L11 - eating disorders

Question 1

What are eating disorders characterised by?

Answer 1

A persistent disturbance of eating/ eating-related behaviour resulting in the altered consumption of food and that significantly impairs physical health or psychosocial functioning

Question 2

What is Pica?

Answer 2

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

Question 3

What is Rumination Disorder?

Answer 3

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

Question 4

What are the characteristics and diagnostic criteria of avoidant/ restrictive food intake disorder?

Answer 4

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

Question 5

When does avoidant/ restrictive food intake disorders typically develop?

Answer 5

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Infants may be irritable and difficult to console during feeding or may appear apathetic (showing no interest) and withdrawn

Question 6

What are the characteristics and diagnostic criteria of anorexia nervosa?

Answer 6

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

Question 7

What are the physical changes associated with anorexia nervosa?

Answer 7

Low blood pressure

Slowed heart rate

Kidney and gastrointestinal problems

Hormonal changes

Anaemia

Loss of hair, tooth decay

Amenorrhea (loss of period)

Question 8

What are the emotional/ behavioural characteristics of anorexia nervosa?

Answer 8

Depressed mood

Social withdrawal

Irritability

Insomnia

Diminished interest in sex

Question 9

What disorders have a co-morbidity level with anorexia?

Answer 9

Bipolar

Depressive

Anxiety disorders

Question 10

What are the prevalence rates of anorexia, when does the disorder typically begin and what % of individuals recover?

Answer 10

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

Question 11

What are the characteristics and diagnostic criteria of bulimia nervosa?

Answer 11

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

Question 12

What are the physical characteristics od bulimia?

Answer 12

Menstrual irregularities

Tearing of tissue in stomach and throat, gastric rupture

Potassium depletion

Cardiac arrhythmias

Loss of dental enamel

Salivary glandules swollen

Question 13

What disorders have a co-morbidity level with bulimia?

Answer 13

Increased frequency of depressive symptoms, bipolar and depressive disorders

Question 14

What are the prevalence rates of bulimia, when does the disorder typically begin and what % of individuals recover?

Answer 14

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

Question 15

What are the characteristics and diagnostic criteria of binge eating?

Answer 15

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

Question 16

What are the prevalence rates of binge eating and what disorders have a co-morbidity level with binge eating?

Answer 16

0.6-5.8% in women
0.3-2% in men

Bipolar
Depressive and anxiety disorders
Substance use disorders

Question 17

What are genetic factors of anorexia and bulimia?

Answer 17

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

Question 18

What are neurobiological factors of anorexia and bulimia?

Answer 18

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

Question 19

What are the sociocultural factors of anorexia and bulimia?

Answer 19

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

Question 20

How can family processes influence the onset of anorexia and bulimia?

Answer 20

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

Question 21

What are the causes of binge eating?

Answer 21

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)

Question 22

What are the treatments for anorexia?

Answer 22

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

Question 23

How effective is CBT in treating anorexia?

Answer 23

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.

Question 24

What is the treatment for Bulimia?

Answer 24

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)

Question 25

What is the treatment for binge eating?

Answer 25

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)

Question 26

Why did the Pandemic result in an increase in eating disorders?

Answer 26

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