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PSYC3018 Abnormal Psychology > *Lecture 17 - Eating Disorders 3: Binge Eating Disorder (BED) and other Eating Disorders (EDs) > Flashcards

*Lecture 17 - Eating Disorders 3: Binge Eating Disorder (BED) and other Eating Disorders (EDs) Flashcards

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1
Q

What questions would you have to ask to attain which eating disorder someone has?

A

BMI

Do you purge after Binge?

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2
Q

What is Pica?

A

The essential feature of pica is the eating of one or more nonnutritive, nonfood substances on a persistent basis over a period of at least 1 month (Criterion A) that is severe enough to warrant clinical attention.

aka eating non-foods

(usually autistic kids who eat non-food substances)

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3
Q

Which specifier does AN have that BN and BED do not?

A

Type

shared specifiers for severity and remission status

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4
Q

Which 2 types of specifiers do AN, BN and BED share?

A
  1. severity

2. remission status

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5
Q

What are the DSM-5 Feeding and Eating Disorders?

Hint: There are 8

A
  1. Pica
  2. Rumination Disorder
  3. Avoidant/Restrictive Food Intake Disorder
  4. Anorexia Nervosa
  5. Bulimia Nervosa
  6. Binge-Eating Disorder
  7. Other Specified Feeding or Eating Disorder
  8. Unspecified Feeding or Eating Disorder
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6
Q

How does the DSM characterise Feeding and Eating Disorders?

A

“….by a persistent disturbance of eating
or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning…”

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7
Q

How does the ICD-10 characterise eating disorders?

A

“…a broad group of psychological disorders with abnormal eating behaviours leading to physiological effects from overeating or insufficient food intake…”

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8
Q

What are the different types of eating disorders according to the ICD-10?

Hint: there are 8

A
  1. Anorexia Nervosa
  2. Atypical Anorexia Nervosa
  3. Bulimia Nervosa
  4. Atypical Bulimia Nervosa
  5. Overeating Associated with Other Psychological Disturbances
  6. Vomiting Associated with Other Psychological Disturbances
  7. Other Eating Disorders
  8. Eating Disorder, Unspecified
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9
Q

How has BED changes from DSM-IV and DSM-5?

A

DSM-IV considered BED to be a “diagnosis in need of further study”.

But included as diagnosis in DSM-5.

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10
Q

What’s criterion A of BED?

A

Recurrent episodes of binge eating; characterised by BOTH of the following:

1) 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 people would eat in a similar period of time under similar circumstances.
2) 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).

N.B. Objectively large amounts of food
e.g. 1 loaf bread, 1L ice cream,
a few bowls of cereal,
a family-sized chocolate block, etc.

N.B. Some people feel that they are “bingeing” when they do not have objectively large amounts of food (e.g. break a diet by eating a few chips or a piece of cake. If loss of control is present, this constitutes a subjective binge episode.

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11
Q

What’s criterion B of BED?

Hint: There are 5 sub-criteria

A

The binge-eating episodes are associated with 3≥ of the following:

  1. Eating much more rapidly than normal.
  2. Eating until feeling uncomfortably full.
  3. Eating large amounts of food when not feeling physically hungry.
  4. Eating alone because of feeling embarrassed by how much one is eating.
  5. Feeling disgusted with oneself, depressed, or very guilty afterward.
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12
Q

What’s criterion C of BED?

A

Marked distress regarding binge eating is present.

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13
Q

What’s criterion D of BED?

A

The binge eating occurs, on average, at least once a week for 3 months.

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14
Q

What’s criterion E of BED?

A

The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

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15
Q

What letters do the criteria for BED use?

A

A-E.

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16
Q

FIX CARD

If a person was “bingeing” by eating a few chips or a piece of cake, can they still meet criterion A?

A

If loss of control is present, this constitutes a subjective binge episode.

Therefore yes I think? Need to clarify.

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17
Q

FIX CARD

A

Individuals with binge-eating disorder are typically ashamed of their eating problems and attempt to conceal their symptoms. Binge eating usually occurs in secrecy or as inconspicuously as possible.

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18
Q

How should one specify the remission status in BED?

A

In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.

In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.

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19
Q

How is severity classified in BED?

A

The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: 1-3 binge-eating episodes per week.
Moderate: 4-7 binge-eating episodes per week.
Severe: 8-13 binge-eating episodes per week.
Extreme: 14 or more binge-eating episodes per week.

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20
Q

FIX CARD

What are some estimated prevalences for BED?

(Begg et al, 2007)
(Hay et al, 2008)
(Butterfly Foundation, 2012)
(NEDC, 2010)

A

The Australian Institute for Health and Welfare (AIHW): estimated 23,464 people with eating disorders in Aus 2003

Only Australian study (Hay et al, 2008) found that the rate of disordered eating behaviour doubled between 1995-2005.

Population based surveys in South Australia, NZ and US yield higher estimates - based on these, Deloitte Access Economics estimates:
913,986 people in Aus with an ED, of which
47% have BED

Estimated global lifetime prevalence of BED:
Women: between 2.5% and 4.5%
Men: between 1.0% to 3.0%.

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21
Q

Roughly, how much more prevalent is BED among individuals seeking weight-loss treatment than in the general population?

(BEDA, 2014)

A

30-40%

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22
Q

What are the risk factors for BED?

Wade, 2010
(NEDC, 2010)

A

1: Genetic factors
• appears to run in families
• which may reflect genetic influences
• 17% to 39% of the variance

  1. Dieting
    • this is the greatest risk factor
  2. Others:
    • trauma (esp. early-life)
    • low self-esteem
    • body dissatisfaction
    • negative emotionality (or difficulties with emotional
    regulation)
    • overvaluation of the importance of weight & shape
    • difficulty regulating emotional states
    • parental substance use.
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23
Q

What are the psychiatric co-morbidities with BED?

What % are each developed?

A

BED similar to other eating disorders in terms of comorbidity.

  • Depression ~54%
  • Anxiety ~37%
  • Substance use disorders ~25%
  • Personality disorders ~25%
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24
Q

What are 7 protective factors?

NEDC, 2010
(not inc. family/societal)

A
  1. High self-esteem
  2. Positive body image
  3. Critical processing of media images
  4. Emotional well-being
  5. School achievement
  6. Being self-directed and assertive
  7. Possessing a genetic predisposition to thinness
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25
Q

What are some family factors that can protect you from BED?

NEDC, 2010

A
  • family connectedness
  • belonging to a family that does not overemphasise weight and physical attractiveness
  • eating meals together regularly as a family
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26
Q

What are some societal factors that can protect you from BED?

(NEDC, 2010)

A
  • climate that accepts a range of body shapes and sizes
  • sporting contexts that value successful performance and not merely physical attractiveness and aesthetics
  • relationships with individuals who are not highly concerned with weight or shape
  • social support
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27
Q

What are the gender differences in the psychiatric co-morbidities with BED?

A

Few gender differences observed; men had
• higher lifetime rates of substance use disorders
• higher current rates of OCD

28
Q

True or False?
Patients with BED with current psychiatric comorbidity reported earlier age at first diet and higher “lifetime-high” BMI.

A

True.

29
Q

BED is associated with obesity and medical conditions related to obesity. List 5 of these.

(NEDC, 2010; Grilo et al., 2009; Mayo Clinic, 2016)

A
  1. joint problems
  2. type 2 diabetes
  3. heart disease
  4. gastroesophageal reflux disease (GERD)
  5. some sleep-related breathing disorders
30
Q

What are the 4 assessments for BED?

A
  1. Eating Disorder Examination (EDE), and Eating Disorder Examination – Questionnaire (EDE-Q)
  2. Binge Eating Scale (BES)
  3. Bulimia Test – Revised (BULIT-R)
  4. Eating Attitudes Test (EAT-26)
31
Q

Outline the Eating Disorder Examination (EDE).

Fairburn, Cooper & O’Connor, 2014

A 
• used in other EDs too
• semi-structured interview
• good reliability and validity
• comprehensive
• sensitive to change
• Global score + 4 subscales:
       1. Restraint Subscale
       2. Eating Concern Subscale
       3. Shape Concern Subscale
       4. Weight Concern Subscale
32
Q

What is the Binge Eating Scale (BES)?

Gormally, 1982

A
  • Valid screening tool for BED
  • 16 items
  • Developed to assess binge eating severity in obese patients
  • Behavioural and cognitive aspects of eating and control of eating
33
Q

What is the Bulimia Test - Revised (BULIT-R)?

Thelen et al., 1991

A
  • 28 item self-report questionnaire
  • Developed to assess the presence of bulimic symptoms
  • Good sensitivity and specificity for BED

(small specific info for research)

34
Q

What is the Eating Attitudes Test - 26 (EAT-26)?

Garner, 1982

A

not necessarily recommended for BED

It is a bit dated.

• Standardised self-report measure of symptoms and concerns characteristic of eating disorders
• Screening tool to assess “eating disorder risk” in high school, college and other special risk samples e.g. athletes
• Includes socio-cultural factors in the development and maintenance of eating disorders
• Useful for detecting subjects at high risk of BED when given in a non-clinical setting (Orbitello et al., 2006)
• Three subscales:
1. Dieting
2. Bulimia & Food Preoccupation
3. Oral Control

35
Q

Treatment of BED

Amianto et al., 2015

A

Psychological therapy
• CBT
• IPT
• DBT

Pharmacologic treatment:
• SSRIs
• SNRIs
- kind of vyvanse - but not in Aus.

36
Q

What are the treatment targets for BED?

both psychological and pharmacologic

A

Psychological treatment for BED targets:
• Reducing binge eating
• Sustainable weight loss (and/or prevention of excess weight gain)
• Increase in ability to cope with negative affect, anxiety
• Relapse prevention

Pharmacologic treatment targets:
• Lowering eating impulsivity
• Improving psychiatric co-morbidities

37
Q

Outline:
• how many studies were reviewed?
• from which countries?
• what was the mean sample size and range?
• what interventions were looked at?
• what was the most common intervention?
• what % used this intervention?

In the major systematic review of BED treatment undertaken in 2012.

(Hay, 2012)

A

Major systematic review to date undertaken in 2012
• 13 studies of BED treatment
• 5 studies with mixed samples including BED

Summary of studies:
• Country (N America n = 9, Europe n = 9)
• Sample Size (mean N = 88; range: 14 to 259)

Interventions:
• Cognitive Behaviour Therapy (CBT) most common (~70% of studies)
• Behavioural Weight Loss (BWL)
• Dialectical Behaviour Therapy (DBT)
• Interpersonal Psychotherapy (IPT)
• Brief Strategic Therapy (BST)
38
Q

FIX CARD

Recent Evidence for Psychological Treatment OF BED

A

Outcome 1: Binge Abstinence

Similar rates to earlier studies
(e.g. Cachelin et al., 2014; Grilo et al., 2012) 30-40% abstinence post-treatment and at ≤12-month follow-up).

Significant improvements in binge frequency also noted with CBT over longer-term follow-up
(e.g. Fischer et al., 2013: 4 year follow-up).

39
Q

FIX CARD

A

Outcome 2: Weight Loss

Most studies measuring weight loss reported weight loss during treatment but weight re-gain or modest sustained weight loss at follow-up. (e.g. Munsch, Meyer & Biedert, 2012: BMI loss maintained at 6-year follow-up, but small effect size).

Weight loss of >5% of initial weight and a loss of >10% was achieved by 61% of patients in a trial of CBT + dietary guidance/restriction (1500kcal/day; Abiles et al., 2013).

40
Q

What was the average abstinence rate post-treatment?

in BED research

A

52%

41
Q

What are the advantages and limitations of CBT as a treatment in BED?

A

Advantages:
• most validated and effective treatment for BED
• CBT effective for reducing binge episodes
• Not bad for co-morbid conditions
• can have full/guided self-help/internet delivery

Limitations:
• Individual CBT is time- and cost-intensive
• often costs between $140-300/hr
• medicare only 10 sessions
• yet takes at least 20 sessions
• hard to manage treatment with full time work
• Modest effects on weight loss

42
Q

What is the aim of CBT in the treatment of BED?

A

To alter unhelpful thinking processes and behaviours that maintain eating disorders.

43
Q

How does CBT work in the treatment of BED?

A
  • Cognitive restructuring to challenge unhelpful thoughts and beliefs about the importance of shape, weight, eating and their control for defining one’s self worth.
  • Addresses unhelpful behaviours such as dietary restriction that may then lead to a binge cycle
  • May address additional factors such as self-esteem, perfectionism, interpersonal functioning, and emotion regulation.
44
Q

FIX CARD

A

see slide 36

45
Q

FIX CARD

A

slide 37

46
Q

Outline Interpersonal Psychotherapy Therapy (IPT). Include the model, aim, focus and what it does(n’t) address.

(NEDC, 2010; Iacovino et al., 2012)

A
  • Based on the psychodynamic model (Freud)
  • Aim: help individuals gain insight into interpersonal relationships in the present, early relationships, and historical life experiences.
  • Focusses on relationships between interpersonal relations, attachment patterns, distressing emotions, and binge eating as a means of coping.
  • Does not directly address diet, cognitions related to dietary restriction, or weight-related issues.
47
Q

Outline Dialectical Behavioural Therapy (DBT).
Include aim, how it is effective and how it is limited.

(NEDC, 2010; Iacovino et al., 2012)

A
  • Aim: emotion regulation and distress tolerance
  • Effective in binge reduction and in lowering concerns about food and body shape
  • No clear results on weight loss, depression, or anxiety.
48
Q

How do Antidepressants work as a treatment for BED?

What 2 kinds of antidepressants are used and do they work? How are they limited?

(Reas & Grilo, 2008)
(NEDC, 2010)

A
  • Antidepressant medication seeks to improve serotonergic neurotransmission.
  • SSRIs: significantly more likely to achieve remission compared to placebo. Difference in weight change between groups was modest (Reas & Grilo, 2008)
  • SNRIs: reduced binge days per week, binge episodes per week, binge-eating related obsessions, clinical global severity of illness, weight, BMI
  • Not enough information on long-term gains. (NEDC, 2010)
49
Q

What are five ways we can try to prevent eating disorders?

A
  1. Encourage people to diet less
  2. Promote Media literacy – critically appraise media messages related to thinness
  3. CBT – modify thinking styles and behaviours that place an individual at risk for developing an Eating Disorder
  4. Cognitive dissonance - targets personal beliefs about the importance of being thin and the thin beauty ideal
  5. Multicomponent – Every BODY Is a Somebody Program
50
Q

True or False?

Many people with BED have financial issues due to supporting their binges (buying so much food can be expensive).

A

True

51
Q

What is rumination disorder?

A

Swallowing and bringing food up and swallowing again and again.

52
Q

What is avoidant/restrictive food intake disorder?

A

Avoiding or restricting certain foods - not because of calories - but rather because of the texture or colour. Kind of like a phobia.

53
Q

True or False?

Pica was the last one to get into DSM as a distinct disorder.

A

False

BED was the last one to get into DSM as a distinct disorder.

54
Q

True or False?

There is an almost equal prevalence of BED in men as there is in women.

A

True

55
Q

True or false?

The prevalence of BED has been stable over the past decade.

A

False, it has been increasing.

56
Q

What is the most prevalent eating disorder from AN, BN and BED?

Is this in just one gender, or both women and men?

A

BED is more prevalent than AN and BN in women and men.

BED has closer prevalence in M/F than in other eating disorders.

57
Q

What is the course that BED usually takes?

Grilo & Masheb, 2000

A

Typically begins in early adulthood (i.e., early to mid-twenties) but can begin earlier or later in life.

58
Q

List 4 triggers for binge eating.

A
  1. negative affect
  2. interpersonal stressors
  3. dietary restraint
  4. boredom
59
Q

Does CBT help with weight loss?

A

Not really.
CBT doesn’t help with weight loss really, just BED.
So even if a patient successfully finishes treatment and does not binge anymore (cured), they can still be overweight.

60
Q

What are the take-home messages about BED?

A
  1. treatment for BED is not there yet (~50% not getting better!)
  2. CBT doesn’t help with weight loss - if finish treatment and not binge, still overweight
  3. CBT most validated and effective, good for co-morbid conditions
  4. but it is time and money consuming
61
Q

Do we have a satisfactory treatment for BED?

A

Treatment for BED is not there yet (~50% not getting better!)

62
Q

What treatment would provide the best results for BED?

A

Combined drug and psychological treatment.

63
Q

What is the EDE-Q?

Fairburn & Beglin, 1994

A

self-report questionnaire

64
Q

What were 5 shortcomings of the recent evidence for psychological treatment of BED?

A
  • More trials necessary
  • Longer-term trials and follow-up required
  • Further research into weight management in BED essential
  • Some studies did not have blind assessors
  • In some instances, method for group allocation was unclear.
65
Q

What was the average cessation rate at follow-up?

in BED research

A

46%

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