Week Eleven - Eating Disorders Flashcards
Eating disorders?
Involve extreme emotions, attitudes, and behaviors surrounding weight, food, size and shape.
Anorexia Nervosa DSM-5 criteria?
A. 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 minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s 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.
ANOREXIA NERVOSA subtypes?
Restricting type: During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e. self-induced vomiting, or the misuse of laxatives, diuretics, or enemas).
Binge-eating/purging type: During the last three months the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e. self- induced vomiting, or the misuse of laxatives, diuretics, or enemas).
Bulimia Nervosa DSM-5 criteria?
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both:
1. Eating in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under
similar circumstances;
2. A sense of lack of control over eating during the episodes (e.g. a feeling that one cannot stop eating or control what or how much one is eating.
B. Recurrent inappropriate compensatory behaviours to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a 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.
Bulimia Nervosa DSM-5 severity specificity?
Mild: An average of 1-3 episodes of inappropriate compensatory behaviours per week
Moderate: An average of 4-7 episodes of inappropriate compensatory behaviours per week
Severe: An average of 8-13 episodes of inappropriate compensatory behaviours per week
Extreme: An average of 14 or more episodes of inappropriate compensatory behaviours per
week
Binge Eating disorder DSM-5 criteria?
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both:
- Eating in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances;
- A sense of lack of control overeating during the episodes (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
B. 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 afterwards.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Binge Eating Disorder DSM-5 severity specificity?
Mild: An average of 1-3 binge episodes per week
Moderate: An average of 4-7 binge episodes per week
Severe: An average of 8-13 binge episodes per week
Extreme: An average of 14 or more binge episodes per week
AFRID DSM-5 criteria?
A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food;
avoidance based on the sensory characteristics of food; concern about aversive
consequences of eating) as manifested by persistent failure to meet appropriate nutritional
and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning
B. The disturbance is not better explained by lack of available food or by an associated
culturally sanctioned practice.
C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or
bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body
weight or shape is experienced.
D. The eating disturbance is not attributable to a concurrent medical condition or not better
explained by another mental disorder. When the eating disturbance occurs in the context of
another condition or disorder, the severity of the eating disturbance exceeds that routinely
associated with the condition or disorder and warrants additional clinical attention.
BIOPSYCHOSOCIAL MODEL
Biological Factors:
- Family history
- Genetic predisposition
- History of dieting
- Type One (Insulin dependent) Diabetes
Psychological Factors: - Low self esteem - Relationship with self - Feelings of inadequacy - Depression, anxiety, fear, or loneliness
Social Factors: • Cultural norms that overvalue appearance – Body dissatisfaction – Drive for perceived ideal body type – Historical trauma – Weight stigma/bullying
Hospitalisation Treatment for ED?
Hospitalisation is often required to normalise electrolytes and other medical problems
Food consumption is gradually increased (via intravenous administration if required)
Can be hospitalised against their will if they refuse to keep their weight at a relatively
healthy level
Once the person’s weight is restored to the level where they are no longer in danger
they can commence psychological treatment
CBT-E?
Developed by Fairburn and colleagues.
Suitable for people with an eating disorder with a BMI between 15 and 40.
Involves 20-40 individual sessions in 4 phases.
Evaluation (including weight and height measurement) and treatment recommendations
CBT-E phase 1?
Motivational interviewing to reduce ambivalence
- Develop a case formulation to guide treatment
- Introduce self monitoring
- Provide psychoeducation about the illness and treatment
- Weekly weighing and education about its ongoing use
- Implementing a pattern of regular eating
CBT-E phase 2?
- Ongoing self monitoring
- Identify barriers to change
- Modify formulation as needed
- Treatment planning for stage 3
CBT-E phase 3?
Main treatment interventions
- Ongoing self monitoring
- Over-evaluation of weight and shape
- Dietary restraint
- Residual binges
CBT-E phase 4?
Maintaining treatment gains
Relapse prevention
