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Psychopathology > TASK 7 - EATING DISORDER > Flashcards

TASK 7 - EATING DISORDER Flashcards

1
Q

anorexia nervosa

A
  • drive for thinness
  • control eating + body/weight
  • restriction
  • low body weight
  • distorted body image
  • intense fear of gaining weight
  • body esteem determines self-evaluation
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2
Q

DSM-5 (AN)

A.

A

restriction of energy intake relative to requirements, leading to significantly low body weight (= less than minimally normal ( BMI)) in the context of age, sex, development + physical health
- underweight

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3
Q

DSM-5 (AN)

B.

A

intense fear of gaining weight/ becoming fat
OR persistent behaviour that interferes with weight gain even though at a significantly low weight
- fear of gaining weight

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4
Q

DSM-5 (AN)

C.

A

disturbance in the way in which one’s body weight/shape is experienced, undue influence of body weight/shape on self-evaluation
OR persistent lack of recognition of the seriousness of the current low body weight
- distorted body image

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5
Q

subtypes (AN)

A
  1. restricting type = during LAST 3 MONTHS, individual has not engaged in recurrent episodes of binge eating/ purging behaviour
    - weight loss primarily accomplished by dieting/fasting and/or excessive exercising
  2. binge eating/purging type = during the LAST 3 MONTHS the individual has engaged in recurrent episodes of this behaviour (even a small amount of food is considered as binging)
    - more comorbid & chronic
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6
Q

prevalence (AN)

A
  • US: women: 0.9, girls: 0.3, males: 0.3
  • 0.4: not all are capable of eating so little, control
  • onset: adolescence/ young adulthood
  • rates will likely go up as criteria were loosened
  • increased since early 20th century
  • lower rates in cultures that put less value on thinness; motivations vary across cultures
  • death rate: 5-9%, suicide rate: 31x that of the general population
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7
Q

bulimia nervosa

A
  • fear of gaining weight
  • often normal weight, less successful in restricting
  • always binge eaters
  • compensation (purging)
  • shame about normal weight –> self-hate
  • body esteem determines self-evaluation
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8
Q

DSM-5 (BN)

A.

A

recurrent episodes of binge eating, characterised by both of the following:

a. eating, in a discrete period of time, an amount of food that is def larger than most people eat during a similar period of time in similar situation
b. sense of lack of control overeating during the episode
- binge eating

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9
Q

DSM-5 (BN)

B.

A

recurrent inappropriate compensatory behaviours in order to prevent weight gain
- compensation

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10
Q

DSM-5 (BN)

C.

A

binge eating + inappropriate compensatory behaviours both occur, on average, AT LEAST ONCE PER WEEK FOR 3 MONTHS
- duration

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11
Q

DSM-5 (BN)

D.

A

self-evaluation is unduly influenced by body shape & weight
- self-esteem dependent on body

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12
Q

DSM-5 (BN)

E.

A

disturbance doesn’t occur exclusively during episodes of anorexia nervosa

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13
Q

prevalence (BN)

A
  • adults: 0.5%, adolescents: 0.9
  • onset: adolescence
  • more common in females, men more focused on gaining muscles
  • rates will likely go up due to loosened criteria
  • cultural differences: more common in western societies
  • significantly increased in second half of 20th century
  • death & suicide rate: high but not as high as AN
  • tends to be chronic
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14
Q

binge-eating disorder

A
  • binge eating, NO compensation
  • often overweight
    distress regarding binge eating
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15
Q

DSM-5 (BED)

A.

A

recurrent episodes of binge eating, characterised by both of the following:

a. eating, in a discrete period of time, an amount of food that is def larger than most people eat during a similar period of time in similar situation
b. sense of lack of control overeating during the episode
- binge eating

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16
Q

DSM-5 (BED)

B.

A

binge eating episodes are associated with 3 or more of the following:

a. eating more rapidly than normal
b. eating until feeling uncomfortably full
c. eating large amounts of food when not feeling physically hungry
d. eating alone because embarrassed by how much one eats
e. feeling disgusted with oneself, depressed or very guilty afterward
- accompanying symptoms

17
Q

DSM-5 (BED)

C.

A

marked distress regarding binge eating

- distress

18
Q

DSM-5 (BED)

D.

A

occurs, on average, at least ONCE A WEE FOR 3 MONTHS

19
Q

DSM-5 (BED)

E.

A

not associated with recurrent use of compensatory behaviour + does not exclusively occur during course of AN or BN
- NO compensation

20
Q

prevalence (BED)

A

2-3.5%

  • somewhat more common in women
  • no racial/ethnic differences
  • chronic
21
Q

other-specified eating/feeding disorders

A
  1. subclinical symptoms of eating disorders (= doesn’t meet criteria but causes clinically significant distress)
    - prevalence: 5%
  2. atypical anorexia nervosa = all criteria for AN are met, except significant weight loss
  3. bulimia nervosa of low frequency and/or limited duration = binging/purging occurs LESS THAN ONCE A WEEK and/or for LESS THAN 3 MONTHS
  4. night eating syndrome = regularly eating excessive amounts of food after dinner + into the night
    - feeding
  5. pica = eat things that are not eatable
  6. rumination disorder = eat things again; rechew, reswallow
  7. avoidant and restricting intake = little kids eat little, choose extensively
22
Q

theories

- genetic/biological

A
  • heritability: AN = 56%, BN = 46%
  • general rather than specific risk
  • changes in puberty seem to trigger onset –> vulnerable period of brain reorganisation
  • damage to hypothalamus: trouble detecting hunger/ stopping when full
  • starvation shrinks the brain
  • serotonin deficiencies –> crave carbohydrates
  • expression of dopamine gene in binge-eating: more pleasure when eating
23
Q

theories

- sociocultural

A
  • standards of beauty (became thinner + thinner since mid 20th century)
  • more valued + encouraged in females
  • media exposure, peer pressure
    BUT what they see as pretty is not encouraged in media (ugly)
24
Q

theories

- cognitive

A
  • low self-esteem + perfectionism + dissatisfaction that comes from social pressures = toxic mix
  • more concerned with opinions of others: more susceptible to social pressures
  • overevaluation bias: self worth is completely dependent on body weight
  • dichotomous thinking: things are either all good or all bad (BN: dietary slip –> respond by completely abandoning efforts to restrict eating)
  • attention bias: unconsciously organise perceptions of the world around body size
25
Q

theories

- emotion regulation

A

= maladaptive strategies to deal with painful emotions (e.g. emotional eating)

  • dieting subtype of binge eating: try to maintain diet –> often fail so binge –> compensate
  • depressive subtype: plagued by depression + low self-esteem –> eat to quell these feelings
26
Q

theories

- family dynamics

A
  • AN: overinvested + overcontrolling parents –> perfectionism, aren’t allowed to show negative feelings, don’t learn to think independently (separation fear + don’t trust own judgement)
  • insecure attachment
  • control of body gives sense of power over self + way to avoid peer relationships
  • history of binge eating among family members
27
Q

theories

- dieting

A
  • need close assessment as these affect people in different ways
  • BED: often have history of dieting, sometimes try to diet but with ridiculous expectations, high level of concern about food, lost internal sensitivity for hunger
  • -> conflicting findings: no causation
28
Q

transdiagnostic model

A

= look at symptoms as themselves not as part of one specific disorder = eating disorder rather than AN, BN, BED

  • disorders share same distinctive psychopathology, common mechanism
  • central cognitive disturbance: over-evaluation of eating, shape, weight + their control
29
Q

transdiagnostic model

- dysfunctional scheme for self-evaluation

A
  • subgroups of patients have one or more of four additional mechanisms that maintain eating disorder
    1. clinically significant perfectionism (esp. prominent in AN)
    2. core/pervasive low self-esteem (esp. in chronic cases)
    3. mood intolerance: difficulties in coping with intense mood states + dysfunctional mood modulatory behaviour
    4. interpersonal difficulties
30
Q

restrained vs. non-restrained

A
  • dietary slip: once you break your diet –> can’t stop anymore and start binging
  • high restraint (already abandoned their rules) –> consume more (already ate too much, can easily go on)
31
Q

three-factor model

A
  1. frequency of PAST dieting + overeating
    - vulnerable to future over-eating by fucking up the hunger system and/or by lowering self-confidence in ability to diet successfully
  2. CURRENT dieting
  3. weight suppression
    - -> differences in eating disorders arise from these 3 factors
    - restrained eaters: fight against eating more than they need
    - current dieters: battle to eat less than they need + maintain a level of restraint even in disinhibiting circumstances
32
Q

treatment (AN)

- psychotherapy

A
  • resistant to therapy
  • recovery less likely the longer one’s had the illness
  • win trust
  • long process with many setbacks + continue to have low self-esteem, family problems and periods of depression + anxiety
  • CBT: confront overvaluation of thinness, rewards for gaining weight
  • family therapy: parents coached to control children’s eating + as therapy progresses child’s autonomy is linked explicitly to resolution of the eating disorder (Maudsley model)
33
Q

treatment (BN)

- psychotherapy

A
  • main issue: extreme concerns about shape/weight
  • recovery more likely the longer one’s had the illness
  • 50% helped
  • monitor cognitions that accompany eating –> confront –> develop more adaptive attitudes
  • reintroduce “forbidden foods”
  • expanded CBTs especially effective
  • interpersonal therapy, supportive-expressive psychodynamic therapy, behavioural therapy
  • dialectic behavioural therapy: focus on emotional regulation
34
Q

treatment (BED)

- psychotherapy

A
  • interpersonal therapy

- dialectical behavioural therapy

35
Q

treatment

- inhibitory learning

A
  • need to distinguish feared stimuli and feared outcome –> specifically target those
    1) core fear: food consumption resulting in weight gain
  • confirmed when restored weight –> inhibitory learning should be only applied after weight restoration
    2) core fear: weight gain resulting in aversive outcomes
  • likely violated during weight restoration, depending on patient’s non-food related exposures
36
Q

treatment

- transdiagnostic treatment

A
  • relevant: particular psychopathological features + the processes maintaining them
    1. education + engaging of patient, initial personalised formulation –> maximal early behavioural change
    2. review of progress + formal assessment of maintaining mechanisms –> revised + extended formulation
    3. largest part: addressing additional processes identified in revised formulation + treatment “modules” focusing on each one of them (also focusing on core cognitive disturbance)
    4. ensuring that progress is maintained after treatment ends
37
Q

treatment

- biological

A
  • SSRIs reduce binge eating + purging –> fail to restore normal habits
  • antidepressants + atypical antipsychotic drugs for AN
  • fluoxetine for BN

Psychopathology (9 decks)

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