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)
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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)
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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
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4
Q

Sub-types of AN and personality characteristics

A
  • The restricting type (ANR)
  • The binge eating/ purging type (ANBP)
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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)
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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).
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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)
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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
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9
Q

Primary symptoms of Anorexia Nervosa

A
  • Denial
  • Depression
  • Mood swings
  • Social Withdrawal
  • Lack of sexual interest
  • Low self esteem
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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
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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
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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)
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13
Q

Purging BN (BNP)

A

Involves the regular use of
purging methods to control weight

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14
Q

Non purging BN (BPnP)

A
  • Regular use of non-purging methods
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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)
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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