Test 6: Eating and Sleep-Wake Disorders

Question 1

What are the characteristics of Bulimia Nervosa?

Answer 1

1) Binge eating
- Excess amounts in discrete time period
- Perceived as uncontrollable
- Associated with guilt, shame, or regret (may be)
- Hide from family members (may)
- High in sugar, fat, or carbs (often)
2) Compensatory behaviors:
- purging (most common)
– most common: self-induced vomiting
– other: diuretics or laxatives
- Excessive exercise
- Fasting or food restriction

Question 2

What are the associated physical features of Bulimia Nervosa?

Answer 2

• Most within 10% normal body weight, have more body fat
• Purging can result in severe medical problems
  – death
  – electrolyte imbalance
  – kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
  – erosion of dental enamel

Question 3

What are the associated psychological features of Bulimia Nervosa?

Answer 3

• Overly concerned with body shape (most)
• Fear of gaining weight, but most have normal body weight
• Comorbid psychological disorders (80% anxiety)

Question 4

What are medical consequences of Bulimia Nervosa?

Answer 4

• Salivary gland enlargement causes by repeated vomiting (cubby face)
• Erosion of dental enamel
• Electrolyte imbalance –> cardiac arrhythmia and renal failure
• Intestinal problems from laxative abuse
• Calluses on fingers and hands from stimulating gag reflex

Question 5

What are the defining characteristics of anorexia nervosa?

Answer 5

Extreme weight loss
- calorie restriction below energy requirements
- binging and purging (may)
- 15% below expected weight
- intense fear of weight gain and losing control over-eating
- relentless pursuit of thinness
- often begins with dieting

Question 6

What are the associated features of anorexia nervosa?

Answer 6

• Marked disturbance in body image (most)
• Comorbid with other psychological disorders (most)
• Organ damage: cardiac damage (heart attack and death)

Question 7

What are the defining features of binge eating disorder?

Answer 7

(New to DSM)
- No compensatory behaviors
- Associated with distress and/or functional impairment

Question 8

What are the associated features of BED?

Answer 8

• Obesity (many)
• Concerns about shape and weight (some)
• Older than bulimics and anorexics
• More psychopathology than non-binging obese people

Question 9

What are the facts and statistics of Bulimia Nervosa?

Answer 9

• Majority are female: 90%+
• Onset: typically adolescence
• Median age: 18-21
• Lifetime prevalence: 1.1% females, 0.1% males
• College women: 6-7%
• Tends to be chronic if left untreated

Question 10

What are the facts and statistics of Anorexia Nervosa?

Answer 10

• Majority: female & white, middle-to upper-middle-class families
  – High expectations,
  – perfectionistic
  – Non-communcative
  – Concerned with outward appearance
• Usually develops around early adolescence
• More chronic and resistant than bulimia

Question 11

What are the causes of Bulimia and Anorexia?

Answer 11

1) Culture
- media portrayals: thinness linked to success and happiness
- Cultural emphasis on dieting
- Standards of ideal body size: change like fashion, difficult or impossible to achieve
2) Biological
- partial genetic component
- deficits in serotonin (binging)
3) Psychological and behavioral
- low sense of personal control and self-confidence
- perfectionistic attitudes
- distorted body image
- preoccupation with food
- comorbidity: anxiety and mood disorders
(Interacting: dietary restraint, family influences, biological & psychological dimensions)

Question 12

What is the psychosocial treatments of bulimia nervosa?

Answer 12

CBT
- treatment of choice
- identifying maladaptive thinking patterns and behavioral habits, then gradual practice of new habits
- learn to eat small, frequent meals,

Question 13

What is the medical treatment of Bulimia Nervosa?

Answer 13

Antidepressants
- Have some effectiveness
- Can help reduce binging and purging behavior
- Usually not efficacious in the long-term

Question 14

What is the psychological treatment of binge eating disorder?

Answer 14

• CBT: similar to that used for bulimia, appears efficacious
• Interpersonal: equally effective as CBT
• Self-help techniques: also appear effective

Question 15

What goals of psychological treatment of Anorexia Nervosa?

Answer 15

• Weight restoration: first and easiest goal to achieve
• Psychoeducation
• Rx: have not been found to be effective
• Behavioral and cognitive interventions: targets food, weight, body image, thought, and emotion
• Treatment often involves the family
• Long-term prognosis for anorexia is poorer than for bulimia

Question 16

What is the background and overview of obesity?

Answer 16

• BMI of 30+
• Not DSM disorder but may be a consequence
• 2008: 33.8% US adults
• 2010: 37.5% US adults
• Mortality rates: closely associated with smoking
• Increasing more rapidly in children/teens and developing countries

Question 17

What is night eating syndrome?

Answer 17

• Occurs in 7-19% obesity treatment seekers
• Occurs in 55% bariatric surgery seekers
• Features:
  – consume 1/3+ daily caloric intake
  – get up during the night to eat
  – patients are wide awake, not binge eating, eat high caloric foods
  – often skip breakfast next morning

Question 18

What are causes of obesity?

Answer 18

• technological advancement
• more common in affluent families
• 30% by genetics
• biological, psychosocial, and personality factors also contribute

Question 19

What are obesity treatments?

Answer 19

• efficacy: moderate success with adults, greater in children and adolescents
• treatment progression: least to most intrusive options
  1) Self-directed weight loss programs: not effective for most people
  2) Commercial self-help programs
  3) Behavior modification programs
  4) Bariatric surgery