Task 7 - Eating disorders Flashcards
Anorexia Nervosa DSM 5
A. Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, development & physical health.
role of BMI : below 15 !
B. Intense fear of gaining weight/ becoming fat OR persistent behaviour that interferes with weight gain even though at a significantly low weight.
C. 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
Anorexia Nervosa - restricted type
– during the last 3 months, no recurrent episodes of binge eating/ purging behaviour.
-Weight loss through dieting/fasting and/or excessive exercising
Anorexia Nervosa - bing eating/ purging type
-last 3 months, recurrent episodes of this behaviour (even a small amount of food is considered as binging)
Prevalence Anorexia Nervosa
- 1 to 2 percent of people
- 90-95 of diagnosed are female
- caucasian women more likely
- onset: 15-19 y.o.
- death rate: 5-8 percent
health issues AN
- cardiovascular
- expansion of stomach
- Bone strength
- Kidney damage
Bulimia Nervosa DSM5
A. Recurrent episodes of binge eating, characterised by both of the following:
- 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
- Sense of lack of control over eating during the episode
B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain
C. Binge eating & inappropriate compensatory behaviours both occur, on average, at least once per week for 3 months
D. Self-evaluation is unduly influenced by body shape & weight
E. Disturbance doesn’t occur exclusively during episodes of anorexia nervosa
Prevalence Bulimia Nervosa
- 0.5 to 3 percent in population
- onset: 15-29 y.o.
- death rate: high, but not as high as AN
- more females
Health issues Bulimia Nervosa
- imbalance in electrolytes -> can lead to heart failure
AN binge/purge type VS Bulimia Nervosa
- both binge and purge
- An: significantly underweight, Bn: often normal/overweight
- An: body image severely disturbed, Bn: overconcerned with weight, but more realistic body image
- An: lack of control during binges, Bn: always lack of control
Binge Eating Disorder DSM 5
A. Recurrent episodes of binge eating, both of the following:
- 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
- Sense of lack of control over eating during the episode
B. Binge eating episodes are associated with 3 or more of the following:
- Eating more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone bc embarrassed by how much one eats
- Feeling disgusted with oneself, depressed or very guilty afterward
C. Marked distress regarding binge eating
D. Occurs, on average, at least once a week for 3 months
E. Not associated with recurrent use of compensatory behaviour & does not exclusively occur during course of AN or BN
Prevalence Binge Eating DSM 5
- 2 to 3,5 of general population
- 30 percent of people in weight loss programs
- high rates of depression and anxiety
- higher incidence of alcohol abuse and personality disorders
other specified feeding/eating disorders ( 5)
1) Atypical anorexia nervosa
2) Bulimia Nervosa (low frequency and/or limited duration)
3) Binge-eating disorder (low frequency and/or limited duration)
4) Purging disorder
5) Night eating syndrome
Atypical AN
-all criteria for AN are met except significant weight loss
Bulimia Nervosa ( low frequency and/or limited duration)
-all criteria except binge eating and compensatory b. less than 1x week and/or less than 3x months
Binge eating disorder ( low frequency and/or limited duration)
-less than 1x week and/or less than 3x month
Purging disorder
-purging to influence weight/shape in absence of binge eating
Night eating syndrome
-regularly eating excessive amounts of food after dinner and into the night
Biological Factors eating disorders
- heritability AN: 56, BN: 50-53
- disfunction hypothalamus: receives messages about food consumption and nutrient level
- > sends messages to cease (beenden) eating
- dysregulation neurotransmitters (norepinephrine, seretonin, dopamine)
- abnormal hormone levels
- starvation-> brain shrinks
- > abnormalities could be consequences as well as causes
Bulimia and Neurotransmitter
- abnormalities is seretonin
- lead body to crave carbohydrates
- people with bulimia often binge on high-carbohydrate foods
social pressure etc . -standards of beauty
- chronic exposure to thin ideal in fashion magazines
- reality TV shows
- if you internalize messages from media -> higher risk
Athletes and eating disorders
- elite athletes do show increased rates of eating disorders
- sport related to weight (boxing) and aesthetic ( ice skating) -> higher risk
- lower rates in nonelite athletes than in nonathletes
Emotion regulation difficulties and eating disorders
- maladaptive strategies for dealing with painful emotions
- depressive symptoms and history of negative affect -> predict anorexic and bulimic symptoms
- emotional eating -> more likely for chronic binge eating
- 80 percent of depressive subtype developed major depression over a 5-year follow up
Cognitive Models of Eating Disorders
- overvaluation of appearance
- shape -> most important aspect of self evaluation
- believe that thinness will bring social and psychological benefits
- body dissatisfaction is combined with perfectionism and low self-esteem
- dichotomous thinking style (all good or all bad)
- obsess over eating routines
- women with bulimic symptoms -> more likely to attend info about body size than info about facial emotions
- attention bias
Family dynamics and eating disorders
- mostly girls who have been unusually ‘good girls’
- daughters do not learn to identify and accept their own feelings and desires
- monitor closely the needs and desires of others
- families have high levels of conflict, discourage expression of negative emotions, and emphasize control an perfectionism
- may come from families that modeled and reinforced bingeing behavior
Psychotherapy for AN in general
- much work to win clients trust and participation and maintain this
- hospitalization and forced feeding sometimes necessary
- long process with many setbacks
Family therapy for AN
-parents are coached to take control over their child’s eating and weight
individual therapy for AN
- CBT
- over evaluation of thinness is confronted
- rewards are made contingent on person’s gaining weight
- relaxation techniques (when anxious about eating)
Psychotherapy for BN and binge eating
…
biological therapies
…
controlled diet leads to….
- less urge to binge and purge
-keeping control -> lesser bulimic thoughts etc
-
3 factor model - article howard
-> explains differences in eating behavior ( in dietary restraint/dieting)
1) frequency of past dieting and overeating -> can impair one’s sense of hunger and satiety
2) current dieting -> prone to overeat during negative affect and/or low arousal (boredom -> cannot ignore urge to eat)
3) weight suppression (desire to maintain low weight)
habituation therapy
-not really useful because you are not tackling core fear (gaining weight)
diet paradox ?
- is diet good to treat bulimic or not??
- if its very restrained -> may lead to binge -> bulimic
- if its to establish healthy choices -> useful
- nothing is really proven
- possible explanation: dieting follows from overeating than the other way around
Comorbidities
- anxiety
- depression
- low self-esteem
- alcohol and substance abuse
caloric restriction leads to…
- longer life span and prevention of age-related disease
- in rodents: short term caloric restriction has been beneficial effects on fertility
feeding disorders
- pica = eat everything
- rumination= auskotzen und wieder essen
dieting VS dietary restraint
- dieting:
- more for anorexic people
- > eating less than one needs
- > to loose weight
- dietary restraint:
- try not to eat too much
- > for people who tend to binge eat
dietary restraint bulimina nervosa (BN)
- in most cases: binge eating occurs after dieting
- but some studies found binge before diet
-> Individuals with BN usually score high on measures of dietary restraint
dieting history in binge eating disorder (BEG)
- BED patients show extensive dieting history (accompanied by binge eating)
- BUT many obese BED patients report they started dieting after binge eating
- > dieting plays a role in developing BED for some individuals but not for others
restraint theory - Nisbett
- people have genetic/preconditioned set-point
- most eating behavior is directed to bring weight in line with set-point (number of fat cells in body)
- dieting reduces cell size -> fat cells become depleted -> informs hypothalamus -> directs behavior to bring weight in line with set point
- obese individuals -> higher set point -> eat more
