W11: Eating Disorders

Question 1

What are eating disorders

Answer 1

They are real life threatening illnesses with potentially fatal consequences they involve extreme emotions, attitudes and Behaviours surrounding weight, food, size and shape

Question 2

What are the DSM eating disorders

Answer 2

Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant – restrictive food intake disorder
Other specified feeding or eating disorder

Question 3

What does the DSMSay about anorexia nervosa

Answer 3

The 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 normally expected

Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though it is significantly low weight

 disturbance in the way in which ones 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

Question 4

What are the subtypes of anorexia nervosa?

Answer 4

Restricting type

Binge eating/purging type 

Question 5

What is the restricting type of anorexia nervosa?

Answer 5

During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour

Question 6

What is the binge-eating/purging type of anorexia?

Answer 6

During the last three months the individual has engaged in recurrent episodes of binge eating or purging behaviour

Purging adds to the seriousness of effects on health

Question 7

What are the consequences of anorexia nervosa?

Answer 7

Low blood pressure 
Heart problems
Kidney problems (not enough fluid intake) 
Gastrointestinal problems 
Bone mass density declines (not enough vitamins and minerals) 
Dry skin (open for infection) 
Brittle nails (not enough calcium) 
Anaemia (low iron and B12) 
Hormone changes 
Hair loss and hair growth (hair growth trying to provide thermal protection) 
Electrolyte changes 
Amenorrhea (loss of periods) 

Can be life threatening and needs ongoing review as to whether the person needs to go to hospital

Question 8

In anorexia, there is a baseline for..

Answer 8

When the person is well enough to complete therapy, if they fall below this level they are sent to hospital for medical monitoring

Question 9

What does the DSM say about bulimia nervosa

Answer 9

Recurrent episodes of binge eating:

• eating in a discrete period of time, and amount of food that is larger than what most individuals would eat in a similar period of time under similar circumstances
• lack of control over eating during the episodes for example a feeling one cannot stop eating

Recurrent inappropriate compensatory behaviours to prevent weight gain such as self induced vomiting, misuse of laxatives, or other medications, fasting or excessive exercise

The binge eating an inappropriate compensatory behaviours occur on average at least once a week for three months

Self evaluation is influenced by body shape and weight

The disturbance does not occur exclusively during episodes of anorexia nervosa

Question 10

How many episodes of compensatory behaviour make up mild bulimia

Answer 10

1-3 per week

Question 11

How many episodes of compensatory behaviour make up moderate bulimia

Answer 11

4-7 per week

Question 12

How many episodes of compensatory behaviour make up severe bulimia

Answer 12

8-13 per week

Question 13

How many episodes of compensatory behaviour make up extreme bulimia

Answer 13

14 or more per week

Question 14

The severity of bulimia indicates..

Answer 14

The level of medical monitoring required

Question 15

What are the consequences of bulimia?

Answer 15

Amenorrhea (loss of periods)
Electrolyte imbalances (leads to heart irregularities)
Dental problems (from recurrent vomiting)
Swollen salivary glands
Gastrointestinal problems (problems with bowel if there is an overuse of laxatives)
Reduced bone density

Question 16

What does the DSM say about binge eating disorder?

Answer 16

Recurrent episodes of binge eating

• eating in a discrete period of time, an amount of food that is much larger than what most individuals would eat in the same period of time under the same circumstances
• a sense of lack of control over eating during the episodes (feeling like you can’t stop eating)

Binge eating episodes are associated with three or more of the following:
– Eating much more rapidly than normal
-Eating until feeling uncomfortable 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 afterwards

Much distress regarding binge eating is present

The binge eating occurs on average at least once a week for three months

Not associated with your current use of inappropriate compensatory behaviours as in bulimia and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

Question 17

How many binging episodes per week constitute a mild binge eating disorder

Answer 17

1-3 per week

Question 18

How many binge eating episodes per week constitute a moderate binge eating disorder

Answer 18

4-7

Question 19

How many binge eating episodes per week constitute a severe binge eating disorder

Answer 19

8-13

Question 20

How many binge eating episodes per week constitute a extreme binge eating disorder

Answer 20

14+

Question 21

What are the consequences of binge eating disorder

Answer 21

Type 2 diabetes
Cardiovascular problems
Respiratory problems
Joint or muscle pain
Insomnia
Early menstruation

Question 22

What does the DSM say about avoidant restrictive food intake disorder (ARFID)

Answer 22

An eating or feeding disturbance (such as an apparent lack of interest in eating food, avoidance based on the sensory characteristics of the food, concerns about aversive consequences of the food) is manifested by persistent failure to meet appropriate nutritional and or energy needs associated with one or more of the following:

• significant weight loss
• Significant nutritional deficiency
• Dependence on enteral feeding or oral nutritional supplements
• Marked interference with psychosocial functioning (prevents you from engaging socially eg. Family bbq)

The disturbance is not better explained by a lack of available food or by and associated culturally sanctioned practice

The eating disturbance does not occur exclusively during the course of anorexia or bulimia and there is no evidence of a disturbance in the way in which ones body weight or shape is experienced

The disturbance is not attributable to a concurrent medical condition or another mental disorder or when the eating disturbance does occur in the context of another condition or disorder the severity exceeds that which routinely is associated with the condition and warrants additional clinical attention


Question 23

Explain the biopsychosocial model of eating disorders

Answer 23

Biological: family history, genetic predisposition, history of dieting (it only takes one trigger for a diet to become something that is clinically significant), type 1 diabetes (because they need to be careful and monitor food intake, this can become a problem)

Psychological: low self esteem, feelings of inadequacy, depression, anxiety , loneliness
(Can’t control things in life but can control what is going in and out of their mouth)

Social: cultural norms that overvalue appearance, body dissatisfaction, drive for ideal body type, weight stigma and bullying

Question 24

A multidisciplinary approach is best for eating disorders who might this involve

Answer 24

Psychologist 
Medical practitioner 
Psychiatrist 
Physiotherapist 
Dietician

Question 25

What is the treatment for eating disorders

Answer 25

Hospitalisation is often required to normalise electrolytes and other medical problems

Food consumption is gradually increased for intravenous administration if required

They can be hospitalised against their will if they refuse to keep their weight in a relatively healthy level

Once the persons weight is restored to the normal level where they are no longer in danger they can commence psychological treatment
- CBT-E

Question 26

What is CBT-E

Answer 26

It is suitable for people with an eating disorder with a BMI between 15 and 40

It involves 20 to 40 individual sessions in four phases which is lengthy

Question 27

What is phase 1 of CBT-E

Answer 27

Phase 1: motivational interviewing to reduce ambivalence
Develops a case formulation to guide treatment
Introduce self monitoring - monitor food consumption
Provide psychoeducation about the illness and treatment
Weekly weighing
Implementing a pattern of regular eating
(2 planned snacks and 3 meals - dieticians involved to make sure full of nutrients)

Question 28

What is phase 2 of CBT-E?

Answer 28

Ongoing self monitoring- food + weight

Identifying barriers to change - include them in action plan and how you can overcome them (this may be readiness and motivation so may need to spend more time in phase 1)

Modify formulation as necessary as you learn about the client

Treatment planning for stage 3

Question 29

What is phase 3 in CBT-E

Answer 29

Main treatment intervention 
- ongoing self monitoring 
Addressing 
- over-evaluation of weight and shape 
- dietary restraint 
- residual binges 

By this stage should see a level of wellness that allows the person to handle cognitive restructuring

Question 30

What is phase 4 of CBT-E?

Answer 30

Well both mentally and physically

Maintaining treatment gains
Relapse prevention

Question 31

Explain family-based therapy for eating disorders

Answer 31

This is particularly important for younger people

It is 2x effective as regular therapy

Parents assume responsibility for referring and the child then begins to take over the responsibility slowly until they become more independent (not until they have reached 95% of their target weight)