Lecture 20 Flashcards
What is the definition of ED by Academy of Eating Disorders
“Eating disorders are serious mental illness with significant life-threatening medical and psychiatric morbidity. Anorexia nervosa has the highest mortality rate of any psychiatric disorder, risk of premature death is 6-12 times higher in woman with anorexia nervosa compared to general population, adjusting for age”
What is the def of Ed by Dr. Jeffery Desarbo, Ed psychiatrist from Long Island, NY
“an eating disorder is a neurobiologically drive process with psychological and medical consequences; it is not a choice”
What is not an eating disorder?
- disordered eating
ex. emotional eating, bored eating, dieting
- ed will happen unless they are prone to it
What is the spectrum related to eating disorder
- body and food acceptance
- body image and eating concerns
- disordered eating
- eating disorders
What are the DSM-5 diagnostic categories and terminology of ED
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
- ARFID (Avoidant/restrictive food intake disorder)
- OSFED & USFED (other specified and unspecified feeding eating disorder)
explain anorexia nervosa
- restriction of energy intake relative to requirements, leading to a significantly low body weight
- intense fear of gaining weight
- disturbance in the way in which on’s body weight or shape is experienced
explain the restricting type of anorexia nervosa
- during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour
- weight is lost primarily through dieting, fasting, and/or excessive exercise
explain binge-eating/purging type in anorexia nervosa
- during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour
ex. self-induced vomiting, or misuse of laxatives, diuretics or enemas
explain bulimia nervosa
- eating, in a discrete period of time, an amount of food that is larger than what most individuals would eat
- a sense of lack of control over eating during the episode
- recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
- at least once a week for 3months
- self evaluation is unduly influenced by body shape and weight
What are 2 ways you can specify AN and BN
- in partial remission, if full criteria was met, but currently no longer fully meets all criteria
- in full remission, if full criteria was met, but now none of the criteria has been met for a sustained period of time
what is binge eating disorder
- regular and sustained binge eating episode
- characterized by both eating in a discrete period of time and a sense of lack of control over eating during the episode
What is avoidant/restrictive food intake disorder?
- AFRID is a new category in DSm-5
- is like AN, except without the body image disturbance or weight/shape overvaluation
What is other specified and unspecified feeding eating disorder?
- OSFED and USFED is new term in DSM-5
- includes atypical AN, BMI in normal range
- purge disorder - sub-threshold forms of BN
- BED on the basis of insufficient frequency or duration of ED behaviours
- night eating syndrome
What is the age of onset for AN
- peak early to mid-adolescence, but may occur at any age, even in childhood
- primarily seen in girls, but boys are seen more frequently in the childhood years
what is the age of onset for BN?
- in later adolescence and young adulthood
what is the age of onset for BED
- young adulthood and mid-life disorder
- more even gender distribution
Who can make the diagnosis
officially:
- medical practitioners, physicians and psychiatrists
- registered clinical (PhD) psychologists
What are the mortality rates of AN and BN
AN - 9-20%
BN - 3%
Death from AN is more than _____ higher than any other chronic illness in 15-24 year old females
12 times
- life expectancy reduction of 20-25 years for chronic anorexia (Harbottle et al., 2008)
estimated ____ in Canada meet the diagnostic criteria for an Ed
- 1 million
review more stats for ED
- 1 IN 10; IE. 10% WITH ED DIE FROM THE DISORDER; 30% RECOVER/ 30% SEMI RECOVER/ 30% ED WILL PERSIST
- EDS HAVE THE HIGHEST OVERALL MORTALITY RATE OF ANY MENTAL ILLNESS, WITH ESTIMATES BETWEEN 10-15% (PER NIED FINDINGS, CANADA)
- SUICIDE IS THE SECOND LEADING CAUSE OF DEATH (AFTER CARDIAC ISSUES) AMONG THOSE WITH AN ED
- 20% OF PEOPLE WITH AN AND 25-35% OF PEOPLE WITH BN MAY ATTEMPT SUICIDE IN THEIR LIFETIME.
What causes an eating disorder
genetics
- epigenetics
Environmental
- ex. childhood exposure, interpersonal interactions, medications, diseases, medical state, microbiome, illicit drug use/chemical exposures, cultural expectations
Individual’s susceptibility
- ex. psychological state, mood, stressors, personality
What are the risk factors?
the 3P’s!!!
Predisposing Factors
- ex. genetics, biology
Precipitating Factors
- turns on the ED
- ex. biology, weight loss, dieting, being sensitive
Perpetuating Factors
- keeps the ED going
- ex. family dynamics
What are some ways for early diagnosis and timely intervention? (8 signs)
- restricting/dieting/binging
- excessive exercise or extreme physical training
- compensatory behaviour to manage weight
— exercise, purging, laxatives, IPECAC - precipitous weight loss or gain or failure to gain expected weight/height in a child or adolescent
- electrolyte/lab abnormalities
- bradycardia
- fainting
- menstrual irregularities or amenorrhea, unexplained infertility
does age matter?
- yes, younger individuals may have higher chance of changing habit/ways of thinking, better prognosis
- younger may have more significant, long term impact
- irreversible - brains, bones and babies
