L11 - eating disorders Flashcards
What are eating disorders characterised by?
A persistent disturbance of eating/ eating-related behaviour resulting in the altered consumption of food and that significantly impairs physical health or psychosocial functioning
What is Pica?
Eating 1 or more nonfood substances (e.g., paper, soap, soil etc) on a persistent basis over a period of at least a month
Often comes to clinical attention following general medical complications e.g., intestinal obstruction
What is Rumination Disorder?
Repeated regurgitation (bringing swallowed food back to the mouth) of food after feeding or eating over a period of at least 1 month.
Regurgitated food can be re-chewed, re-swallowed or spit out
Malnutrition may occur
What are the characteristics and diagnostic criteria of avoidant/ restrictive food intake disorder?
Avoidance/ restriction of food intake
Significant weight loss + nutritional deficiency, growth, delay
Dependence on enteral feeding (tube) or oral nutritional supplements
Marked interference with psychosocial functioning
When does avoidant/ restrictive food intake disorders typically develop?
In infancy or early childhood and may persist in adulthood
Infants may be irritable and difficult to console during feeding or may appear apathetic (showing no interest) and withdrawn
What are the characteristics and diagnostic criteria of anorexia nervosa?
Significantly low body weight in context of age, sex, developmental trajectory and physical health (usually involves starvation and/or purging
Persistent behaviour that interferes with weight gain e.g., strenuous exercise
Intense fear of gaining weight
Disturbance in self-perceived weight or shape
What are the physical changes associated with anorexia nervosa?
Low blood pressure
Slowed heart rate
Kidney and gastrointestinal problems
Hormonal changes
Anaemia
Loss of hair, tooth decay
Amenorrhea (loss of period)
What are the emotional/ behavioural characteristics of anorexia nervosa?
Depressed mood
Social withdrawal
Irritability
Insomnia
Diminished interest in sex
What disorders have a co-morbidity level with anorexia?
Bipolar
Depressive
Anxiety disorders
What are the prevalence rates of anorexia, when does the disorder typically begin and what % of individuals recover?
0.1-3.6% in women
0-0.3% in men
Typically begins in adolescence or young adulthood (75-90% of women)
Typical onset 14-18 years
70% recover (in 6-7 years)
but show an elevated suicide risk
What are the characteristics and diagnostic criteria of bulimia nervosa?
Recurrent episodes of binge eating followed by compensatory behaviour (fasting, vomiting, misuse or laxatives or exercising)
Occurs at least once a week for 3 months usually secretly
Individuals tend to be between normal and overweight
What are the physical characteristics od bulimia?
Menstrual irregularities
Tearing of tissue in stomach and throat, gastric rupture
Potassium depletion
Cardiac arrhythmias
Loss of dental enamel
Salivary glandules swollen
What disorders have a co-morbidity level with bulimia?
Increased frequency of depressive symptoms, bipolar and depressive disorders
What are the prevalence rates of bulimia, when does the disorder typically begin and what % of individuals recover?
0.3-4.6% in women
0.1-1.3% in men
Peak in older adolescence and young adulthood (90% are women)
70% recover (10% still show symptoms) also show an elevated risk of mortality
What are the characteristics and diagnostic criteria of binge eating?
recurrent episodes of binge eating; lack of control during binges
Marked distress about binging
Occurs on average at least once a week for 3 months
Absence of compensatory behaviours
Occurs in normal/ overweight and obese individuals
What are the prevalence rates of binge eating and what disorders have a co-morbidity level with binge eating?
0.6-5.8% in women
0.3-2% in men
Bipolar
Depressive and anxiety disorders
Substance use disorders
What are genetic factors of anorexia and bulimia?
1st degree relatives - 10% more likely to become anorexic + 4% more likely to become bulimic
Twin studies show high heritability
44-88% - anorexia
28-83% - bulimia
the remaining variance is due to non-shared/ individual specific environmental factors
What are neurobiological factors of anorexia and bulimia?
Abnormal levels of:
Cortisol - regulated by hypothalamus - consequence of starvation
Serotonin - explains comorbidity with depression
Dopamine - controls the hypothalamus + regulation of appetite –> lack of pleasure associated with eating - eat more vs less motivated to eat
What are the sociocultural factors of anorexia and bulimia?
Social pressure to be thin as it’s seen as attractive in western cultures
An increasing gap between the ‘ideal’ body and reality causing dissatisfaction and negative affect
How can family processes influence the onset of anorexia and bulimia?
Strong family attitude towards weight and shape –> successful dieting = acceptance
Lack of harmony within the family
Ineffective parenting
Both of the latter could lead to ED as a need for control over the individuals life.
Social and family norms lead to cognitive distortions (towards body shape)
self-worth becomes dependent on being thin
weight gain decreases perceptions of control and self-esteem
What are the causes of binge eating?
Food addiction - pleasurable food act as a drug of abuse - activating the dopamine reward system
Cues present at the time of meal can be associated with reward –> leads to food seeking behaviour
Negative mood and hunger higher at prebinge times
Jansen et al. (1998)
Stein et al. (2007)
What are the treatments for anorexia?
Step 1 : Hospital
Focus on weight gain –> through high calorie diet/ “force feeding”
Step 2: Out-patient
Focus on long-term cognitive and behavioural change
Achieved through CBT:
Challenge distortions
Question society’s standard of beauty
Training to realise healthy weight can be maintained without extreme dieting
Teach exercise control
Pharmacotherapy - medication influencing serotonin and dopamine activity
How effective is CBT in treating anorexia?
Allan et al. (2014)
Reviewed 16 studies
Showed that CBT is effective in treating anorexia
Improvements in BMI, ED symptoms and mental health
Outpatient CBT: Significant weight gain after 12 months BUT half of patients didn’t complete their treatment.
What is the treatment for Bulimia?
CBT
replace binge eating with 3 meals a day (without purging) and develop coping strategies (e.g., call a friend, play a game)
Eat previously avoided types of food
Stop hiding body shape (wear fitting clothing)
Learning relapse prevention strategies
Education
Develop understanding that eating regularly won’t result in weight gain
Pharmacotherapy
Treatment with Prozac - decreases eating, vomiting and depression (Walsh et al 2000)
What is the treatment for binge eating?
Behavioural treatment
Individual/ Group CBT - reduces binge eating and improves abstinence rates for up to 4 months after treatment
Proved to be effective
Pharmacotherapy:
Antidepressants, appetite suppressants and anticonvulsants (Carter et al., 2003)
Why did the Pandemic result in an increase in eating disorders?
Social isolation
Food insecurity - panic buying –> changes relationship with food
Pressure to exercise
Loss of routine + perceived control
Difficulty accessing face to face clinical services, reduced access to usual support networks
