week6 Eating disorders Flashcards
describe the clinical features and medical complications of bulimia nervosa, anorexia nervosa, and binge eating disorder;
BULIMIA NERVOSA; one of the most common mental disorders in US college campuses. Eat more than average and usually junk foods, and person feels out of control with their eating. Attempts to compensate for binge eating typically by purging (eg self induced v+, use of laxatives and diuretics. Some will exercise excessively. some will fast for long periods between binges. V+ may lose 50% of the consumed calories. Overly concerned with body weight.
Medical consequences of excessive purging include enlarged salivary glands, eroded dental enamel on front teeth,scrapes on the knuckles from teeth,electrolyte disturbances and their sequelae,, also lay down more fat. Issues from laxatives include gi issues. someimes amenorrhea
Often comorbid with anxiety and mood disorders, and substance abuse disorders. If depression present, more likely followed bulimia than caused.
Most are within 10% of normal weight.
Most are ashamed of purging and binging.
ANOREXIA NERVOSA; Morbid fear of gaining weight and losing control over eating.Become extremely underweight.Most are proud of their control and diets.
Less common than bulemia. Typically starts in adolescence in one who is or perceives themselves to be overweight. Severe exercise is common. If binging/purging occurs, it is on considerably smaller amounts of food.
2 subtypes-restricting, and binge/purging. Some argue the subtypes are not useful distinctions. Never satisfied with their body weight, and even when emaciated, they still see self as overweight. Many adept at mouthing platitudes of gaining weight being necessary but many have little genuine belief that they have a problem. May become the cook of family so can control food, some hoard food.
Medical consequences include cessation of period(amenorrhea), dry skin, brittle hair,, intolerance of cold temperature, low blood pressure, starvation, organ failure. Anxiety and or depression often comorbid, also frequently obsessive compulsive disorder, also often substance abuse disorder, and if so, often a cause of suicide.
BINGE-EATING DISORDER; experience extreme distress over binging but do not engage in compensatory behaviours. Sufferers frequently found enrolled in weight loss programs etc.Some studies show 30% meet criteria for obesity.
discuss the prevalence of eating disorders and the manner in which cultural and developmental factors impact on this;
90-95% of bulimics are women.Male bulimics tend to be slightly older to develop disorder, and are 80% homosexual/bisexual. Hundreds of years ago, majority of bulimics were male.
One study found 13% of females had experienced an eating disorder before reaching 20 years of age.
Eating disorders more prevalent amongst athletes whose sports have some critical weight category or judgement re body.
BED sufferers are more likely male.
Average age of onset of eating disorders is 18-21 years.
Eating disorders less common in Africans american women (and less body dissatisfaction) cf caucasions. Even in societies with low prevalences of eating disorders eg Egypt, their immigrants to Western societies had increased incidence of eating disorders.
Most cases of eating disorders begin in adolescence and in western culture, “ideal” women are thin and childlike whereas “ideal” men are tall and muscular and post puberty changes bring women further from ideal and men closer as they lay down more muscle, whereas girls tend to lay down more fat.This big factor in body dissatisfaction.
Rarely, might also occur in very young children or in adults over 55.
describe the social, biological and psychological factors thought to contribute to the development of eating disorders;
Media has big influence on setting “ideal” image goals esp for teenagers. Overweight men are far more likely to be characters in tv shows etc than overweight women.
Biology effects body size, which may or may not make one closer to ideal.
Family influences how one sees oneself and norms such as diet or exercise.Also anxiety predisposition or not. Mothers with anorexia are more likely to restrict their children’s food intake also and can be to detrimental effect. Also, some families have erroneously put their toddlers on diets because thought were too chubby and resulted in failure to thrive.
Bulimia and anorexia are some of the most culturally-specific mental illnesses, therefore, there must be a societal effect.
Families of those who develop anorexia, are typically successful, hard-driving, concerned re external appearance and eager to maintain harmony (often ignore or deny conflicts). Typically the mother’s of anorexics are more perfectionist and initially the ones wanting daughters to be thin. Later research however says the family influence on dz development is less than at first thought.
Relatives of those with an eating disorder are 4-5 times more likely than general population, to develop an eating disorder also.
Those with eating disorders are more likely to have low serotonin, esp bingers. Binge eating episodes also peak post ovulation, and some speculate that hormonal changes at puberty might “switch on” hormones responsible for binge eating and the start of bulimia.
Many young females with an eating disorder have very low self esteem and feel a great level of lack of personal control, and frequently are high in perfectionism. There is intense preoccupation with how one’s appearance will be perceived by others. some, have difficulty with negative emotions and attempts to cope with them may drive bingeing, exercise, purging, etc etc,
discuss the pharmacological treatments of eating disorders;
In general, drugs completely ineffective for anorexia, and somewhat helpful for bulimia. Some anti depressants useful for bulimia, particularly during bingeing/purging cycles. Some found prozac to have 47-65% reduction in episodes of bingeing/purgeing.
SSRI’s may have some effect also. Thought both medication types might be better combined with psychotherapy.
discuss the psychological treatment of eating disorders;
Typically psychotherapy with only minor alterations for specific dx, can be utilised for any eating disorder, and is called CBT-E(cognitive behavioural therapy enhanced) and focuses on correcting the distortive assessment of one’s weight, plus the maladaptive attempts at controlling weight.
CBT-E FOR BULIMIA; teach how harmful bingeing/purgeing are, and ineffectiveness of laxatives etc, and adverse effects of dieting.Patients scheduled to eat small amounts of food 5-6 times daily, without going longer than 3 hours between planned meal/snack. Later address dysfunctional thoughts and attitudes re body shape, weight and eating. Coping strategies to resist impulse binge/purge and arrange so not alone during eating at least initially. 5 months of CBT-e resulted in full recovery for 42% (imagine some improved but did not recover). Another study found cbt-e to have 65% remission (full recovery)rate
Inter-personal therapy (IPT) has also shown some benefit (33-49% remission) but less than cbt-e.
Not proven, but thought there is likely to be benefit in doing combination of cbt-e, ipt and family therapy.
BINGE-EATING DISORDER; Stopping the bingeing leads to improved weight loss in those who were obese. Ipt is as effective as cbt (60% remission)at treating BED, and prozac was ineffective. There is some benefit to weight loss programs, but less efective than cbt or ipt. Men with more severe obesity levels, required longer tx programs. Guided self-help cbt can also be useful. At least 70% of reduction in bingeing by week 4 of a cbt program usually indicates will have long term success (so if not showing response might be someone who will respond better to ipt).
ANOREXIA; First goal is to restore weight and body function. If less than 75% of healthy weight, might need inpatient care. 85% will be able to gain weight in initial inpatient settings. Knowing they are not allowed to leave until have gained sufficient weight, seems to work for many patients. However once back to an adequate weight, the harder part of therapy begins.CBT-e had a 22% failure/drop out rate cf nutritional counselling with a 73% failure/drop out rate.
One study found a 64% improvement rate for cbt-e.
Addressing anxiety and emotion dysregulation are part of cbt-e. Family therapy is also thought to be particularly important in addressing pervasive attitudes re body shape and in normalising meals. Family based therapy (fbt) seems effective in young girls (less than 19 years) who have had only a short course of disorder) (42-49% effective). Cbt-e is started to show some good response rates also.
discuss the prevention of eating disorders.
Targeting college at risk females esp those who do not have a disorder but have some concerns re their weight, has shown good success at
prevention, primarily with interactive internet based courses on structured health education designed to improve body image satisfaction.
