chapter 9 Flashcards
(63 cards)
eating disorders
Involve disordered eating behaviors and maladaptive ways of controlling body weight
- Often occur together with other psychological disorders such as depression, anxiety disorders, and substance abuse disorders
eating disorders demographics
Typical onset in adolescence
Mainly reported as impacting women, though impacts all genders
Disorders involve interplay of body weight, food consumption, and compensatory behaviors
anorexia nervosa
An eating disorder characterized by maintenance of an abnormally low body weight, a distorted body image, and intense fears of gaining weight
Rarely lose their appetite
Other common features:
- Failure to recognize the risks posed by maintaining body weight at abnormally low levels
Two subtypes: binge eating/purging type and restricting type
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 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
Restricting type
During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior. This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
Does not have binging or purging episodes
Tend to rigidly, even obsessively, control their diet and appearance
Binge-eating/purging type
During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior
Characterized by frequent episodes during the prior three month period of binge eating or purging (such as by self induced vomiting or overuse of laxatives, diuretics, or enemas)
Difficulties with impulse control - may lead to problems with substance abuse
Tend to alternate between periods of rigid control and impulsive behavior
Body mass index (BMI)
A measure of height-adjusted weight, and a level of 18.5 is considered the minimal standard of healthy weight
anorexia nervosa specify if in
In partial remission
After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met
In full remission
After full criteria for anorexia nervosa were previously met, none of the criteria have been meet for a sustained period of time
Medical Complications of Anorexia Nervosa
Dermatological:
Skin cracking, drying and discoloration, thinning of hair
Cardiovascular:
Heart irregularities, low blood pressure, dizziness
Gastrointestinal:
Constipation, abdominal pain, impacted bowels
Menstrual:
Amenorrhea
Loss of period
Musculoskeletal:
Muscular weakness and abnormal bone growth
Suicide risk:
8x more likely than general population
Bulimia Nervosa
An eating disorder characterized by recurrent binge eating followed by self-induced purging, accompanied by over concern with body weight and shape
At least once a week for three months
Late adolescence or early adulthood
criteria for bulimia nervosa
A) Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode
B) Recurrent inappropriate compensatory behaviors 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
severity of bulimia nervosa
Severity based on average episodes of inappropriate compensatory behaviors per week
Mild: 1-3
Moderate: 4-7
Severe: 8-13
Extreme: 14 or more
bulimia nervosa specify if in
In partial remission
After full criteria for bulimia nervosa were previously meet, some, but not all, of the criteria have been met for a sustained period of time
In full remission
After full criteria for bulimia nervosa were previously met, not of the criteria have been met for a sustained period of time
Medical Complications of Bulimia Nervosa
Impact of constant vomiting and exposure to stomach acid
- Skin irritation
- Tooth decay
- Dental cavities
- Decrease taste receptor sensitivity
Musculoskeletal:
Abnormal pain, impacted relational with bowels and reflexive elimination, muscular weakness
Menstrual:
Amenorrhea
Loss of period
Sociocultural factors eating disorders
Common in western cultures
Idealization of thinness
Gendered expectations of body
Comparison to others
Cultural value on body composition
Psychosocial and emotional factors of eating disorders
Not all exposed develop eating disorders
Tie to deep emotional issues
Linked to abusive histories
Negative emotions can trigger episodes
‘Relief’ of upsetting emotions
differences of binging, purging, restriction
Binging: intake, endorphin rush
Purging: release and relief
Restriction: control, mastery
Learning perspectives of eating disorders
Weight phobia theory
Negative reinforcement of relief through compensatory behaviors
Cognitive factors of eating disorders
Black and white thinking
Negative beliefs about self
Family factors of eating disorders
“Identified patient” represents family dysfunction
Disordered eating often as a response to chaos in home
Biological factors of eating disorders
Brain abnormalities related to hunger and appetite
Genetic predispositions
Binge-eating disorder
Repeated binge-eating episodes, but there is no compensatory behavior afterward to reduce weight
Average of at least once a week for three months
Lack of control over eating, consuming far greater amounts of food than people typically eat in the same span of time
Tend to be more depressed, have greater difficulty regulating their emotions, and have more disturbed eating behaviors
Strongly linked to obesity
May fall in the broader domain of compulsive disorders
CBT
criteria of binge eating disorder
A) Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- eating, in a discrete period of time (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
- A sense of lack of control over eating during the episode
B) The binge eating episodes are associated with three (or more) of the following:
- eating much more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of feeling embarrassed by how much on is eating
- feeling disgusted with oneself, depressed, or very guilt 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
Orthorexia
Not an official diagnosis, but proposed
A) Obsessive focus on “healthy” eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualized as an aspect of ideal health rather than as the primary goal. As evidenced by the following:
- Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health
- Violation of self imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame
- Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinate to ideation about healthy food.
B) The compulsive behavior and mental preoccupation becomes clinically impaired by an of the following:
- malnutrition, severe weight loss or other medical complications from restricted diet
- intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet
- positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior
