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Psychopathology of Everyday Life > Lecture 9 - Eating Disorders > Flashcards

Lecture 9 - Eating Disorders Flashcards

1
Q

What are some incorrect pre-conceptions people have about people with eating disorders?

A
  1. You can tell whether someone has an eating disorder just by looking at them.
  2. Someone with an eating disorder will not be in a “healthy”/”normal” weight range.
  3. Eating disorders are a choice and people should just either eat more or less.
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2
Q

What is considered normal/healthy eating attitudes and behaviours?

A

Eating when you’re hungry and stopping when you are satisfied.

Use healthy, moderate constraint that is not too restrictive.

Sometimes just eating because it feels good.

Overeating at times or sometimes wishing you had eaten more.

Eating is only one important area of your life.

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3
Q

The DSM-5 section for eating disorders also has feeding disorders.
What are feeding disorders and how do the differ from eating disorders?

A

Eating disorders tend to involve a poor body image aspect.

Feeding disorders are more about the process of eating.

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4
Q

What are the disorders listed as eating disorders and feeding disorders in the DSM-5?

A

Eating Disorders:
Anorexia Nervosa.
Bullimia Nervosa.
Binge eating disorder.
Other specified eating and feeding disorders.
Other unspecified eating and feeding disorders.

Feeding disorders:
Pica.
Rumination disorder.
Avoidant/Restrictive Food Intake Disorder.

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5
Q

How is Anorexia Nervosa diagnosed according to the DSM-5?

A

Persistent restriction of energy intake leading to low body weight.

Intense fear of weight gain and persistent behaviour to prevent weight gain.

High levels of distress and preoccupation with weight and food.

Disturbance in how body is perceived, and how seriousness of health implications.

Undue influence of weight or shape on self-evaluation, including their self-worth. Some can feel that their value as a person entirely depends on their weight.

Thought: “undue” is an interesting choice of words when describing the belief that a small body is required for acceptance and love and self-worth. In a society that values looks above most things and that glorifies and sees thinness as success, it is not “undue infleunce”, it is the inevitable influenced of the culture on developing minds.

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6
Q

What are the subtypes of Anorexia Nervosa?

A
  1. Anorexia Nervosa - Restricting Type
  2. Anorexia Nervosa - Binge-eating/purging type.
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7
Q

Can people be diagnosed as “in partial remission” if criterion A (low weight) is no longer met, but was previously met, and there is still significant fear of weight gain and/or there is an undue influence of body weight on self-evaluation (criterion B and C respectively)?

A

Yes.

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8
Q

What is the severity of anorexia nervosa based on ?

A

Body weight and functional impairment and psychological stress.

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9
Q

What is the sex ratio of anorexia nervosa?

A

10:1 for females:males.

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10
Q

What is the twelve month prevalence for anorexia nervosa?

A

0.4-0.8%.

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11
Q

What is the typical age of onset for AN?

A

Adolescence to early 20s.

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12
Q

What are the common comorbid mental health disorders that those with AN have?

A

Anxiety and depression.
OCD.

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13
Q

What percentage of those with AN also have an anxiety disorder or depression?

A

30 - 60% - I would have thought there would be a larger proportion of comorbidity.

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14
Q

Is it common for those with AN to be told they had OCD traits as a child?

A

Yes.

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15
Q

What are some of the psychological factors and their clinical presentation for AN?

A

Psychological factors:Clinical Presentation.

Perfectionism - gradually eliminating food.

Harm avoidance - food rituals.
Feelings of ineffectiveness - preoccupation with food.

Inflexible thinking - ignoring hunger cues.

Socially inhibited - wearing baggy clothes.

Overly restrained emotional expression.

Autistic features common - ??

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16
Q

What are some of the reasons it is difficult for individuals with AN to think flexibly and critically, especially about their disorder?

A

Their body and brain go into survival mode, lessening access and energy supply to the prefrontal cortex, which is required for lateral thinking. This type of thinking is also challenging and energy consuming. People with AN often do not have the spare energy or emotional capacity to engage in this difficult type of thinking.

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17
Q

What are some features of eating disorders that can be seen in those with autism?

A

Not eating certain foods.
Requiring rituals around food and eating.

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18
Q

Do individuals who restrict food intake quite quickly lose a sense of their hunger cues?

A

Yes.

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19
Q

Individuals with AN often wear baggy clothes. This makes it difficult for those around them to intially notice the weight loss.

T/F?

A

Yes.

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20
Q

Is Body Dysmorphic Disorder often diagnosed alongside AN?

A

Yes.

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21
Q

What are some physical side effects of AN?

A

Brittle, dry hair.
Muscle wastage and osteoporosis.
Amenorrhea.
Life threatening biochemical changes.
Cardiac symptoms.

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22
Q

Does AN have the highest death of Mental health disorders?

A

Yes.
These deaths are both due to starvation and suicide.

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23
Q

What are some of the cognitive changes that often occur with AN?

A

Mild deficits in executive functioning, memory, verbal, and visuospatial processing. This can impede recovery.

These impacts on the developing brain in adolescents can be severe.

24
Q

What are DSM-5 criteria for Bulimia Nervosa?

What are the two subtypes of BN?

A

A. Recurrent episodes of binge eating.
-eating large amount of food in a discrete period of time.
-sense of loss of control during the binges.

B. Recurrent inappropriate compensatory behaviour to “Deal” wit the excess calories - e.g. purging via vomiting.

C. Occurs at least once per week for at least 3 months.

D. Self-evaluation unduly influenced by body shape and size.

E. Does not occur exclusively in AN episode.

Subtypes:
1. Purging
2. Non-purging - this can look like restriction/fasting after binges.

NB: Lecturer mentions that one of the key aspects of BN is restriction. Individuals restrict and then this makes them more biologically susceptible to a binge.

25
Q

What is the female:male ratio for BN?

A

10:1.

26
Q

What is the prevalence of BN?

A

1-1.5%

27
Q

BN has a bit of later typical onset than AN. What is the average age of onset for BN?

A

Late adolescence to early adulthood.

It can often be preceded with AN.

28
Q

What are some of the co-morbid disorders?

A

Depression, anxiety, substance use disorders.

29
Q

What are the diagnostic criteria for Binge Eating Disorder?

A

A. Recurrent bing eating episodes.
B. Three or more of the following:
-embarrassment and shame that can lead to eating in private
-eating more rapidly than normal
-eating until uncomfortably full
-eating large amount of food when not hungry
-intense feelings of depression or guilt after binges
C. Marked distress due to binging
D. Occurs at least once per week for more than three months
E. NO REGULAR USE OF COMPENSATORY BEHAVIOURS - this is what differentiates BED from BN.

30
Q

Are thew sex differences for BED less skewed than the sex differences for AN and BN?

A

Yes.
This is interesting and also understandable.

31
Q

What is the 12-month prevalence of BED?

A

2-3%

32
Q

In the DSM-5, what are the Other Specified Feeding or Eating Disorders (OSFED)?

A

These are disorders where the individual meets most of the criteria for an eating or feeding disorder except one or more of the required criteria.

An example would be atypical anorexia nervosa. This is where your weight is not below the underweight BMI range.
Another example would be Purging Disorder or Night Eating Disorder.

33
Q

Is ATYPICAL ANOREXIA NERVOSA more common than AN?

A

Yes, ironically, given the name.

34
Q

What are Unspecified Eating or Feeding Disorders?

A

Can be given when there is not enough time to determine the nature of the eating disorder, such as in an emergency room.

35
Q

What are the Feeding Disorders according to the DSM-5?

A

Avoidant Restrictive Food Intake Disorder.

36
Q

What are the diagnostic criteria for Avoidant Restrictive Food Intake Disorder?

A

A. Persistent failure to meet calorie/nutrional intake needs.
B. Not better explained by a lack of available food or a culturally sanctioned practice.
C. Behaviour does not occur exclusively in during an AN or BN episode and there is no emphasis or anxiety around body image that is driving the lack of intake.
D. Not attributable to another medical condition or better explained by another MH disorder.

37
Q

What are some of the reasons people avoid intake of food in ARFID?

A

The individual may hate the smell of certain foods, the texture, or the process of eating.
They may have been very selective eaters as children that lead to the development of heightened senstivities or associations with certain foods.

38
Q

Is ARFID for common in males or females?

A

Males interestingly.

39
Q

What are the diagnositc criteria for Pica?

A

A. Persistent eating of non-food substances for at least one month.
B. This eating of non-food substances is developmentally inappropriate.
C. If occurring in the context of another mental health disorder or medical condition, such as pregnancy, there is enough disturbance that it requires its own diagnosis.

40
Q

What are the diagnostic criteria for Rumination disorder?

A

A. Repeated regurgitation of food for a period of at least one month.
B. Not due to a medical condition.
C. Does not occur exclusively in an episode of AN, BN, or ARFID.
D. If occurring alongside another mental health disorder the disturbance in clinically significant enough to warrant its own diagnosis.

41
Q

What is Disordered Eating?

A

Not in the DSM-5.
This is when individuals have distress and disturbance around eating, but do not meet all criteria for DSM-5 eating disorders.
Very common, especially in young people.

42
Q

What is Orthorexia?

A

Not in the DSM-5.
Cognitive processes around purity and health and cleanliness.
Not as much of an emphasis on body shape and size, but more on purity and health.
Individuals can have very rigid thinking.
Can impair function in social and occupational settings.
Can be very distressing.

43
Q

“Health is not a property of food, it is about how we eat.”

A

This was a quote from the lecturer.
I appreciate that.

44
Q

Is there a lot of overlap of the criteria for different EDs in the DSM-5?

A

Yes.

45
Q

What are the similarities and differences between AN-BP and BN-BP?

A

AN-BP involves “subjective” binges followed by purging.

BN-BP involves “objective” binges followed by purging.

46
Q

What is the difference between BN-NP (non-pruging) and BED?

A

BN-NP involves compensatory behaviours, such as resitriction and fasting.
BED does not involve compensatory behaviours.

47
Q

What is the dual pathway for binge eating disorders, such as Bulimia nervosa and BED?

A
  1. Binge eating as a result of restriction.
  2. Binge eating as an emotional regulation technique.
48
Q

Why are DSM-5 EDs diagnoses still important even though a transdiagnostic model explains the interplay of symptoms and reasons behind symptoms very well?

A

Specific diagnoses are helpful in research and developing treatments and giving people access to certain healthcare options - this is very relevant in the US and other places that do not have universal healthcare.

49
Q

What are some risk factors and correlates for EDs?

A

Dieting - number one risk factor.
Personality factors, such as neuroticism.
Culture - body dissatisfaction, thin idealisation.

Cross-sectional factors included childhood abuse, weight-based criticism.

50
Q

Are cisgender females more likely to develop eating disorders?

A

Yes.

51
Q

What are some factors for EDs in cisgender men that are generally different to EDs in cisgender women?

A

Average age of onset later than women.
Often brought on by a job that requires a certain body shape.
Mascularity more of a focus.
Dieting is a less common risk factor.
Many men with an ED identify as gay or bisexual.

52
Q

Is there research that EDs are higher in transgender populations?

A

Yes.
Likely due to body dissatisfaction or feeling as though one’s body does not reflect ones gender. Also a higher pressure to “fit in”, assimilate.
Transgender men also often try and restrict to prevent secondary sex characteristics, such as menstruation.

There is evidence to suggest that ED symptoms decrease when transgender people reaceive gender affirming care.

53
Q

Is heritability of eating disorders high?

A

Yes.
Around 40-60%

54
Q

What are some of the genes that have been implicated in EDs.?

A

Serotonin transporters.
Some other genes that are also implicated in OCD and metabolic genes.

55
Q

What are some of the evidence-based treatments for EDs?

A
  1. Family based treatment for AN- young person’s parents taking a primary role in re-feeding young person. Can be very stressful for whole family.
  2. CBT/CBT-E.

nb: EDs unlikely to recover spontaneously without treatment.

56
Q

What are some barriers to treatment for EDs?

A

Individuals may not realise how severe EDs is.
EDs are egosyntonic - there is part of the self that wants to keep the ED - a safety mechanism.
There is often a fear of change and what life without the ED would be.
So much fear around what it would be like to be in the world without the ED.

Low BMI often involves in patient treatment. This is not only expensive, but also very intense and fear-inducing.

ED treatment often involves addressing the behaviours early. There is a lot of resistance to this, of course.

Psychopathology of Everyday Life (13 decks)

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