarchy and establish the least feared situation and gradually go up to the most feared situation
○ This is also used for OCD
○ Important that the therapist does these exposures with the client
68
Describe Interoceptive Exposure
* When the feared stimulus is not external, but instead internal
* Systematic exposure to feared bodily symptoms
* Therapist is doing this with the client in every instance
* Ex: breathing through a coffee straw
* Exposure to the internal physiological sensations that may accompany panic
* If client has a panic attack during treatment, this can be an effective learning experience
69
Describe Exposure and Response Prevention
* For OCD
* Focus is on exposure to feared stimuli without engaging in safety behaviours (ex: compulsions)
* Operates according to the principles of Pavlovian extinction
* Exposing self to trigger by refraining from avoidance behaviours and not having negative reinforcement -> leads to habituation
* Also done for PTSD in some cases
* Very challenging treatment
70
Describe the Cognitive Triangle
- Thoughts influence feelings and behaviours (2nd wave)
- Behaviours influence thoughts and feelings
- Feelings influence behaviours and thoughts
71
What are the different types of cognitive distortions?
- All or nothing thinking (aka black and white thinking -> ex: if I'm not perfect I have failed)
- Mental filter (only paying attention to certain types of evidence -> noticing our failures but not our successes)
- Jumping to conclusions (2 types: mind reading -> imagining we know what others are thinking and fortune telling -> predicting the future)
- Emotional reasoning (assuming that because we feel a certain way, what we think must be true)
- Labelling (assigning labels to ourselves or other people)
- Over-generalizing (seeing a pattern based upon a single event, or being overly broad in the conclusions we draw)
- Disqualifying the positive (discounting the good things that have happened or that you have done for some reason or another)
- Magnification (catastrophizing) and minimization (blowing things out of proportion or inappropriately shrinking something to make it seem less important)
- Should/must (using critical words like "should" and "must" can make us feel guilty, or like we have already failed)
- Personalization (blaming self or taking responsibility for something that wasn't completely your fault)
72
Describe the CBT Thought Record
- Where were you?
- Emotion or feeling
- Negative automatic thought -> encourage patients to say what their immediate automatic thoughts were in the situation
- Evidence that supports the thought
- Evidence that doesn't support the thought
- Alternative thought
- Emotion or feeling
- Goal: getting people to question things that in the moment feel entirely factual to them -> are there other ways to think about this?
- Even if patient feels 1% less stress, that's still progress
- Demonstrates how if we change the way we think, we can change the way we feel
73
What are common treatments for depression?
* Often incorporates a combination of behavioural activation and cognitive restructuring through thought records
* Behavioural activation: positive reinforcement based form of treatment -> idea that people with depression gain positive reinforcement from everyday activities
- Ex: setting goals like going to the gym
74
What are common treatments for anxiety and OCD?
* Anxiety and OCD treatment often relies on cognitive restructuring in addition to exposure techniques:
* In-vivo exposure (systematic desensitization)
* Interoceptive exposure
* Imaginal exposure
* Exposure and response prevention
75
Describe Acceptance and Commitment Therapy (ACT)
* 3rd wave
* Mainline CBT focuses on disputing thoughts
* General goals of ACT are to:
* Foster acceptance of unwanted thoughts and feelings -> idea of letting anxiety flow through you (not putting life to the side to fight anxiety)
* Stimulate action that improves the circumstances of living -> focus on personal values and then look at in what ways behaviours are interfering with a life that one values
* Discourage experiential avoidance -> “an unwillingness to experience negatively evaluated feelings, physical sensations, and thoughts” - Hayes (2005)
* Hayes argued for increasing willingness to experience these things -> letting go of the struggle
76
What's an example of the importance of ACT that can be demonstrated to a client during therapy?
* Writing down all fears in a certain scenario on sugar packets and then throwing those thought sugar packets to the client and asking them to catch them as they answer questions
* Demonstrates how it's difficult to focus on the present when fighting and engaging with thoughts instead of letting them flow through us
77
What are the 6 core pathological processes present with psychological inflexibility?
- Dominance of the Conceptualized Past and Future; Limited Self-Knowledge
- Lack of Values; Clarity/Contact
- Unworkable Action
- Attachment to the Conceptualized Self
- Cognitive Fusion
- Experiential Avoidance
78
What are the 6 core therapeutic processes present with psychological flexibility?
- Contact with the present moment (be here now)
- Values (know what matters)
- Committed action (do what it takes)
- Self-as-context (pure awareness)
- Defusion (watch your thinking)
- Acceptance (open up)
