Eating Disorders

Question 1

prevalence of eating disorders

Answer 1

in the US, lifetime prevalence in increasing order for anorexia, bulimia and BED are 0.9%, 1.5% and 3.5% for women, and roughly 1/3 that in men (except men have 2.0% in BED)

• internationally, the lifetime prevalence of BED is also higher than for bulimia (1.4 vs 0.8), but see that these are lower than the US rates
• disorders both onset in late teens/early 20s (tho slightly younger for bulimia, which was also found to persist longer)
• in canada, women are also more likely to report an eating disorder than men, and the highest rates appear to be in women 15-24

Question 2

do those with eating disorders get treatment?

Answer 2

• only a relatively small portion of those who require treatment actually seek it out in a given year, and it’s usually obtained from the general medical sector
• we also see a clear difference in hospitalization between women and men, and higher rates among young women

Question 3

commonalities of anorexia and bulimia

Answer 3

• diagnoses share several clinical features, the most important being intense fear of being overweight
• suggested that these may be two variants of a single disorder as opposed to distinct diagnoses
• for example, co-twins of people diagnosed with anorexia are more likely than average to have bulimia

Question 4

DSM criteria for anorexia

Answer 4

• restriction of energy intake relative to requirements, leading to significantly low body weight (in the context of age, sex, developmental trajectory and physical health); defined as weight less than minimally normal or expected
• intense fear of gaining weight or of becoming fat, or persistent behaviour that interfered with weight gain despite already being a significantly low weight
• disturbance in the experience of shape or body weight, undue influence on self-evaluation, or persistent lac of recognition of the seriousness of the current low body weight
• further diagnosed as restricting or binge eating/purging type

Question 5

restricting type anorexia

Answer 5

• during the last 3 months, the individual hasn’t engaged in recurrent episodes of binging or purging behaviour
• subtype describes presentations in which weight loss in primarily accomplished through dieting, fasting, and/or excessive exercise

Question 6

binge eating/purging type anorexia

Answer 6

-during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (self-induced vomiting or misuse of laxative, diuretics or enemas)

Question 7

overvaluation of appearance

Answer 7

the tendency to link self-esteem and self-evaluation with thinness

• among ppl with acute anorexia, lower body wt is as’d with increased self esteem
• anorexics consistently overestimate their own size and choose a thin figure as being idea for them (or for others too)

Question 8

development of anorexia

Answer 8

• typically begins in early to middle teens, often after an episode of dieting and exposure to life stress (prevalence among children and adolescents thought to be increasing)
• both men and women at risk for eating disorders are also prone to depression, panic disorder and social phobia; women were at substantially greater risk for mania, agoraphobia and substance dependence (comorbidity is high)

Question 9

comorbidity of eating disorders and SUDs

Answer 9

• there’s a high rate of co-occurring eating disorders and SUDs
• meta analysis in spain found no link between anorexia and illicit drug use, but did find a clear link to bulimia
• canadian investigators have specifically tied to drug use to the bingeing and dieting cycle

Question 10

physical changes with anorexia nervosa

Answer 10

• decreased blood pressure, heart rate, and bone mass
• kidney and GI problems
• dry skin, brittle nails, hair loss and laguna (fine soft hair)
• changes in hormone and electrolyte (K, Na) levels
• mild anemia
• tiredness, weakness
• cardiac arrhythmias, sudden death
• decrease in white and grey matter (with the grey loss being irreversible)

Question 11

prognosis of anorexia

Answer 11

• 70% of patients recover, but it often takes 6-7 years and relapses are common because changing distorted values about thinness is difficult, particularly in cultures that value and therefore highly reinforce thin appearance
• death rates 10x greater than the general pop, and 2x greater than patients with other psychological disorders

Question 12

mortality in eating disorders

Answer 12

• there’s likely to other disorder that matches the mortality risk associated with anorexia, at 5.1/1000 persons (EDNOS coming in 2nd at 3.0, then bulimia at 0.7)
• predictors of death include lower BMI, older age at first presentation for treatment, and alcohol misuse
• most common causes are from suicide or the physical complications of the illness
• anorexia associated with a 25 yr reduction in life expectancy

Question 13

suicide in eating disorders

Answer 13

• 1/5 of deaths attributed to anorexia involve suicide
• review found that suicide rates aren’t elevated in bulimia as the are in anorexia, though people with bulimia are more likely to have suicidal ideations

Question 14

bulimia nervosa

Answer 14

• from the greek word meaning “ox hunger”
• involves episodes of rapid consumption of large amounts of food (binge) followed by compensatory purging behaviours
• binge is defined as eating excessive amounts of food in under 2 hrs; these typically occur in secret and may be triggered by stress
• purging can be vomitting, fasting, or excessive exercise

Question 15

DSM diagnosis of bulimia

Answer 15

• defined as eating an excessive amount of food within a defined period (usually 2hrs), and includes a sense of lack of control over the behaviour
• the bingeing and compensatory behaviours must continue at least once a weel for 3 months
• bulimia not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss

Question 16

bulimia and fear of gaining weight

Answer 16

• a morbid fear of fat is an essential diagnostic criterion as it covers the core psychopathology of the disorder, makes the diagnosis more restrictive and makes the syndrome more closely resemble the related anorexia
• fat talk, the tendency for (esp female) friends to take turns disparaging their bodies to one another, seems to be important; seems to reflect a highly defensive and negative sense of self, and both average and overweight targets were seen as more likable if depicted engaging in fat talk

Question 17

development of bulimia

Answer 17

• typically begins in late adolescence or early adulthood
• extreme body dissatisfaction found among 7-8% percent of young boys and girls suggests that at risk individuals can be identified from a fairly young age
• among only girls, it was found that body satisfaction decreased as BMI increased
• many are somewhat overweight before disorder onset, and binge eating often starts during a dieting episode
• about 70% of clients recover, though ~10% remain fully symptomatic
• also found that many bulimics will develop anorexia, and even more so vice-versa

Question 18

physical side effects of bulimia

Answer 18

• potassium depletion and changes in electrolytes
• irregularities in the heartbeat
• diarrhea
• tearing of tissues in the stomach and throat
• swollen salivary glands
• loss of dental enamel

Question 19

binge eating disorder diagnosis

Answer 19

• includes recurrent binges (>1/wk for min 3 months) with lack of control and causing distress, along with at least 3 of the following:
• eating more rapidly than normal
• eating until uncomfortably full
• eating alone due to feelings of embarrassment
• eating large amounts of food when not feeling hungry
• feeling disgusted with oneself, depressed, or very guilty
• distinguished from anorexia by absence of wt loss, and from bulimia by absence of compensatory behaviours; more treatment responsive than either

Question 20

binge eating disorder - risk facotrs

Answer 20

• linked with impaired work and social functioning, depression, low self-esteem, substance abuse, dissatisfaction with body shape
• risk factors: childhood obesity, critical comments regarding being overweight, low self-concept, depression, childhood abuse (physical or sexual)
• the average live time duration of BED (14.4 yrs) may be greater than that of AN or BN

Question 21

genetic etiology of eating disorders

Answer 21

• the role of genetic factors has been largely ignored relative to other disorder due to prevailing emphasis on socio-cultural factors
• despite this, both anorexia and bulimia run in families (supported by twin studies that report higher concordance rates in monozygotic twins, and observation that first degree relatives of young women with anorexia are 4x more likely than average to have the disorder themselves)
• research also shows that key features such as bodily dissatisfaction and strong desire to be thin appear to be heritable

Question 22

eating disorders and the brain

Answer 22

• the hypothalamus is a key centre in regulating hunger and eating; lesions to the lateral hypothalamus in indicated loss of weight and appetite
• paraventricular nucleus has also been implicated
• hypothal regulates some hormone levels, such as cortisol, but abnormalcy observe in anorexics seems to be less a cause and more so a result of self-starvation (levels return to normal following abnormal weight gain)

Question 23

endogenous opioids and eating disorders

Answer 23

• starvation may increase levels of endogenous opioids, which reduce pain, enhance mood, and suppress appetite among those with low body weight, resulting in a positively reinforcing euphoric state
• excessive exercise would also increase opioids and this be reinforcing
• hardy and waller hypothesize that bulmia is mediated by low levels of endogenous opioids which are thought to promote the craving; the euphoric state produced by food ingesting thus reinforces bingeing

Question 24

eating disorders and neurotransmitters

Answer 24

• low levels of 5HT and it’s metabolites have been found in ppl with bulimia and are linked with negative mood and changes in self concept that seem to precipitate binge episodes
• hildebrandt’s model states that genetic polymorphisms at birth limit thee serotonergic system and associated genes may be further limited by exposure to harsh environments (maladptive parenting styles)
• resulting env estrogens then predisposed female adolescents to weight gain, increasing perceived need to engage in dieting that may become excessive

Question 25

scarlett o’hara effect

Answer 25

• chaiken and pliner advanced the theory that women respond to socio-cultural pressures by eating lightly in an attempt to project images of femininity
• empirical research determined that women portrayed as eating heavily are seen as less feminine
• comes from gone with the wind, where the woman ate at home before a BBQ so she wouldn’t appear manly by eating too much at the actual event

Question 26

media and eating disorders

Answer 26

• contemporary research examined relative impact of various media on body image ideals and dissatisfaction
• study of 12 y/os found increases in ED symptoms as’d with increased exposure to fashion magazines, but not to amount of television viewed
• interestingly though, watching soap operas was as’d with increased drive for thinness in both boys and girls

Question 27

activity anorexia

Answer 27

• not official in the DSM, but research from the uofa suggests that some ppl become anorexic because of the pursuit of fitness as opposed to thinness
• the loss of appetite when engaged in physical activity
• dancers and models both share pressure to maintain ideal appearance, but dancers engage in much more strenuous physical activity, had higher rates of anorexia, and more disturbed eating attitudes
• peiece and epling suggest it’s accounted for by two interrelated motivational factors; food deprivation increases reinforcement effectiveness of physical activity, which in turn decreases the reinforcement effectiveness of food

Question 28

cognitive-behavioural views of eating disorders

Answer 28

• for anorexia, emphasize fear of fatness and body image disturbance as motivating factors that make self-starvation and weight loss powerful reinforcers
• behaviours that acheive/maintain thinness are negatively reinforced by reduction of anxiety abt becoming fat
• dieting/weight loss may create a sense of self-control of mastery that can be positively reinforcing
• personality and sociocult variables also included the explain development of fat fear and body image disturbances

Question 29

the thinspiration effect

Answer 29

• an exception the the general effects on cognition with exposure to thin media
• chronic dieters actually feel thinner after looking at idealized images of the thin body, which motivates them to continue to diet, however this can begin the process of dieting that eventually leads to distress because the dieter doesn’t eventually obtain the body image

Question 30

poor ethics in the study of eating disorders

Answer 30

• hunger and malnutrition experiments were conducted in aboriginal communities in the 40/50s by leading nutritional experts with the govt. of canada
• unethical controlled experiments lacking informed consent were conducted in varioius regions, included the northern cree ppl of MB
• alleged that researchers indentified ppl young and old who were starving, and denied some food and nutrient to study them, with up to 1000 children kept malnourished or even starved bc it suited research purposes

Question 31

eating disorders and neuroticism

Answer 31

• ppl with anorexia and bulimia are high in neuroticism and anxiety, and low in self-esteem
• the role of neroticism as a LT predictor of anorexia was also confirmed in a recent twin study
• these ppl score high on measures of traditionalism, indicating strong endorsement of family and social standards

Question 32

narcissism and eating disorders

Answer 32

-AN and BN clients characterized by high lvls of narcissism that persist even when the disorder is in remission
-the use of a narcissistic defensive “poor me” style predicts greater treatment dropout
narcissism is characterized by excessive focus on the self and heightened sense of self-importance and grandiosity; thought to be compensatory for a fragile sense of self esteem and these indv are consequently highly reactive to criticism

Question 33

perfectionism and eating disorders

Answer 33

• hewit and flett created a multidimensional scale that assesses self- and other-oriented perfectionism, as well as socially prescribed perfectionisn
• both wt-restored and underweight anorexics had elevated scores on self-oriented, and the underweight also had high socially prescribed scores
• anorexics who engage in excessive exercise are distinguished by /remarkably high/ levels of self-oriented perfectionism

Question 34

eating disorders and relapse

Answer 34

• rates of relapse are high; a study by carter found that ~40% of successfully treated anorexics relapsed during the 1 yr follow-up period
• he found that relapse was more likely for indv with binge-purge anorexia and more OCD-like checking behaviours
• also noted that lower motivation to recover predicted subsequent relapse

Question 35

medication for eating disorders

Answer 35

• bc bulimia in particular is often comorbid with depression, it’s frequently treated with antidepressants such as fluoxetine (prozac), which has been shown as superior to placebo in reducing bingeing and vomitting, and also decreased depression and lessened distorted attitudes towards food/eating
• unfortunately not consistently effective, may be no benefits following weight restoration, and dropout rate is higher than in CBT interventions
• NO drugs have been found effective in treating anorexia

Question 36

psychological treatment of anorexia

Answer 36

-generally a two tiered process:
the immediate goal is to help the indv gain wt to avoid medical complications/the possibility of death; operant-conditioning programs have been somewhat successful for ST weight gain
-both CBT and IBT have been effective for treatment of anorexia (thought these are usually recommended for bulimia, and a modified family therapy rec’d for ana)

Question 37

fairburn’s therapy

Answer 37

• a CBT approach for the treatment of bulimia; best validated and current standard, encouraging the indv to question society’s standards for physical attractiveness
• they uncover and change beliefs encouraging them to starve themselves to avoid becoming overweight
• help to see that normal body wt can be maintained w/o severe dieting, and unrealistic restriction of intake can often trigger binges
• not all is lost with just one bite of high-cal food, and snacking need not trigger a binge
• alter all/nothing thinking so patient can begin to eat more moderately
• also assertion skills to help cope with unreasonable demands from others, and to lear more satisfying ways of relating to ppl

Question 38

prevention of eating disorders in canada

Answer 38

• studied by stice and shaw
• largest intervention effects were seen when the prevention was specifically aimed at high risk participants, the program is interactive (vs didactic), multiple sessions were involved, and if only females 15+ were targeted