Problem 7 Flashcards
Anorexia nervosa
Refers to a condition where one starves the self + subsists on little or no food for very long periods
–> still thinking they have to lose more weight, thus developing elaborate rituals around food
Name the requirements for a person to be diagnosed with Anorexia nervosa.
- Refusing to maintain a body weight that is normal for age
- Body weight is at least 15% below the minimum norm
- -> <18.5 BMI - Fear of becoming fat; distorted image of the self
- -> thus, e.g. engaging in excessive exercising
(4. Amenorrhea
- -> no menstruation ) - only DSM-4
Restricting type of AN
Simply refusing to eat as a way of preventing weight gain
e.g.: not eating for days, eating very small amounts each day
Binge/purge type of AN
Periodically engaging in bingeing or purging behaviors
e. g.: self-induced vomiting
- -> 50% of AN patients
How is the binge/purge type of anorexia different to bulimia nervosa ?
- People with anorexia are still underweight whereas bulimia patients usually have normal to overweight body weight
- Women with anorexia usually have amenorrhea, bulimia patients do not
Prevalence of anorexia nervosa ?
Comorbidity ?
- a) 1-2% life time prevalence
b) More caucasian women
c) Begins in adolescence
- -> 15-19 y/o - Depression
b) OCD
Anorexia nervosa has a death rate of 5-8%.
What are the most serious consequences of it ?
- Heart failure
- -> irregular or too slow heart beat - Expansion of the stomach to the point of rupturing
- No bone strength
- -> due to amenorrhea
Bulimia nervosa
BN
Is a eating disorder characterized by uncontrolled eating/binging that is followed by behaviors designed to prevent weight gain from the binges (Compensation)
–> chronic
Name the requirements for a person to be diagnosed with bulimia nervosa.
- Binges occur over a discrete period of time
- -> 1x/week for at least 3 months - Amount of food is larger than normal
- Average binge of 3000-4,500 kcal
- Lack of control
- -> feeling compelled to eating even though not hungry - Self induced vomiting
What is the main difference in people with anorexia vs bulimia ?
Their self-evaluations strongly differ
–> whereas people with anorexia might have a distorted body image, patients with bulimia have a rather realistic one
BUT: still both are unhappy with their body
Purging type of BN
Involves the use of self induced vomiting or purging medications to control body weight
Non-purging type of BN
Involves the use of excessive excise or fasting to control body weight
Prevalence of BN ?
- 0.5-3% life time prevalence
- more women
- More caucasian/westernized cultures
- occurs in adolescence
- -> 15-29 y/o
Although bulimia nervosa doesn’t have a death rate as high as anorexia it does involve serious medical complications.
Name the most serious one.
Imbalances in the body electrolytes, which can lead to heart failure
–> result from fluid loss from the excessive vomiting
Binge eating disorder
BED
Is a eating disorder that where the person can’t refrain from eating and is thus over weight
–> chronic
Prevalence of BED ?
Comorbidity ?
- a) More women
b) No ethnic/racial differences
2.
a) Depression
b) Anxiety
c) personality disorders
d) alcohol abuse
Eating disorder not otherwise specified/unspecified + otherwise specified (NOS + OS)
OS:
Individuals who have some severe symptoms of anorexia or bulimia nervosa but do not meet all criteria for either disorder will be classified as OS
NOS/Unspecified:
Having some symptoms of eating disorders but cant place it, meaning put a name on it
–> most common eating disorder
Prevalence of NOS eating disorders
- Culturally bound
- -> wealthy developed countries, that value thinness - Increased in recent decades
- -> increased availability of food - 5% life time prevalence
Biological factors contributing to eating disorders
- Eating disorders result from imbalances in the neuro-chemicals involved in the regulatory system of the hypothalamus (Serotonin)
–> causes individuals trouble to detect hunger vs stop eating when full
BUT: Abnormalities can also be the cause, as they sometimes disappear with weight gain
- Genetics
- -> heritability of 56% (AN) + 50-80% (BN)
How does the hypothalamus regulate eating ?
By receiving messages about recent food consumption + sending message to cease eating when the nutritional needs are met
–> done by neurotransmitters (NE, SER, DOP) and hormones (INS, CORT)
Social factors + cultural norms contributing to eating disorders ?
- Cultural ideals that shift historically
- -> reinforced via TV, magazines - Groups within a culture
- -> athletes, models
Eating disorder behavior may sometimes be maladaptive strategies to deal will painful emotions.
There are 2 main subtypes.
Name them.
- Depressive subtype
- -> suffer great social + psychological consequences - Dieting subtype
- -> try to maintain diet but often fall of wagon to engage in binge eating
–> will become chronic
Cognitive factors contributing to eating disorders
Fairburn
- Overvaluation of ones appearance (Attention bias)
- -> body shape is considered as the most important aspect of the self - Body dissatisfaction, perfectionism, low self esteem
- Trying to conform to others wishes
- Dichotomous thinking
- -> things are either very good or very bad
How can family dynamics contribute to the development of eating disorders ?
Over-invested + controlling parents, thus combination of
a) low parental warmth
b) high parental demands
–> will have daughters trying to please their parents, never accepting own feelings + desires
Which forms of therapy has been proven to be most effective for Anorexia nervosa patients ?
- CBT
- Family therapy
–>The main goal is to gain trust + maintain it
Which forms of therapy have been proven to be most effective for bulimia nervosa ?
- CBT
- -> most effective - IPT
- Supportive excessive psychodynamic therapy
–> teaching the client to monitor cognitions that accompany eating + developing more adaptive attitudes towards weight + body
ex.: including “forbidden” food into diet
Which biological treatments are most effective for bulimia nervosa ?
Antidepressants
–> namely SSRIs, which reduce binge eating + purging behaviors
What are possible causes of the development of AN?
AN patients engage in a
- Suppression mindset
- -> inhibiting thoughts about food that elicit craving - Cognitive reappraisal mindset
- -> immediately thinking about negative consequences about food
=> thus, these frequent exposures without eating will eventually extinguish appetite (Extinction)
What are possible causes of the development of BED or BN?
Dieting, meaning the deliberate restriction of food intake
e.g.: eating restraint causes overeating
Does caloric restriction prolong life ?
Yes, there have been significant evidence that claims so
–> mechanisms by which this occurs are similar across species
BUT: specific nutrient-sensing pathways implicated in theses anti-aging effects are yet to be discovered
There has been debate over the diagnostic instability of eating disorders.
Is the assumption that the diagnoses change over time really true ?
Yes,
It has been shown that there is considerable flux between the 3 specific eating disorder diagnoses (AN,BN,EDNOS)
e.g.: patients who don’t recover from AN will cross over to BN
–> thus, they are best seen as a single entity, due to their commonalities
Name the possible mechanisms by which dieting will increase the risk for BN or BED.
- Unhealthy dieting behavior –> weight loss –> chronic hunger
- Dieting depends on the reliance on cognitive controls, which might be disrupted (thus BED)
- Dieting might result in depletion of tryptophan
- -> binge eating to restore these levels
CBT has been proven to be an effective treatment option of AN.
However, there has been new evidence that dissecting the core fear of it will be even more effective.
How can one go about this?
By engaging in
- Inhibitory learning
–> if food consumption its the core fear + weight gain the feared outcome then foods will have to be presented that don’t result in weight gain
- Weight maintenance diet, which will decrease bulimic symptoms
Restraint theory (Nisbett)
Suggests that individual differences in relative deprivation (relative to set-point weight) produces corresponding eating behavior
–> people have genetic/preconditioned set points
Transdiagnostic Perspective
Suggests that eating disorders share the same distinctive psychopathology
–> common mechanism, thus important to focus on symptoms
- Perfectionism
- Low self esteem
- Mood intolerance
- Interpersonal difficulties
Experimental psychopathology
EPP
Refers to an efficient way to gain knowledge about the mechanisms of eating disorders
–> found out that
- Dieting follows binge eating not other way round
- AN deactivates reward related brain areas
- -> reduces appetite motivation - Treatment should involve conditioning to learn to associate body with positive social feedback
Feeding disorder
- PICA
- -> eating things that are not edible - Rumination disorder
- -> chewing on things for a longer period - Avoidant/restrictive food intake disorder
- -> very picky eating, underweight but due to fear of food not fear of weight-gain
=> no weight/shape related problems
Maintenance model
- Overvaluation
- -> control + body weight - Start of diet
- a) Binge eating
- -> leads to purging
b) underweight
- -> leads to starvation
=> more focused now on weight thus:
- Overevaluation
- -> Vicious cycle of defining yourself by how you evaluate the self
Milkshake experiment
Gave people who were on a diet vs those without diet 0-3 milkshakes
- -> those w/o diet that had no milkshake will eat more ice cream, but those who had milkshake will not
- -> with diet still eat more ice cream, whether they had milkshake or not
=> Diet is the cause of binge eating
