Lecture 6 - Eating Disorders

Question 1

What is PICA?

Answer 1

• persistent eating of non-nurtitive, non-food substances
• 1mth
• childhood onset most common
• in adults: MI and ID
• prev unclear

Question 2

What is Rumination Disorder?

Answer 2

• repeated regurgitation of food after feeding/eating
• 1mth
• childhood onset most common
• in adults: MI and ID
• prev unclear

Question 3

What is Avoidant/Restrictive Food Intake Disorder?

Answer 3

• avoidance/restriction of food intake
• failure to meet requirements for nutrition or insufficient energy intake through oral intake of food
• weight loss, nutritional deficiency, dependence on enteral feeding/oral nutritional supplements, interfered functioning
• childhood onset most common
• COMORBIDITIES: anxiety, OCD, neurodevelopmental (ASD, ADHD, ID)

Question 4

What are the DSM-5 criteria for Anorexia?

Answer 4

• restriction of energy intake leading to low body weight
• intense fear of gaining weight/becoming fat or persistent behaviour interfering with weight gain
• disturbance in way one’s shape/weight is experienced
• self-evaluation unduly influenced by shape/weight
• persistent lack of recognition of seriousness of low body weight
• subtypes: restricting, binging/purging

Question 5

What is the prev, onset, comorbidity and course of AN?

Answer 5

• prev: 0.1-1% (10F:1M)
• subthreshold more common
• onset: late teens/early 20s (later onset becoming more common)
• comorbidity: 60% dep, 33% anx
• course: highly variable
• recover
• fluctuate + relapse
• chronic deteriorating course (20%)
• cross-over to BN (50%)
• high rates of suicide
• mortality rate 5-10%

Question 6

What are the associated features of AN?

Answer 6

DISORDERED EATING

• food rituals
• food preoccupation
• food preferences
• cook for others, not self
• hungry but refuse to eat

PHYSIOLOGICAL COMPLICATIONS

• hair thin
• low HR/BP
• anaemia
• kidney failure
• bloat
• cog feature: mood, mmeory, concentration

PSYCHOLOGICAL FEATURES

• perfectionism
• feelings of ineffectiveness
• inflexible thinking
• overly restrained emotional expression (eg. anger)
• limited social spontaneity

Question 7

What are the DSM-5 criteria for Bulimia?

Answer 7

• recurrent episodes of binge eating
• recurrent inappropriate compensatory behaviours to prevent weight gain
• binging 1/wk for 3 mths
• self-evaluation unduly influences by shape/weight

Question 8

What is the prev, onset, comorbidity and course of BN?

Answer 8

• prev: 1-1.5% (10F:1M)
• subthreshold more common
• onset: late-early adulthood (later than AN)
• often occurs after an episode of dieting
• course: chronic or intermittent
• often lasts several years
• remission and recurrences of binging often alternate
• comorbidity: MDD, anxiety, substance use 33%

Question 9

What are the associated features of BN?

Answer 9

PSYCHOLOGICAL FEATURES

• low SE
• guilt
• preoccupied with food
• recognise behaviour is abnormal

PYSIOLOGICAL COMPLICATIONS

• anaemia
• swollen cheeks
• abraised knuckles
• irregular HR
• sore/irritated throat

Question 10

What is Binge Eating Disorder? Prevalence?

Answer 10

• recurrent episodes of binge eating (size, time, control)
• 1/wk for 3mths

3+ of

• eating rapidly
• eating until uncomfortably full
• eating when not physically hungry
• eating alone (embarrassed)
• disgusted with oneself (depression, guilt)
• 1.6% F, 0.8% M
• higher in obese populations

Question 11

What are OSFED and UFED?

Answer 11

Other Specified FED:

• atypical AN (not low weight)
• atypical BED (lower freq/duration)
• atypical BN (lower freq/duration)
• night eating syndrome
• purging disorder (without binging)

Unspecified FED:

• behaviours cause clinical distress/impairment but don’t meet full criteria for any other disorder
• clinician may not want to specify which criteria were met
• may be insufficient info to make specific diagnosis

Question 12

What is the deal with males and eating disorders?

Answer 12

• 10% of EDs in males
• 17% diet
• 31% want heavier, 31% want lighter
• body dissatisfaction increasing (15% in 1972, 34% in 1985 and 47% in 1997)
• extreme dieting/self-induced vomiting increasing more in M than F

Question 13

What are the treatment outcomes for EDs?

Answer 13

• worse for AN (50%) than BN (75%)
• better short-term from BED (25-80%) and at 1yr follow-up
• higher remission for EDNOS short-term (<5yrs) (68%) > but at 5yrs there is little diff b/w EDNOS and BN

Question 14

What are the prognostic factors of EDs?

Answer 14

• AN: severity, duration, body/weight concern
• BN: severity, psychiatric comorbidity
• BED: early abstinence from binge eating and to interpersonal factors

Question 15

What are the genetic risk factors for EDs?

Answer 15

• moderate heritability
• AN: 50-60%
• BN: 58-83%
• BED: 82%
• teenage obesity: 86%

Question 16

What are the biological risk factors for EDs?

Answer 16

• chem imbalances in neuroendocrine system (hunger, appetite, digestion, emotions, thinking etc.)
• 5HT and NE low in acutely ill (link b/w MDD and EDs? or result of starvation?)
• excessive levels of cortisol in AN (and MDD) > issue with hypothalamus
• brain structure: parietal cortex smaller > overestimate own weight, lack insight… or caused by starvation??

Question 17

What is the relationship between ED and cognition?

Answer 17

• generally average-high intellect
• in acutely unwell AN: mild cog deficits (exec functioning, memory, verbal and visuospatial processing) > not in recovered patients
• deficits in cog flexibility and central coherence (AN and BN)

Question 18

What is the role of personality in EDs?

Answer 18

• AN-R: obsessive, perfectionistic, socially inhibited, harm avoidance, emotionally restrained
• AN-BP: impulsive, extroverted
• AN: OCPD traits in childhood??
• BN: impulsive, interpersonally sensitive, low SE, Cluster B + Cluster C (esp. BPD), substance use

Question 19

What are the early environmental risk factors in EDs?

Answer 19

• AN: obstetric complications, childhood feeding/sleeping problems, high physical exercise, over-anxious parenting, OCPD traits, perfectionism, -ve SE
• BN: obstetrics complications, dieting, childhood/parental obesity, alcoholism, pubertal timing, sexual abuse, -ve SE
• BED: childhood obesity, family over-eating/binge-eating, high parental demands, -ve affect, parental mood, substance misuse, perfectionism, separation from parents, maternal problems with parenting

Question 20

What are the interpersonal and social risk factors in EDs?

Answer 20

INTERPERSONAL

• trouble fam/personal rships
• difficulty expression emotions/feelings
• history of teasing about size/weight
• high parental expectations + maladaptive parenting (chicken v egg?)
• childhood feeding difficulties
• history of trauma or abuse (60-75% BN patient have a history of physical/sexual abuse)

Question 21

What are the cultural risk factors in EDs?

Answer 21

• media and cultural pressures
• glorify thinness + obtaining perfect body
• narrow definitions of beauty
• value people on physical appearance NOT inner qualities
• people in professions emphasizing thinness are more vulnerable (modelling, dancing, weightlifting)

Question 22

Explain the GxE interactions in EDs

Answer 22

• lability may result from accumulation of psychosocial risk factors
• trigger illness in genetically vulnerable adolescents
• currently looking into epigenetics

Question 23

Explain the aetiological model of EDs

Answer 23

• predisposing: vulnerability
• precipitating: stressors; lead to weight loss > benefits of weight loss discovered
• perpetuating: maintain weight loss

Question 24

What is the transdiagnostic model of EDs?

Answer 24

AN > BN 50%
BN > AN 30%

• same core psychopathology underlies all EDs (over-evalute eat/shape/weight and their control)
• expressed in similar attitudes/behaviour (restriction, vomit/laxatives, body checking, binging, preoccupation with eating/shape/weight)

MAINTAINING PROCESSES

• perfectionism
• low SE
• mood intolerance
• interpersonal difficulties

Question 25

What is orthorexia?

Answer 25

• obsession with proper nutrition
• restrictive diet + ritualised patterns of eating + rigid avoidance of foods that are ‘unhealthy’ or ‘impure’
• may lead to: nutritional deficiencies, medical complications similar to AN, psychological complications (frustration, guilt, self-loathing, social isolation)

15 item measure

• 13% Aus dieticians
• 45% Turkish doctors
• 56% Turkish performance artists

Question 26

Explain the transdiagnostic treatment model of EDs

Answer 26

• suitable for all EDs (specific diagnosis is not relevant)
• treatment content dictated by the presenting psychopathological features and the processes maintaining them

4 STAGES

1. 4 weeks. Engage, educate, initial formulation
2. Review progress so far, identify barriers to change, formal assessment of the 4 transdiagnostic processes, revise/extend formulation
3. Dictated by formulation, modify eating disorder psychopathology, address additional processes
4. Ensuring progress is maintained after treatment finishes