week 4 Flashcards
What is the definition of anorexia?
severe loss of appetite
What is the definition of nervosa?
emotional reasons
What are the DSM-IV criteria for anorexia?
A. Refusal to maintain 85% of normal body weight
B. Intense fear of being overweight, when they are significantly underweight
C. Disturbance in the way in which one’s body weight is experienced
D. Amenorrhea
What are the DSM-IV subtypes of anorexia?
- restricting type
- binge eating/purging type
What are some associated features of anorexia?
- Depressed mood, social withdrawal, irritability, insomnia, diminished interest in sex.
- Obsessive-compulsive features
What is the prevalence of anorexia?
- More common in industrialised societies
- 0.5-1% of females.
- 10-20:1 gender ratio
What is the mean age of onset for anorexia?
17
What is the long-term mortality rate for anorexia?
10% (although medical complications and suicide impact on mortality rates)
What are the physical consequences of anorexia?
Mild anemia Dehydration Fluid and electrolyte disturbances Reduced resting energy expenditure Constipation Abdominal pain Cold intolerance; hypothermia; reduced body temperature Lethargy and muscle weakness Hypotension Dry, cracking skin Lanugo: fine downy body hair on face and neck Brittle fingernails Bradycardia: increased/decreased heart rate Peripheral edema: yellowish discolouration of skin Dental enamel erosion – due to vomiting Impaired renal function Cardiovascular problems Osteoporosis
Describe the psychoanalytic aetiology of anorexia
- Eating is a substitute for sexual expression
- Reflection of conflict between wanting to attain independence and selfhood within the family and a fear of growing up
Describe the learning aetiology of anorexia
Weight phobia or striving to effect image of slimness emulated and modeled by society
Describe the genetic aetiology of anorexia
- Occur at higher rates in first degree biological relatives
- MZ twins higher concordance than DZ twins
Describe the biochemical aetiology of anorexia
- Disturbance in hypothalamic functioning
- However, not known whether disturbance is the cause of anorexia, result of weight loss and caloric restriction, or result of emotional distress of patient
Describe the family systems aetiology of anorexia
- Deflecting attention away from family conflict
- Families try to be too positive and do not acknowledge conflicts
- Triangulation = over communication from both parents with the child, but not enough communication between the parent
What is the behavioural method of treating anorexia?
Examples are: • Not allowed to weigh themselves • Food schedules • Small meals • Watching them eat
How is family therapy used to treat anorexia?
- changing the patient role of the anorexic
- redefining the eating problem as an interpersonal one
- preventing the parents from using their child’s anorexia as a means of avoiding conflict
What drug has been used in an attempt to treat anorexia?
Chlorpromazine - (limited success)
What are the subtypes of bulimia?
Purging & non-purging
What are the DSM-IV criteria for bulimia?
A. Recurrent episodes of binge eating.
B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain.
C. Behaviour occurs on average at least twice per week for 3 months.
D. Self evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.
What is the prevalence of bulimia?
- occurs in 1-3% of adolescent females
- 1:10 gender ratio
However, because of its nature, rates of bulimia are extremely underestimated
What are the associated features of bulimia?
- depression
- anxiety
- substance abuse or dependence
personality disorders (borderline PD most common)
What are the physical consequences of bulimia?
- Fluid and electrolyte abnormalities
- Loss of dental enamel; chipped teeth; increased dental cavities
- Menstrual irregularity or amenorrhea
- Dependence on laxatives to produce bowel movements
- Sore throats
- Swollen salivary glands
- Nutritional deficiencies
- Dehydration
- Purging type more likely to have physical problems than non-purging type
What are the main differences between anorexia and bulimia?
- Bulimia within normal weight range
- Many individuals with anorexia do not purge
- Appetite can be decreased in anorexia – increased in bulimia
- Amenorrhea occurs less often in bulimia
Describe the genetic aetiology of bulimia
Increased frequency of bulimia, mood disorders and substance abuse and dependence in first-degree biological relatives
Describe the biochemical aetiology of bulimia
- Abnormalities in endogenous opioids
* Nature of mechanism still uncertain
Describe the stress theory aetiology of bulimia
- bulimics perceive they have lack of control, experience higher levels of anxiety, and have coping deficits
- Alexithymia= a personality construct characterized by the sub-clinical inability to identify and describe emotions in the self.
Describe the cognitive theory aetiology of bulimia
Overconcern with body weight, size, and shape; body image distortion; desire to be thinner; and perception of being out of control when eating
Describe the social factors aetiology of bulimia
Lower perceived social support; more negative interpersonal interactions and higher levels of conflict; lower social skills and social competence
How is CBT used to treat bulimia?
- Cognitive restructuring: thinking about relationship with food. 79% median reduction in frequency of bingeing.
- Exposure response prevention:
- Technique tries to prevent or delay purging after bingeing
- Mixed results
- Benefits of cognitive restructuring enhanced by addition of response prevention
What drug is used to treat bulimia?
Antidepressants.
