Lecture - Eating Disorders Flashcards
- What are eating disorders characterised by?
- What are the consequences of eating disorders?
- Tell me about the identification of eating disorders
- Disturbances of eating behaviours and a core psychopathology centred on food, eating and body image concerns
- It obviously affects quality of life, impacts on all aspects of to + economic aspect. There is high mortality and morbidity. The impairment outcomes for severed and enduring AN are comparable to depression and schizophrenia
- Hard for patient themselves - it’s usually fam etc who are concerned. There might be complications bc of purging or some other medical investigations
What is the prevalence of AN, BN and BED?
AN: 1% women, 0.5% med (early-mid adolescence)
BN: 2% women, 0.5% men (late adolescence/early adulthood)
BED: 3.5% women, 2.0% med (middle-life)
These disorders affect all ethnicities and SES groups and genders etc. They’re often under diagnosed and usually occur high school/uni or ballet etc.
What are the factors that lead it disorders happening (aetiology) and what can you say about the recovery process?
Aetiology:
- things such as socio-cultural factors like families should be thin etc all contribute to eating disorders
- Having genetic heritability is also really important
- Eating disorders can and do occur at any age
Recovery process:
-Most sorta do make recovery
What is ARFID
It’s newly introduced to the DSM and she just wanted us to know it exists. It stands for Avoidant/restrictive food intake disorder
Comes when young and not focussed around body image – jut restrictance from foods. Not about weight or calories, just like yellow food – avoid banada, fish and chips etc
What’re the three diagnostic criteria for AN?
- There needs to be restriction of energy intake rel. to requirements so you get lower body weight in context of age, sex, etc
- Intense FEAR of gaining weight or persistent behaviour that interferes with weight gain (even though they skinny af)
- Disturbances in the way in which one’s body weight/shape is experienced and it affects self-evaluation or you like don’t care about the seriousness of your skinniness
There are two types of AN, what are they?
- Restricting type: during last 3 months, no recurrent episodes of binge eating/purging. They just lose weight through fasting/excessive exercise
- Binge-eating/purging type: In last three months, has engaged in recurrent episodes of binge eating or purging
What are the physical signs and symptoms of AN?
General, neuro psychiatric, cardio resp, gastrointestinal, endocrine and dermatologic
General:
- emaciation,
- ankle oedema,
- cold intolerance,
- preoccupation with additional weight loss despite being thin af
Neuro psychiatric:
- insomnia
- self harm
- suicidal
- depression/anxiety
Cardio resp:
-chest pain
Gastrointestinal:
-constipation, abdominal pain
Endocrine:
-low bone mineral density
Dermatologic:
-hair loss (bc of loss of protein)
What are some behaviours that you can use to recognise AN is going to happen?
Eating, exercise and psychological/social changes
Eating:
- constant focus on food, dieting etc
- skipping meals
- visiting bathroom after meals
Exercise:
- Stressed if unable to excessive,
- excessively exercising
Psychological/social changes:
- mood changes
- elements of obsessive behaviours
- social withdrawal
What did Prof James Lock find out?
With AN:
We have elss than 4 years to intervene and for person to become physically and psychologivally well else they’ll suffer for lifetime
Be thoughtful about how to assess and notice early on – not necessarily diagnose
What are treatments for AN?
- Psychoeducation for both client and the family
- Keep their physical health monitored
- CBT:
- restructuring thoughts/thinking errors
- behavioural experiments to include avoided foods - Take to clinical psychologist
What are the A-E criteria for BN?
A: Recurrent episodes of binge eating (episode = eat in discrete period of time, lack of control over eating)
B: Recurrent inappropriate compensatory behaviour to prevent weight gain (vomit, exercise)
C: The binge + purge at least once a week for 3 months
D: Self-evaluation is unduly influenced by body shape and weight
E: The disturbance does not occur exclusively during episodes of AN
So with specific thing of BN, there is either partial or full remission. There is also a gradient of severity: mild, moderate, severe and extreme - describe that
Severity is dependent on frequency of inappropriate compensatory behaviour + other symptoms and functional diability
Mild: 1-3x a week
Moderate: 4-7x a week
Severe: 8-13x a week
Extreme: 14+ episodes a week
What are physical signs and symptoms of BN (general, oral/dental, cardio resp, dermatologic, gastro intestinal)
General:
-fluctuating weight patterns
Oral/dental:
- oral trauma/laceration
- dental erosion
- swollen parotid glands
Cardio resp:
-chest pain
Dermatologic:
-calloused knuckles
Gastro intestinal:
- abdominal bloating
- constipation
What are co-morbid illnesses associated with AN and BN?
Both: depression
AN: physical illness, anxiety
BN: substance abuse, PTSD, self-harm
What are the risks and prognosis for AN and BN?
BN: it has an external locus of control (food is soothing and controls you?), you have weight fluctuations, have slim ideal body weight
Prognosis for BN: may have comorbidity, have avoidant personality structure
AN: egosyntonic - behaviours, values, feels are consistent with one’s ideal self-image
Prognosis for AN: duration and severity
BED:
1. This is where you have recurrent episodes of binge eating. What is an episode of BE characterised?
- What are BE episodes associated with (three or more of the following)
- What is definitely present regarding BE?
- What’s the frequency of binge eating?
- Is it associated with recurrent use of inappropriate compensatory behaviour?
- In discrete period of time and amount more than what most would eat then and there. Also, need a sense of lack of control - can’t stop
- Eating much more rapidly than normal, eating until uncomfortably full, eating large even if not hungry, feeling disgusted with oneself
- Marked distress
- Once a week for 3 months
- No
What are the associated features of BED?
- Depression/anxiety (approx 30%)
- Non-specific tension (alone, boredom etc)
- Overweight/obese
- Dieting
- Low self esteem
What’re some general assessment and screen questions?
What is the SCOFF questionnaire?
What else does assessment include (ED/mental health and a physical exam)
- “Has there been any change in your weight”
- ‘Do you have binge?”
- How do you feel about your appearance?”
- “Are you dissatisfied with your body size?”
- “Do you think you should be dieting?”
S- sick (do you make yourself sick bc you feel uncomfy full?)
C- control (do you worry that you hv lost control over how much you eat?)
O- one stone (have you recently lost more than one stone in a 3mnth period?
F- fat (do you think you’re too far even if others say you’re thin?)
F- food (would you say that food dominated your life?)
————a score above 2 indicates a follow up required
Ask about cognitions of weight/shape, methods of weight control, eating behaviours etc
Physical exam: menstrual history, medical history, hydration, temperature, squat test etc
What else? Well schools can develop policies and communication pathways, plan conversations in advance etc
Treatment is medical, psychological, psychosocial and motivation
Starvation syndrome - what is it?
We have a genetically determined weight range. Restriction/weight loss will increase our level of hunger and increase thoughts about food and decrease metabolism
What’s the treatment for BED?
Need a structure for eating - sit an eat at one place etc.
Need to address the issues that maintain the eating disorder
Do a recording thing on a recording app
CBT
What is it?
You need to understand the links between thoughts, feelings, physical state and behaviour
What are other cognitions in eating disorders?
Permissive cognition - when dieting becomes unsustainable, you say I’ll binge and then purge later.
What’re tips for a more +ve body image?
- Develop a lifestyle that keeps you healthy
- Work on positive affirmations about your body
- Stay away from places that pull down your self-esteem
Severe and enduring AN - tell me about it
It has entrenched pattern of food restriction
Entrenched anorexic cognitions
Identity intertwined with anorexia
BMI under 17.5
