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neuroscience and clinical psychology > 9 - eating disorders I > Flashcards

9 - eating disorders I Flashcards

1
Q

what is BMI?

A

body mass index
weight in kg/height in m2

overweight = BMI>25
obese = BMI>30

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2
Q

what is the diagnostic criteria for anorexia nervosa?

A
  1. persistent restriction of energy intake leading to significantly low body weight
  2. intense fear of gaining weight OR persistent behaviour that interferes with weight gain
  3. disturbance in the way one’s body weight or shape is experiences OR

undue influence of body shape and weight on self-evaluation OR

persistent lack of recognition of the seriousness of the current low body weight

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3
Q

what are the subtypes of anorexia nervosa?

A

restricting
binge-eating/purging type

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4
Q

critiques of anorexia nervosa diagnostic criteria

A
  • people differ in their set point for weight (is weight/BMI useful)
  • various suggestions over the years
  • athletes are classed as overweight
  • ballerina and gymnasts sanctioned to be underweight
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5
Q

what makes us more likely to notice anorexia?

A
  • better at spotting extreme examples
  • when we have seen before and after states
  • where weight loss is way beyond BMI 17.5
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6
Q

what is the diagnostic criteria for bulimia nervosa?

A
  1. recurrent episodes of binge eating:
    - eating, in a discrete period of time more than most people would eat
    - sense of lack of control over eating during episode
  2. recurrent inappropriate compensatory behaviour in order to prevent weight gain:
    - self-induced vomiting, misuse of laxatives, diuretics, fasting, excessive exercise
  3. binges and compensatory behaviours occur at lease once a week for 3 months
  4. self-evaluation unduly influenced by body shape/weight
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7
Q

critiques of bulimia nervosa diagnostic criteria

A

a binge can be:
- subjective (loss of control)
- objective (loss of control + excessive intake)

defining compensatory behaviours
- is vomiting always self-induced?
- is exercise for health or to control weight

how often do behaviours have to happen?

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8
Q

what is the diagnostic criteria for binge-eating disorder?

A
  1. recurrent episodes of binge eating:
    - eating, in a discrete period of time more than most people would eat
    - sense of lack of control over eating during episode
  2. associated with 3 or more of the following:
    - eating rapidly
    - eating until uncomfortably full
    - eating lots of food when not hungry
    - eating alone because of embarrassment
  3. marked distress regarding binge eating
  4. binging at least once a week for 3 months

not associated with compensatory behaviours

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9
Q

critiques of binge eating disorder diagnostic criteria

A

same issues as for bulimia nervosa

need to understand motivation for introducing this category
- access to insurance money to treat overweight/obese patients

BED patients have trouble accessing services

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10
Q

what are other specified feeding and eating disorders (OSFED)?

A
  • atypical cases
  • present with many symptoms of other eating disorders but do not meet full criteria for diagnosis
  • introduced for insurance reasons
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11
Q

what are examples of OSFEDs?

A
  • atypical anorexia (weight loss but still within normal range)
  • atypical bulimia (of low frequency or limited duration)
  • atypical binge-eating disorder (of low frequency or limited duration)
  • purging disorder
  • night eating syndrome
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11
Q

what is avoidant/restrictive food intake disorder (ARFID)?

A
  • primarily in children and young people
  • disturbance in eating (weight loss, nutritional deficiency)
  • absence of typical beliefs about food or fear of weight gain
  • replacing and extending ‘fussy’ eating
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12
Q

what are the subtypes of ARFID?

A
  • sensory-based avoidance
  • lack of interest
  • food associated with fear-evoking stimuli

effective treatments are primarily behavioural, focusing on anxiety/exposure

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13
Q

what did Fairborn et al say?

A

diagnosis of specific eating disorders does not do what it should
- 40-50% of cases don’t fit neatly into diagnoses
- OSFED are largest single group
- many fail to stay in one diagnosis
- does not indicate best treatment

we should shift away from rigid diagnoses to trans diagnostic model

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14
Q

what are the biological risks associated with eating disorders?

A
  • cardiac complications
  • muscular weakness
  • osteoperosis
  • liver damage
  • oesophageal tearing
  • fainting
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15
Q

what is incidence?

A

number of new cases in a set window of time

16
Q

what is prevalence?

A

number of current cases (point prevalence) or number of people who have had the problem over the past year (annual prevalence) or over lifetime (lifetime prevalence)

17
Q

why is it hard to calculate incidence?

A

slow onset
secrecy
slow diagnosis

18
Q

what is the lifetime prevalence rates of eating disorders?

A

anorexia = 4% women, 0.3% men
bulimia = 3% women, 1% men
binge eating disorder = 2.8% women, 1% men

indication that OSFED has highest lifetime prevalence

western cultures: prevalence of bing eating 6.1% women, 0.7% men

19
Q

why is it not enough to look at medical records?

A
  • only say how many cases were spotted
  • GPs not perfect at spotting cases
20
Q

what is the impact of westernisation on eating disorders?

A

increased identification and prevalence

Curacao study showed more cases among non-whites in recent years

Fiji study showed a clear link to the introduction of western media

21
Q

why is the causal evidence for eating disorders very weak?

A
  • lack longitudinal data
  • selective sampling
  • risk of selecting memory and when asking
  • risk of misinterpreting associations
22
Q

why are neurobiological factors for eating disorders unclear?

A
  • where are responsible genes?
  • are they responsible for eating disorders direction or other risk factors
  • is hypothalamic damage preventing hunger?
  • issue of causality
23
Q

what maintains an eating disorder?

A

cognitive patterns

24
Q

what are the two main cognitive patterns in eating disorders?

A
  • broken cognitive link between eating and weight
  • overvaluation of appearance and weight to be acceptable
25
Q

what is the ‘broken cognitive link’?

A
  • drives restriction, then bingeing, then gaining weight, then restriction
  • cognitive dissonance element
26
Q

what are safety behaviours?

A

behaviours that calm us temporarily when we are anxious but long-term makes them more fearful of overeating

  • bing-eating
  • restricting
  • body avoidance/checking
  • exercise
  • purging
27
Q

what emotional factors of eating disorders?

A
  • anxiety is the biggest single emotion maintaining and and triggering eating problems
  • anger
  • loneliness
  • boredom
  • depression is more of a consequence than a cause
28
Q

what are perceptual factors involved in eating disorders?

A
  • think they are 25-30% larger than they are
  • misperceive our weight ‘thought-shape fusion’, thinking about foot makes them larger
29
Q

what are social factors involved in eating disorders?

A
  • social pressure to be thin is widespread in western culture
  • evidence that reading fashion magazines worsens body image, self-esteem
  • social media is more aggressive, image-based sites encouraging comparison, ‘thinspiration’
30
Q

how do we formulate behaviours of a an eating disorder?

A

used to normalise what patients do when they binge-eat
identify triggers and setting conditions
- exposure
- starvation
- emotion/stress
- disinhibition (alcohol etc)

31
Q

what is the model used to formulate cases?

A

A-B-C model
linking antecedents, behaviours and consequences

focus on feedback loops that maintain the problem

neuroscience and clinical psychology (9 decks)

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