Test 2 Flashcards by Sydney Coopland

First written account of binge purge behaviours dates back to 4 BC to AD 65
Noted in Ancient Rome
Religious roots – fasting

Historical context of Eating Disorders

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Society and culture influence prevalence of eating disorders
In North America and Western Europe – rates have increased since ______’s

1920

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Unrestricted eating
Watchful eating
Increasing weight and shape preoccupation
Clinical eating disorders

Continuum of Eating Experiences

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eating to the occasion and being spontaneous…. not restricting before or after

Unrestricted eating

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Paying attention to what is being eaten (mindful kind of?)
Possibly a diet

Watchful eating

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refers to when individuals spend excessive time thinking about their weight/shape and this interferes with their functioning (e.g., being distracted while engaged conversation because thinking about weight/shape)

Preoccupation with weight/shape

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An eating disorder is a serious, complex, mental health issue that affects one’s emotional and physical health.
An unhealthy relationships with food, their weight or appearance.
e.g. anorexia, bulimia and binge eating disorder

Clinical eating disorders

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Pica
Rumination Disorder
Avoidant/Restrictive Food Intake Disorder
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Other Specified
Unspecified

DSM 5- Feeding and Eating Disorders

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An eating disorder in which a person eats things not usually considered food.
Young kids often put non-food items (like grass or toys) in their mouths because they’re curious about the world around them.

Pica

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a rare behavioral disorder in which food is brought back up from the stomach. It is either rechewed, reswallowed, or spit out.

Rumination Disorder

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extremely selective eaters and sometimes have little interest in eating food. They may eat a limited variety of preferred foods, which can lead to poor growth and poor nutrition.
(occurs in children frequently?)

Avoidant/Restrictive Food Intake Disorder (ARFID)

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a psychiatric disease in which patients restrict their food intake relative to their energy requirements through eating less, exercising more, and/or purging food through laxatives and vomiting. Despite being severely underweight, they do not recognize it and have distorted body images.

Anorexia Nervosa

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It is characterized by uncontrolled episodes of overeating (called bingeing). This is followed by purging by self-induced vomiting, misuse of laxatives, and other methods.

Bulimia Nervosa

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regularly eat much more food than most people. They often eat quickly, eat when they are stressed or upset (instead of just when they’re hungry), and feel like they can’t stop eating, even when they’re uncomfortably full. They also binge at least once a week for several months.

Binge Eating Disorder

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have symptoms that are similar to one or more eating disorders, but may not meet all the criteria for these conditions.

Other Specified

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where behaviours cause clinically significant distress or impairment of functioning, but do not meet the full criteria of any of the feeding or eating disorder criteria.

Unspecified

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Pica
Rumination Disorder
Avoidant/Restrictive Food Intake Disorder

These three are more common in ________ and individuals with intellectual disabilities.

children

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Criteria A
Restriction of intake leading to significantly low body weight
Criteria B
Intense fear of weight gain and persisting behaviour even if actually losing weight
Criteria C
Distorted body image (weight, shape, self-evaluation) or lack of recognition of the seriousness of current low weight

Mild – BMI 17 or greater
Moderate – BMI 16-16.99
Severe - BMI 15-15.99
Extreme – BMI less than 15

DSM Anorexia Nervosa

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U
N
D
E
R

Underweight
Nervous about weight
Distorted perception
Excessive exercise
Restricting calories

(Anorexia DSM)

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Can be:
Restricting type
Binge/purge type

Anorexia

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OCD brain patterns
“I need to lose weight/purge”
“I am fat”

Anorexia

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During the last 3 months, person has not engaged in episodes of binge eating or purge behaviours

Restricting type (Anorexia)

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During the last 3 months, the person has engaged in episodes of binge purge behaviours

Binge-eating/Purging type (Anorexia)

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After full criteria met, Criteria A is still and B or C

In Partial Remission (Anorexia)

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After full criteria met, no criteria has applied for a substantial period of time

In Full Remission (Anorexia)

Abnormal lab findings may lag behind damaging effects Anemia, leukopenia Amenorrhea Dehydration High cholesterol Decreased liver function Vitamin & mineral deficiencies

Physiological effects of Anorexia

Decreased thyroid functioning Damage to heart & kidneys Decreased energy, lethargy Constipation Abdominal pain Cold intolerance Low BP & pulse Dry, cold skin Lanugo Peripheral edema Dental erosion Osteoporosis Decreased concentration

Physiological effects of Anorexia

Can be fatal: Starvation, suicide, heart attacks, electrolyte imbalance Hospitalization may be necessary

Anorexia

Temperamental – Persons who develop anxiety disorder or obsessive compulsive disorder in childhood are at increased risk of developing anorexia nervosa

Temperamental Risk Factors (Anorexia)

Associated with cultural settings in which thinness is valued

Environmental Risk Factors (Anorexia)

Increased risk if there is a history among 1st degree relatives

Genetic and Physiological Risk Factors (Anorexia)

Feelings of ineffectiveness Strong need to control environment Inflexible thinking Limited social spontaneity, restrained initiative & emotional expression Perfectionism is strongly associated Increased prevalence in some sports – ballet and wrestling

Associated Traits of Anorexia

Criteria A: Recurrent episodes of binging characterized by: Eating in a short period of time (usually 2 hours) much more than people normally consume A sense of overeating and lack of control over the binge behavior Criteria B: Recurrent use of means to prevent weight gain (inappropriate compensatory behaviours) Criteria C: Frequency at least twice once a week for 3 months Criteria D: Excessive concern with body shape & weight Criteria E: Behaviour does not occur solely with Anorexia Nervosa

DSM Bulimia Nervosa

Full criteria previously met, now some but not all criteria met

In partial remission - DSM Bulimia Nervosa Specifiers

Full criteria previously met, now no longer present for a substantial period of time

In full remission - DSM Bulimia Nervosa Specifiers

Mild 1-3 episodes per week Moderate 4-7/week Severe 8-13/week Extreme 14+/week

Severity - DSM Bulimia Nervosa Specifiers

Serious cardiac events and skeletal myopathies are associated with use of syrup of ipecac Gastrointestinal problems and rectal prolapse have been reported

Health concerns (Bulimia)

Fatalities associated with: Cardiac arrhythmias Gastric ruptures Suicide

Bulimia

Weight concerns, low self-esteem, depression, anxiety in childhood increase risk

Temperamental Risk Factors (Bulimia)

Associated with cultural settings in which thinness is valued. Associated with childhood abuse

Environmental Risk Factors (Bulimia)

Associated with childhood obesity Increased risk if there is a history among 1st degree relatives

Genetic and Physiological Risk Factors (Bulimia)

B O W L

Binge eating Offsetting behaviours Weekly (2x wk for 3 months) Linked to self esteem

Weight loss Limited intake Proud of weight loss

Anorexia Nervosa

Typically normal weight or slightly overweight Characterized by binge eating Ashamed of problem

Bulimia Nervosa

Criteria A – Eating, in a discrete period of time (usually 2 hours) an excessive amount of food (more than people would typically eat Lack of control over pattern Criteria B – Eating more rapidly than normal Eating until uncomfortably full Eating large amounts of food, even when not hungry Feeling embarrassed about how much one is eating Feeling disgusted with self, depressed, or guilty afterwards

DSM Binge Eating Disorder

Criteria C – must produce marked distress about binge eating Criteria D – persists over time (more than 3 months) Criteria E – exclusion criteria – not associated with bulimia nervosa or anorexia nervosa Mild 1-3 binge episodes per week Moderate 4-7/week Severe 8-13/week Extreme 14+/week

DSM Binge Eating Disorder

Feels out of control & unable to stop eating during binges Feels guilty, distressed or ashamed of binge eating Maybe normal weight, over weight or obese Tends to have a history of diet failures Associated with depression and obesity

Binge Eating Disorder

Atypical anorexia nervosa – Bulimia nervosa (of low frequency and/or limited duration) Binge-eating disorder (of low frequency and/or limited duration) Purging Disorder Night Eating Disorder

DSM Other Specified Eating Disorders

Meet (anorexia) criteria except is of normal weight

Atypical anorexia nervosa

Meet all (bulimia) criteria except occurs less than once a week and/or for less than 3 months

Bulimia nervosa (of low frequency and/or limited duration)

Meet all criteria (binge eating) except occurs less than once a week and/or for less than 3 months

Binge-eating disorder (of low frequency and/or limited duration)

purging behavior without binge eating

Purging Disorder

in evening and/or after awakening from sleep eat excessive amounts of food (able to recall eating)

Night Eating Disorder

Participants’ descriptions highlighted a tension between anorexia nervosa as being functional and playing a positive role in their lives whilst also being perceived as negative.

Williams & Reid

(1) Relationship with anorexia nervosa (2) Striving for the perfect self (3) Controlling the self through the body (4) Battling the ‘anorexic voice’.

4 Overarching Themes in William & Reid

Genetics Trauma Critical family Nutrition Physical health issues Stress Drugs

Risk factors for depression

Excessive studies demonstrate that ________ is due to the interaction of numerous complex factors: Monoamine Neurotransmitter Dysfunction Neuroendocrine Factors Neural Diathesis Stress Hypothesis Immune Factors Genetic Factors Environmental Factors Nutritional Deficiencies Cognitive Theories

depression

Less activity in prefrontal cortex Over activity in limbic system

Neurological changes in depression

Assess symptoms against baseline functioning Assess the effect of symptoms on functioning in all the domains of the person’s life Assess severity of depression Suicide ideation/attempts Sleep and appetite Psychotic features Larger number of symptoms in criteria met, greater severity

Assessment of mood symptoms (depression)

________ is a well-known mnemonic listing the symptoms of major depressive disorder, according to the DSM-5.

SIGECAPS

Sleep changes Inerest lost Guilt (worthlessness) Energy loss (fatigue) Cognition – difficult concentrating Appetite Psychomotor Suicide risk

__________, ________behaviours or self-mutilation No intent to die Private means to bring relief from intolerable psychic pain or numbness May also occur in psychotic illness as part of delusional thinking

Self-harm, self-injurious

Thoughts, ideas, feelings Intent or no intent

Suicide Ideation

A plan to end ones life

Suicide Plan

An act with at least some degree of intent to die Died by Suicide

Suicide Attempt

Sex (male) * men typically use more lethal means, therefore more likely to complete Age (below 19 or above 45) Depression, hopelessness (decreased concentration, appetite, sleep or libido) Previous deliberate self harm (one or more previous attempts) Excessive alcohol or drug use (impulsive) R - Loss of rational thinking (psychosis – command hallucinations) Separated, widowed, divorced (loss of supports) Organized plan or serious attempt No social supports Stated future intention to self harm or new onset illness

SAD PERSONS

Suicide ideation Suicide intent and lethality Meaning and motivation for suicide Suicidal plan – access to means, lethality of means, practiced or rehearsed plan Protective factors Physiological, cognitive and affective states Coping potential (reasons for living) Risk factors Substance use Self-harm

Suicide assessment

Disruptive Mood Dysregulation Disorder Major Depressive Disorder (Including Major Depressive Episode) Persistent Depressive Disorder Premenstrual Dysphoric Disorder Substance/Medication-Induced Depressive Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder Unspecified Depressive Disorder Prolonged Grief Disorder (NEW)

DSM 5 - Depressive Disorders

Childhood disorder (onset must be between 6 to 10) Developed to counter over-diagnosis of bipolar disorder in children Persistent irritability, frequent periods of extreme dysregulation of behaviour Children tend to develop depressive or anxiety disorder rather than bipolar disorder later in life.

Disruptive Mood Dysregulation Disorder

Diagnostic Criteria A: Severe, recurrent temper outbursts B: Temper outbursts inconsistent with developmental level C: Occur 3 or more times a week D: Mood between outbursts is persistently irritable or anger E: A – D symptoms present for 12 months F: A – D symptoms present in at least three settings G: Dx should not be made for first time before 6 years or after 18 years of age H: Evidence of onset before age 10

DSM – Disruptive Mood Dysregulation Disorder

Criteria A: 5 or more of the following present for 2 weeks Depressed mood Loss on interest or pleasure Weight loss or weight gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthless or guilt Poor concentration or indecisiveness Recurrent thoughts about death Criteria B: Causes significant distress or impairment to important areas of functioning

DSM – Major Depressive Episode

A – Presence of at least one Major Depressive Episode B – The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of life C – The episode is not related to a substance or medical condition D- The occurrence of the major depressive episode is not between explained by schizoaffective disorder, schizophrenia, or delusional disorder E- There has never been a manic or hypomanic episode

DSM - Major Depressive Disorder

Grief is a natural reaction to any loss & to anticipated loss Grief = feelings of emptiness & loss Grief tends to occur in waves which subside over time (reactivity & duration) Grief tends to thoughts of lost person/thing

Depression vs Grief

Specifiers: Mild, moderate, severe With anxious distress With mixed features With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern

DSM 5 – Major Depression Specifiers

Presence of at least 2 of following during mania, hypomania, or depressive episode 1. Feeling tense 2. Feeling usually restless 3. Difficulty concentrating because of worry 4. Fear something awful may happen 5. Feeling may lose control of self

Depression w/ Anxious Distress

Full criteria for depression plus at least 3 of following 1. Elevated, expansive mood 2. Inflated self-esteem 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or racing thoughts 5. Increase in energy or goal directed activities 6. Increased high risk behaviours 7. Decreased need for sleep

Depressive episode w/ mixed features

Criteria A (either) - Loss of pleasure in all or almost all activities and/or - Lack of reactivity to usual pleasurable stimuli Criteria B (3 or more) - Profound despondency, despair, or moroseness, or ‘empty’ mood - Depression worse in the morning - Early morning waking - Marked psychomotor retardation or agitation - Significant anorexia or weight loss - Excessive or inappropriate guilt

Depression w/ Melancholic Features

Criteria A Mood reactivity (mood brightens towards actual or potential positive events) Criteria B (2 or more) Significant increase in weight or appetite Hypersomnia Leaden paralysis (heavy feelings in legs and arms) Long-standing pattern of interpersonal rejection sensitivity (not limited to the depressive episode) that results in impairment in functioning

Depression w/ Atypical Features

Delusions or hallucinations are present at any time in the episode With Mood - Congruent Psychotic Features: During the episode the delusions and/or hallucinations experienced are consistent with delusional themes – low self esteem may become a paranoid delusion With Mood – Incongruent Psychotic Features : Content to the delusion and/or hallucination does not match the themes described above (can also be a combination)

Depression w/ Psychotic Features

At least 3 of the following : Stupor Catalepsy Waxy flexibility Mutism Negativism Posturing Mannerism Stereotypy (repetitive movement w no purpose) Agitation Grimacing Echolalia Echopraxia

Depression w/ Catatonia

Mania, hypomania, depression Can be present with or without psychotic features Onset during pregnancy or 4 weeks post-partum 3 to 6% experience major depressive episode with pregnancy or post-partum

Depression w/ Peri-partum Onset

Lifetime pattern of at least one type of mood episode occurring predictably with a certain time of the year. Full remission predictably occurs at another time of the year Can be mania, hypomania, or depression

Depression w/ Seasonal Pattern

Criteria A: Depressed mood for most of day, more often than not, for at least 2 years. Criteria B: two or more of following, while depressed Poor appetite or over eating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or indecisiveness Hopelessness

DSM- Persistent Depressive Disorder (previously Dysthymia)

Criteria A: 5 symptoms present week before onset of menses, start to improve within a few days after onset, minimal or absent symptoms at other points in cycle Criteria B (one or more of following) Marked affective lability Marked irritability, anger, interpersonal conflict Marked depressed mood, hopelessness, self-deprecating thoughts Marked anxiety, tension, and/or keyed up/ on edge. Criteria C (one or more of following) Decreased interest in usual activities Subjectivity difficulty in concentration Lethargy, easily fatigued, marked lack of energy Marked change in appetite Hypersomnia or insomnia Sense of being overwhelmed or out of control Physical symptoms - Psychomotor retardation

DSM- Premenstrual Dysphoric Disorder

Recurrent brief depression Short duration depressive episode (4-13 days) Depressive episode with insufficient symptoms

Other Specified Depressive Disorder

Criterion A: Presence of one or more delusions for one month or more Criterion B: Has never met Criterion for schizophrenia Criterion C: Functioning not markedly impaired & behaviour not obviously odd, mental status & social functioning intact (outside of direct impact of delusion). Criterion D: Any mood disorders are brief compared with total duration of delusional period Criterion E: Not better accounted for by substances or general medical condition

Delusional Disorder

Criteria A: Two or more of these symptoms must be present for at least one month (can be less if being successfully treated) And at least one symptom must be either 1, 2, or 3 1. Hallucinations 2. Delusions 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms Continuous disturbance for 6 months Social or occupational dysfunction (or both) for significant portion of the time. Specify if: it occurs with catatonia

DSM 5 - Schizophrenia

May appear fairly sudden to others but symptoms often begin to slowly develop over six months to a year

Onset of Schizophrenia

Changes in personality Withdrawal Dropping out of normal activities

Prodromal Stage (Schizophrenia)

Lifetime prevalence is 1% of population Persons with a diagnosis of schizophrenia have a reduced life expectancy of 25 years 20-40% of clients have at least one known suicide attempt 5% die by suicide Socioeconomic challenges

Schizophrenia Prognosis

In some instances, clients experiencing schizophrenia can drink excessive amounts of water, to the point of water intoxication and even death. Cause is unknown Symptoms often devastating Can be chronic

Polydipsia

Differentiation between schizophrenia, schizophreniform disorder, & brief psychotic disorder is made primarily by ________ of symptoms

duration

more 1 day but less than 1 month.

Brief Psychotic Disorder

at least 1 month but less than 6 months.

Schizophreniform Disorder

continuous signs of disturbance for at least 6 months (must include 1 month of active symptoms)

Schizophrenia

Criterion A: Presence of one or more of the following. At least one must be 1, 2, or 3 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behaviour Criterion B At least one day, less than one month Criterion C Not better explained by other causes (substance use) Specify if: With catatonia, With Peripartum onset, With stressors, or Without Stressors

DSM 5 – Brief Psychotic Disorder

Does not include Negative Symptoms as a criteria (schizophreniform and schizophrenia do)

DSM 5 – Brief Psychotic Disorder

Criterion A At least two of following, significant symptoms, must include 1, 2, or 3 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behaviour 5. Negative symptoms Criterion B Duration at least 1 month but less than 6 months Specify if: With catatonia

DSM 5 – Schizophreniform Disorder

Similar Criterion for schizophrenia with two differences: 1. Duration is shorter, more than 1 month but less than 6 months 2. Impaired social and occupational functioning is not a necessary criterion

Schizophreniform Disorder

Criterion A: An uninterrupted period of illness during which there is a major mood episode concurrent with Criterion A of schizophrenia Criterion B: Delusions or hallucinations for two or more weeks in the absence of a major mood episode during the lifetime duration of the illness Criterion C: Symptoms that meet Criterion for a major mood disorder are present for the majority of the total duration of the active and residual portions of the illness Criterion D: Not better accounted for by a substance or medical condition

Schizoaffective Disorder

Person has psychotic symptoms during periods when they do not have mania or depression – periods of at least 2 weeks Onset typically early adulthood but can be in late life Prognosis somewhat better than schizophrenia

Schizoaffective Disorder

Presentation with predominant hallucinations or delusions where there is evidence that the disturbance is the direct physiological consequence of a general medical conditions. Example: Endocrine disorders (hypo or hyperthyroidism) epilepsy, and brain lesion Does not include: Delirium Symptoms caused by the stress related to a general medical disorder

Psychosis Due to Another Medical Condition

Symptoms following a head injury Client with hyperthyroidism Unusual age of onset Lack of family history of psychotic illness Unexpected physical signs or symptoms (weakness, staggering, numbness altered sensorium, pain) Olfactory hallucinations Usual age = >40 yrs

Factors to increase suspicion of a medical cause

Must be evidence of a contributing medical condition, rule out mental disorder, delirium, substance, medication as cause. Must cause clinically significant distress or dysfunction. Examples: - Neurological conditions - Head trauma - Metabolic conditions - Vitamin deficiency (B12)

Catatonia due to a medical condition

Psychosis (hallucinations or delusions) related to direct physiological effects of a substance: Drug of abuse Medication Exposure to a toxin Examples: Alcohol, amphetamines, cocaine, hallucinogens, inhalants, opioids, sedatives, ect. Anticholinergics, anticonvulsants, antidepressants, antihistamines, ect Carbon dioxide, carbon monoxide, insecticides, ect

Psychosis due to medication/substance use

Previous or known drug use Occupations at high risk of exposure to toxins Medications known to evoke psychotic symptoms Unusual age of onset Lack of family history Atypical course or symptoms Persistence of psychosis typically short term(but can persist for months)

Factors to increase suspicion of a medication/substance use cause

Presence of positive, negative, and/or cognitive symptoms However, the symptoms and/or duration do not meet the criteria of a DSM diagnosis Or, additional investigation is required to determine if there an underlying cause (ie medical or substance related) to explain symptoms

Psychosis not otherwise specified

Illness strikes early in life Lack of insight is associated with poorer prognosis Stigma and disability often causes social isolation Possible chronic course of illness & lack of social supports leads to poverty, homelessness, legal involvement, substance abuse Increased the risk for type II diabetes, high blood pressure and heart disease

Challenges

Recovery has been described as a process that is used to assist persons to live their lives in meaningful ways, when provided with the appropriate resources and supports (Barker & Buchanan-Barker, 2011).

Typically write in past tense

Unless is happening in the _______ or has not yet occurred The primary investigator will employ phenomenology as research method.

present

Person experiencing schizophrenia … Or Person with schizophrenia Rather than “patients with schizophrenia” or “schizophrenics”

Person first language

Use plural “they” “their” Rater than “he/she” “him/her”

Gender inclusive language