week 12 Flashcards
What messages are given about weight in our culture
You can never be too thin or buff enough
Weight is a moral issue
Implicit association test → weight discrimination
Just eat more (toxic food environment)
How important is genetics in determining out weight
50% of variability in weight is associated with genes
What is anorexia nervosa
Significantly low body weight in the context of age, sex, developmental trajectory, and physical health
Intense fear of gaining weight and persistence in not gaining weight
Disturbance in experience of weight or shape, undue influence of weight or shape on self-evaluation, persistent lack of recognition of the seriousness of the current low body weight
Restricting type: weight loss is accomplished primarily through dieting, fasting and or excessive exercise
Binge eating/purging type: recurrent episodes of binge eating or purging behavior (
Anorexic range less than 18.5 (ICD-11)
Bulimia Nervosa
Recurrent episodes of binge eating
Eating in a discrete period of time, an amount of food that is larger than what most individuals would eat in a similar period of time under similar circumstances
A sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behaviors like self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting or excessive exercise
Must occur at least once a week for 3 months
Self-evaluation is unduly influenced by body shape and weight
The disturbance does not occur exclusively during episodes of anorexia nervosa
Binge-Eating Disorder
Recurrent episodes of binge eating
Episode of binge eating is characterized by:
Eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances
A sense of lack of control over eating during the episode
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
At least once a week for 3 months
Obesity
Excess of weight associated with health problems
Chronic medical condition
Different groups are more affected
Non-hispanic black and hispanic adults
Lower education
Intersection of race and education
Also consider age
Which is the most frequently occurring eating disorder
Binge eating
Which of these disorders also affects men significantly
Binge eating
What proportion of individuals with Binge-Eating Disorder are overweight
36-42%
What is the age of onset for these different eating disorders
AN → peak onset 13-18 years peaking at 18
BN → age of onset 16-17 years old
Binge eating → late teens to early 20s
What are co-occuring disorders with anorexia nervosa and bulimia nervosa
Major Depression (50-70%)
Anxiety disorders (13-60%)
Drug and Alcohol and BN (25%)
Personality disorder (25%)
BPD → BN
OCPD → AN
What are medical comorbidities associated with anorexia
Heart attacks
Renal and metabolic complications ex hypothermia sensitivity to cold and heat, disturbed electrolytes due to vomiting
Hematological problems
Dermatological complications (dry skin, head hair loss, hair growing)
Neurological- fatigue, dizziness, hyperactivity
Mortality
What are medical comorbidities associated with bulimia nervosa
Fluid and electrolyte damage from purging
Gasto-intestinal complaints
Cardiovascular problems due to electrolyte problems
Russell’s sign
Headaches, poor problem solving
Irregular periods
Renal problems
Dental decay from vomiting
Mortality
What are medical comorbidities associated with obesity
Hypertension
Cardiovascular disease
Type II diabetes
Some cancers
Respiratory problems like sleep apnea
Osteoarthritis
What is an objective binge
Experiencing a loss of control over eating while eating an unusually large amount of food in one sitting
What are secondary psychological problems associated with anorexia and bulimia
Preoccupation with food, weight and shape
Depression, mood swings
Loss of concentration
Preoccupation and Anxiety of food
Social withdrawal
Low self esteem
Obsessiveness
Perfectionism
Poor sleep
Odd eating patterns
How are the courses of anorexia and bulimia similar or different
AN
Highest Psychiatric mortality rate → 16% after 21 years
Death ½ suicide and ½ physical complications
After 21 years, 51% fully recovered; 21% partially recovered; 10% not recovered and 16% dead
BN
Onset late adolescent to early 20s
30% shift from AN to BN
Waxing and Waning course
6 mths to 10 years outcome 50% fully recovered, 20% meet full criteria for BN and 30% relapse
11-12 year outcome 70% remission
Mortality approximately 0.3%
Which eating disorders have multiple evidence based treatments
AN
Family Based Therapy
Phase 1: parents take charge of weight restoration
Phase 2: clients regain control of eating
Phase 3: developmental issues
Principle features
Theoretical view of the cause of AN
Empowerment of parents
Separation of the illness from the client
CBT- Enhanced
All eating disorders
2 forms
Focused
Broad: includes additional modules (mood intolerance, clinical perfectionism, and major interpersonal problems
Focused on to stop dieting
What are evidence based treatments for bulimia nervosa
CBT
19 sessions x 4.5 month individual tx
3 stages, sessions staggered
1. Behavioral strategies → self monitoring, regular eating, alternative behaviors, stimulus control, problem solving
2. Cognitive restructuring → body image
3. Relapse prevention
Psychotherapy
Pharmacotherapy
What are evidence based treatments for binge-eating disorder
Pharmacological
CBT
Interpersonal psychotherapy
Behavioral weight loss
Self-help
Surgery
