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2 - Differential and clinical > Lecture 6 - Eating disorders > Flashcards

Lecture 6 - Eating disorders Flashcards

1
Q

Eating disorders are serious psychiatric disorders characterised by what?

A

Abnormal eating or weight control behaviours

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2
Q

What kinds of individual characteristics affect the form of body and weight concerns?

A

Gender, age, culture

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3
Q

What are two main DSM criteria of anorexia nervosa?

A

A. Lower energy intake than needed - significantly low body weight.
- Either exercising a lot or restricting eating

B. Intense fear of weight gain and/or acts to prevent weight gain.

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4
Q

What is important to consider when assessing low bodyweight in anorexia?

A
  • People have biological, genetic predispositions to have a certain body size and shape specific to them
    • Significantly low bodyweight FOR THEM, not just for the average person - have to take into account many factors when seeing if bodyweight is low enough for clinical concern
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5
Q

What three things do you need to experience at least one of to be diagnosed with anorexia?

A

C. At least one of:
1) Has body weight/shape disturbance
2) Uses body weight/shape/eating to evaluate self-worth
3) Doesn’t recognize seriousness of current low weight

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6
Q

What are anorexia nervosa specifiers?

A

Restricting: no recurrent binge-eating or purging in last 3 mo
Binge-purging: recurrent binge-eating and/or purging in last 3 mo
- Does not necessarily have to be body image orientated

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7
Q

Why are BMI specifiers for anorexia limited and unhelpful?

A
  • Limits who can have treatment and sends an awful message
    • Does not predict physical risk - rapid and recent weight loss - puts body into shock and out of balance - can be dangerously unwell even if someone is not overweight

Mild: ≥ 17
Moderate: 16-16.9
Severe: 15-15.9
Extreme: < 15

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8
Q

What did the Minnesota starvation experiment entail, and what was found out about the psychological impacts of starvation from this?

A

36 male conscientious objectors during the war; 25% weight loss induced
- Understand what happens with rapid weight loss, and how can you safely help people to regain weight
- None had eating disorders but had significant emotional changes

Changes:
Amotivation, anhedonia, apathy, asociality
Depression, anxiety, rigidity, restlessness
Food obsessions / rituals, hoarding

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9
Q

Can weight loss induce anorexia?

A

Yes - many AN symptoms happen as a consequence

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10
Q

Can you give intense psychological therapy to someone with severe anorexia?

A

No

Can’t do intense psychological therapy if someone is seriously medically unwell - has to be a degree of weight gain first to be ethical otherwise it is too high risk

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11
Q

What is the first criterion for bulimia nervosa?

A

A. Repeated binge eating episodes (at least once a week for 3 months):
1) Eats more food than most people would eat, in similar circumstances, in a specific time period AND
2) Feels a lack of control over eating

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12
Q

What are the second and third criteria for bulimia nervosa?

A

B. Repeated efforts to compensate for the binge to prevent weight gain: e.g. self-induced vomiting; laxative misuse; fasting; or excessive exercise. Anything that is a reaction to eating excessively on a regular basis
C. Uses body weight/shape to evaluate self-worth

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13
Q

Is 8-13 instances of compensatory behaviour per week in bulimia considered moderate or severe?

A

Severe

Mild: 1-3
Moderate: 4-7
Severe: 8-13
Extreme: >= 14

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14
Q

What percentage of self-worth does body weight, body shape and eating become in anorexia and bulimia?

A

84%
Compared to 20% for healthy people

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15
Q

What is the first criterion of binge eating disorder? BED

A

A. Repeated binge eating episodes (≥1 / week for 3 mo):
1) Eats more food than most people would eat, in similar circumstances, in a discrete period of time AND
2) Feels a lack of control over eating.

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16
Q

DSM criteria:
When binge eating, patients… (5 things)

A

1) faster than normal
2) until uncomfortably full
3) without feeling physically hungry
4) alone because of embarrassment
5) Feel disgust/ low mood / guilt after

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17
Q

Does BED have the same severity boundaries as bulimia?

A

Yes

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18
Q

Why is it argued that negative body image in BED should be included as a specifier?

A

Many people with BED:

Are more body dissatisfied than people without BED - something about BED that makes you more dissatisfied
Show over-valuation of weight, shape and eating - when it is present show worse symptoms and have lower quality of life
In line with this, treatment strategies for BED often address body image concerns.

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19
Q

What is OSFED (other specified feeding or eating disorder) also called and what characterises it?

A

Atypical AN

All criteria met for AN except significantly low body weight
- Rapid bodyweight loss is still not healthy even when someone is not at the low bodyweight stage

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20
Q

What is the differences in OSFED bulimia and OSFED BED compared to the typical disorders?

A

All criteria met for BN OR BED except symptom frequency / duration

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21
Q

What is the most prevalent eating disorder?

A

BED

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22
Q

What age group has lowest ED rates?

A

60+ year olds

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23
Q

Why are men not supported well to talk about ED symptoms?

A

It is seen as a feminine problem

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24
Q

What is the mortality risk of AN, BN, BED and OSFED, relative to average mortality risk?

A

Anorexia nervosa: 5 times higher
Bulimia nervosa: 1.5 times higher
BED: 1.5 times higher.
OSFED: 1.7 times higher.
Causes include physical complications & concurrent mental health difficulties

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25
How does age of onset for AN, BN, BED and OSFED differ?
AN, BN and OSFED similar - peak onset between 15-20 BED peaks a bit later, and onset age is more spread out
26
What is average time between onset and treatment for AN, BN and BED?
Anorexia nervosa: Onset to treatment: 30 months Bulimia nervosa: Onset to treatment: 53 months Binge-eating disorder: Onset to treatment: 48 months.
27
What is average relapse rate for AN and BN?
AN Relapse > 25%; highest in first year BN Relapse > 30%; highest in first year
28
What is average remission for AN, BN and BED?
AN At 22-year follow up, 62% full remission. BN At 22-year follow up, 68% full remission. BED Remission ~ 30-80%; little long-term data.
29
What is the prevalence of subclinical symptoms of eating disorders - binge eating with compensatory behaviours, and binge eating without these?
5% women & 3% men regularly binge-ate and used compensatory behaviours 3% women and 1% men reported regular binge-eating without compensation Eating disorder symptoms are expressed dimensionally not categorically across populations
30
Are eating disorder symptoms higher in transgender people or cisgender people?
Eating disorder symptoms higher in transgender people than cisgender people1. Transgender adolescents report: an eating disorder diagnosis in the past year (16%), use of diet pills (14%), compensatory behaviours (16%)
31
Why might body dissatisfaction be higher in transgender youth?
Partially due to rigid socially-promoted body ideals (‘muscular men and thin women’) High prevalence of other MH conditions in trans people - general vulnerability? Helps try and cope with dysphoric experiences - suppressing onset of puberty helps to suppress development of secondary sex characteristics
32
What is the most common diagnostic crossover between EDs? (movement within or between categories over time)
AN to BN Then, BN to BED or BN to AN Then, BED to BN
33
What fraction of individuals with a full-threshold ED diagnosis at baseline shift to a sub-threshold or OSFED diagnosis?
1/3 This critiques rigidity of diagnostic criteria
34
What are common co-occurring conditions with EDs?
Anxiety Depression (incl bipolar) OCD Substance use Emotion dysregulation Also overlap with ASD (anorexia), and ADHD (BN and OSFED)
35
How could impairments in EF enable development of an ED?
Impairments in executive functions which “allow individuals to adapt information processing & behaviours according to their goals” i.e. self-regulation.
36
What executive functions are impaired in EDs?
Some people with EDs show inhibitory control impairment Cognitive flexibility (set shifting) impaired in all acute eating disorders Attention bias towards disorder-salient stimuli present in all eating disorders Working memory: some impairment for all EDs but inconsistent However, unclear whether this is a cause or consequence of EDs
37
What structural differences are present in the brain with AN?
Structural differences in AN – lower grey and white matter – most resolve with weight regain.
38
How is reward system activity different in people with AN, BN and BED?
People with AN show heightened dopamine-related brain activity to food related stimuli – does not completely normalise with weight recovery. Because people are so hungry so reward seems greater People with BN show a greater reward response to food when they are experiencing low mood. People with BED show greater reward response to food coupled with increased impulsivity and compulsivity.
39
What are heritability estimates for AN, BN and BED?
AN range between 0.48 and 0.74 BN, between 0.55 and 0.62, BED, between 0.39 and 0.45
40
Is AN likely to be polygenic?
Yes
41
Can EDs bring about epigenetic changes?
Yes Experience of a long-term eating disorder is likely to alter the way that genes are expressed (e.g. DNA methylation) in many parts of the body i.e. epigenetic changes
42
Which eating disorders have heritability overlap?
AN and BN - explains people moving between these disorders
43
How is appearance ideal internalization and pressure and body dissatisfaction a psychosocial risk factor for EDs?
Having a rigid, unrealistic ideal body and perceiving pressure to resemble it leads to body dissatisfaction and motivates changed eating behaviour
44
How is negative emotionality/neuroticism a psychosocial risk factor for EDs?
Being predisposed to experience negative emotions linked to later eating pathology
45
How is bullying, weight related teasing and criticism based on weight, size etc. a psychosocial risk factor for EDs?
- Early criticism/abuse due to weight/eating establishes weight-related concerns - Includes family discussion and critical terms used while growing up
46
How is food-related illness e.g., T1 diabetes a psychosocial risk factor for EDs?
- Scrutiny of dietary intake for medical reasons prompts focus on weight, eating & control. - Huge focus on eating - Dia-bulimia = not taking insulin so that blood sugar spikes but body does not break down and store carbohydrates
47
How does the media contribute to eating disorders?
Eating disorders involve, in an exaggerated form, behaviour that is normal in our culture and highly valued Thin bodies highly sought after Social bonding to be dissatisfied with our bodies Capitalism - buy more weight loss things, viewing our bodies as a project to build on, trying to become an acceptable object in a socio-cultural space Cultural attitudes to eating and weight Constantly changing beauty standards
48
The depiction of overweight people in news media was analysed with content analysis. What did they find about pictures of overweight people displayed?
72% of images were negative and stigmatizing manner. Higher weight individuals more likely to: have their heads cut out of the photos have only abdomens or lower bodies shown be shown eating or drinking Less likely to be shown fully clothed or having clothes that fit, wearing professional clothing, or exercising.
49
Is body size a protective characteristic
No Legally cannot discriminate against someone for it
50
What is the cyclic relationship between EDs and the media?
People with high pre-existing body dissatisfaction far more susceptible to the experimental effects of exposure to media images. Higher body dissatisfaction, unhealthy weight control strategies, increased over-valuation of weight and shape leads to Increased preoccupation with body shape, size, eating, weight, and their control leads to Seeking out images, information, products about weight/body/shape changes (and the cycle continues)
51
Does being exposed to mass media directly cause clinical eating syndromes?
No Does not solely cause EDs - It strengthens psychopathological processes, causes negative emotional experiences, & activates cognitive behavioural tendencies in vulnerable people - The content reinforces the schematic ingredients (building blocks) of body dissatisfaction and/or a preoccupation with weight, shape, eating and size. - Even for people who are not vulnerable to eating disorders (e.g. no genetic diathesis) media content influences their body ideals, appearance comparisons and self-evaluations. - Media messages feed societal norms about anti-fat stigma and ‘moral responsibility’ for body size and weight loss - makes it seem ok to stigmatise bigger people
52
What treatment would be given to someone at very high physical and psychological risk?
Inpatient care - aim to gain weight and stabilise condition
53
What treatment would be given to someone at high psychological risk but low physical risk?
Day programme 9-5, having meals with others, support, activities, fun things
54
What treatment would be given to someone at medium psychological risk?
Outpatient care
55
What three main psychological therapies are recommended by NICE for treating EDs?
Individual psychotherapy (CBT-E; AN, BN or BED) Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA; AN) Specialist supportive clinical management - helpful for people who don't want intensive therapy Can also do: Guided self-help for BED or BN (4 weeks only) Group CBT-E for BED Eating-disorder-focused focal psychodynamic therapy (FPT; AN, weaker evidence base)
56
What does enhanced CBT (CBT-E) for EDs target?
- Targets the “core psychopathology” rather than specific ED
57
What is involved in enhanced CBT for eating disorders?
Outpatient, individual treatment: typically 20 sessions over 20 weeks - If patient is underweight/ has AN: 40 sessions (extra sessions to treat barriers to change; e.g., low motivation, undereating, and low weight) Comes in two forms: - Focused CBT-E: over-evaluation of eating, weight, shape; dietary restriction or restraint (core psychopathology) - Broad CBT-E: extra factors that are maintaining difficulties
58
Is enhanced CBT more effective than inter-personal therapy?
Yes
59
What treatments for BED showed significant long-term improvements in binge-eating symptomatology and associated psychopathology?
self-guided therapy (including online CBT-E) psychotherapy (predominantly group CBT)
60
What three approaches can help prevent eating disorders?
Universal prevention programmes (aimed at everyone) Media literacy Understanding one’s relationship to media; critically analysing effects of media on self and others

2 - Differential and clinical (18 decks)

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