Week 4 - Lecture - Eating Disorders Flashcards
definition of ED
Severe, psychiatric disorders characterised by a dysfunctional relationship with food and distorted perceptions about the body, that significantly impairs physical health and/or psychosocial functioning. (APA, DSM-5).
AN in DSM 4 compared to DSM 5
DSM-4:
- Refusal to keep body weight above minimal healthy level (85%)
- Fear of weight gain
- Disturbance of body experience
- Amenorrhea
DSM-5:
- Restriction of intake leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Fear of weight gain
- Disturbance of body experience
subtypes of AN
- Restricting
- Binge-eating/purging
BN in DSM4 and 5
DSM-4:
- Recurrent episodes of binge-eating
- Compensatory behaviours
- Bingeing & compensation happen twice per week over at least 3 months
- Self-evaluation is unduly influenced by body shape & weight
- Not simply a phase of anorexia
DSM-5:
- Recurrent episodes of binge-eating
- Compensatory behaviours
- Bingeing & compensation happen once per week over at least 3 months
- Self-evaluation is unduly influenced by body shape & weight
- Not simply a phase of anorexia
binge-purge cycle
cycle:
strict dieting
diet slips or difficult situations arise
binge eating is triggered
purging to avoid weight gain
feelings of shame and disgust
binge eating disorder
- Newish binge eating disorder (BED)
- Recurrent episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances; eating very fast in the absence of hunger.
- Marked by feelings of loss of control and guilt, embarrassment, or disgust.
- Bingeing happens once per week over at least 3 months.
- Mild 1-3, 4-7,8-13, extreme 14+ binge periods a week
- Can binge over 10000 at a time
Eating disorders: not otherwise specified; EDNOS; DSM-IV
- Atypical anorexia nervosa (significant restriction and fear of weight gain but is of normal weight)
- Low frequency bulimia nervosa (not meeting the thresholds)
- Low frequency binge eating disorder (not meeting thresholds)
- Purging disorder (self-induced vomiting, laxatives, exercise etc but no binging)
- Night eating syndrome (eat lots of food a night not related to hunger)
Pica (consume non-nutritious substances - non-food)
Rumination disorder (regurgitate part digested food)
Avoidant/restrictive food intake disorder (such a restricted diet they are unable to make their nutritious needs, impact physical and psychological health)
sub-threshold disorders
- 40-50% of cases do not fit neatly into diagnosis
- Atypical cases (OSFED) are the largest group
- Many people move from one diagnosis to another
- Sub-threshold disorders are most common
shift away from rigid diagnoses
model
- Transdiagnostic model (Waller, 1993; Fairburn et al., 2003)
incidence and prevalence of ED
- 62% of people with eating disorders have symptoms before the age of 16 (PwC, 2016)
- All figures taken from Westernised cultures (similar across countries)
- Peak age of onset is slightly younger in AN (14-16 years vs 18-20 years; but many cases are younger or older).
- BED: compared to other eating disorders, more common in males and older people.
- Female: male ratio (approx. 20:1 > more recent suggestions = 10:1)
- Anorexia nervosa (0.5-1.0% of teenage girls)
○ 21 new cases per 100000 population per year - Bulimia nervosa (1-2% of women aged 16-35)
○ 30 new cases per 100000 population per year - BED (epidemiological studies are lacking. Extrapolation estimates are 3.6% of women and 2.1% of men aged 18-70)
○ Similar to BM in terms of new cases per year but not known yet - OSFED (2-3% of women aged 16-35)
why might ED rates differ?
○ Definitions used for diagnosis (DSM-4 vs 4)
○ Individual assessors/therapist opinion
○ Sample - clinical cases only or self-reported
○ Other researcher variables, e.g. new cases only, not re-referrals
○ Across cultures; less ED? Less acceptable? Fewer treatment opportunities?
covid 19 and ED
- Systematic review of 53 studies (Devoe et al., 2022)
- Evidence to suggest that the pandemic led to:
○ increased diagnoses of EDs (↑15%);
○ increased hospital admissions for EDs (↑48%)
○ and increased ED symptoms. - Increased co-morbidity (e.g., anxiety, depression, suicidal ideation; Taquet et al., 2021)
- Decreased access to care and treatment, changes to routine and loss of structure, social isolation.
- Evidence to suggest that the pandemic led to:
diagnosis and treatment
- Takes 15 months between spotting symptoms and starting treatment on average (PwC, 2015)
- Hamilton et al., (2022) – 5.28 years between symptom onset and treatment seeking in Australian sample (n = 119).
death and ED
- Meta-analysis from Arcelus, Mitchell, Wales & Nielsen (2011).
○ Elevated risk of death for all patients with eating disorders.
§ Significant increase for those with AN.
○ In practice: If I see 1000 patients with AN a year in my clinic, 5 will die and 1.3 will die of suicide
○ Patients with AN have nearly 6 times more chances of dying than people without AN
○ Older on assessment →higher mortality
disability-adjusted life years
- Australian Institute of Health & Welfare
○ EDs are 6th in terms of disability-adjusted life years: from early mortality and reduced quality of life for ages 15-24.
