Lecture 11 - Eating Disorders Flashcards
Lecture overview and themes
Introduction to anorexia nervosa, bulimia
nervosa, and binge eating disorder
* Risk factors
* Treatments
Themes
1. Nature vs nurture
2. Maintenance cycles
3. Individual differences
What EDs does this lecture look at?
Anorexia nervosa, bulimia nervosa, binge eating
What are some ways at disgnosing these
Anorexia:
BMI < 17.5; corresponding weight-for-height percentile (children)
Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight
gain
Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or
persistent lack of recognition of seriousness of low bodyweight
Anorexia nervosa (AN)
Bulimia:
Recurrent episodes of binge eating (on average at least once a week for 3 months), as characterized
by both:
* Eating objectively large amount within any 2-hour period
* Recurrent inappropriate compensatory behaviours to prevent weight gain
Self-evaluation is unjustifiability influenced by body shape and weight
The disturbance does not occur exclusively during episodes of anorexia nervosa
Binge eating:
Recurrent episodes of binge eating (at least once a week on average for 3 months), characterized by
eating objectively large amount within any 2 hours and lack of control
No compensatory behaviours associated with binge eating and doesn’t occur within an episode of
anorexia or bulimia nervosa
Binge eating associated with 3 or more of 6 features (e.g., rapid eating, eating until uncomfortably
full
Marked distress re: binge eating
Binge eating disorder (BED)
Diagnoses continued
4 severity categories:-
Mild
Moderatae
Severe
Extreme
Severity based on weight (AN) and frequency of behaviours
(BN and BED)
Different subtypes of AN: restricting; bingeing-purging
What are some consequences of disordered eating
Physical:
Heart
Temperature
Immune System
Oedema
Behavioural, cognitive and mood changes:
Rigidity
Preoccupation with food
Eating slowly
Binge eating
Narrowing interests
Dreaming about food
Difficulty sleeping
Social withdrawal
Difficulty concentrating
Low energy levels
Effects of purging
Vomiting
Dental problems
Bloodshot eyes
Swollen parotid
glands
Detached retinas
Acid reflux
Stomach tear
Stomach pain
Halitosis
Laxatives
Cathartic colon
Reliance on laxatives
Gastrointestinal pain
General
Oedema
Dehydration
Electrolyte loss, which can lead to cardiac arrest
What can binge eating lead to?
- Obesity
- Gastrointestinal Effects
- High blood pressure
- Diabetes
What is it highly co-morbid with?
Highly comorbid with
Depression
OCD
Substance misuse
On gender differences
10 times more articles on dieting and weight-management in
women’s media than in men’s and clear gender gap in EDs
Different body ideals for men women
Could this explain different rates?
There are a variety of psychological factors involved in eating disorders. Give some examples of these.
-Overevaluation of weight/shape/eating/their control is
considered a ‘core psychopathology’
Four other factors might interact with overevaluation to
exacerbate EDs for some: clinical perfectionism; core
low self-esteem; mood intolerance; interpersonal
difficulties
In some cases, e.g., binge eating disorder,
overevaluation is of less primary importance, and mood
intolerance might be the primary driver of this behaviour
However, overevaluation of weight/shape does also
seem to be associated with binge eating disorder
(e.g., Goldschmidt et al., 2010) – although, is this a
cause or consequence?
What are some features of the transdiagnostic model of eating disorders
Proposes that a core psychological feature underlies a variety
of ED presentations: overevaluation of weight/shape/eating
and their control
This leads to behaviours designed to control
weight/shape/eating, but these ultimately end up reinforcing
the initial overevaluation (a maintenance cycle / vicious cycle)
This model is the basis of CBT-E (CBT enhanced for EDs; Fairburn, 2008) and dictates the focus of treatment
Give an actual overview of this model
Overevaluation of eating,
shape, weight, and their
control can lead to:
Strict dieting and
other weight-control
behaviour which can lead to:
Low weight
“starvation
syndrome
Factors which influence all 3:
-Preoccupation with eating
-Social withdrawal
-Heightened fullness
-Heightened obsessionality
What does a psychological approach to EDs look like?
A focus on stabilising / normalising weight through targeting
behaviours such as dietary restriction, bingeing, and vomiting
Targeting the core psychological feature (overevaluation of
weight and shape) in a variety of ways…
Pie charts
Behavioural experiments
Mirror exposure
Reintroducing feared foods
There may be a focus on the other psychological elements if
present (core low self-esteem; clinical perfectionism; mood
intolerance; interpersonal difficulties)
What are some other treatments for EDs?
- Family therapy (systemic therapy)
Indicated for children and young people
In a better position to use the family’s resource’s and address family
dynamics directly (e.g., Maudsley family-based treatment for AN; group
family therapy)
2.MANTRA: specifically for anorexia / anorexic presentations and based
on research on specific factors:
Cognitive characteristics like rigidity or detail-focus
Developing a non-anorexic identity
- Medication: not to be offered as sole treatment for eating disorders
- Matrics Cymru / Matrics Plant includes other therapies in its evidence
tables, e.g., interpersonal therapy (IPT) – this was dropped from the
NICE Guidelines in 2017
When is compassion focused therapy for overating relevant
People with high levels of shame/self-criticism
People who lack self-compassion
Where the overeating seems to be rooted in these difficulties
What are some risk factors for developing EDs: the biopsychosocial perspective
- Biological factors (e.g., the effects of starvation,
genetics) - Psychological factors (e.g., overevaluation of
weight/shape, perfectionism, self-esteem) - Social (e.g., family influences, media, life experiences)
Talk more about potential biological predispositions
EDs ‘run in families’ (Wade, 2010)
However, can’t disentangle genetic from environmental influences
with family studies
Twin studies suggest some heritability (Wade, 2010; Fairburn &
Harrison, 2003)
But what is being inherited? Can you really inherit an ED?
Genetics: inconclusive as to which genes, if any, might be
involved
This field is beset with “methodological inconsistencies and few
reliably replicated findings” (Trace, 2013)
The evidence differs for different types of ED
The role of social factors
Adverse childhood experiences: Guillaume et al. (2016) found a variety of
childhood trauma subtypes (emotional, physical, and sexual abuse) to be
associated with ED symptoms
Studies are often retrospective in nature, so open to criticisms of recall bias
A study with a prospective design: Copeland et al. (2016) found that bullying
predicts ED symptoms for victims (and bullies!)
Family factors
Fairburn et al. (1997): women with BN reported higher parental expectations, dieting
within the family, comments from family members about appearance, than general
sample of people with mental health problems
People with AN perceive their family to have poorer communication, to be more
rigid, and less cohesive than controls (Vidovic et al., 2005)
Difficult to tell to what extent family dynamics are shaped by an ED…
Or how much some of this is a shared genetic traits
Studies on the role of the media
Swami et al. (2010): international study showing that more exposure to
Western media is associated with higher body dissatisfaction among
women
…however, some argue that rise of eating disorders in other
countries also due to things like urbanization and industrialisation
(Pike & Dunne, 2005 – on the rise of EDs in Asia)
Also fiji study:
The impact of TV on disordered eating in media-naïve adolescent girls
(Fiji)
Attitudes to body image changed drastically with the coming of TV in
1995 and American teenage programmes
Within 3 years the number of girls who purged to control weight rose
from 0% to 11% and sig. increased scores on the EAT-26 scale
Rethinking EDs: developed as a coping strategy
Some people might get safety/structure from them,
others might see it as a means of looking a certain way,
for others it might be to do with fertlility/sexuality and womanhood (not eating can stop periods and physical development, for example),
for some people not good at communicating emotion ED might be a way of communicating distress for example
Summary of the lecture
- AN, BN, and BED are three of the most common eating disorders
- There is crossover between these disorders and perhaps common
underlying factors - Causes are multi-factorial: genes, neurochemistry, social/emotional
and cognitive factors, parenting, peers and mass media - Complex, temporal, and bi-directional relationships
- Treatments: medication not a first-line approach; psychological
treatments such as CBT-E and family therapy, some transdiagnostic,
others specific to one type of ED
