Week 4 Chapter 11 Eating Disorders revision

Question 1

What are the basic features required for a diagnosis of anorexia nervosa?

Answer 1

1. restriction of behaviours that promote healthy body weight / refusal to eat
2. Intense fear of gaining weight & being fat
3. Distorted body image or sense of body shape

Question 2

What are the 2 types of anorexia nervosa?

Answer 2

*restricting type
severely limiting food intake

*binge-eating/purging type
regularly engage in binge-eating & purging

Question 3

At what age does Anorexia Nervosa develop and what events usually precipitate its onset

Answer 3

• Anorexia Nervosa usually begins in the early to middle teenage years
• Often after an episode of dieting & the occurrence of a life stress
• Anorexia is 10 times more frequent in women than men

Question 4

What are the physical consequences of anorexia nervosa?

Answer 4

Self starvation & laxative use lead to:
Low blood pressure, reduced heart rate, kidney & gastrointestinal problems, declining bone marrow, dry skin, brittle nails, changes in hormone levels, anemia. Hair loss, lanugo (a fine soft body hair) Changes in electrolyte levels (potassium & sodium) which are for neural transmission; lead to tiredness, weakness, cardiac arrhythmias, sudden death.

Question 5

Which other disorders co-occur with eating disorders?

Answer 5

Women:
Depression, OCD, phobias, panic disorder, substance use disorder & personality disorders

Men:
Mood disorders, schizophrenia, substance use disorder

Suicide rates are quite high: 5% complete suicide & 20% attempt it

Question 6

What’s the prognosis for people with anorexia nervosa?

Answer 6

• Between 50% & 70% do recover
• Recovery usually takes 6 - 7 years & relapses are common prior to developing a stable pattern of eating and weight maintenance
• Anorexia is life threatening: death rates are 10 times higher than the general population & twice as high as other psychological disorders
• Early death often comes from congestive heart failure & suicide

Question 7

What are the key features of Bulimia Nervosa?

Answer 7

• episodes of rapid consumption of an excessive amount of food within a short amount of time (2 hours), then a feeling of losing control over eating, as if one cannot stop.
• This is followed by compensatory behaviour (vomiting, fasting, excessive exercise) to prevent weight gain
• Body shape & weight are extremely important for self-evaluation

Question 8

What are the key differences between anorexia nervosa and bulimia nervosa?

Answer 8

• Bulimia is not diagnosed if the binging & purging occurs in the context of anorexia & it’s extreme weight loss.
• People with anorexia lose a tremendous amount of weight, whereas people with bulimia do not

Question 9

When does bulimia nervosa typically develop?

Answer 9

• in late adolescence or early adulthood

* Many people are somewhat overweight to start with & the binge eating often starts during an episode of dieting.

Question 10

What other conditions typically co-occur with bulimia nervosa?

Answer 10

• Depression, Personality Disorders, Substance use disorders, conduct disorder
• NB: Bulimia symptoms can predict onset of depression & vice versa - thus each disorder is a risk factor for the other
• Suicide rates are higher than with the general population but considerably lower than for those with anorexia

Question 11

Even though people with bulimia tend to have a normal BMI, there are still physical consequences for people with bulimia. What are these?

Answer 11

• menstrual irregularities, amenorrhea, potassium depletion,
• laxative use can lead to electrolyte depletion which causes irregular heart beat
• vomiting can lead to menstrual problems, tearing of tissue in the stomach & throat, loss of dental enamel, swollen salivary glands
• death is about 4% of people with bulimia

Question 12

What is the prognosis for people with bulimia nervosa?

Answer 12

• 75% recover
• approx 10% - 20% remain fully symptomatic
• early intervention is linked to better outcomes
• Those who binge & vomit more & have comorbid substance use or depression have poorer outcomes

Question 13

What are the key features of binge-eating disorder?

Answer 13

• Reported binge eating episodes (1/week for at least 3 months)
• Lack of control during the episodes
• DIstress about the binging
• Binge eating episodes includes at least 3 of the following:
• eating more quickly than usual
• eating until overfull
• eating large amounts even if not hungry
• eating alone due to embarrassment about large quantities of food
• feeling bad (disgusted, guilty or depressed) after the binge
• no compensatory behaviour is present

Question 14

What distinguishes binge eating disorder from Anorexia or bulimia nervosa?

Answer 14

*The absence of weight loss
*The absence of compensatory behaviour (purging, fasting, excessive exercise)
*Most often people with binge eating disorder are obese (BMI over 30)
NB: not all obese people binge eat
*about 2%-25% of obese people might qualify for a diagnosis of binge eating disorder

Question 15

What is binge eating disorder associated with?

Answer 15

Binge eating disorder is associated with obesity and a history of dieting

• impaired work and social functioning
• depression, low self-esteem, substance use disorder & dissatisfaction with body shape

Question 16

What are the physical consequences of Binge Eating Disorder?

Answer 16

*Many are a function of obesity: increased risk for type 2 diabetes, cardiovascular problems, breathing problems, insomnia, joint/muscle problems
Other problems independent of obesity include:
*sleeping problems, anxiety, depression, irritable bowel syndrome, early onset menstruation

Question 17

What is the prognosis for people with binge eating disorder?

Answer 17

• 25%-82% of people recover

* people often have binge eating disorder for 14.4 years - far longer than anorexia or bulimia

Question 18

What factors contribute to the development of an eating disorder?

Answer 18

• genetics
• neurobiology
• sociocultural pressure to be thin
• personality
• the role of the family
• the role of environmental stress

Question 19

What hormonal abnormalities occur in the hypothalamus as a result of self-starvation?

Answer 19

Abnormal cortisol levels occur in the hypothalamus as a result of self starvation and return to normal after weight gain

Question 20

What evidence is there to support endogenous opioids playing a role in eating disorders?

Answer 20

Endogenous opioids are substances produced by the body to reduce pain sensations, enhance mood & suppress appetite

• Opioids are released during starvation which may positively reinforce a euphoric state for people with anorexia or bulimia
• excessive exercise also increases opioids and so further exacerbates the situation
• we don’t yet know however if the low levels of opioids are a cause of bulimia or an effect of the changes in food intake or purging

Question 21

What evidence is there to support serotonin playing a role in feeling satiety (feeling full) for people with eating disorders?

Answer 21

• Serotonin promotes feelings of satiety (fullness)
• people with bulimia may have a serotonin deficit that causes them not to feel full as they eat
• food restriction also interferes with serotonin synthesis in the brain - for people with anorexia, the severe food restrictions could interfere with the serotonin system

Question 22

What evidence is there to support serotonin metabolites & an underactive neurotransmitter playing a role in eating disorders?

Answer 22

*Low levels of serotonin metabolites have been reported in people with anorexia and bulimia
*People with anorexia that have not returned to a normal weight range show a poorer response to serotonin agonists than people with anorexia who have returned to normal weight
*People with bulimia have smaller responses to serotonin agonists
these all contribute to the neurotransmitter being under active

Question 23

What evidence is there to support the neurotransmitter dopamine playing a role in eating disorders?

Answer 23

• Dopamine is linked to the pleasurable aspect of food that compel animals to go after food
• restrained eaters appear to be more sensitive to food cues
• women with anorexia showed greater activation in the ventral striatum (a brain area linked to reward & dopamine activation) than women without Anorexia when viewing pictures of underweight women
• women with An or BN have a greater expression of dopamine transporter gene DAT which regulates the reuptake of dopamine

Question 24

What do the cognitive behavioural theories of eating disorders focus on understanding in relation to eating disorders?

Answer 24

Understanding thoughts, feelings, behaviours that contribute to distorted body image, fear of fat, and loss of control over eating.
People with eating disorders have maladaptive schemata that narrow their attention towards thoughts & images related to body shape, weight, and food

Question 25

What sociocultural factors influence attitudes to body weight?

Answer 25

The standards society sets for ideal body weight has greatly reduced over the past 50 years

• thinness is highly valued by society
• paradoxically, obesity has more than doubled in this period
• dieting to lose weight is more common
• liposuction & other surgical procedures are now available
• body dissatisfaction has grown - leading to fear of being fat
• exposure to media portrayals of unrealistically thin models also influences body dissatisfaction
• there are websites promoting anorexia and bulimia encouraging people to become seriously underweight

Question 26

What are the gender related sociocultural factors that influence eating disorders?

Answer 26

• One primary reason for more women than men developing an eating disorder is that western standards reinforce the desirability of being thin for women more than men
• the objectification of the female body leads women to be defined by their bodies far more than men
• this leads to self-objectification - seeing their body through the eyes of others leading to greater shame about their bodies
• as we get older women & men tend to be less concerned about the ideal body shape

Question 27

What have cross-cultural studies found in regard to eating disorders?

Answer 27

• Even though anorexia is found across a variety of cultures, there is a variation of the presentation of anorexia across cultures (e.g. not all have the fear of becoming fat)
• Bulimia appears more common in industrialised societies (rarely seen in non westernised cultures)

Question 28

How do personality factors influence the development of eating disorders?

Answer 28

• perfectionistic, shy, and compliant personality styles tend to predict the onset of eating disorders
• perfectionism can be self-oriented, other-oriented or socially-oriented: people with anorexia had higher levels of self & other oriented perfectionism than those without anorexia

Other factors:
*body dissatisfaction, poor interoceptive awareness (the extent people can distinguish different biological states of their bodies), propensity to experience negative emotions

*High levels of family conflict, which is related to perception of family discord by the person with the eating disorder

Question 29

What are the major treatments for people with eating disorders?

Answer 29

• Hospitalisation (intravenous feeding)
• Medications: antidepressants (prozac)
• Psychological therapies