Lecture 21 - Eating disorders Flashcards
PICA
o Core features: eating of non-nutritive, non-food substances; at least 1 month
- Inappropriate for the developmental age and cultural traditions
o Mechanisms: unknown, stress and lack of specific nutrients may play a role; prevalence inconclusive
o Observed in pregnant women, as well as in individuals with schizophrenia and intellectual disability (we don’t know much more than just case studies)
o Links with postpartum depression or OCD, however lack of systematic studies
Rumination disorder
o Core features: Repeated regurgitation of food over a period longer than 1 month. Regurgitated food may be re-chewed, re-swallowed or spit out
- Not due to medical condition or other eating disorder
- Onset can be any age
- Very little known, potential link with GAD
Avoidant/Restrictive Food Intake Disorder
o Core features: eating or feeding disturbance (lack of interest, concern about aversive consequences of eating) shown by persistent failure to meet nutritional or energy needs
- Not explained by medical or cultural factors
- Not better explained by other ED (anorexia) or disorder (MDD)
o Not the same as an anxiety disorder
- Ex: social phobia; fear of being watched when eating
- Specific phobia: fear of vomiting
Binge Eating Disorder
o Core features: recurrent episodes of binge eating; eating within any 2 hour period an amount of food larger than what most people would eat in similar amount of time under similar circumstances
- A sense of lack of control
- Eating more rapidly; eating until uncomfortably full, not physically hungry, eating alone; feeling of disgust
- At least once a week for 3 months***
- Not better explained by other disorders (like bulimia)
o NOT the same as obesity (which is not defined as a mental health disorder)
o BED can occur in normal-weight/overweight
o Prevalence b/w 0.8-1.6%
o However, possibly underdiagnosed and undertreated
o BED vs. Other disorder
- Ex: MDD/Bipolar: increased appetite/weight
- BPD: impulsive eating
- Differential diagnosis or both are given, depending on clinical presentation
Bulimia Nervosa
o Recurrent episodes of binge eating
o Recurrent compensatory behaviours to prevent weight gain (ex: laxatives, fasting, excessive exercise)
o At least once a week for 3 months
o Often starts in adolescence of young adulthood
o Binge eating begins often after episode of dieting to lose weight
o Small % of individuals develop anorexia nervosa (10-15%); opposite happens more often
o Etiology
- Prevalence 1-1.5% (but suspected to be more than that)
- Diathesis stress model most accepted
• Genetic vulnerability X stress
• Trigger (ex: dieting)
• Outcome: BN symptoms
o Factors associated with BN
- Early risk factors: childhood trauma; Genes: related to dopaminergic system (ex: genes linked to impulsivity)
- Other factors: depression, fear of gaining weight, low self-esteem; childhood obesity; early pubertal maturation
o Depression can precipitate onset of BN, but also lead to relapse of BN after recovery
- Depression co-occurs with BN
o BN vs. Other Disorders
- Ex: MDD/bipolar: increased appetite/weight gain; but do not have inappropriate compensatory behaviours or excessive body concern
- BED: binge eating, but BED does not have regular inappropriate compensatory behaviours
- Borderline Personality Disorder: both impulsive eating
Anorexia Nervosa
o Core symptoms (just recognize them, no need to know by heart)
- Restriction of energy intake relative to requirements, leading to a significantly low body weight appropriate for sex and age and physical health
- Intense fear of gaining weight or persistent behaviour that interferes with weight gain, in spite of low weight
- Disturbance in the way body weight or shape is experienced, and lack of recognition in seriousness of low body weight
o Prevalence
- Community 1%
o 10:1 female/male ratio, but increasingly diagnosed in males
o Often starts in adolescence or young adulthood
o More often now as well diagnosed in children as well as at middle age
o Study: prevalence stable over 3 decades, but onset earlier
o Mental health problem with the highest level or mortality
o Related diagnosis
- Anxiety disorders (ex: social anxiety disorder: fear of being watched eating)
- MDD (often secondary to AN)
- OCD (OCD goes beyond obsession/compulsions related to eating)
o Anorexia Nervosa purging type – bulimia nervosa: BN keeps normal weight; but AN doesn’t
o Avoidant restrictive food intake disorder: does not have fear of gaining weight compared to AN
o (know symptoms, don’t need details in specific differences between the disorders, but know what could be similar)
o Etiology
- Diathesis stress model most accepted
• Genetic vulnerability X stress
• Trigger (Ex: dieting)
• Outcome: AN symptoms
Treatment of eating disorders
- Cognitive therapy is common treatment option for ED
- Called CBT-E (developed by Fairburn)
- Usually multi-modal treatment, including medication, psycho-education etc.
Media and eating disorders
Generally as a risk factor exposure to media is an important factor BUT a lot of people have the same exposure and they’re okay so why are the images disturbing to some rather than others
