L10 - Eating Disorders 1 Flashcards
1
Q
What are the growing rates of dieters?
A
- 42.2% of adolescents trying to lose weight in 2015
- 26% of people in England and Wales in 2021 are obese
2
Q
What was a study looking at changes in weight control behaviours and weight perception in adolescents in the UK?
A
- 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
3
Q
What is the role of the media
A
- 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
4
Q
What was a study on body image in women?
A
- 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
5
Q
What is an Eating Disorder?
A
- Persistent disturbance of eating, or eating-related behaviour
- Impaired physical health and psychological wellbeing
- Examples are Anorexia Nervosa, Bulimia Nervosa and Binge-Eating Disorder
6
Q
What is Anorexia Nervosa?
A
- 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
7
Q
What are the Psychological Symptoms of AN? (DIP IN LID)
A
- 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
8
Q
What are the behavioural symptoms of AN?
A
- Avoidance or restriction of eating
- Excessive exercising
- Lengthy/frequent toilet visits
- Overt or secret
- Drinking excessive fluids
9
Q
What are the physiological symptoms of AN?
A
- 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
10
Q
What is Bulimia Nervosa (BN)
A
- 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
11
Q
What is Binge-Eating Disorder (BED
A
- 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
12
Q
What are comorbidities with eating disorders?
A
- Depression
- OCD
- Substance-Use disorders
- Personality disorders
- Autism spectrum disorder
- Eating disorders crossover with each other
13
Q
What are other un/specified Eds?
A
Using DSM-IV diagnostic criteria, 60% of treatment seeking adolescents and adults are diagnosed with ‘Eating Disorder Not Otherwise Specified’
14
Q
What is the transdiagnostic CBT-Model?
A
- 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
15
Q
What is the prevalence of ED?
A
- Binge Eating Disorder - 2%
- BN - 1%
- AN - 0.9% women, 0.3% men
- Other: most common
16
Q
Is the prevalence of ED changing over time?
A
- 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
17
Q
What was a study looking at who would have an ED?
A
- 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%
18
Q
What is the Average age of onset of Eds?
A
- AN: 16-20yo
- BN: 21-24
- BED: 30-50
19
Q
What is the difference in gender in Eds?
A
- 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
20
Q
Why are Eds underdiagnosed in men?
A
- 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
21
Q
What is the diversity of EDs?
A
- 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
22
Q
How are Eating disorders are multi-determined?
A
- Biological factors
- Individual risk factors
- Family influences
- Sociocultural factors
23
Q
What are the genetics of ED?
A
- 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
24
Q
How is the genetic influence mediated?
A
- Three obvious ways:
- Determination of body weight/space/size
- Determination of brain chemistry
- Determination of personality traits
- Not mutually exclusive
25
Q
What brain structures are involved in EDs?
A
- 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
26
Q
What neurotransmitters are involved in Eds?
A
- 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
27
Q
What is Set Point Theory?
A
- 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.
28
Q
Puberty and the role of Sex Hormones:
A
- 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
29
Q
Study looking at support for Eds?
A
- 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)
30
Q
Activities to Promote Positivity Body Image and Body Acceptance?
A
- Curate body positive and inclusive messages
- Exercise for pleasure, strength and accomplishment
- Make a gratitude list
- Challenge negative body talk
- Practise self-kindness
