Last Week Eating Disorders Flashcards
ANOREXIA NERVOSA overview of. Criteria
DSM 5 criteria:
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Subtypes:
Restricting type
Binge-eating/purging type
DSM-V: FEEDING AND EATING DISORDERS
Pica
Rumination Disorder
Avoidant/Restrictive Food Intake Disorder
Anorexia Nervosa
Restricting type
Binge-eating/purging type
Bulimia Nervosa Binge-Eating Disorder
Other Specified Feeding or Eating Disorder Unspecified Feeding or Eating Disorder
ANOREXIA NERVOSA: CORE FEATURES
PERSISTENT ENERGY INTAKE RESTRICTION
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Severity in DSM-V depends on BMI
BMI =
weight in kg height in meters 2
Mild: BMI > 17
Moderate: BMI = 16–16.99 Severe: BMI = 15-15.99 Extreme: BMI < 15
BMI is not the only consideration
18.5 BMI “cutoff” used by Centers for Disease Control and Prevention and WHO
But can depend on clinical history; treatment aim usually BMI = 20
For adolescents, compare to expected developmental trends (e.g., failure to make weight gain)
ANOREXIA NERVOSA: CORE FEATURES
INTENSE FEAR OF GAINING WEIGHT
Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
Phobia of gaining weight
Fear of gaining weight may not be alleviated by weight loss (may actually increase)
Fear of gaining weight at times denied: focus on behaviour preventing weight gain
DISTURBANCE IN SELF-PERCEIVED WEIGHT OR SHAPE
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Distortions in self-view (not always present): overall or specific body parts
Excessive focus on body weight and shape (e.g., frequent weighing, using tape measure, mirror)
Body weight and shape tied to self-esteem and self-concept
Thinness valued over health concerns
Can also overvalue the “control” of weight itself (seen as an accomplishment or mark of discipline)
ANOREXIA NERVOSA: SUBTYPES
RESTRICTING TYPE
Weight loss primarily accomplished through dieting, fasting, and/or excessive exercise.
Forbidden foods
Small portion sizes or specific ways of eating (e.g., small plates, small utensils)
PURGING TYPE
Binge eating or purging behaviour (self-induced vomiting, misuse of diuretics, laxatives or enemas)
Compared to bulimia, small portions and more consistent purging
Characterized by underweight, small portions. Aside on insulin purge
About 50% of patients correspond to either type
Unclear whether truly distinct
Severity?
Continuum? (common to change subtype)
Personality traits
ANOREXIA NERVOSA: CLINICAL CORRELATES
Rigid, inflexible thinking
Difficulty thinking about alternatives; don’t like change; cling to preconceptions Impediment to treatment
Depressive symptoms
E.g., depressed mood, social withdrawal, feelings of ineffectiveness
Self critical intensify symptoms
Perfectionism
Especially self-critical perfectionism
Intensifies certain aspects of the ED (e.g., extreme standards are applied to eating, weight, and shape)
Obsessive-compulsive features
Both related and unrelated to food (e.g., hoard food, collect recipes, obsessive weighing, counting calories) Concerns about eating in public
Strong need to control one’s environment
BULIMIA NERVOSA
DSM-V criteria
Recurrent episodes of binge eating:
A) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
B) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
BULIMIA NERVOSA: CORE FEATURES
BINGE EATING
Objectively large amounts of food: must ask in assessment
Roughly 1500 calories in a binge; discomfort at fullness
Shame, often kept secret
COMPENSATORY BEHAVIOURS
Severity based on frequency of compensatory behaviours per week
Mild: 1-3, Moderate: 4-7, Severe: 8-13, Extreme: 14+ In
In clinical samples, vomiting is most common
behaviour (2/3 of patients)
In community samples, exercise and strict
diet are most common compensatory behaviours (only 1/5 vomiting)
BULIMIA NERVOSA: CORE FEATURES
SELF-EVALUATION
Dominated by shape and weight
Unlike AN, weight typically in normal range
Episodes often triggered by low mood, interpersonal stressors, intense hunger following restriction, or feelings re: body shape or weight
Binges/purges can provide temporary relief from tension, dysphoria, or fullness
Often followed by low mood, shame, self-criticism
Subtypes removed in V non purging removed
BN: CLINICAL CORRELATES
Impulsivity
E.g., in relation to purging but also other behaviours Emotional instability and erratic dietary pattern
Substance abuse
Subgroup that engages in substance abuse (common overlap)
Self-injury and BPD
Subgroup meets criteria for Borderline Personality Disorder
Childhood abuse?
Mixed evidence from research
CHANGES FROM DSM-IV eating disorders ednos
Prior to DSM-V, many eating disorder patients were diagnosed as EDNOS (Eating Disorder Not Otherwise Specified):
No amenorrhea
AN symptoms but healthy weight
Frequency of binge/purge
Other syndromes (e.g., chew and spit)
To address this problem, changes were applied to the DSM-V criteria:
Anorexia: removed requirement for amenorrhea
Bulimia: reduced frequency from 2x/week to 1x/week on average
Wilson & Sysko, 2009: literature review demonstrated that the clinical characteristics for both groups were similar
Creation of binge eating disorder diagnosis
Clinical correlates and course are different from those of other EDs
Reliably diagnosed
BINGE EATING DISORDER
Recurrent episodes of binge eating:
A) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than
what most individuals would eat in a similar period of time under similar circumstances.
B) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
The binge-eating episodes are associated with 3 or more of the following:
A) Eating much more rapidly than normal.
B) Eating until feeling uncomfortably full.
C) Eating large amounts of food when not feeling physically hungry.
D) Eating alone because of feeling embarrassed by how much one is eating.
E) Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least once a week for 3 months.
Severity based on frequency of binge eating episodes / week.
The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour.
May be overweight or not
BINGE EATING DISORDER correlates
Individuals with BED differ from in meaningful ways from individuals with AN and BN
More likely to be obese
Age of onset is later
Course of BED is different e.g., dysfunctional dieting follows onset of BED whereas dysfunctional dieting often precedes onset of BN
Individuals with BED differ from individuals who are obese but do not have BED Greater psychiatric co-morbidity
Poorer functioning
CBT and IPT are associated with significantly greater improvement in functioning relative to weight loss programs alone in treatment of BED
PREVALENCE
ANOREXIA:
Prevalence: approx. 1% (APA, 2000)
Gender differences: more females than males
Males sometimes underdiagnosed
Thinness vs. athleticism
Influence of sexual orientation? (Yelland & Tiggeman, 2003; Martins et al., 2007
