Lecture 6: eating disorders Flashcards
anorexia vs. bulimia (verschil)
In anorexia, binge-eating episodes and compensatory behaviors can be present like in bulimia. However, the main difference is that patients with bulimia are not underweight and they have at least 1 episode and compensatory behavior a week.
one thing that bulimia, anorexa and binge eating disorder have in common is….
over-evaluation of weight and shape
wat zijn de trends van ED over the years
anorexia has stayed more or less the same, bulimia has become less prevalent.
however, the prevalence among young people has risen for anorexia, might be because it is recognized earlier due to media attention
hoe heet het als mensen veel te weinig eten, maar niet door angst om af te vallen
avoidant/restrictive food intake disorder (ARFID)
avoidant/restrictive food intake disorder (ARFID) =
a feeding disorder that involves a persistent failure to meet appropriate nutritional and/or energy needs. There is no fear of weight gain and no body image disturbance but there is weight loss, nutritional deficiency and often a need for tube feeding.
- sensory based avoidance
- arousal/interest-based avoidance
- concern/fear based avoidance
ARFID sensory based avoidance =
certain foods are avoided based on sensory characteristics (only eating soft foods).
ARFID arousal/interest based avoidance=
foods are avoided because there is no presence of feelings of hunger or interest to eat. Thus, one can simply forget to eat.
ARFID concern/fear based avoidance
foods are avoided because of traumatic experiences related to eating (almost having been choked).
which is the most prevalent ED (and which one do people think is the most prevalent)
Because anorexia nervosa gets the most attention, people often think it is the most prevalent. However, it is actually the least prevalent. Other specified eating and feeding disorder is the most prevalent eating disorder: most people have symptoms and criteria from many types. Daarna binge eating disorder
= eating disorder not otherwise specified (EDNOS)
wat is de main drive van eating disorders
People with eating disorders have a lot of ‘noise’ in their head: they have recurrent, time-consuming, and intrusive thoughts about eating that cause anxiety and distress. They experience obsessions and compulsions that are very similar to those in OCD, body dysmorphic disorder and autism spectrum disorders. Unsurprisingly, there is high comorbidity between these disorders.
compulsive controlling behaviours in ED:
- Body checking: checking in windows, weighting, pinching the side, making a lot of selfies.
- Counting: counting calories, eating the same everyday so one does not have to count.
- Rituals & rules: cutting food into small pieces, arranging food on the plate, using specific utensils.
- Preventing weight gain: exercising a lot, vomiting, using laxatives.
- Escape from/suppression of negative emotions: binge-eating.
doel van binge-eating
Binge-eating is often used as an escape from negative moods. It alleviates emotional stress by drawing the attention away from emotional distress and narrowing focus to the immediate environment: food.
second stage of eating disorders
After a while, a lot of negative consequences begin to outweigh the positive ones:
- Psychological: increases in negative mood (depressed, anxious, guilt, disgust), stress, obsessive behaviors and rules, problems with concentration, emotional numbness.
- Physical (visible): being underweight or overweight, lanugo (hair starts to grow all over the body), poor blood circulation (blue hands or feet, acrocyanosis), erosion of the teeth and swelling of glands in the jaw (as a consequence of vomiting), Russells sign (op vingers door overgeven).
- Physical (invisible): low blood sugar, heart problems, lack of growth in children, kidney problems, low sodium and potassium levels which are necessary for muscles (also the heart), amenorrhea (sometimes infertility), osteoporosis.
- Social: social isolation, difficulties in social engagement, conflicts with parents or partners, avoidance of situations involving eating or body exposure (beach, restaurants), avoidance of physical activities, not being able to work or go to school.
first stage of ED
positive consequences:
- feelings of control
- relief of anxiety in short term
- increased self-esteem
- this is what i do best, better than others
- stronger ego and identity
- feeling special
- identity becomes highly related to eating behaviours
- prevention weight gain
- escape from negative emotions
course of ED and mortality
Around 50% of those with anorexia or bulimia recover fully, 30% recovers only partly, and 20% remain chronic. ED has the highest mortality of all psychiatric disorders (1/5 people with AN)
multidisciplinary teams of ED
Treatment for eating disorders involves a team of many disciplines: psychologists, psychiatric nurses, dieticians, psychiatrists, somatic physicians, art/drama/body-oriented therapists, and expert patients.
psychotropic medication for ED
Medication only has a limited effect as a supplement in case of therapy resistance, to avoid relapse, and for comorbid disorders.
wat is een ander belangrijk onderdeel van treatment of eating disorders
eating diary: patients can gain awareness over their eating patterns as well as (emotional) triggers
treatment seeking in ED
A lot of people with ED do not seek help, or it takes them a long time to do so (3-5 years on average).
More than 50% of people never receives treatment.
Barriers to seeking help:
- Feelings of shame,
- fear of stigmatization,
- problems with disclosure
- a lack of knowledge
- lack of acknowledgement of ED
e-health treatments
- Proud2Bme (an e-health website with blogs and chats that are online 24/7. It is basically a healthy alternative to pro-anna websites. People can anonymously chat with others and gain knowledge about their disorder.
- Featback (an e-health automated monitoring and feedback system, tailored to a specific person. Every week, a patient answers questions about 4 topics: a) Concern with body weight and shape, b) unbalanced
nutrition and dieting, c) binge eating, and d) compensatory behaviors.)
wat liet research in Featback zien
Research has found that Featback had a significant effect compared to waiting list control. Subjectively, patients reported an added value of therapist support, but this was not the case in objective data.
Featback was most effective for bulimia, particularly with mild to moderate symptoms. In anorexia nervosa, contact with a recovered patient was evaluated very highly in addition to Featback. Results are still being analyzed though.
anorexia nervosa subtypes
- restrictive subtype (veel sporten, weinig eten)
- binge/purging subtype
consequenties van avoidant/restrictive food intake disorder
- weight loss
- nutritional deficiency
- tube feeding
- psychosocial functioning
other specified feeding and eating disorders kenmerken
50% of patients in treatment, most patients have characteristics of all ED subtypes, in general population these make up for 75% of the people with an ED
wat bedoelen ze met “diagnosis not static”
there are a lot of different subtypes, most people have different subtypes throughout their life. -> having an eating disorder in general is more stable than the specific EDs are.
waar tussen switchen mensen het meeste qua diagnosen
AN-R <-> AN-BP
AN-BP -> BN
BED -> BN
(eigenlijk niet direct vanaf BED naar AN-R)
zie schrift
wat zijn, naast compulsivity ook vergelijkbare obsessive thoughts and behaviours across the compulsive disorders
obsessions with symmetry
rigid thinking styles in eating disorders=
- Deficits in mental flexibility
- Holding on to old habits
- Extreme focus on details
- Difficulties in seeing the whole picture
need for control and rigidity in ED:
- rigid thinking styles
- perfectionism, extreme need for control
- compulsive behaviours and obsessive thoughts
-> strong routines, difficult to change behaviours
hoe zie je less mental flexibility in de praktijk
niet meer mogelijk om normale routine aan te houden, omdat hun gedachtes het overnemen, heel lastig om hier vanaf te switchen.
hoe voelt eating in BED
als een escape:
- Feeling numb while bingeing—”like you’re not really there or you’re on auto-pilot”
- Chewing helps to forget
- “Feels like being in a tunnel”
- Loss of control over eating: ‘I have no choice’
- The only thing on their mind is food
- ‘I deserve something nice’
stepped care disease management model =
proud2Bme
featback
respijthuis
support groep
verpleegkundige aan huis
poliklinisch (outpatient)
dagopname
intramuraal/opname (inpatient)
why do we need ehealth
due to the large gap between onset of symptoms and actual treatment (+/- 4 jaar)
featback=
automated monitoring and feedback system
treatment AN and BN
outpatient treatment (bv CBT) -> Focus on weight recovery, abstinence from binge eating and purging, restoration of negative body image and dysfunctional cognitions.
when outpatient treatment does not lead to weight recovery -> intensive treatment
- youth -> multi-family treatment
- soms psychotropic medication as supplement, voor; therapy resistance, to avoid relapse, comorbid disorders
treatment BED
- outpatient CBT
- sometimes followed by weight loss programme
- antidepressants supplementation
- self-help programs based on CBT
waar focust cognitive remediation therapy op
the how, rather than the what of thinking.
CRT aims to improve memory, planning skills, and flexibility
* Improves the awareness of ongoing thinking processes
* Use of exercises, reflection and behavioral tasks, to develop more flexible thinking styles
* Reflection about thinking styles during these cognitive exercises is a crucial part of CRT
voor wie is CRT behulpzaam
- eating disorders
- schizophrenia
advantages of e health in ED
- lagere kosten
- bereikbaarheid
- flexibel
- gemakkelijk bijhouden van eetgedrag, stemming, triggers (beter inzicht)
- minder stigma
- feedback: directe feedback en aanmoediging helpt motivatie
- can bridge the gap between symptoms and treatment
content of CRT sessions
every exercise needs to be linked to daily life!
30-45 minuten, in totaal 3-6 exercises
structure:
1. task: explanation and execution
2. reflection: which thinking strategies were used
3. translation: link to daily life
voorbeeld van zo’n exercise
central coherence: focus on a picture with multiple things in it (cat and mouse)
- Did you see more than one figure?
- Which strategy did you use?
- Did you think that you had to find more figures quickly?
- Was it difficult to alternate between the figures?
- How can you use this experience in your daily life?
- Try to take the perspective of someone else?
- Might it help to take a step back to see the whole picture?
- Could you translate this exercise to your daily life? And in what respect?
wat zijn voordelen aan CRT
- gaat niet over food/weight/shape
- niet over emoties
- meer motivatie door positieve feedback
- niet over wat je denkt, maar hoe je denkt
- goed of fout maakt niet uit (fijn bij perfectionisme)
- exercises are easy and fun
- snelle improvements
- gevoel dat je echt een dagelijks verschil kan maken
