Psychopathology 1: Eating Disorders Flashcards
1
Q
Common mental health disorders
A
- Symptoms regarded as extreme forms of ‘normal’ emotional experiences
such as depression, anxiety or panic, (The
Mental Health Foundation)
2
Q
‘Less common mental health disorders ‘
A
- Disorders whose ‘psychotic’ symptoms
interfere with a person’s perception of reality and
may include hallucinations, delusions or
paranoia, with the person seeing, hearing,
smelling, feeling or believing things that no one
else does, (The Mental health Foundation)
3
Q
What is Anorexia Nervosa?
A
- Mental illness with highest rates of mortality and relapse, and no approved pharmacological treatment.’ Temizer et al (2022)
- Characterised as self starvation syndrome
- Major sign is emaciation caused by food refusal
- Intense fear of becoming fat /gaining weight.
- Body Image disturbances.
- It is proposed and predominantly affects women
4
Q
Sub-types of AN and personality characteristics
A
- The restricting type (ANR)
- The binge eating/ purging type (ANBP)
5
Q
Individual differences in Anorexia Nervosa
A
- Considerable research attempted to identify different aspects of personality or temperament involved in mental health issues
- Research identified distinct personality traits in individuals with eating disorders- relatively specific to each disorder- argued they can distinguish eating disorder sufferers from healthy people
- Tend to have high levels of harm avoidance, a personality trait characterized by worrying, pessimism, and shyness, and low levels of novelty seeking, which includes impulsivity and preferring new or novel things (Fassino et al., 2002)
6
Q
Individual differences in Anorexia Nervosa
A
- Different subtypes of anorexia have slightly different personality traits, with the binge/purge subtype showing slightly higher levels of
impulsivity and novelty-seeking (Bulik et al., 1995) - This subtype tends to be from an older age group, they may have substance use
disorders, display suicidal behaviour, and demonstrate more lack of control (Klump et al., 2000) - Demonstrated higher levels of neuroticism (characterized by depression, anxiety, worry, and
moodiness). (Bollen & Wojciechowski, 2004) - The restricting subtype had higher levels of persistence and is generally associated with younger age, perfectionist tendencies, constraint in eating / other behaviours. (Klump et al., 2000).
7
Q
Diagnosing- DSM – IV changed to DSM -5 in 2013
A
- Refusal to maintain weight (less than 85% normal)
- Changed to restricted calorie intake, focus is now on behaviour rather than refusal which implies intention (removed)
- Intense fear of becoming fat/ denial of low weight
- Distorted body image
- Amenorrhea (least 3 consecutive menstrual cycles)
8
Q
Diagnostic criteria of AN using DSM - 5
A
- Persistent restriction of energy intake leading to
significantly low body weight - Either an intense fear of gaining weight or of
becoming fat, or persistent behaviour that
interferes with weight gain - Disturbance in way one’s body weight or shape
is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
9
Q
Primary symptoms of Anorexia Nervosa
A
- Denial
- Depression
- Mood swings
- Social Withdrawal
- Lack of sexual interest
- Low self esteem
10
Q
Secondary Symptoms of Anorexia Nervosa
A
- Constipation
- Low Blood Pressure
- Hypothermia
- National Association of Anorexia Nervosa and Associated Disorders (USA) 2013 reported that 5 – 10% of anorexics die within 10 years after contracting the condition; 18-20% of
anorexics will be dead after 20 years and only 30 – 40% ever fully recover
11
Q
Bulimia Nervosa
A
- Referred to as ‘binge-purge syndrome’ because massive quantities of food are eaten, then measures taken to rid the body of potential fat – producing calories
12
Q
Bulimia Nervosa DSM -5 Criteria
A
- Recurrent episodes of binge eating
- Eating, in a discrete period of time an amount of
food that is larger than most people would eat during a similar period of time and under similar circumstances - Sense of lack of control over eating
during the episopde - Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting
- The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months
- Self-evaluation is unduly influenced by body shape and weight
- Estimated those with eating disorder, 40% are Bulimic (Adult National Morbidity Survey)
- 30% of women with BN have a lifetime history of
AN, (Keel & Klump)
13
Q
Purging BN (BNP)
A
Involves the regular use of
purging methods to control weight
14
Q
Non purging BN (BPnP)
A
- Regular use of non-purging methods
15
Q
Individual differences in Bulimia Nervosa
A
- Demonstrate high levels of harm avoidance, however can coexist alongside high levels of novelty seeking (Fassino et al., 2002)
- Brown, Haedt-Matt, & Keel, (2011) found those with binge/ purge subtype of anorexia show traits midway between restricting anorexia and bulimia
- High levels of impulsivity, emotion dysregulation, and anxiety in women with bulimia
- Greater impulsivity associated with more frequent purging behaviours
- Scientists found people who have trouble regulating amount of dopamine in brains have higher levels of novelty-seeking (Zald et al.,
2008), and that this also occurs in women with bulimia (Groleau et al., 2012)
16
Q
Secondary Symptoms Of BN
A
- Depression
- Mood swings
- Suicidal tendencies
- Awareness of problem
- Often ‘normal’ weight
- Cyclical nature of disorder
17
Q
Consequences of BN
A
- Potassium Depletion
- Weakness
- Cardiac Arrhythmia
- Renal damage
18
Q
Personality factors in AN & BN- King’s College London 5 obsessive-compulsive personality traits
A
- Perfectionism
- Inflexibility
- Being rule driven
- Drive-for-order
- Excessive doubt and cautiousness
- Women with both AN & BN significantly more
likely show signs of these traits in childhood - Childhood obsessive-compulsive personality traits showed high predictive value for development of eating disorders in
adulthood (Anderluh et al., 2003)
19
Q
Aetiology of Eating Disorders
A
- No single factor responsible
- Range of Psychological, Sociological and
Biological processes - Current research has a good idea of what risk
factors are involved but little insight into how they
are involved.
Södersten, P., Brodin, U., Zandian, M., & Bergh, C.
(2019).
20
Q
Biological/ Genetic factors
A
First degree relatives of females with AN are more likely to develop an ED
- Monozygotic twins have higher concordance rates than dizygotic twins for the development of ED
- Hypothalamus area linked to controlling eating, and malfunctioning of this structure has been put forward as a possible explanation of A.N. and B.N. (Shaikh 2011)
21
Q
Neurotransmitter involvement
A
- Altered serotonin levels - correlations between
anorexic/bulimic behaviour and changes in levels of serotonin - With higher levels of harm avoidance associated with higher levels of serotonin in the brain (Cloninger, 1985)
- Scientists found people who have trouble regulating the amount of dopamine in their brains have higher levels of novelty-seeking (Zald et al., 2008), and that this also occurs in women with bulimia (Groleau et al., 2012)
- Serotonin activity will produce greater alterations in altering serotonin activity and lowering mood in women than in men
22
Q
Brain areas and ED
A
- Brain abnormalities found in people
with ED - Areas of brain appear to be shrunken
- Total white & grey matter sig. decreased, it is not clear whether this caused or resulted from ED, (de Zwann 2006)
- Addictive, maladaptive aspects of excessive
exercise and food restriction may effect brain
changes (Aoki 2021) - Occupations that demand excessive
exercise / food restriction are at risk
23
Q
ED in ethnic minorities-contradictions
A
- Stereotypes about who gets ED preventing people from minoritized groups from seeking and
getting medical treatment (white women only) - Themes evident in disordered eating are:
the pursuit of identity, power, self-esteem & respect- pervasive in the lives of oppressed
ED are associated with negative affect, & mood
disorders, low self esteem and perfectionism
24
Q
The Treatment of Eating Disorders
A
ED difficult to treat:
- Sufferers deny they are /underweight/have a
problem/ill - Individuals (esp. AN) need medical as well
as psychological treatment, to prevent
death - ED highly co morbid with other psychological disorders, which may make treatment difficult and complex
25
Q
National service framework: mental
health
A
- Sets out government’s quality standards for
mental health services - SCOFF questionnaire is a brief and
memorable tool designed to detect eating
disorders and aid treatment - Showed excellent validity in a clinical population and reliability in a student population Luck et al (2022)
26
Q
Physical
A
- Bed rest
- Restoration of body weight
- Intravenous feeding
- Maintain body weight
- Drug Therapy
27
Q
Psychodynamic- focus-alter the irrationality
A
- Psychotherapy
- Family therapy
- Cognitive Behavioural therapy
28
Q
Pharmacological treatments
A
- Both AN & BN frequently co morbid with
major depression
-Antidepressants are used to treat
- Pharmacological treatments have tended to
be less successful with AN, although limited
studies have been done
