EXAM 2 - Eating Disorders Flashcards
Anorexia Nervosa: Overview
Extreme weight loss – hallmark of anorexia
Restriction of calorie intake below energy requirements (Sometimes defined as 15% below expected weight)
Intense fear of weight gain
Often begins with dieting
Subtypes:
Restricting: Diet to limit calorie intake
Binge-eating-purging: Purge to limit calorie intake
DSM 5 Diagnostic Criteria for Anorexia Nervosa
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 that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior 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.
Specify type:
Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eat-ing or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
Anorexia Nervosa Comorbid Disorders
Obsessive-Compulsive Disorder
Depression (70% at some point)
Personality Disorders
Medical Complications from Anorexia
Constipation and other GI problems Cessation of menstruation for women Being cold Lethargy Anemia Lanugo Electrolyte Imbalance Kidney Problems Cardiovascular Problems Most fatal due to organ damage
Bulimia Nervosa: DSM-5
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behavior in order 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 behaviors 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: Comorbid Disorders
Depression (20%; but 50 to 70% at some point in lives) Anxiety Disorders (80%) Substance Abuse (2 in 5 abuse substances) Personality Disorders
Medical Complications from Bulimia
Erosion of dental enamel Gag reflex (regurgitation of food) Enlarged salivary glands Electrolyte imbalance Rupture of the esophagus or stomach
Binge Eating Disorder: Overview and Defining Features
New disorder in DSM-5 (kind of; it was in DSM-III)
Binge eating without associated compensatory behaviors
Associated with distress and/or functional impairment (e.g., health risk, feelings of guilt)
Excessive concern with weight or shape may or may not be present
Binge-Eating Disorder: Associated Features
Approximately 20% of individuals in weight-control programs suffer from BED
Approximately half of candidates for bariatric surgery suffer from BED
Better response to treatment than other eating disorders
Tend to be older than sufferers of anorexia and bulimia
Higher rates of psychopathology than non-bingeing obese individuals
DSM 5 - Diagnostic Criteria for Binge-Eating Disorder
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
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 people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge-eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.
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 behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Etiology of Eating Disorders: Social Factors
Current society views thin women as attractive
The media influences communication of the message that “thin is in.”
Some professions even encourage abnormally low weight
Ballet, Modeling, Gymnastics, Wrestling
Causes of Eating Disorders: Family Influences
Parents with distorted perception of food and eating may restrict children’s intake too (e.g., put chubby toddlers on unnecessary diets)
Families of individuals with anorexia are often:
High achieving
Concerned with external appearances
Overly motivated to maintain harmony > leads to poor communication and denial of problems
Disordered eating also strains family relationships
Causes parental guilt and frustration
Family Problems (“Psychosomatic Families”—Salvadore Minuchin’s theory)
Etiology of Eating Disorders: Psychological Factors
Psychological Factors Hilde Bruch’s Ego Psychology Theory Identity problems are at the core Struggles for control are evident They lack “introceptive awareness” Other Psychological Factors Depression Preoccupation with Social Self Distorted body image Overly restrictive dieting Family Problems (“Psychosomatic Families”—Salvadore Minuchin’s theory) Low sense of personal control and self-confidence Perfectionistic attitudes Distorted body image Preoccupation with food Mood intolerance Preoccupation with Social Self
Causes of Eating Disorders: Biological Factors
Some genetic component
Relatives of people with eating disorders are 4-5x more likely to develop an eating disorder
Not clear what is inherited
May be nonspecific traits like emotional instability or impulsivity
Low levels of serotonergic activity often found in eating disorders
Set Point Theory
Set Point determines “ideal” weight
Dieting lowers metabolism (rate at which body expends energy)and hyperlipogenesis can occur (storage of abnormally large amounts of fat in fat cells)
