Lecture 12: Eating Disorders: Chapter 11 Flashcards
What are the 8 feeding and eating disorders in the DSM?
- Pica
- Rumination disorder
- Avoidant/restrictive food intake disorder
- Anorexia Nervosa
- Bulimia Nervosa
- Binge-eating disorder
- Other specified feeding or eating disorder
- Unspecified feeding or eating disorder
Which 3 eating disorders occur often in children?
- Pica
- Rumination disorder
- Avoidant/restrictive food intake disorder
What is pica?
Eating nonfood substances for extended periods
What is rumination disorder?
Repeated reurgitation of foods (bring food back to the mouth)
What is avoidant/restrictive food intake disorder?
Diminished interest in food based mostly on the sensory aspects of food
What is nervosa?
It indicates that the loss of appetite is due to emotional reasons
What are the 3 main symptoms of anorexia nervosa?
- Restriction of food that leads to very low body weight; body weight is significantly below normal
- Strong fear of weight gain or behavior that interferes with weight gain
- Distorted body image
How is weight loss typically achieved in anorexia?
Dieting, purging (laxatives, induced vomiting) and excessive exercise
What is the difference in binge eating between anorexia and bulimia?
Bulimia: very big binge: 4000-10000 calories in a very short time
Anorexia: think they have a binge while they don’t (2 slices of bread)
What are the 2 subtypes of anorexia nervosa?
- Restricting
- Binge-eating/purging
How can you assess the severity of anorexia?
with BMI
What is striking in assessing body image in people with anorexia?
They overestimate their current size and ideally would be very thin
When does anorexia typically start?
Early to middle teenage years
How are the gender differences in prevalence for anorexia?
3x more likely in women
What are typical symptoms of anorexia in men?
More emphasis on muscularity as well as thin or lean bodies
Why is there such a large gender difference for anorexia prevalences?
Greater cultural emphasis on women’s beauty, which has promoted a thin body shape as the ideal
What are comorbid disorders with anorexia?
Depression, OCD, specific phobias, panic disorder, various personality disorders
What are the suicide rates among people with anorexia?
5% completing suicide
20% attempting suicide
What are some physical consequences of anorexia?
Low blood pressure, slow heart rate, kidney problems, decline bone mass, dry skin, brittle nails, change in hormones, hair loss, tiredness, weakness, cardiac arrhythmias
What percentage of people recover from anorexia? How long does that take?
50-70%
Takes 7 years approximately. Relapses are common
What is often the cause of death in people with anorexia?
Physical complications (heart failure), especially for people who suffered for years
What is the main difference between anorexia and bulimia?
Anorexia: extreme weight loss
Bulimia: no weight loss
What are the 3 main symptoms of bulimia nervosa?
At least 3 months, once a week
1. Repeated episodes of binge eating
2. Repeated compensatory behaviors to prevent weight gain, such as vomiting
3. Body shape and weight are extremely important for self-evaluation
What are diuretics?
Pills that make you pee a lot and lose liquid in your body. They don’t really help with losing weight
How do you the assess the severity of bulimia?
Amount of compensatory behaviors per week
What are common comorbid disorders of bulimia?
Depression, personality disorders, anxiety disorders, substance use disorders, conduct disorder
How are the suicide rates in bulimia compared to anorexia?
Higher rates than the general population, but substantially lower than in anorexia
What comes first, bulimia or the comorbid disorder? What can we conclude from this?
Bulimia surfaced before substance use disorder
Bulimia predicted the onset of depression, but depression also predicted onset of bulimia symptoms
So each disorder increases risk for the other
What are the physical consequences of bulimia?
Potassium depletion, diarrhea, irregular heart beat, tearing of tissue in the stomach and throat, dental damage, swollen salivary glands
What percentage of people with bulimia recovers? What percentage remains fully symptomatic? What is linked to a better prognosis?
70% recovers
10-20% remains fully symptomatic
Intervening soon after diagnosis has a better prognosis
What are the 2 defining symptoms of binge eating disorder?
At least 3 months, once a week
1. Repeated binge eating episodes
2. Binge eating episodes must include several features (eating fast, eating even if not hungry, eating past feeling full, feeling bad about eating so much)
When are you obese?
When you have a BMI over 30
What is the distinction between bulimia and binge eating disorder?
Binge eating disorder has no compensatory behaviors
How do you assess the severity of binge eating disorder?
The amount of binges per week
Explain how not all obese people meet criteria for binge eating disorder?
Only those who have binge episodes and report feeling a loss of control over their eating qualify for this diagnosis
What are physical consequences of binge eating disorder?
Increased risk diabetes 2, cardiovascular problems, chronic back pain, headaches, sleep problems, anxiety, depression, early onset of menstruation
What is the prognosis of binge eating disorder?
25-82% recover
Duration of recovery may take longer than recovery for anorexia or bulimia
What are 8 subscales of eating disorders?
- Drive for thinness
- Bulimia
- Body dissatisfaction
- Ineffectiveness
- Perfectionism
- Interpersonal distrust
- Interoceptive awareness
- Maturity fears
What is the basic idea behind the transdiagnostic model?
It’s based on the observation that the main maintaining processes are likely to be largely the same across different eating disorder diagnoses
What would someone with an eating disorder say that is a big part of the self-image?
Largely body weight and shape
Why does the frequency of binging increase in bulimia?
Because there is compensating behavior ‘undoing’ the binging (I can purge the calories later)
How is binge eating perceived in eating disorders?
As a being a failure: I don’t have self control
What are 3 things that increase chance of binge eating?
- Strict dieting and weight-control behavior
- Significantly low weight
- Events and associated mood changes
What are the 3 possible consequences of binge eating?
- Compensatory vomiting/laxative use
- Over-evaluation of shape and weight and self-control
- Strict dieting
What is a very important idea behind the transdiagnostic model? (also: study it (slide 18 eating disorders)
There are many feedback loops, so eating disorders are really a vicious cycle
What are the 6 steps of the cognitive behavior theory of bulimia? What is missing in this?
- Low self-esteem and high negative affect
- Dieting to feel better about self
- Food intake is restricted
- Diet is broken
- Binge
- Compensatory behaviors to reduce fears of weight gain
Missing: There are a lot of feedback loops missing
What are 4 additional maintaining factors besides the transdiagnostic model?
- Core low self esteem
- Clinical perfectionism
- Mood intolerance
- Interpersonal difficulties
What is the heritability of anorexia? And bulimia?
Anorexia: 0,5-0,7
Bulimia: 0,55-0,62
Which non-shared environmental factors contribute to eating disorders?
Peer interaction, parent interactiono
What is the key brain center for regulating hunger and eating?
Hypothalamus
What is the hypothalamic model? What does it not account for (3)?
There are hormonal differences in the hypothalamus as a result of self-starvation. They return to normal after weight gain.
- They do keep hungry
- Have an interest in food
- Body image disturbance not explained
There was an fMRI study of women with anorexia and controls where they had to choose between 2 foods. What were the results and what were the main differences on the brain level? What is the main conclusion of this?
Results: women with anorexia chose more often for the low calory option
Brain level: comparable activity in ventral striatum (associated with reward) during the food choice task. Different in dorsal striatum (associated with habitual choices and anxiety): more activity in anorexia
Conclusion: dieting or restrictive eating may become habitual and these habits may become rewarding
Which two disorders can be explained by the incentive-sensitization theory and what is it?
Substance use disorders and eating disorders
The craving (wanting) of food and the pleasure (liking) that comes with it –> dopamine plays a role in both aspects
Cues elicit dopamine responses, leading to craving, which promotes binging
What type of cues may elicit craving food?
External cues, such as billboards and adds
For eating problems, people with greater activation in areas of the brain associated with dopamine and reward during the presentation of food cues are …
More likely to subsequently gain weight
How is serotonin related to eating?
It’s related to feeling full
How are serotonin levels in peole with anorexia and bulimia? What may be effective treatment for this?
They are very low, so there is underactivity
Antidepressants can increase serotonin
What is the main focus of neuroscience of eating disorders nowadays? What is lacking research?
Mechanisms of hunger, eating and satiety
Lacking: fear of gaining weight, possible brain changes before the onset of eating disorders
Evidence so far doesn’t show that … come … the onset of eating disorders
What does this mean?
brain changes - before
So brain changes may happen because of under/overeating, but not the other way around. So brain processes don’t cause eating disorders
What is the emphasis of cognitive behavioral theories of anorexia? What type of reinforcement are we talking about?
Emphasis on body-image disturbance as the motivating factor that reinforces weight loss
Negative reinforcement: dieting takes away anxiety
Positive reinforcement: sense of self-control and comments from others
Do negative emotions predict restricted eating or does restricted eating predict negative emotions?
Both: restricted eating predicts more negative emotions and experiencing negative emotions predicted more restricted eating
Why is binging in bulimia a vicious cycle?
The purging temporarily reduces anxiety from eating too much, but it also lowers self-esteem, leading to more binges
When do people with bulimia typically binge?
When they encounter stress and experience negative emotions
What are the results from cognitive research on attention and problem solving in eating disorders? (2)
- Focus attention more on and remember more food-related words
- Pay more attention and remember other people’s body size better than emotions
What is the paradox of the body image culture?
The ideal body is thin according to culture, but obesity is getting far more common
Which group of people is at higher risk of developing an eating disorder and why?
People who are overweight or have fear of becoming overweight, because of cultural norms of being thin
What is a social predictor of body dissatisfaction in men?
Greater discrepancy between muscularity of actual self and ideal self, increased after viewing images of muscular men
How does the real-ness of body pictures affect body image?
It doesn’t matter if the pictures are real or not, they are associated with a negative body image and they are also seen as very real (despite knowing they’re fake)
What is the influence of viewing pro-eating disorder websites on eating behavior?
Viewing these sites led to eating more the following period
What is the objectification theory?
Prevalence of objectification messages (e.g. women viewed through sexual lens) leads to self-objectification in women (seeing their bodies through the eyes of others. It causes women to feel more shame about their bodies.
What is some evidence on the question if eating disorders and weight concerns go away with age?
Women: Eating disorder symptoms decreases, risk factors for eating disorders decreases, even though they weighed more
–> possibly because of changes in life roles
Men: more concern about weight and more dieting
What is the difference in anorexia cross culturally? (2)
- Less cases of eating disorders in non-western countries
- Intense fear of weight gain is not the main reason of anorexia in non-western cultures
Why does bulimia increase in non western countries?
Because they adopt more westernized culture practices and have access to more food
What are racial/ethnic differences in eating disorder prevalences? (3)
- Anorexia: more prevalence white
Bulimia/binge eating: no large differences - White/latinx: more body dissatisfaction
- Asian Americans: more thin-ideal beliefs
What is the influence of restriction of food on personality and behavior?
It results in preoccupation with food, poor concentration, lack of sexual interest, irritability and moodiness
What is an importan personality characteristic in eating disorders?
Perfectionism –> predicted the onset of anorexia in young adult women (limited evidence though)
What are three types of perfectionism? How is this in people with anorexia?
- Self-oriented: high standards for self
- Other oriented: high standards for others
- Social oriented: trying to conform to high standards of others
Girls with anorexia have higher self and other oriented perfectionism
What is a characteristic of families that is associated with eating disorders?
High levels of conflict in family, but parent and child reports don’t always agree when describing characteristics of families of people with eating disorders
Troubled family situations can be a cause but also a result of eating disorders
What happens when a person with anorexia is hospitalized?
For intravenous feeding to save a person’s life
What is the effectiveness of treating eating disorders with antidepressants?
Bulimia: It’s effective in reducing purging and binge eating and treats the often comorbid depression
Anorexia: little success
Binge eating: not effective (limited evidence)
What are the 2 goals of treatment of anorexia?
- Immediate gaining weight, avoiding medical complications
- Long-term maintenance of weight gain
What are 2 common psychological therapies of anorexia?
CBT or Psychotherapy –> reduces relapse
How can family therapy help treating anorexia?
Based on the notions that interactions among members of the family can play a role in treating the disorder
What is the most validated treatment of bulimia? How does it work?
CBT: question society’s standards for physical attractiveness and seeing that healthy body weight can be maintained without severe dieting –> altering all or nothing thinking
Are outcomes of treating bulimia better if antidepressants are added to CBT?
Mixed evidence: may be useful to alleviate depression, but not enough evidence
What is CBT guided self help (CBT-gsh) in bulimia?
People receive self-help on topics such as perfectionism, body image, negative thinking and food and health. They briefly meet with a therapist –> effective treatment compared to wait-list control group
What are 3 effective treatments for binge eating disorder?
- CBT
- IPT (interpersonal therapy)
- CBT-gsh
What is the most effective treatment of binge eating disorder?
A therapist leading a CBT group
What is a transdiagnostic process?
The label given to a mechanism which is present across disorders, and which is either a risk factor or a maintaining factor for the disorder
What is the body project prevention program?
Focused on deemphasizing sociocultural influences on thinness
What is the healthy weight program? Is it effective?
Working on healthy weight and exercise programs for themselves, not that effective!
What are 5 important aspects of treating eating disorders?
- Motivation
- Autonomy
- Good therapeutic relationship
- Focus on eating, self-evaluation, interpersonal things
- Activities
What can be treated with acceptance and commitment therapy (ACT)?
Nearly everything: it’s very transdiagnostic
