INP midterm - EATING DISORDERS

Question 1

Arguments for or against obesity as a medical disorder.

Answer 1

For: genetic influences are strong
–> MCR4 binge eating and FTO - eating high caloric foods

Against: environmental factors contribute to risk and are slow to changes
–> penetrance for genetic effects isn’t 100%

Question 2

Arguments for or against obesity as a behavioral disorder.

Answer 2

For: expression of obesity is ultimately mediated by behavior (intake > expenditure)
–> long-term behavior change, even in high risk environments, is not impossible

Question 3

Arguments for or against obesity as an eating disorder.

Answer 3

For: people who have binge eating (BED) and night eating (NES) can develop obesity

Against: Not ALL obesity is associated with disordered eating.

Question 4

What constitutes an ED in the context of obesity?

Answer 4

1) do obese people eat more than their ‘healthy’ counterparts? most do. sustained and high energy intake often leads to overweight/obesity
2) do obese people display abnormal pattern of eating? some do, especially those with binge eating and night eating disorders

Question 5

What are the DSM-V diagnostic criteria for Binge Eating Disorder (BED)?

Answer 5

1) Recurrent episodes of binge eating with: lack of sense of control and amount of food is relatively large
2) Occurs at least 1 per week for 3 months
3) No regular use of compensatory behavior
4) Feeling of distress and impeding on daily function

Question 6

What are the associated features with binge eating disorder?

Answer 6

1) Greater impairment in work and social functioning
2) Greater concern with body shape and weight
3) Increased general psychopathology (BSI)
4) Greater proportion of adult life on diets
5) More frequent H/O depression, alcohol. drug abuse, and treatment for emotional problems

Question 7

Binge eating disorder - medication as a treatment option

Answer 7

Short-term
–> placebos effective short-term

Short and long-term

• -> Antidepressants
• -> Appetite suppressants (i.e. dexfenfluramine sibutramine)
• -> Anticonvulsants

Question 8

Binge eating disorder - cognitive behavioral therapy as a treatment option

Answer 8

–> change thoughts about behavior to solve problem

–> good results

–> BEST studied

–> caveat: effective for binge eating disorder but NOT weight loss

Question 9

Binge eating disorder - interpersonal psychotherapy as a treatment option

Answer 9

–> based on idea that binge eating is maintained by unresolved problems in interpersonal functioning

–> Problem areas: grief, interpersonal role dispute, role transition, interpersonal deficit

–> Promising therapy

–> associated with improved weight course

Question 10

Binge eating disorder - dialectical behavioral therapy as a treatment option

Answer 10

–> sees binge eating as a response to stress

–> focus on emotional, mindfulness, and stress relieving therapy

–> Promising therapy

Question 11

Binge eating disorder - behavioral weight control as a treatment option

Answer 11

LCD: low calorie diet (restriction)

VLCD: very low calorie diet (restriction)

Question 12

What is night eating syndrome by DSM-V criteria?

Answer 12

1) Recurrent episodes of night eating (eating after awakening from sleep or excessive food consumption after the evening meal aka more than a midnight snack)
2) Awareness and recall of eating
3) Not explained by external influences or local social norms, BED, or another medical disorder or substance use
4) Causes significant distress and/or impairment in function

Question 13

What are some of the psychological abnormalities and treatment options for night eating syndrome?

Answer 13

ABNORMALITIES
–> More eating episodes/24 hours

–> More night time awakenings

–> Greater proportions of energy intake at night

–> Eating the heaviest meals at night

–> 52% (more than half) of awakenings accompanied by food intake

–> Higher depression scores

–> Lower self esteem

–> Less daytime hunger

–> Less success in weight loss programs over the 1 month follow-up assessment

TREATMENT

• -> CBT
• -> Medication
• sertraline and potentially topiramate

Question 14

Do obese patients have higher rates of psychiatric illness?

Answer 14

Yes
–> People who come in for treatment generally have 1+ co-morbidities

–> Most obese people are not psychiatrically ill, but they are important signals for depression and possibly anxiety

Question 15

What types of psychiatric illness are more prevalent in this population and what group is at highest risk?

Answer 15

Major depression
–> And depression with suicidal ideation

Mood and anxiety disorder
–> With and without substance use

There has been a reciprocal relationship between obesity and depression

 - -> Obesity causes depression and depression contribute to the prevalence of obesity
 - -> Indicates a cycle of depression and obesity

Question 16

What are the other burdens of obesity?

Answer 16

Negative Attitudes
–> This can come from children (bullying), health care providers (discrimination), and internalized fat-phobia

Opportunity Costs
–> Employment and earnings, college acceptance, rental availabilities, marriage opportunities

Expenses ($51.6 BILLION in direct medical costs)

Daily wear and tear… of everything

Attribution of control (“if only you would lose weight…”)

Question 17

Theory of the development of eating disorder - how do predisposing factors lead to the development of an eating disorder

Answer 17

back and forth relationship between ED and health

Predisposing factors (risk factors i.e. genes, gender, cultural ideals of beauty) → precipitating (triggering) factors → amplifying & maintaining factors (e.g. reinforcement of weight loss, gastric emptying/CCK release, vomiting)→ EATING DISORDER 
 --> How health and genetics can lead to eating disorder

Question 18

DSM-V criteria for anorexia nervosa (AN)

Answer 18

1) Restriction of energy intake relative to requirements leading to a significantly low body weight
2) Intense fear of gaining weight or persistent behavior to avoid weight gain
3) Persistent lack of recognition of the seriousness of current low body weight

Subtypes: restricting and binge/purge

Question 19

What are some risk factors and important physical consequences of AN that were discussed in class?

Answer 19

Lanugo → thin fine hairs on the body → resolve after the resolution of AN

Arrhythmias (prolonged QT) → associated with low weight and sudden death →

High CHL in the liver → reduction in fatty foods does not solve this

Osteoporosis → permanent

Question 20

Explain how AN and its metabolic sequelae develop and whether they are permanent or reversible.

Answer 20

→ Adipose tissue distribution
→ Biochemical abnormalities
→ Physical signs: lanugo, brittle hair/nails
All of these above recover after treatment

Bone density does NOT recover after treatment

Question 21

What are the main treatment goals for AN (according to APA Practice Guidelines)

Answer 21

→ Restore body weight to normal limits

→ Correct biological and psychological sequelae of malnutrition

→ Normalize eating patterns

→ Achieve normal perceptions of hunger and satiety

Question 22

How are the APA treatment goals achieved?

Answer 22

→ Clear, reasonable weight gain goals

→ Family involvement, if appropriate

→ Nutritional education and support

→ Back-up plans (more structured treatment, if needed)

→ Measure success in physiologic terms (i.e. restoration of menses)

Question 23

What are the results of weight gain in the patient with AN with regards to body composition?

Answer 23

Adipose tissue not distributed normally during weight recovery

Adipose disproportionately deposited around waist and in abdominal cavity in women with AN

The study showed that for patients who maintain normal body weight over a 1y period had a normalized adipose tissue distribution

Question 24

What are the key diagnostic features of Bulimia nervosa?

Answer 24

→ Episodes of binge eating

→ Inappropriate compensatory behavior

→ Without concurrent AN** can’t have both AN and BN

Question 25

What are some of the physical consequences of Bulima nervosa?

Answer 25

→ Dental erosion

→ Russell’s sign
→ callous on the knuckles due to sticking fingers in the back of the mouth and rubbing teeth

→ Salivary gland enlargement
→ not permanent
→ usually goes away about 3-4 wks after the stopping of purging

Complications due to purging
→ swallowing item used to purge with (example: fork :/ )

Question 26

What are the key practice guidelines and treatment strategies for bulimia nervosa?

Answer 26

→ psychotherapy

→ medication - antidepressants - work better than placebo

Note: Bulimia has been seen to be more responsive with medication and CBT treatment than AN in meta-analysis

Question 27

Theory of the development of eating disorder - how does treatment reinforce better health with those suffering from an eating disorder?

Answer 27

Treatment → Secondary prevention (e.g. school-based programs for screening and support) → protective (resilience) factors/ primary preventions (e.g. accepting environment, and positive body self-esteem)
–> This is how treatment, prevention, and support can help lead to better health in individuals with ED