set 9 - sleeping and eating disorders Flashcards
eating disorders
overview:
1) classification of eating disorders
- binge-eating disorder
- bulimia nervosa
- anorexia nervosa
2) biological factors & treatments
3) psychological factors & treatments
eating disorder
defining characteristic
Defining characteristic
- Self-worth is highly influenced by body shape
- if it is not influenced by this, then they will not meet criteria for ED
Disorders
- Binge-eating disorder
Life% = 1%-2% - common to women - Bulimia nervosa
Life% = 1.5%-4% - 10x more common to women - Anorexia nervosa
Life% = 1.5%-2.5% - 10x more common to women
binge-eating disorder
Recurrent episodes of binge eating (criteria of bingeing)
- Eating an amount of food that is far larger than most people would consume in that situation
- Sense of lack of control over eating
Associated with (symptoms)
- Eating much more rapidly than normal
- Eating alone due to embarrassment
- Bingeing when not hungry
notes:
- depends on the individual what is excessive
- lack of control – they can’t stop or choose what food to eat
- bingeing must occur at least once a week for 3 months
- they need at least 3 of 5 of the symptoms
bulimia nervosa
1) Recurrent episodes of binge eating
2) Recurrent compensatory behaviours to prevent weight gain
- compensatory behaviours include vomiting, using laxative, and diuretics, some may fast and exercise
3) Excessive influence of weight and shape on self-evaluation
- how they view themselves changes upon their weight and shape
notes:
- bingeing should occur at least once a week
- lots of negative side effects, there is a strong desire to be thin
- they still stay within 10% of their normal body weight
anorexia nervosa
1) Food intake restriction leading to significantly low body weight
- they eat less food, which leads to significant low body weight (vary within age, gender
2) Intense fear of gaining weight or becoming fat, or persistent engagement in behaviour that interferes with weight gain
- they deprive themselves of food because they are scared to become fat
3) Distorted body image, self-worth influenced by body weight or shape, or persistent lack of recognition of seriousness of low bodyweight
- perceived perception of their own body size have exaggerated body views, even if they are dangerously underweight, they still view themselves as overweight
notes:
- should meet all 3 criteria
- 25-40% BELOW A LOW BODY WEIGHT
they tend to have more control, for them weight loss must be lost everyday, staying in the same weight is unacceptable
- 5% will die within 10 years (due to starvation or suicide)
2 subtypes of anorexia nervosa
1) restricting
- Severe restrictions on amount and type of food eaten.
& Restrictive behaviors (counting calories, skipping meals, eliminating certain foods (such as carbohydrates).
- Often combined with excessive exercise. (dieting, fasting and excessive exercise characterizes that)
2) binge-eating and/or purging
- Restrict food intake
- Engage in binge eating and/or purging behaviors (i.e., vomiting, use of
laxatives or diuretics)
*significantly underweight
- looks like bulimia but the difference is that people with anorexia they adapt very strict diet whereas ppl with bulimia purge to lose weight
- people with bulimia tend to hover around normal body weight whereas ppl with anorexia tend to be dangerously underweight weight will differentiate these two
ED onset, course, and gender differences
1) Tends to onset in adolescence or young adulthood
- 90% of cases are diagnosed before 20yrs
- Onset associated with stressful life event (exposure to violence, family conflict, stress at school can be associated with ED)
- Chronic unless treated
- Relapse is common
2) Vast majority are women
- interestingly, men with ED are more likely to be gay or bisexual. Maybe there is more emphasis on body image and appearance
3) Young athletes are vulnerable
- young athletes are vulnerable because there is focus on their body weight, shape, strength
- they are competitive in nature, disorder in eating can be very much reinforced
- their methods often go unnoticed because restrictive eating is an expected behaviour
ED biological factors and treatment
1) Etiological factors
- Genetic contribution - family members with individuals with ED are 5x more likely to develop it
- may be linked to impulsitivity and emotional instability
- Low level of serotonergic activity - lack or improper diet leading to that
- The runner’s high/exercise anorexia- can reinforce excessive exercising behaviour
2) Treatment
- SSRIs - short term
- Atypical antipsychotics - not a lot of evidence however they have a side effect of weight gain
ED psychological factors
culture
(Culture)
- Significant increase in rates since the 1950s
- Significantly less common in developing and non-Western countries - there are higher rate in Caucasians
- Exposure to media - there is a direct connection with media exposure, media influences what an acceptable body type is
- African-Americans vs. Caucasians
ED psychological factors
views on weight
Etiological factors
(Views on weight)
- Dieting teenagers - 60% of females and a third of men in gr 8 and 9 are dieting / dieting is a risk factor for developing an ED
- What the other sex wants - women tend to assume that men want thin women and men assumes that women wants a muscular man
- Choosing friends who reinforce body-image ideas
ED psychological factors
other cognitive factors
Etiological factors
(Other cognitive factors)
- Low sense of control - diminished sense of control in bulimia is low
- in anorexia there is a low set of control, as the disorder progresses their sense od control increases,
- High perfectionism - high perfectionism tends to be linked to low self esteem (common to ppl with anorexia)
- Perceptions of body shape - for them a single snack can cause them to view their body to be fatter
- Inaccurate beliefs about what is a healthy weight - they often have an unrealistic belief about how low they can go and still be healthy
ED psychological factprs
family influences
- perfectionistic mothers - tend to reinforce cultural opinions on weight and emphasize self control
- family preoccupation with appearance - perfectionistic parents see children as a reflection of them
- how they dress their kids and how they present themselves
ED psychological treatment
issues in treatment
1) Very unlikely to seek treatment
- people with anorexia are unlike to seek treatment because they complete deny that they don’t have a problem
- people with bulimia avoid treatment due to shame (a lot of shame associated with bulimia) / more likely to be forced into treatment
2) Often fake agreement with treatment
- they may agree and comply so they can be let out sooner, go home and continue
3) If too thin, weight must be restored first
- if they are dangerously underweight, no 1 priority is to restore weight
ED psychological treatment
CBT
CBT is fairly effective 40-60% success rate
1) Psychoeducation around health effects
- important - what are they doing to their body
- Help restructure cognitive distortions or views that they may have
- challenge those dyfucntional patterns
2) Meals controlled by therapist, workers, and family
3) Challenge dysfunctional thoughts regarding body shape, weight, and eating
ED psychological treatment
IPT(interpersonal psychotherapy)
Targets dysfunctional relationships
- work relationships with their mother
- family therapy is more common in anorexia and acc increases success
May work as well as CBT over the long term
- in terms of ED, a combination of medications, CBT and IPT may be the best
