Ch11 (lesson 13) eating disorders

Question 1

Types of Eating Disorders (DSM-5 Feeding and Eating disorders) (main 3 + other 3)

Answer 1

1) Anorexia Nervosa

2) Bulimia Nervosa

3) Binge Eating Disorder

• pica
• rumination
• avoidant/restrictive food intake disorder

Question 2

Eating Disorders, definition

Answer 2

severe disturbances in eating behaviors such as eating too little/much

Question 3

Anorexia Nervosa DSM-5 Criteria

Answer 3

1) Restriction of behaviors that promote healthy weight; body weight significantly below normal
- BMI less than 18.5 for adults
- usually through dieting, can also involve purging (vomiting or laxatives/diuretics) and excercise

2) Intense fear of gaining weight and being fat
- can’t be “too thin”

3) distorted body image/ sense of body shape
- feel “fat” even when emaciated

(amenorrhea (period stops) no longer required for diagnosis)

Question 4

two subtypes of anorexia nervosa:

Answer 4

Restricting
- weightloss achieved by severly limiting food intake, w/ no binge-eating/purging during last 3 months

Binge-eating/purging
- also engages in binge-eating and purging during last 3 months

longitudinal research suggests questionable validity of subtypes

Question 5

how do people with anorexia see their body/ weight

Answer 5

• they overestimate their own body size
• but fairly accurate on weight b/c they weigh themselves frequently

Question 6

Anorexia Nervosa onset, triggers

Answer 6

onset: early to middle teen years

• usually triggered by dieting and stress

Question 7

Anorexia Nervosa prevalence (w vs m)

Answer 7

women 10x more likely
- symptomatology in men similar to women, though

Question 8

anorexia Nervosa comorbidity (+ suicide rates)

Answer 8

often comorbid w depression, OCD, phobias, panic, alc, personality disorders
- in men, comorbid w substance dependence, mood disorders, or schizophrenia

suicide rates high in anorexia
- 5% complete
- 20% attempts

Question 9

Physical Changes in Anorexia

Answer 9

• low blood pressure, heart rate decrease
• kidney and gastrointestinal problems
• anemia
• loss of bone mass
• brittle nails, dry skin, hair loss
• Lanugo (soft downy body hair)
• depletion of potassium and sodium electrolytes
  
  • causes tiredness, weakness, death

Question 10

prognosis of anorexia (+ death rates)

Answer 10

50-70% eventually recover
- may often take 6-7 years
- relapse common

difficult to modify distorted view of self esp. in cultures that value thinness

anorexia is life threatening
- death rates 10x higher than gen pop
- death rates 20x higher than other psych disorders

Question 11

Bulimia Nervosa DSM-5 criteria

Answer 11

• Recurrent eps of binge-eating (excessive amount consumed under 2 hrs)
  
  • feeling loss of control over eating (eats till uncomfortably full)
• recurrent compensatory behaviors to prevent weight gain
  
  • purging, fasting, exercise, laxatives/diuretics
• body shape/weight extremely important to self-eval
• binge eating and compensatory behaviors occur on avg 1x per week for 3 mo

Question 12

bulimia- binge triggers and characteristics

Answer 12

• triggered by stress, neg emotions, neg social interactions
• typical food choices: sweets, easily consumed high-calorie foods
• avoiding craving can later increase likelihood of binge
• typically occur in secret
• reports of losing awareness/dissociation
• followed by shame and remorse

Question 13

bulimia nervosa prevalence(among w) /onset

Answer 13

• onset late adolescence early adulthood
• 90% women
• 1-2% prevalence among women
• typically overweight that led to dieting
• bulimics typically have normal BMI

Question 14

Comorbidity- Bulimia (+ suicide)

Answer 14

-comorbid w depression, personality disorders, anxiety, substance abuse, conduct disorder

• suicide attempts and completions higher than general pop but much lower than anorexia

Question 15

physical changes due to bulimia

Answer 15

• menstrual irregularities
• potassium depletion from purging
• laxative use depletes electrolytes, which can cause cardiac irregularities
• loss of dental enamel from stomach acids
• mortality rate of 4%

Question 16

prognosis of bulimia

Answer 16

• 75% recover
• 10-20% remain fully symptomatic
• early intervention linked w improved outcomes
• poorer prognosis/ higher severity when depression and substance abuse are comorbid

Question 17

Binge-Eating Disorder DSM criteria

Answer 17

Recurrent episodes of binge eating, on avg atleast 1x a week for 3 mo

Binge eating episodes include at least 3:
- eating more rapidly than norm
- eating until uncomfortably full
- eating large amounts when not hungry
- eating alone b/c embarrassed of quantity
- feeling disgusted, guilty, depressed after binge

no compensatory behavior present

Question 18

Binge eating disorder vs Anorexia vs Bulimia

Answer 18

Binge eating vs Anorexia:
- absence of weight loss in binge eating

binge eating vs bulimia:
absense of compensatory behaviors in binge eating disorder

anorexia vs bulimia:
- anorexia can have binging and purging, but there must be weight loss. Bulimia doesn’t have weight loss

Question 19

Binge-Eating disorder and obesity

Answer 19

• associated with obesity and history of dieting
  
  • BMI >30
• Not all obese ppl meet criteria for binge eating
  
  • must report binge eps and feeling loss of control over eating
  • approx 2-25% qualify

Question 20

risk factors for (leading to) binge eating

Answer 20

childhood obesity, early childhood weight loss attempts, been taunted about weight

• low self-concept
• depression
• childhood physical/sexual abuse

Question 21

prevalence binge eating (ethnic, sex)

Answer 21

equally prevalent among euro, african, asian, hispanic-americans

more women than men

0.2- 4.7% lifetime prevalence

Question 22

Psychical changes binge eating disorder- problems assoc. w obesity

Answer 22

• increased risk type II diabetes
• cardiovascular disease
• breathing problems
• physical ailments (joint/muscle pain

Question 23

Psychical changes binge eating disorder- independent of obesity

Answer 23

• sleep problems
• anxiety/ depression
• irritable bowl syndrome
• early menstruation

Question 24

prognosis binge eating

Answer 24

• about 60% (btwn 25-85%)
• most common and lasts longest of three eating disorders
  • lasts 14 yrs on avg

Question 25

comorbidity binge eating

Answer 25

mood disorders, anxiety, adhd, conduct disorder, substance use

Question 26

Etiology of Eating Disorders- Genetics

Answer 26

• Family + twin studies support genetic link
  
  • 1st degree relatives of ppl w anorexia >10x more likely
  • 1st degree relatives of ppl w bulimia 4x more likely
  • higher MZ concordance rates for both anorexia and bulimia
• body dissatisfaction, desire for thinness, binge eating, weight preoccupation heritable
• environmental factors (eg family interactions) play greater role in etiology
  
  • more research on genetic/enviro interaction needed

Question 27

Etiology of Eating Disorders- neurobiological factors - endogenous opioids

Answer 27

low levels of endogenous opioids
- substances that reduce pain, enhance mood, suppress appetite
- released during starvation
- may reinforce restricted eating of anorexia
- excessive exercise increases opioids
- low leves of opioids (beta-endorphins) in bulimia promote craving
- reinforce binging

Question 28

Etiology of Eating Disorders- Neurobiological factors- Neurotransmitters

Answer 28

Serotonin related to feelings of satiety
- low levels of serotonin metabolites in anorexics and bulimics
- antidepressants that increase serotonin often effective in treating eating disorders

dopamine related to feelings of pleasure and motivation
- anorexics feel more positive and rewarded when viewing pictures of underweight women

Question 29

Etiology of Eating Disorders- Neurobiological factors- parts of the brain

Answer 29

hypothalamus not directly involved

(txtbook adds)
brain imaging studies in areas assoc w rewards
- both women w and w/out anorexia showed comparable brain activation in ventral straitum
- anorexics showed activation in dorsal striatum
- suggests the habit of food restriction becomes rewarding

-

Question 30

the restraint scale- eating disorders

Answer 30

• excessive restraint in anorexia
• in binge eating and bulimia restraint leads to loss of control

restrained eaters may be on their way to an eating disorder

Question 31

Etiology of Anorexia- Cognitive Behavioral View

Answer 31

Anorexia

• focus on body dissatisfaction and fear of fatness
• certain behaviors ( restrictive eating, exercise) negitively reingforcing
  
  • reduce anxiety about weight gain
• feelings of self control about weight loss positively reinforcing
• Perfectionism and personal inadequacy lead to excessive concern about weight
• criticism from family and peers regarding weight can play a role

Question 32

Etiology of Bulimia - Cog Behavioral view

Answer 32

• self-worth strongly influenced by weight
  
  • low self-esteem
• rigid restrictive eating triggers lapses, which can become binges (“off limit” foods)
• after binging, disgust w oneself and fear of gaining weight lead to compensatory behavior
• purging temporarily reduces anxiety about weight gain
  -neg feelings about purging lead to lowered self-esteem which triggers further bingeing
• stress, negative affect trigger binges
• restrained eating plays central role in bulimia
  
  • restraint scale

Question 33

schematic of cognitive behavioral theory of Bulimia

Answer 33

low self esteem and high neg affect —>

dieting to feel better about self —>

food intake restricted too severely —>

diet broken —>

binge —>

compensatory behaviors to reduce fears of weight gain

Question 34

Etiology of Eating disorders: sociocultural factors

Answer 34

• american society values thinness for women, muscles for men
• dieting esp among women, more prevalent
  
  • precedes onset
• body dissatisfaction and preoccupation w thinness also predict eating disorders
• societal objectification of women (sexual objects)
• unrealistic media portrayals (shame not meeting ideal)
• overweight individuals viewed w disdain, more pressure to be thin

Question 35

Etiology of Eating disorders: gender factors

Answer 35

objectification of women’s bodies
- women defined by bodies; men by accomplishments
- leads to “self-objectification”(objectification theory)
- women see their bodies through eyes of others
- leads to more shame when fall short

aging and changes in life roles associated w decreased eating disorder symptoms

Question 36

Etiology of Eating disorders: cross-cultural factors

Answer 36

• anorexia found in many cultures
  
  • even those not under west influence
  • may not include fears of getting fat
• in some cultures, higher weight sign of fertility/healthiness
• as countries westernize, eating disorders increase
• bulimia more common in industrialized societies

Question 37

Etiology of Eating disorders: ethnic factors

Answer 37

white women compared to women of color:
- gap btwn white women and WoC diminishing, esp for bulimia
- biggest gap for college women
- more dieting and body dissatisfaction in white teens
- BMI increases linked to body dissatisfaction

body dissatisfaction and symptoms of bulimia strongly correlated with high acculturation stress in ethnic minorities

prevalence of binge eating disorder and bulimia in Latina women comperable to white
- anorexia rare

Question 38

Etiology of Eating disorders: personality factors

Answer 38

• eating behaviors impact personality
  
  • semi-starvation leads to preoccupation w food and personality changes
• personality characteristics impact eating
  
  • perfectionism, lack of interoceptive awareness (body states), neg affect predicted disordered eating
    
    • perfectionism remains high even after treatment

Question 39

Etiology of Eating disorders: family factors

Answer 39

family characteristics
- self report indicates high levels of family conflict
- parental reports don’t always indicate family problems

• one observational study showed parents no greater levels of neg statment than controls
• more observational studies needed

Question 40

Etiology of Eating disorders: child abuse

Answer 40

• self reports of high rates of childhood sexual and physical abuse
• reports of abuse not specific to eating disorders, also found in other diagnostic categories
• presence of abuse may be too general variable
  • age and type of abuse may be more sig.

Question 41

treatments of eating disorders: medications

Answer 41

antidepressants:
- effective for bulimia not anorexia
- dropout and relapse rates high
- limited research suggests not effective in binge eating disorder
- for weight loss or reducing binges

Question 42

treatments of eating disorders: anorexia psychological treatments

Answer 42

• immediate goal to increase weight to avoid medical complications and death
• 2nd goal long term maintenance of weight gain
  • can be even more challenging

CBT
- reductions in symptoms through 1 yr

Family-based therapy (FBT) found to be effective
- anorexia viewed as interpersonal issue (rather than individual)
- use of “family lunch” sessions
- early results show improved outcomes over individual therapy

Question 43

treatments of eating disorders: Bulimia psychological treatments

Answer 43

• CBT more effective than medication
  
  • adding Exposure and Ritual Prevention (ERP) increases effectiveness of CBT in short term
• Challenge societal ideals of thinness
• Challenge beliefs about weight/dieting
• challenge all-or-nothing beliefs about food
  
  • one bite doesn’t have to lead to binging
• increase self-assertiveness skills to improve interpersonal relatedness
• increase regular eating patterns (three meals a day)

Question 44

treatment of eating disorders: psych treatment of binge-eating disorder

Answer 44

• CBT shown to be effective
  
  • teaches restrained eating through self-monitering, self-control, and problem solving skills
• CBT more effective than medication
  
  • esp group CBT
• ITP (Interpersonal Therapy) equally as effective as CBT
• Behavioral weight-loss programs promote weight loss, but don’t curb binge eating

Question 45

Prevention of Eating Disorders

Answer 45

psychoeducational approaches
- educate early about dangers of eating disorders

deemphasize sociocultural influences
- dissonance reduction intervention to deemphasize sociocultural influences

risk-factor approach
- healthy weight intervention to develop healthy weight and exercise programs

most helpful:
- interactive
- adolescents 15 or older
- girls only
- multiple sessions