Lecture 13 Anorexia

Question 1

diagnosis criteria for AN

Answer 1

Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health)

Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).

Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Question 2

specifier/subtypes of AN

Answer 2

restricting: during last 3 months, not engaged in recurrent episodes of binge/purge, weight loss accomplished primarily through dieting, fasting, excessive exercise

binge-eating/purging: during last 3 months, engaged in recurrent episodes of binge/purge behaviour

Question 3

alternative conceptualisation: embodiment

Answer 3

bio-psycho-social paradigm: defines and categorises AN as a disturbance in the way in which one’s body weight or shape is experienced

Conceptualizing anorexia within the broader construct of embodiment enables the inclusion of a range of embodied experiences

an embodied framework departs from the Cartesian mind–body dualistic impression of human functioning to emphasize the interactions between the mind, the body, and the self within their social structures

enables researchers to anchor enquiry into the body by shifting the vantage point from an externally driven orientation to the subjective experience of the ‘body-subject’ that is experientially aware and connected to feelings and sensations of the corporeal body

Question 4

alternative conceptualisation: feminism

Answer 4

situate EDs in relation to the wider social expectations surrounding Western femininity, ranging from gendered discourses on appetite, sexuality, economic power to social roles

Anorexia can be seen as a culture-bound syndrome, understood as a cultural metaphor for issues of control, compliance and body ownership in a patriarchal system

Question 5

medical risks of AN

Answer 5

1. neurological:
   - pseudoatrophy of the brain
2. metabolic:
   - hypothermia, dehydration
3. cardiovascular:
   - hypotension, bradycardia (slow heart), prolonged Qt interval, arrhythmia
4. haematological:
   - iron deficiency anemia
5. renal:
   - acute and chronic renal failure
6. endocrine:
   - amenorrhoea (no period)
7. musculosketal:
   - osteopenia (low bone density), stress fractures
8. gastroenterlogical:
   - delay gastric emptying, severe constipation
9. immunological:
   - more severe bacterial infections

Question 6

indications for hopitalisation in AN

Answer 6

1. physiological instability
   - severe bradycardia (hr <50 day, <45 night)
   - hypotension (<80/50)
   - hypothermia (<35.5)
   - orthostatic changes in pulse or blood pressure
2. cardiac arrhythmia
3. electrolyte disturbances (low potassium, sodium, phosphate)
4. severe malnutrition (weight < 75% IBW)

Question 7

prognosis of AN

Answer 7

• risk of successful suicide 32 times than expected, MDD: 21 times
• average duration of illness = 7 years

Question 8

research perspectives in AN

Answer 8

• remarkably little change in our ability to treat AN over the past 25 years
• weak evidence for treatment efficacy
• exception: family therapy for adolescents, which focuses on enabling parents to refeed their child, stop them from exercising, prevent hospitalisation
• a team with paediatricians, nutritians, psychiatrist
• 1 year in total (6 months parents feeding, 3 months regain control, 3 months psychotherapy)
• unclear whether this approach is superior to other types of family therapy or to individual therapy

Question 9

the adolescent patient

Answer 9

family-based treatments for adolescents with anorexia nervosa: Single family and multi-family approaches.

most adolescents get better with FBT, particularly if the treatment is undertaken early in course of disorder before the negative effects of living with an eating problem have taken too great a toll

Question 10

general problems in AN treatment research

Answer 10

1. insufficient sample size
   - 11 controlled psychotherapy studies, median sample size per group 15
   - 8 controlled medication trials, median sample size per group 20
2. recruitment difficulties
   - not cost-effective to continue trials after 3 years
3. placebo controls

Question 11

results: phase two tipping point

Answer 11

• externalise AN as an enemy
• insights about how it happens
• understood by others