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iBSC Abnormal Psychology > Session Eighteen (Eating Disorders) > Flashcards

Session Eighteen (Eating Disorders) Flashcards

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1
Q

According to DSM-5, what are the 3 main eating disorders?

A
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder
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2
Q

Explain the difference between the 3 core EDs?

A

AN = People restrict their caloric intake but do NOT sustain a healthy body weight

BN = Marked by binging and purging

BED = Marked by binging without purging

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3
Q

At what age do eating disorders develop?

A

AN = early, mid or late adolescence (mean age = 18.9)

BN = late adolescence to early adulthood (mean age = 19.7)

BED = adult onset (mean age = 25.4)

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4
Q

How common are the respective eating disorders?

A

All reasonably common.

BED most common, followed by BN and AN least common.

Prevalences:

  • AN = 1-2% in Europe
  • BN = 1-2% in Europe
  • BED = 3-10% in Europe
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5
Q

Distinguish between an eating disorder and an especially strict diet?

A

ED:

  • Attempt to control life and emotions
  • Self-esteem is based entirely on weight
  • Weight loss is viewed as a way of achieving happiness
  • Becoming thin is the primary concern, health is irrelevant

Dieting:

  • Healthy dieting is an attempt to control weight
  • Self-esteem is based on far more than your body image
  • Weight loss is a way to improve health and appearance
  • Goal is to lose weight but doing so in a way that optimises health
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6
Q

What are the criteria for an AN diagnosis?

A
  • Significantly low body weight within the context of age, sex and physical health
  • Intense fear of gaining weight
  • Disturbed body perception
  • BMI below 18.5
  • Commonly associated with depression, OCD and autism
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7
Q

What are some consequences of the dietary deficiencies seen in AN?

A
  • Amenorrhoea
  • Low libido
  • Growth retardation
  • Osteopena
  • Kidney damage
  • Heart malfunction
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8
Q

What are the criteria for diagnosis of BN?

A
  • Recurrent binges
  • Excessive preoccupation with food, shape and weight
  • Methods to compensate for over eating (vomiting/laxatives/ exercise)
  • Atypical BN = BN + exercise
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9
Q

What is BN commonly associated with?

A
  • Affective disorders
  • Impulse control disorders
  • Drug or alcohol dependence
  • Anxiety disorders
  • ADHD
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10
Q

What are the criteria for diagnosing BED

A

Recurrent binge eating with control loss + 3 of the following:

  • Rapid consumption of food
  • Eating until an unpleasant feeling of fullness is reached
  • Eating without being hungry
  • Frequent food intake with the consequences of embarrassment, disgust, feelings of guilt
  • Suffering pressure due to one’s eating habits

Importantly: no compensatory measures for weight reduction

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11
Q

What are OSFED?

A

Other Specified Feeding and Eating Disorders:

  • Atypical BN (non-purging BN)
  • Atypical AN (An with a BMI above 18.5)
  • Avoidant or`restrictive Food intake
  • Bigorexia (muscle dysmorphophobia)
  • Orthorexia
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12
Q

Give some examples of behaviours seen in ED patients?

A
  • Food rituals
  • Keeping cold to encourage calorie burning
  • Self-induced vomiting and rumination
  • laxative and enema use
  • Rigorous exercise
  • Purging
  • Insulin misuse
  • Steroid use
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13
Q

Give some examples of ED cognitions?

A
  • Fear of fatness
  • Food rules e.g. low fat, low carb, raw, clean…
  • Over valuation of thinness or muscularity
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14
Q

How common are eating disorders in children?

A

Moderately common, becoming more so.

  • 40% of 9 year olds and 80% of 12 year olds report dieting
  • AN is most common actual diagnosis, can onset as young as 8
  • ARFID is common in this age range
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15
Q

What is ARFID?

A

Avoidant or Restrictive Food Intake Disorder, extreme pickiness

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16
Q

Why are eating disorders in childhood especially concerning?

A

Long term physical complications, resulting from malnutrition:

  • Growth delay
  • Pubertal delay
  • Dental problems
  • Osteoperosis
  • Fertility issues long term
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17
Q

What is distinct about eating disorders in men?

A
  • Drive is more for increased muscularity than for thinness
  • Increased proportion of men affected in childhood, and in BED
  • Steroids use is commonly seen
  • Harder to diagnosis in men as BMI rarely falls below 18.5
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18
Q

Why might incidences of ED be rising?

A
  • More people feel able to present to services
  • Greater exposure to risk factors
  • Higher levels of stress
  • Onset occurring at younger age
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19
Q

What etiological factors have been associated with eating disorders?

A
  • Numerous epigenetic, social, psychological factors
  • Although no one gene has been identified yet
  • Recent research suggests the role of specific personality factors e.g. high levels of neuroticism
  • Negative life events (e.g. childhood trauma or abuse) may be linked
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20
Q

Give some physiological consequences of eating disorders?

A

Affects every system

  • Low self-esteem, depression, anxiety
  • Dental issues, swollen jaw, tooth decay, gum disease
  • Chronic sore throat, indigestion, heartburn, damage to the oesophagus
  • Cardiac arrest, arrhythmia, heart failure, low BP
  • Ulcers, stomach pain, rupture
  • Bowel problems, constipation
  • Osteoperosis, spinal issues
  • Irregular or absent periods and libido
  • Kidney dance form dehydration
  • Muscle weakness
  • Dry skin
21
Q

Name some psychological effects of an eating disorder?

A
  • Sexual disinterest
  • Social isolation
  • Relationship dysfunction
  • Carer burn out
  • Psychosocial dysfunction
  • Suicidal ideation
  • Depression
  • Financial dependency
  • Alcoholism
22
Q

What impact does an eating disorder have on the brain?

A
  • This is of great concern as onset of illness is normally early to late adolescence, a time of significant synaptic pruning and myelination
  • Disruption to these processes is associated with long term issues

Titova et al, 2013:

  • AN linked to reduced grey matter volume, white matter volume
  • Reduced structural development in regions of the brain associated with reward and somatosensory processes
  • Regional decreases in the left hypothalamus, left inferior parietal lobe, right lentiform nucleus and right caudate
23
Q

What factors are important to consider when choosing a treatment pathway for AN?

A
  • Severity
  • Age
  • Stage
  • Psychosocial functioning
  • Any relevant co-morbidities (if patient is depressed or self-harming, have to be careful which one to treat first)
24
Q

What are the NICE guidelines surrounding the treatment of children and young people with eating disorders?

A
  • Consider AN family therapy (FT-AN) first
  • Can be delivered either in single family format or with other families as well
  • Involvement of family is really strongly related to positive outcomes in children with ED
  • But also important to ensure young people are given the option to have sessions separately to their families
25
Q

How does family based treatment work?

A

Rationale:

  • Empowers the family to re-feed the child or adolescent
  • Effective for children aged below 18 with less than 3 years of illness duration

Components:

  • Weekly weighing
  • Support of parents in facilitating changes in eating patterns
  • Siblings are often involved
26
Q

What therapies are available for adults with AN?

A
  • CBT-ED
  • Maudsley AN Treatment for Adults (MANTRA)
  • Specialist supportive clinical management (SSCM)

If above are unacceptable, ineffective or contraindicated, consider:
- Eating disorder focused focal psychodynamic therapy (FPT)

27
Q

Outline how CBT can be performed for AN or BN?

A
  • Target behaviours (regular pattern of eating with no compensation)
  • As well as the thoughts and emotions that maintain these symptoms
  • Focus is on addressing dieting, food avoidance, over valuation of weight and shape

Components:

  • Planned meals and snacks
  • Psychoeducation
  • Behavioural exposure-record
  • Relapse prevention
28
Q

Outline how MANTRA works?

A

Form of treatment that targets the key maintaining factors of AN. Involves challenging thinking styles relating to:

  • Rigidity, fear of making mistakes
  • Avoidance of interpersonal relationships
  • Positive beliefs about the utility of anorexia
  • Enabling of and accommodating the illness
29
Q

What is distinct about MANTRA as a treatment methodology and why has it been so effective?

A
  • Targets the maintaining factors of the condition
  • Specific to the needs and characteristics of people with AN
  • Effective as AN is a somewhat unique condition in terms of the behavioural rigidity and emotional distancing it creates, MANTRA aims to target that
30
Q

Outline how SSCM can be used for AN?

A

Aim of this form of therapy is to help the patients make a link between their symptoms and their eating behaviour and weight, and to support them in a gradual return to normal eating.

Components:

  • Combined clinical management like information giving, advice, encouragement, with a supportive therapeutic style
  • Practical and supportive approach, unlike CBT o MANTRA which is more psychological
31
Q

When would you consider inpatient treatment for Eating disorders?

A
  • Severely low BMI
  • Rapid weight loss
  • Early signs of organ failure
  • Dangerous co-morbidity (diabetes is the big one)
  • Failure to respond to outpatient care options
32
Q

What did the Cochrane review into the various therapies for An suggest?

A

Moderately effective: CBT, SSCM, MANTRA

Interpersonal therapy was weakly effective

Family involvement was good for teenagers, weak for adults

33
Q

What therapies are available for BN?

A
  • CBT-E (for eating disorders)

- Guided self-help methods

34
Q

Outline how Fairburn’s Transdiagnostic model for eating disorders explains BN?

A
  • Cognitive behavioural model
  • Suggests binge/purge is induced by negative life events, mood intolerance
  • Maintained by negative self evaluation, low self-esteem and perfectionism
  • These all influence dieting and binge eating behaviours which then in turn lead to…
  • Vomiting and laxative misuse
35
Q

Outline the facets of guided self-help for BN?

A
  • Education
  • Behavioural change
  • Often involves CBT aspects
36
Q

What benefits are there to Guided self-help for eating disorders?

A
  • Treatment skills can be taught
  • Cost-effective, can be delivered by therapists with generic skills
  • Sustainable changes, materials can be accessed if relapse occurs
  • Scaleable to widespread population
37
Q

Outline the 2017 NICE guidelines for BN?

A
  • BN focused guided self-help programmes for adults with BN should use cognitive behavioural self help materials
  • If self-help does not work or is contra-indicated, consider CBT-ED
38
Q

Outline the 2017 NICE guidelines for BED?

A
  • Refer to NICE guidelines on obesity assessment and management
  • Guidance for weight loss and bariatric surgery
  • Offer a BED focused guided self help programme
  • Generally though, there is a lack of research into this field
  • Most patients end up being treated as obesity and missing out on the psych/eating disorder component of their condition
39
Q

How effective is CBT in the treatment of eating disorders?

A

Highly effective for BN

Moderately effective for BED

Not very effective for AN (although still some benefit, especially if paired with family therapy)

40
Q

Outline what pharm therapy is currently available for the treatment of eating disorders?

A

NEVER prescribed in the absence of psych therapy

For BN:

  • Fluoxetine
  • Topiramate

For BED:
- Lisdexamfetamine (LDX)

41
Q

What is the typical course of an ED, and what changes occur during this transition?

A

High risk, to Prodrome, to Early stage ED, to Established illness, to Late stage.

  • As the illness progresses, changes begin to occur in the brain that become more and more difficult to reverse and the impact of ED symptoms become more intense
  • However there is a period of time during the first 3 years of the condition where intervention extremely effective
  • In spite of this early intervention remains rare
42
Q

What brain changes are seen in late stage ED?

A
  • Altered activity in the insula
  • Changes to the mesolimbic reward and fear systems
  • Altered activation in prefrontal regions
  • Dysfunctional cortico-striatal systems that mediate self-regulatory control
  • Dorsal circuits and ventral circuit changes
43
Q

What is a promising new form of therapy for AN?

A

Repetitive Transcranial Magnetic Stimulation (rTMS). Safe and non-invasive form of brain stimulation, applied directly to the skull of awake and conscious subjects

Reasoning:

  • The DLPFC is implicated in self-regulatory control difficulties of AN
  • rTMS to the DLPFC demonstrates efficacy in other neuro-circuitry based disorders
44
Q

Outline the findings of the McClelland et al RCT into rTMS for AN?

A
  • Those given real rTMS reported reduction in core AN symptoms such as urge to restrict and feeling fat
  • Real and sham groups did not however differ in terms of stress, anxiety or mood
  • Safety; BP and pulse remained unchanged in both groups
  • Tolerability; real found to be slightly more uncomfortable than sham, but not intolerable
  • Acceptability; 82% who actually had the rTMS would consider having ti again
  • Limitation: small and unbiased sample
45
Q

How might rTMS help patients?

A

By increasing cognitive control over rewarding, habitual and compulsive symptoms, leading to reduced core AN symptoms

46
Q

Name an early intervention mechanism for ED?

A

F:RE:ED:

  • Aims to reduce duration of untreated eating disorder
  • Delivers adapted evidence based treatments for age and illness stage
47
Q

How does F:RE:ED work?

A
  • Referral received
  • Within 2 days receive a phone screening from a FREED champion, engage with the young person to assess their illness onset
  • If suitable offer a FREED assessment within 2 weeks
  • Within another 2 weeks aim to start with treatment

Overall process should take under 4 weeks

48
Q

What are some benefits of the FREED programme?

A

Reduction in:

  • down stream costs
  • duration of untreated eating disorder
  • waiting times

Leads to:

  • earlier recovery
  • best possible outcomes
  • empowerment of patients
  • greater engagement
49
Q

What evidence is there to support the benefit of FREED?

A

McClelland et al, (not-published):

  • 60% of FREED patients returned to normal BMI after 12 months
  • vs 16.6% of audit patients

iBSC Abnormal Psychology (19 decks)

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