Chapter 10

Question 1

Prevalence of Anorexia in women

Answer 1

believed to affect approximately 0.3% of women

Question 2

Prevalence of Bulimia in women

Answer 2

believed to affect about 1% to 3% of women

Question 3

Prevalence of Bulimia and Anorexia among men

Answer 3

estimated at about 0.02 for anorexia and 0.1%

Question 4

According to its Greek roots, Anorexia means

Answer 4

Anorexia means “without desire for [food].”

Question 5

Average age group that Anorexia develops

Answer 5

between the ages of 12-18

Question 6

The 3 Clinical Features of Anorexia Nervosa

Answer 6

1. Restriction of food intake leading to weight loss or a failure to gain weight resulting in a “significantly low body weight” of what would be expected for someone’s age, sex and height.
2. Fear of becoming fat or of gaining weight.
3. 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 denial of the seriousness of the current low body weight.

Question 7

Criteria for anorexia from DSM4 that was not put in DSM5 and why

Answer 7

menstrual cycle eliminated in DSM 5 because it is unfair to men and women and anorexic women could take hormone pills to change this criteria

Question 8

BMI criteria for anorexia

Answer 8

Less than 85% of your expected weight = anorexia

- Does not take into account muscle mass or being heavier to start with

Question 9

“Safe” vs. “Feared” foods

Answer 9

Safe - safe for consumption, will not cause too much weight gain, like rice cakes and celery
Feared food – will cause weight gain, meat, ice-cream

Question 10

Role of “social support” in anorexia

Answer 10

• Pro- ‘Ana’ websites
• Thinspiration
• Other people with anorexia can further someone’s illness

Question 11

2 general subtypes of anorexia

Answer 11

1. binge eating/purging type

2. restrictive type

Question 12

Restricting Type of Anorexia involves

Answer 12

• Weight restriction through fasting & exercise

Question 13

Binge Eating/Purging Type of Anorexia involves

Answer 13

Regular objective binge eating or purging
- Vomiting, laxatives, diuretics, or enemas
Poorer prognosis
Tend to have problems relating to impulse control
May involve substance abuse or stealing.
Underweight

Question 14

Some Medical Complications of Anorexia

Answer 14

• dermatological problems such as dry, cracking skin; fine, downy hair; even a yellowish discoloration of the skin
• Cardiovascular complications such as heart irregularities, hypotension (low blood pressure), dizziness upon standing, and sometimes blackouts

Question 15

Weight loss complications of Anorexia

Answer 15

Osteoporosis
Cardiovascular problems (incl cardiac arrhythmia)
Dry hair, hair loss, & lanugo (fine fuzzy hair)
Decreased fertility
Lethargy
Dry skin
Renal failure (kidney failure)

Question 16

According to its Greek roots, Bulimia means

Answer 16

Large hunger

Question 17

Bulimia nervosa is characterized by

Answer 17

recurrent episodes of gorging on large quantities of food, followed by use of inappropriate ways to prevent weight gain like purging, fasting, or engaging in excessive exercise

Question 18

Clinical Features of Bulimia Nervosa

Answer 18

1. Recurrent episodes of binge eating
   - Excessive amount of food in 2 hrs or less
   Sense of lack of control while binging
2. Inappropriate compensatory behaviours
3. Binging/purging occur ~2/week for 3 months or more
4. Self-evaluation excessively influenced by weight & body shape

Question 19

Subtypes of Bulimia Nervosa

Answer 19

Purging – take in the food then compensate by getting it out

Non-purging – don’t take in the food, compensate with long periods of fasting or excessive exersise

Question 20

Difference between Binge/Purge Anorexia and Purging Bulimia

Answer 20

Maintaining of extremely low body weight is a characteristic of Anorexia but not of Bulimia

Question 21

Medical Complications of Bulimia

Answer 21

1. Skin irritation around the mouth due to frequent contact with stomach acid, blockage of salivary ducts, decay of tooth enamel, and dental cavities.
   - The acid from the vomit may damage taste receptors on the palate, making the person less sensitive to the taste of vomit.
2. Russell’s signs
   - People who can induce vomiting; scratched knuckles from putting them in your mouth
3. Electrolyte imbalance

Question 22

EDNOS

Answer 22

• Eating Disorder Not Otherwise Specified
• Disturbances in eating behavior that do not necessarily fall into the specific category of anorexia, bulimia, or binge eating disorder
• Most common diagnosis

Question 23

Binge Eating Disorder

Answer 23

• Objective binge eating without compensation
• Distress in regard to binging
• Feelings of lack of control
• Occurs on average 2/week for 6 months
• Associated with obesity

Question 24

Pica

Answer 24

Persistent eating/chewing/licking of non-nutritive substances
Ex. my strange addictions

Question 25

Rumination Disorder

Answer 25

Repeated regurgitation of food for a period of at least one month Regurgitated food may be re-chewed, re-swallowed, or spit out.

Question 26

Avoidant/Restrictive Food Intake Disorder

Answer 26

An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs

Question 27

Treatment and Recovery rate for EDs

Answer 27

Notoriously difficult to treat with the highest mortality rate of all disorders About 70% will eventually recover, but there are high relapse rates and residual food issues still persist after treatment

Question 28

Genetic factors of EDs

Answer 28

Genes on chromosomes 1 & 10 linked to increased risk

Question 29

Neurochemistry factors of EDs

Answer 29

- Endogenous opioids - Serotonin is important for regulating satiety (fullness) dysregulation in patients with Eds

Question 30

Psychosocial factors of EDs

Answer 30

- social pressures - media - Body dissatisfaction

Question 31

Sociocultural factors of EDs

Answer 31

- social pressures and expectations | - peer pressure

Question 32

Dieting statistics for young women

Answer 32

Four out of five (80%) young women in the U.S. have gone on a diet by the time they reach their 18th birthday.

Question 33

Family Factors of EDs

Answer 33

- Families of young women with EDs tend to be more often conflicted, overprotective, dysfunctional, but less nurturing and supportive. - The parents seem less capable of promoting independence in their daughters. - Conflicts with parents over issues of autonomy are often implicated in the development of both anorexia nervosa and bulimia. - The girl may be the identified patient although the family unit is what is dysfunctional.

Question 34

Personality of girls with EDs

Answer 34

Perfectionists

Question 35

Emotional Factors of EDs

Answer 35

- Restricting food intake may be a misguided attempt to relieve upsetting emotions by seeking mastery or control over one's bodies. - Binge eating may represent an attempt at coping with emotional distress

Question 36

Learning perspective on EDs

Answer 36

- Conceptualizes eating disorders as a type of weight phobia - In bulimia, the binge-purge cycle usually begins after dieting to lose weight. - For anorexia, food rejecting behavior is negatively reinforced by relief from anxiety about weight gain.

Question 37

ED treatments

Answer 37

SSRIs (antidepressant) will reduce symptoms but usually does not successfully treat patients and is less effective than Cognitive behavioral therapy (CBT) which is the gold standard for treatment of bulimia

Question 38

Anorexia recovery rates with treatment

Answer 38

Only 17% showed full recovery and 0% receiving nutritional counselling recovered

Question 39

Cognitive Behaviour Therapy treatment stages for Bulimia

Answer 39

``` Stage 1 (behavioral) - Focus on establishing control over eating using Psychoeducation Behavioral strategies to normalize eating Stage 2 (cognitive) - Focus on distorted thoughts about body & food Stage 3 (maintenance & relapse) ```

Question 40

Therapy for Anorexia

Answer 40

- Family therapy is the most effective treatment for anorexia - Inpatient hospitalization (Force feed, programs, etc.) are often needed in extreme cases - Behavioral therapy with rewards (like privileges and social opportunities) made contingent on adherence to the refeeding protocol.

Question 41

Binge Eating Disorder Treatment

Answer 41

Cognitive-behavioral therapy (CBT) is used by remove situation that leads to the binge eating

Question 42

Changes to Anorexia from DSM-IV-TR to DSM 5

Answer 42

* Amenorrhea (the absence of a menstrual cycle in a woman) has been removed as a requirement for anorexia to be diagnosed in women. * Criterion A, now focuses on behaviors, like restricting calorie intake and no longer includes the word “refusal” in terms of weight maintenance * Criterion B has been expanded to include not only overtly expressed fear of weight gain, but also persistent behavior that interferes with weight gain

Question 43

Changes to Bulimia from DSM-IV-TR to DSM 5

Answer 43

• The DSM-5 criteria reduces the frequency of binge eating and compensatory behaviors that people with bulimia nervosa must exhibit from a minimum of twice a week to just once a week

Question 44

Changes to Binge Eating Disorder from DSM-IV-TR to DSM 5

Answer 44

* Binge eating disorder graduates from the DSM-IV category of “disorders needing further research” into its own diagnostic label * The minimum average frequency of binge eating has been changed from at least twice weekly for 6 months to at least once weekly over the last 3 months

Question 45

Changes to Avoidant/Restrictive Food Intake Disorder from DSM-IV-TR to DSM 5

Answer 45

* The DSM-IV feeding disorder of infancy or early childhood has been renamed avoidant/ restrictive food intake disorder * The category was broadened and expanded

Question 46

Changes to Pica and Rumination Disorders from DSM-IV-TR to DSM 5

Answer 46

• Revised for clarity and to indicate that the diagnoses can be made for individuals of any age

Question 47

Online test questions

Answer 47

Discuss eating disorders in men. What are two major treatments for bulimia nervosa? Comment on their success rate. What are two major treatments of anorexia nervosa? Comment on their success rate. Summarize the current state of our understanding of the cause of eating disorders. Discuss the type of program used in the day hospital program of Toronto General Hospital. What are some of the comorbid disorders associated with anorexia nervosa and bulimia nervosa? Describe, discuss, and differentiate between the two major eating disorders, anorexia nervosa and bulimia nervosa.