X - Feeding and Eating Disorders

Question 1

Eating Disorder

Answer 1

A disorder characterized by persistent abnormal or disturbed eating habits. Includes: Pica, Rumination Disorder, Avoidant/Restrictive Food Intake Disorder, Anorexia Nervosa (Restricting Type or Binge eating/Purging type), Bulimia Nervosa, Binge Eating Disorder, Other Specified Eating Disorder, Unspecified Eating Disorder

Question 2

Eating Disorder vs. Disordered Eating

Answer 2

An individual with disordered eating is often engaged in some of the same behavior as those with eating disorders, but at a lesser frequency or lower level of severity.

Question 3

Two most common forms of eating disorders

Answer 3

Anorexia nervosa and bulimia nervosa. Both disorders share a pathological fear of gaining weight and a relentless pursuit of thinness.

Question 4

Anorexia Nervosa (DSM-V)

Answer 4

Characterized by:
(A) Restriction of intake relative to requirements -> significantly low weight in context of age, sex, development, health.
(B) Intense fear of gaining weight, or persistent behavior to prevent gain even though at a significantly low weight
(C) Disturbed feelings about weight or shape, excessive influence of weight on self-evaluation, or a lack of recognition of seriousness of current low body weight.

Two types:

(1) Restricting Type - Dieting, Fasting, and/or Exercise
(2) Binge-Eating/Purging Type - Vomiting, Laxatives, Diuretics, Enemas

Question 5

Significantly low weight

Answer 5

A weight that is less than minimally normal or expected.

Question 6

Bulimia Nervosa (DSM-V)

Answer 6

Characterized by:
(A) Recurrent episodes of binge eating
(B) Recurrent inappropriate compensatory behaviors to prevent weight gain such as vomiting, misuse of laxatives, diuretics
(C) The binge eating and compensatory behaviors occur on average at least once a week for 3 months
(D) Self-evaluation unduly influenced by body shape/weight
(E) Disturbance does not occur exclusively during episodes of anorexia nervosa

Question 7

Weight of individuals with anorexia vs. bulimia

Answer 7

Whereas anorexic patients usually of significantly low weight, bulimic patients typically of normal weight or slightly overweight.

Question 8

Binge Eating Disorder (DSM-V)

Answer 8

(A) Recurrent episodes of binge eating
(B) Binge-eating episodes associated with 3 or more of following: eating more rapidly, feeling uncomfortably full, eating large amounts when not hungry, eating alone due to embarrassment, feeling disgusted or guilty afterwards
(C) Marked distress regarding binge eating
(D) Occurs at least once a week for 3 months

Question 9

Bulimia Nervosa vs. Binge Eating Disorder

Answer 9

Latter does not involve compensatory behaviors such as self-induced vomiting.

Question 10

Eating disorders and gender

Answer 10

Estimates 3 females : 1 male. However may be underdiagnosed in males due to gender stereotypes.

Question 11

Medical complications of eating disorders

Answer 11

Anorexia can lead to death from arrhythmia, kidney damage, renal failure. Highest mortality rate of any psychiatric disorder.

Bulimia can lead to electrolyte imbalances, low potassium, damage to hands, throat, teeth from vomiting

Question 12

Eating Disorders and Suicide

Answer 12

After medical complications, suicide most common cause of death in anorexia. Around 3-23 percent of patients will make a suicide attempt - rate of completion 50 times greater than normal population. Body weight may be emotionally protective. Bulimia does not have increased rate of completion but suicide attempts in 25-30 percent of cases.

Question 13

Recovery rates

Answer 13

Anorexia: approximately 1/2 recover
Bulimia: recovery rate higher than AN
Binge Eating Disorder: Like BN, high rates of clinical remission

Question 14

Diagnostic Crossover

Answer 14

Occurs when a patient with one form of eating disorder is later diagnosed with another form of eating disorder. Cross-over is more likely between subtypes such as restricting and binge-purging types of AN. Uncommon between binge-eating disorder and anorexia and from bulimia to anorexia.

Question 15

Probable diagnostic crossovers

Answer 15

• Between AN restricting and binge-purging subtypes
• BED and BN
• AN binge-purging to BN, some BN to AN binge purging.

Question 16

Anorexia Nervosa Binge-Purging vs. Bulimia Nervosa

Answer 16

Find out distinction

Question 17

Comorbidity

Answer 17

Eating Disorders associated with clinical depression, OCD, substance abuse (particularly in binge-purging AN and BN), Various personality disorders such as borderline personality disorder and avoidant personality disorders.

Question 18

Biological factors of Eating Disorders

Answer 18

Genetics: AN and BN show some heritability but research inconclusive.
Brain abnormality in Hypothalamus
Neurochemistry: altered serotonin. Some patients respond well to treatment with SSRIs. Note that serotonin also impacts other neurotransmitter systems.

Question 19

Sociocultural factors of Eating Disorders

Answer 19

Sociocultural emphasis on extreme thinness. The thin ideal is often internalized. Western values have trended towards thinness.

Question 20

Familial factors in Eating Disorders

Answer 20

Family may culturally transmit pathological values. ED within family affects family functioning. Both parents may contribute to development.

Families of patients with ED show: Limited tolerance of disharmonious affect, emphasis on propriety and rules, over-direction of child, subtle discouragement of autonomy, high expectations, poor conflict-resolution skills, preoccupations over thinness and good physical appearance.

Question 21

Values/Personality Risk Factors of Eating Disorders

Answer 21

Values and personality: internalization of thin ideal, perfectionism, negative self-perception, negative emotionality, self-criticism

Question 22

Cognitive and Personality Risk Factors of Eating Disorders

Answer 22

Obsessive thoughts, distortions of attention/memory, obsessions about weight, weight plays central role in self-worth, all or nothing/black or white thinking, Internalization of thin ideal, perfectionism, negative self-perception, negative emotionality, self-criticism

Question 23

Combining Risk Factors in Eating Disorders

Answer 23

Combination of:

(1) Sociocultural expectations to look/act a certain way
(2) Family interactions that negate autonomy
(3) Individual vulnerabilities based on genetics, personality, self-esteem, identity deficit
(4) Stress in transitional periods

Question 24

Treatment of Anorexia Nervosa

Answer 24

Very challenging as there is a high drop-out rate and lack of data on effective treatments. Priority - restore weight. Interventions include medications (SSRIs, Antipsychotics), Family Therapy, CBT (most effective in BN as AN is cognitively rigid)

Question 25

Treatment of Bulimia Nervosa

Answer 25

Medications: SSRIs more effective than in AN
CBT: Behavioral component to normalize eating pattern, cognitive to get rid of cognitive distortions and dysfunctional thought patterns.