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
