Lecture 6: Eating Disorders

Question 1

What did most people end up with in DSM - IV? What did this encompass?

Answer 1

EDNOS (= Eating Disorder Not Otherwise
Specified)
 ‘subclinical’ AN or BN
 Binge Eating Disorder
 ‘Purging Disorder’
 ‘Night Eating Syndrome’
 ‘Grazing’

i.e. these sub disorders are not formally recognised as disorders

Question 2

whats different about DSM - 5?

Answer 2

 Anorexia Nervosa
 Bulimia Nervosa
 Binge-Eating Disorder
 Other Specified Feeding or Eating Disorder
 Unspecified Feeding or Eating Disorder

i.e. no EDNOS, Binge-eating disorder formally recognised AN and BN still there, but now other specified and unspecified is there.

Question 3

How is Anorexia Nervosa diagnosed? What is impt to note?

Answer 3

 Restriction of energy intake, leading
to a significantly low body weight for age, sex,
developmental stage, and physical health.
- (BMI < 18.5)

 Intense fear of gaining weight or becoming fat
even though underweight

 Body image disturbance
- persistent lack of recognition of seriousness of low
body weight,
- undue influence of body weight/shape on self- evaluation

 Restricting vs Binging/Purging type

NB: restriction is a necessary symptom of AN

Question 4

What are two associations of AN? give more detail about them and what they lead to?

Answer 4

Psychological problems
 Depressed mood, irritability, anger, social withdrawal,
preoccupation with food, poor concentration
 Often associated with ‘starvation syndrome’
 Comorbid: Depressive disorder, Anxiety Disorders (esp Social Phobia), Substance use disorders, Personality
disorders (Obsessive Compulsive Personality Disorder)

Physical problems
 Low body temperature, Brittle hair / nails, Hair growth (To compensate for the lack of fat, lanugo (fine hair) will grow all over the body to keep it warm.)
 Low oestrogen => Osteoporosis (brittle bones)
 Malnutrition, Anaemia, Immune system suppression

–> Mortality rate of 5-10% over a 10 year period and a suicide rate similar to depression

Question 5

Explain 3 aspects of the Epidemiology of AN.

Answer 5

1) Prevalence
 affects 0.5-1.0% of females
 90% of individuals with AN are female

2) Age of onset
 typically begins in mid-late adolescence

3) Course
 Slow recovery (takes up to 10 years for most)
 20% remain chronically ill
 About 50 percent go on to develop BN

Question 6

how is Bulimia Nervosa diagnosed? (3)

Answer 6

1) Recurrent episodes of binge eating:
 Eating in a discrete period of time an
amount of food that is definitely larger than
most people would eat during a similar
period of time and under similar
circumstances.
 A sense of lack of control over eating during
the episode

2) Recurrent inappropriate compensatory
behaviour in order to prevent weight gain:
 Purging: self-induced vomiting, laxative abuse,
 Non-purging: fasting, excessive exercise
 Purging vs non-purging type

3) Body image disturbance
 Undue influence of body weight/shape on selfevaluation

Question 7

What are the associated features of BN + how are they different to AN? impt to note?

Answer 7

Similar psychological features, however with personality disorders (Borderline Personality Disorder) is more common. Depression seems less of an issue?

Physical problems
 Associated with binges (e.g., stomach rupture)
 Associated with compensatory behaviours
(e.g. loss of dental enamel, scarring/ulceration of
the oesophagus, salivary gland enlargement, loss
of normal bowel function, dehydration, electrolyte
disturbances => irregular heartbeat, heart failure)

NB: BN sufferers appear very passive

Question 8

What is the epidemiology of BN and how is it different to that of AN? (4)

Answer 8

Prevalence
 affects 1-3% of females (slightly higher than AN)
 90% of individuals with BN are female (same as AN)

Age of onset
 late adolescence to early adulthood (continues to occur a bit later than AN)

Course
 Long term outcome is better than for AN:
 10% still affected after 10 years

EDs are becoming more recognised in men
 Muscle Dysmorphia

Question 9

Explain the proposed Biological explanations (2).

Answer 9

Genetic factors
 Family and twin studies suggest moderate
heritability component for AN and BN
- Also higher depression, personality disorders,
substance use in families of persons with ED
 No adoption studies have been conducted:
- Difficulty separating genetics and environment

Neurotransmitter disturbances
 Serotonin involved in appetite regulation
 Mixed findings regarding direction of causation

Question 10

Regarding proposed psychological causes, what do AN and BN have in common?

Answer 10

 tendency to base self-worth on weight/shape
 desire to attain unrealistic levels of thinness
 intense fear of gaining weight

Question 11

What did Fairburn suggest?

Answer 11

High degree of overlap in proposed causes

–> Transdiagnostic model (Fairburn et al, 2003)

Question 12

what causes did Fairburn show were common? (4) what is impt to note?

Answer 12

 core low self esteem
 perfectionism
 distress intolerance
 interpersonal difficulties
 (Fairburn et al 2003)

NB: they argue the most important aspect is the over-evaluation of eating, shape, weight and their control

Question 13

some proposed psycho-social causes? (3) . elaborate

Answer 13

Family factors
 Higher parental criticism, control and conflict
 Lower parental empathy and support
 Comments regarding child’s eating/body
 Parental modelling of eating/body concerns
 Difficulty in determining direction of causation

Peer factors: social approval

Sociocultural values
 Emphasis on thinness as a key basis of
attractiveness (especially for females)

Question 14

Give an example of sociocultural values being exemplified?

Answer 14

Trend in Body Mass Index in

Miss America Pageant Winners (dipped under healthy 18.5)