Module 10 - Eating Disorders Flashcards
What are the major eating disorders
-Anorexia nervosa
-Bulimia nervosa
-Binge-Eating Disorder
- Other specified/Unspecified eating or feeding disorder
Diagnostic Features of Anorexia Nervosa
A. restriction of energy intake relative to requirements, leading to significantly low body weight
B. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with gaining weight even though at a significant low weight
C. Disturbance in the way one’s body weight or shape is experienced, persistent lack of recognition of the seriousness of the current low body weight
Restricting type- During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour
Binge-eating/Purging Type - During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behaviour
Diagnostic features of Bulimia Nervosa
A. Recurrent episodes of binge eating. Binge eating is characterized by both of the following:
1) Eating in a discrete amount of time (within 2 hour time frame), an amount of food that is definitely larger than what most individual would eat in that same time period, under similar circumstances
2) A sense of lack of control over eating during the episode (cannot stop, or control what or how much they are eating.
B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self induced vomiting, laxatives, diuretics or other medications; fasting, or excessive exercise
C. The binge eating and compensatory behaviour both occur, on average, at least once a week for 3 months.
D. Self evaluation is unduly influenced by body weight or shape
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Diagnostic features of Binge Eating Disorder
-Recurrent episode of binge eating
-must report at least 3 additional features (such as eating rapidly, eating until uncomfortably full, eating large amounts of food even when not hungry, eating alone bc of embarassment, feeling disgusted, guilty, depressed after binge.
Obesity is not required for diagnosis
Other specified/Unspecified eating or feeding disorder (OSFED)
Encompasses eating disorders of clinical severity that do not meet the specific criteria for anorexia, bulimia or BED.
Ex: someone who meet bulimia criteria but engages less than 1/x per week.
For other individuals with OSFED, the eating disorder symptoms combine in a different way than in one of the 3 specified eating disorder categories, but are still clinically significant.
Ex: OSFED purging disorder is characterized by regular purging behaviours (vomiting or laxative), in the absence of binge eating, by individuals who are within the normal weight range
Night eating syndrome
Unspecified feeding or eating disorder applies to individuals with eating disorders that cause distress or impairment, but do not meet criteria for any specified disorder.
What are overlapping features of eating disorders?
Anorexia and Bulimia:
-Undue influence of body weight or shape on self evaluation (a central diagnostic componenet in bulimia but 1/3 alternative criteria for anorexia)
Bulimia and Binge Eating:
- recurrent episodes of binge eating (but bulimia engages in compensatory behaviour and BED does not)
- definition of binge eating for BED is identical to bulimia, but BED do not compensate and BED individuals must report at least 3 additional features (such as eating rapidly, eating until uncomfortably full, eating large amounts of food even when not hungry, eating alone bc of embarassment, feeling disgusted, guilty, depressed after binge.
What is the difference between Bulimia and Anorexia binge type?
Anorexia - binge eating/purging type not only engages in food restriction (and possibly excessive exercise), but also regularly engage in binge and purging behaviour
Bulimia is recurrent episodes of binge eating (eating within a 2 hour time frame more than most would eat in that time period) and recurrent episodes of compensatory behaviour to get rid of it/make up for it to prevent the weight gain.
These may differ only in respect to whether their weight is significantly lower than what is expected for their height and age.
What are the important etiological factors?
-Genetic and Biological factors
-Psychological theories; sociocultural, family, personality/individual, traumatic events
- Integrative models
Genetic and Biological etiology factors of eating disorders
Biological heritability is approximately 50% (with some studies as high as 88%)
Dysfunctional neurotransmitter activity:
-role of serotonin (satiety, mood, impulse control) - anorexia and bulimia
-dopaminergeric alterations - BED
-role of puberty hormones and onset of ED for girls
Psychological theories etiology of eating disorders
-Socio-cultural factors; internalization of body image ideals
- Family factors; children with mothers with ED at higher risk, related to mothers concerns about childs weight. Children of mothers with low edication and in families with high exposure to stress were also at increased risk. Current view is that family factors may be relevant but do not play a primary role in causation.
- Personality factors; correlational not cause but lower extraversion and higher perfectionism, neuroticism documented across all Ed’s.
Individuals with anorexia show high levels of constraint, rigidity, low levels of novelty seeking
Individuals with Bulimia show high impulsivity and novelty seeking, characteristics overlapping with borderline personality disorder
-Traumatic events; all childhood maltreatment were significantly associated with all types of ED’s but difficult to determine if the trauma itself is the causal factor
What personality traits have been identified as risk factors for developing and ED?
negative emotionality
poor interoceptive awareness
neuroticism and perfectionism
Integrative models etiology of eating disorders
Etiology of E.D’s are multifactorial
Suggests that bulimia develops and is maintained due to an interaction of risk and maintenance factors.
Socio-cultural variables (media exposure, idealization of thin) and psychological factors (perfectionism, negative emotionality), which interact with genetic risk factors in order to influence the development of ED.
Once behaviours such as binge eating or purging are initiated, negative affect may serve as a maintenance factor because these behaviours temporarily relieve negative emotions.
Body dissatisfaction may also maintain bulimia through the persistence of dieting, which further increases vulnerability of binge eating
Integrative etiology has not yet provided predictive power sufficient to prospectively identify individuals most likely to develop an ED.
What treatment approaches are used for ED’s?
-Biological
-Psychological; CBT, interpersonal therapy, nutritional counseling, family therapy, self help
Biological treatment approaches for ED’s and the empirical evidence to support it
Bulimia:
-antidepressants (prozac approved around the world but only modestly effective)
-Anticonvulsant (Topamax off-label modestly effective)
BED:
Antidepressants good efficacy
-off-label topiramate has shown good results with both symptoms and weight loss
-Vyvanse (an ADHD med) good for acute treatment and preventing relapse
Anorexia:
-Pharmacological attempts unsuccessful
-atypical antipsychotic “promising” results for helping with weight gain but no effect on the behaviours
Neurostimulation -
-DBS has strongest rationale for use with ED’s and primary researched with severe and enduring anorexia, shows promise but not yet considered an effective treatment
-rTMS shows mixed outcomes, some showing promising findings and others showing no difference
Psychological treatment approaches for ED’s and the empirical evidence to support it
Psychotherapy remains treatment of choice for Bulimia.
-CBT is leading evidence based treatment for ED’s - Transdiagnostic theory that Anorexia, Bulimia, BED and OSFED have similar underlying psychopathological processes and maintaining factors
-CBT-E (enhanced for Eating Disorders) - proven an effective treatment for adolescents and adults with ED’s and is recommended for first line of treatment for adults with bulimia and BED
-Interpersonal - a comparable option to CBT with similar results. An effective treatment but CBT-E continues to outperform at post treatment followup
-Nutritional counselling - immediately with anorexia to medically stabilize the individual. Not recommended as a stand alone treatment for ED’s.
-Family Therapy; Maudsley approach for adolescents where initial focus is on symptoms with caregivers playing a key role in managing the patient’s eating behaviours. No attention is paid to the cause of the disorder. Although FBT (family based therapy) and individual therapy appear to perform similarly at the end of treatments for adolescence, those who did FBT did better during their follow up.
-Self help produced modest and clinically significant improvements to overall ED psychopathology. there is also evidence that self help resources improved binge eating, especially those with BED.
