L10 - Eating Disorders 1

Question 1

What are the growing rates of dieters?

Answer 1

• 42.2% of adolescents trying to lose weight in 2015
• 26% of people in England and Wales in 2021 are obese

Question 2

What was a study looking at changes in weight control behaviours and weight perception in adolescents in the UK?

Answer 2

• Methods: examined weight controlled behaviours, weight perception and depression in 3 cohorts of adolescents born in 1970, 1991-2 and 2000-2
• Results: Increase in weight control behaviours over time
• Higher in girls but prevalence increased more in boys
• Results not explained by changes in BMI across cohorts
• Increase over time in adolescent’s over-estimating their weight
• Overestimation of weight is associated with higher depression

Question 3

What is the role of the media

Answer 3

• Media bombard us with a standard of beauty
• Promotes thin ideal
• Media forms associations between beautiful (thin) people with happy lives and high moral standards

Question 4

What was a study on body image in women?

Answer 4

• 146 undergrad women had an ecologically momentary assessment: frequency of appearance comparisons, direction of comparison, context, satisfaction, mood, diet/exercise thoughts and behaviours
• In person comparisons were most common context
• Upward comparisons most common and were associated with greatest negative outcomes on social media

Question 5

What is an Eating Disorder?

Answer 5

• Persistent disturbance of eating, or eating-related behaviour
• Impaired physical health and psychological wellbeing
• Examples are Anorexia Nervosa, Bulimia Nervosa and Binge-Eating Disorder

Question 6

What is Anorexia Nervosa?

Answer 6

• Restriction of energy intake relative to requirements, leading to significantly low body weight
• Intense fear of gaining weight
• Disturbance in the way one’s body weight or shape is experiences
• Results in restricting and binge-eating/purging

Question 7

What are the Psychological Symptoms of AN? (DIP IN LID)

Answer 7

• Intense fear of weight gain
• Irritability and anxiety
• Low self-esteem
• Pre-occupation with food, calories, weight, size
• Impaired memory, attention, concentration
• Not recognising the seriousness of the condition
• Distorted or unhelpful thinking styles
• Distorted body image

Question 8

What are the behavioural symptoms of AN?

Answer 8

• Avoidance or restriction of eating
• Excessive exercising
• Lengthy/frequent toilet visits
• Overt or secret
• Drinking excessive fluids

Question 9

What are the physiological symptoms of AN?

Answer 9

• Affects whole body
• Brain and nerves: can’t think right, fear of gaining weight, moody, bad memory
• Heart: low bp, slow heart rate, heart palpitations and heart failure
• Hair: thins and brittles
• Blood: anemia
• Muscles: weak, swollen joints, fractures, osteoporosis
• Kidneys: stones and failures
• Body fluids: low potassium, magnesium and sodium
• Intestines: constipation, bloating
• Skin: bruise easily, dry skin, growth of fine hair all over body, get cold easily, yellow skin, brittle nails

Question 10

What is Bulimia Nervosa (BN)

Answer 10

• Recurrent episodes of binge eating: feel a lack of control overeating
• Recurrent inappropriate compensatory behaviours to prevent weight gain
• Binge-eating and compensatory behaviours occur on average once a week for three weeks
• Self-evaluation unduly influenced by body shape and weight
• Not experiencing AN
• Includes Purging and non-purging

Question 11

What is Binge-Eating Disorder (BED

Answer 11

• Recurrent episodes of binge eating
• 3+ of the following: Eating more rapidly than normal, till uncomfortably full, large amounts of food when not hungry, eating alone due to embarrassment, feelings of disgust/depression/guilt
• Distress
• At least once a week for 3 months on average
• No compensatory behaviour: Not AN/BN

Question 12

What are comorbidities with eating disorders?

Answer 12

• Depression
• OCD
• Substance-Use disorders
• Personality disorders
• Autism spectrum disorder
• Eating disorders crossover with each other

Question 13

What are other un/specified Eds?

Answer 13

Using DSM-IV diagnostic criteria, 60% of treatment seeking adolescents and adults are diagnosed with ‘Eating Disorder Not Otherwise Specified’

Question 14

What is the transdiagnostic CBT-Model?

Answer 14

• Developed to address the high degree of movement within Eds and to support those who have an unspecified ED
• Life events that affect mood, stress, wellbeing
• Thoughts include: over-evaluation of eating, perfectionism, low self-esteem
• Behaviours: restriction of energy/food intake/binge eating, and compensatory weight control behaviours
• Emotions: Negative emotions and difficulty tolerating these
• Physiological: physical health changes related to low body weight
• Apply to both BN and AN

Question 15

What is the prevalence of ED?

Answer 15

• Binge Eating Disorder - 2%
• BN - 1%
• AN - 0.9% women, 0.3% men
• Other: most common

Question 16

Is the prevalence of ED changing over time?

Answer 16

• Mistakenly thought to be a modern condition
• AN stable for past decades, incidence among those <15 yo has increased
• BN increase 1970-1990, but now in decline

Question 17

What was a study looking at who would have an ED?

Answer 17

• Searched movie and TV characters depicting individuals with an ED and coded demographics of each character
• Heterosexual: 75.56%
• White: 84.85%
• Women: 89.39%
• Under 30yo: 84.85%

Question 18

What is the Average age of onset of Eds?

Answer 18

• AN: 16-20yo
• BN: 21-24
• BED: 30-50

Question 19

What is the difference in gender in Eds?

Answer 19

• Gender ratio previously thought to be 10:1, but recent estimates suggest 3:1
• Men experience more sociocultural pressure to have toned/muscular bodies
• Gay and Bisexual men

Question 20

Why are Eds underdiagnosed in men?

Answer 20

• Seen as a women’s disorder
• Bias in diagnostic criteria: emphasis on desire to be thin vs lean/muscular, and methods of weight control
• Leads to risk of misdiagnosis and less likely to receive appropriate, specialist treatment

Question 21

What is the diversity of EDs?

Answer 21

• Lack of cohesion and sense of belonging in identity
• ED serves a purpose: gain control and to affirm gender identity
• Discrimination
• EDs are experienced differently by people who are gender diverse or neurodivergent
• Perception that different identities are intertwined and interact

Question 22

How are Eating disorders are multi-determined?

Answer 22

• Biological factors
• Individual risk factors
• Family influences
• Sociocultural factors

Question 23

What are the genetics of ED?

Answer 23

• Start by looking at family rates since one would predict higher rates in relatives
• Found ED at 3x more common among relatives of individuals with AN or BN than among relatives of individuals without AN/BN
• Indicative of some element of familial transmissibility
• AN > 10 times more common in relatives In AN sufferers
• Twin studies show there is a strong but not 100% genetic contribution
• If there is genetic mechanism underlying the familial pattern, it is not an all-or-nothing mechanism, more consistent with increased susceptibility

Question 24

How is the genetic influence mediated?

Answer 24

• Three obvious ways:
• Determination of body weight/space/size
• Determination of brain chemistry
• Determination of personality traits
• Not mutually exclusive

Question 25

What brain structures are involved in EDs?

Answer 25

• Hypothalamus: Ventromedial hypothalamus and lateral hypothalamus are involved in satiety and appetite
• Frontal Cortex: Temporal cortex is involved in body image perception & Orbitofrontal cortex involved in monitoring the stimuli pleasantness

Question 26

What neurotransmitters are involved in Eds?

Answer 26

• Serotonin: Involved in mood, obsessions, appetite regulation and impulse control
• Patients with AN have low levels of serotonin metabolites
• After recovery, BN/AN patients have higher levels of 5-HIAA than controls
• Dopamine: Recent interest given its role in reward systems

Question 27

What is Set Point Theory?

Answer 27

• Hormones involved in appetite and weight regulation
• Hormones: Leptin (satiety) and Grehlin (hunger)
• Leptin reduces and grehlin increases food intake
• Leptin secretion is profoundly disturbed in AN and the degree of hypo-leptinaemia in acute AN is an indicator of the severity of the disorder.

Question 28

Puberty and the role of Sex Hormones:

Answer 28

• Puberty is a key risk period for the development of Eds
• Most theories focus on the risks arising from the psychosocial effects of pubertal development in girls
• Before puberty, genetic influences account for 0% of the variability in disordered eating, but genetic factors account for over 50% during and after puberty
• Oestradiol is potent regulator of gene transcription in CNS and recent theories propose that ovarian hormones may activate genetic risk for disordered eating in girls during puberty

Question 29

Study looking at support for Eds?

Answer 29

• Facebook micro-intervention to improve body image
• Randomly assigned to one of 1. body positive facebook group, 2. appearance neutral facebook 3. facebook as usual
• Body positive and neutral groups experienced decreased body dissatisfaction (small to medium)
• Body positive group experienced decreased appearance comparisons (small to medium effects)

Question 30

Activities to Promote Positivity Body Image and Body Acceptance?

Answer 30

• Curate body positive and inclusive messages
• Exercise for pleasure, strength and accomplishment
• Make a gratitude list
• Challenge negative body talk
• Practise self-kindness