ICL 10.5: Hunger, Obesity & Eating Disorders

Question 1

what kind of relationship do we have with food?

Answer 1

1. food as fuel
2. food as positive reinforcement
3. learned taste preferences versus nutrient driven preferences

food is more about a pleasurable experience to us instead of just for nutrition like animals!

Question 2

how is food fuel?

Answer 2

food is an essential element for life: along with air and water

we do not feed as animals, we eat (sharing food is unique to humans)

food is less nutritious/nutritious food expensive

fast food is convenient

Question 3

how is food positive reinforcement?

Answer 3

satisfying hunger is often overruled by satisfying pleasure

eating can be used to compensate for depression, anxiety, low self-esteem and more

Question 4

what factors contribute to weight?

Answer 4

1. genetics
2. diet
3. activity level
4. sleep/sleep deprivation
5. metabolic syndromes

so it’s a myth that obesity is completely under voluntary control; all these things contribute to weight and BMI

Question 5

what are the trends in rates of obesity in the US?

Answer 5

so much more obesity it’s insane….

especially in the south

with each decade, there’s more states reporting higher levels of obesity

Question 6

what are the 7 principle eating disorders?

Answer 6

1. anorexia nervosa (AN); restricting type and binging/purging type
2. bulimia nervosa (BN); purging and/or non-purging can occur but NOT a type
3. binge eating disorder (BED)
4. pica-eating non-food stubstances
5. rumination disorder; repeated regurgitation of food
6. night eating disorder
7. avoidant restrictive food intake

Question 7

what is the DSM5 for anorexia nervosa?

Answer 7

A. persistent energy intake restriction leading to significantly low weight (weight that is less than minimally normal/healthy)

BMI < 18.5

B. intense fear of gaining weight (being fat) or persistent behaviors that interfere with weight gain

C. a disturbance in self-perceived weight or shape, or persistent lack of recognition of the seriousness of current low body weight

Question 8

what is the restricting type of anorexia nervosa?

Answer 8

1. during last 3 months
2. NOT engaged in recurrent binging or purging
3. weight loss through dieting, fasting and/or exercise

Question 9

what is the binge eating and purging type of anorexia nervosa?

Answer 9

1. during past 3 months

2. recurrent episodes of binge eating or purging behavior (vomiting, misuse of laxatives, diuretics, enemas)

Question 10

what are the signs and symptoms associated with anorexia nervosa?

Answer 10

1. dry skin
2. cold intolerance; hypothermia, blue/purple hands and feet
3. lanugo hair; scalp hair loss
4. constipation
5. primary or secondary amenorrhea
6. orthostatic hypotension
7. sinus bradycardia
8. osteoporosis
9. depression
10. anxiety
11. hypochondriasis
12. isolation
13. food preoccupation

Question 11

what is the prognosis for anorexia nervosa?

Answer 11

10-31% with poor outcome

mortality increases 5.6% per decade of disease

~15% may develop bulimia nervosa, up to 50% develop some other eating disorder –> because eventually if you survive anorexia for more than a decade or two, it really turns into more of BN than AN

prolonged time to full recovery = average 6 years; therapist, families and doctors have to be in this for the long run

risk for depression, anxiety, alcohol abuse

~ 45% never marry

Question 12

what is the course of anorexia nervosa?

Answer 12

prepuberty weight –> gain weight in adolescence –> anorexia

so now they’re consciously trying to lose weight by reducing calories or they’re purging

as you try to improve and gain weight, you reach a critical point where they will feel acutely feel worse and a lot of people drop out of therapy/treatment at this point because because at that point in their weight was too hard

Question 13

what is the DSM5 criteria for bulimia nervosa?

Answer 13

A. recurrent binge eating

eating in a discrete period of time (e/g/. 2-hours) an amount that is larger than most individuals would typically eat; lack of control over eating during that episode

B. recurrent compensatory behaviors to prevent weight gain like vomiting, misuse of laxatives, diuretics, fasting excessive exercise

C. binge eating & compensatory behaviors occur on average once per week for 3 months

D. self evaluation unduly influenced by body shape & weight

E. does not occur exclusively during episodes of anorexia nervosa

Question 14

what are the signs and symptoms associated with bulimia nervosa?

Answer 14

1. mouth sores
2. dental problems
3. esophageal tears
4. pharyngeal trauma
5. swollen parotid glands
6. Russel’s sign (knuckle calluses)
7. bloody diarrhea
8. irregular periods
9. heartburn, chest pain
10. muscle cramps
11. weakness

Question 15

what is the prognosis for bulimia nervosa?

Answer 15

mortality unknown

frequent relapses after recovery

20-46% may have eating disorder symptoms 6 years after treatment

55% develop mood disorders

42% develop substance abuse disorders

10-15% cross-over to anorexia (can move back and forth) –> you cannot be diagnosed with both!! someone who is bulimic is not underweight 99% of the time which is the defining difference between the two

Question 16

what is the DSM5 criteria for binge eating disorder?

Answer 16

A. recurrent binge eating episodes

eating in a discrete period of time (e/g/. 2-hours) an amount that is larger than most individuals would typically eat with a lack of control over eating during that episode

B. eating episodes associated with at least “3” of the following:

1. eating very rapidly
2. eating until uncomfortably full
3. eating when large amounts of food when not hungry
4. eating alone due to embarrassment
5. feeling guilty or disgusted with self after a binge

C. marked distress concerning the binge is present

D. episodes occur at least once per week for 3 months

E. NO recurrent compensatory purging, exercising, or fasting and Anorexia or Bulimia is not present

Question 17

what is Pica- eating non-food substances?

Answer 17

persistent eating of non-food substances >1 month

ex. chalk, balloons, chalk, grass, crayons, sand, soap, baby powder, clay
cornstarch: ½ box can send blood sugar rocketing
2. inappropriate to developmental level
3. not part of culturally normative practice

Question 18

what is rumination disorder?

Answer 18

repeated regurgitation of food for > 1 month

not associated with medical disorder

does not occur exclusively during AN or BN or Binge eating Disorder

Question 19

what causes eating disorders?

Answer 19

there’s no agreed upon cause, it’s multifactorial

1. genetics
2. psychosocial/family

enmeshment (no emotional boundaries, overprotection, rigidity –> so these eating disorders are their way of having control over something when their family takes away all the other control in their life

3. cultural

feminine vs. masculine ideals and media images

Question 20

what is enmeshment?

Answer 20

family allows individual members little-to-no autonomy or personal boundaries

encouraged to feel whatever the rest of the family feels and strongly discouraged from developing their own feelings and preferences

Question 21

what do you need to consider when treating someone with anorexia?

Answer 21

someone with anorexia wants to be working with someone who “likes” their symptoms

they see therapy/treatment as a violation of their values and rights because they have a right not to eat; all they see are the pros of anorexia

you have to find a way to work together and talk about the depression, anxiety, how they feel about themselves etc. instead of talking about their weight because it won’t work

Question 22

how do you treat eating disorders?

Answer 22

1. treat medical complication first!
2. treat co-occurring psychiatric disorders like depression, anxiety, substance use, etc.
3. hospitalization may be an option
4. outpatient psychotherapy

Question 23

what psychotherapy options can be used to treat eating disorders?

Answer 23

1. motivational Interviewing: helps in initiating treatment
2. cognitive behavior therapy: helpful for Bulimia and Binge Eating; is often used in Anorexia but the evidence is equivocal
3. family therapy – small effect sizes for Anorexia
4. interpersonal therapy: small effect sizes for anorexia

Question 24

how are medications used to treat eating disorders?

Answer 24

they have a limited role because most are unwilling to take medications and they’re very sensitive to side effects

sometimes people with bulimia will take SSRIs for depression

Question 25

which of the following symptoms are more likely to indicate bulimia nervosa?

A. amenorrhea, fainting

B. dry skin, cold intolerance

C. mouth sores, knuckle

D. soft skin, fine hair

E. migraine, subcutaneous fat

Answer 25

C. mouth sores, knuckle