Lecture 9.1: Eating Disorders Flashcards
What are Eating Disorders?
Eating Disorders are conditions characterised by severe and persistent disturbance in eating behaviours with associated distressing thoughts and emotions
What are the 2 ‘Classical’ Eating Disorders?
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
What is Anorexia Nervosa?
- Refusal to maintain weight at or above a.
minimally normal weight according to height
and age - Intense fear of gaining weight or becoming fat
even though underweight - Body image disturbance
- Amenorrhea (absence of at least 3 consecutive
menstrual cycles)
What are the 2 Types of Anorexia Nervosa?
- Restricting Type
- Binge-Eating / Purging Type
What is Bulimia Nervosa?
- Recurrent binge eating (excessive amount of
food over 2 hrs, sense of lack of control) - Inappropriate compensatory behaviour.
(vomiting, laxatives, excessive exercise) - Twice a week for 3 months
- The binge eating and inappropriate
compensatory behaviour both occur, on
average, at least twice a week for 3 months - Self-evaluation unduly influenced by body
shape/weight
What are the 2 Types of Bulimia Nervosa?
- Purging Type
- Non-Purging Type
What causes an Eating Disorder?: Biological Factors (5)
- Genetic Factors
- Females: Male is 10:1
- OCD/Autism-Spectrum Traits
- Metabolic Vulnerability
- Environmental influences in perinatal period
What causes an Eating Disorder?: Psychological Factors (9)
- Personality Traits
- High ability to delay rewards
- Increased sensitivity to social ranking and
threat - Body Image Disturbance
- Alexithymia
- Self-esteem
- Depression
- Anxiety
- Self-harm
What causes an Eating Disorder?: Psychosocial Factors (7)
- Parental Eating Problems
- Peer Stress
- Trauma
- Culture
- Thin Idealisation
- Middle-to-High Socioeconomic Status
- Social Media
What causes an Eating Disorder?: Behavioural Factors (5)
- Over-control of weight and eating
- Over-concern with BMI
- Social Isolation
- Coping by avoidance or perfectionism
- Impaired physical and mental quality of life
The ‘Need for Self-Control’ is a key component in Eating Disorders, why is this? (4)
- Dieting provides direct and immediate evidence
of self-control - Control of eating has potent effect on others in
the immediate environment - Means of arresting or reversing puberty (threat
to self-control) - Western society emphasis on shape and weight
What/Who are Perfectionists?
‘Perfectionists are those whose standards are high beyond reach or reason, people who strain compulsively and unremittingly toward impossible goals and who measure their own worth entirely in terms of productivity and accomplishment’
What is Impulsivity?
Acting on the spur of the moment; not
focussing on the task at hand; not
planning and thinking carefully
What is the only approved drug in the UK/USA to treat BN?
Fluoxetine hydrochloride
What factors are influenced by Serotonin (5-HT Receptors)?
- Appetite & Satiety
- Impulsive/Compulsive/Obsessional Behaviour
- Mood & Emotional Processing
Why is Serotonin (5-HT Receptors) important in EDs?: Anorexia Nervosa
- 5-HT system is inherently unstable and poorly
modulated - 5-HT system fluctuates erratically
- Dieting causes a reduction of 5-HT signal
transmission in BN - Possibly contributing to low mood
- Binges used to modulate 5-HT
Why is Serotonin (5-HT Receptors) important in EDs?: Bulimia Nervosa
- Premorbid disturbance in 5-HT
neurotransmission - Contributes to anxious, obsession traits which
tend to predate dev of AN - Restricted eating as a means of reducing 5-HT
functional activity (possibly via TRP availability) - Therefore reducing anxiety
What is the Effect of Orexin on appetite?
Increases Appetite
What is the Effect of Peptide YY(3-36) on appetite?
Signals from the gut decrease appetite
by inhibiting neurones that that produce
neuropeptide Y and Agouti-related protein
What is the Effect of Insulin and Leptin on appetite?
Decrease appetite via stimulating melanocortin producing neurones
What is the Effect of Ghrelin on appetite?
Signals from the gut increase appetite stimulating NPY and AgRP neurones and stimulating Orexin release
Enhanced Cognitive Model of EDs (5 Step Cycle)
Negative Self-Belief
Negative Thoughts
Emotions/Feeling
Thoughts about Eating
Problematic Eating Behaviours
Treatments for Eating Disorders: AN (8)
- Inpatient psychiatric treatment of 2-3 months
- Followed by close outpatient monitoring and re-
feeding regimen - Nutritional counselling and education
- Behavioural therapy (rewards to reinforce)
- Cognitive-Behavioural Therapy
- Family Treatment
- Interpersonal Group therapy
- Medication
Treatments for Eating Disorders: BN (6)
- Outpatient Clinics
- Behavioural Therapy
- Cognitive Behavioural Therapy
- Family Treatment
- Group Therapy
- Medication
What is an SSRI? How do they work?
- Selective serotonin reuptake inhibitor
- Work by blocking (“inhibiting”) reuptake
- Meaning more serotonin is available to pass
further messages between nearby nerve cells
What are topics of focus in CBT in EDs? (6)
- Emphasis on self-monitoring of eating and
weight - Psychoeducation about weight, shape and
eating - Establishing regular pattern of eating including
snacks - Involving a significant other (family member,
partner, friend) - Identifying barriers to change
- Working on maintaining mechanisms
