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.
