Task 7 Eating disorders Flashcards
Other specified feeding or eating disorder
o Individuals migrate between anorexia nervosa, bulimia nervosa and binge-eating disorder, so meeting the criteria for two or more disorders
o In some cases, they do not meet criteria for one of the disorders but are below threshold in two or more
Anorexia nervosa
• Starve themselves, and stay convinced that they need to loose more weight
• Feeling of fatness, and fear of becoming fat
o Good feelings only when they have complete control over eating and loose weight
Amenorrhea
stop of having menstrual periods because of extreme low weight
DSM-5 AN
at least 3 months of symptoms, severity is determined by BMI under 15 is extreme
o A Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected
o B Intense fear of gaining weight or of becoming fat, or of persistent behaviour that interferes with weight gain, even though at a significantly low weight
o C Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Subtypes of AN
Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
• Not necessarily large amounts of food, can be only little but causes still a need for purging
• More likely for comorbidity esp. impulsive, suicidal and self-harming behaviour
Prevalence AN
0.9% in women and 0.3% in males US (no males in Europe)
o In USA Caucasians are more likely to develop the disorder
o Acceptance of beauty prototype in different cultures influences prevalence
Then religious considerations
o Time interval might interact
Outcome AN
o Death rate of 5% to 9%
o Most serious consequences impair heart functioning
o 31 times the suicide rate of normal population
Cormobidity AN
depression, OCD, anxiety disorders and substance abuse disorder
Bulimia Nervosa
• Core characteristic bingeing, uncontrolled eating followed by behaviour which should protect from weight gain
DSM-5 BN
o A Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances
A sense of lack of control overeating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
o B Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
o C The binge eating and inappropriate compensatory behaviours both occur, on average, at least once per week for 3 months
o D self-evaluation is unduly influenced by body shape and weight
More realistic as in anorexia nervosa
o E The disturbance does not occur exclusively during episodes of anorexia nervosa
Prevalence BN
0.5 for adults and 0.9 in adolescence o Much more common in females o More common in westernized cultures o Increased after 1950 o 25% had anorexia before
Outcome BN
o Fluid loss caused by vomiting
o 7.5 times higher suicide rate than normal
• Tends to be a chronic condition, more purging predicts worse treatment effects
Binge-eating disorder DSM-5
o A Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
o B The binge-eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty afterward
o C marked distress regarding binge eating is present
o D The binge eating occurs, on average, at least once a week for 3 months
o E The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
Prevalence BED
2 to 3.5 % in general population
History of frequent dieting, membership in weight control programs and family obesity
Somewhat more common in women
High rates of depression and anxiety and possibly a higher incidence of alcohol abuse and PD
Tends to be chronic
Biological theories
o Tends to run in families
heritability of 56 for anorexia nervosa
41 heritability for binge-eating disorder
o Genes appear to carry a general risk (no specific disorder)
o Change in hormones in girls puberty might trigger onset
o Might be caused by imbalances in neurochemicals or by structural or functional problems of hypothalamus
The thin ideal and body dissatisfaction (factor)
Thin is more attractive in girls
More exposure to “you have to be thin” increases body dissatisfaction
• One of the strongest predictors
Friends can influence too
• Strongest predictor of symptoms was the amount of media exposure the girl’s friend had
Athletes and eating disorders
People doing professional sports classified as aesthetic or weight dependent were more likely to have AN or BN
Changes in Puberty lead to the unreachable aim to regain this figure
Cognitive factors
Social pressure in combination with low self-esteem and perfectionism predict strongly the development of eating disorders
Dichotomous thinking style: People with eating disorders judge thinks as either all good or all bad (e.g. after one cookie thinking that they will eat all)
People with bulimic symptoms judge the world by their bodies
Emotional regulation difficulties
Maladaptive strategy to deal with painful emotions
Dieting subtype: greatly concerned about their body shape and try their best to maintain weight by strict diets, but they frequently abandon their regimen and engage in binge eating
Depressive subtype: eat to quell feelings of depression and low-self-esteem
• More impairment in life and less efficiency in treating
• More risk for comorbidity
Family dynamics
Controlling parents withdraw their children possibilities of own choices, when the children then leave their parents they realize the manipulation and detect the freedom of food choice and intake (could be protection)
Mothers might encourage loosing weight
Extinction therapy
Not only exposure rather exposure to stimuli with regard to violate expected fear outcomes that results in learning of non-threat associations
Long-term process
When weight gain is feared exposure might not work
When self-concept is the core fear it might be successful
transdiagnostic theory
dysfunction in perception of weight, figure, eating and control are same in all disorders
stability of subtypes
o Anorexia nervosa: most stable
o Bulimia nervosa: between AN and EDNOS
o EDNOS: most unstable
New Cognitive behaviour theory on BN maintenance
- Clinical perfectionism: self-worth is judged on basis of striving to achieve goals and success at achieving them despite adverse consequences
- Low self-esteem: in addition, towards criticism of eating, body shape and weight BN patients have unconditional negative view of themselves and its seen permanent in identity; It’s problematic because it 1) creates hopelessness about capacity to change thus negatively affecting compliance to treatment (in other words what’s the point in treatment if things cannot get better) and (2) more intense pursuit of control over eating, shape and weight
- Mood intolerance: inability to cope with certain emotional states, e.g. anger, anxiety depression or even positive ones such as excitement patients engage in dysfunctional mood modulatory behaviour of binge eating, vomiting or intense exercising to stabilize mood
- Interpersonal difficulties: since binge eating can be caused by negative events, negative interpersonal events can also trigger binge behaviours, thus BN patients are very sensitive towards social interactions
Diet boundary
cognitive controls override the physiological controls over food intake
Restrained is undermined feels failure lose control & overeat
