Chapter 9 – Eating Disorders And Obesity Flashcards
(35 cards)
What does the term anorexia nervosa literally mean?
Lack of appetite induced by nervousness
At the heart of this disorder is an intense fear of gaining weight or becoming fat, combined with a refusal to maintain even a minimally low bodyweight. There is a disturbance in the way in which ones 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 bodyweight. In postmenarcheal females, amenorrhea, The absence of at least three consecutive menstrual cycles.
Anorexia nervosa
Disorders of food ingestion, regurgitation, or attitude that affect health and well-being, such as anorexia, bulimia, or binge eating
Eating disorders
What are the two subtypes of anorexia nervosa?
The restricting type and the binge-eating/purging type
In this type of anorexia nervosa, every effort is made to limit the quantity of food consumed. Caloric intake is tightly controlled and patients often try to avoid eating in the presence of other people. When they are at the table, they may eat excessively slowly, cut their food into very small pieces, or dispose of food secretly.
Restricting type
In this type of anorexia nervosa, individuals either binge, purge, or binge and purge
Binge-eating/purging type
And out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances
Binge
Refers to the removal of food from the body by such means as self-induced vomiting or miss use of laxatives, diuretics, and enemas. Other compensatory behaviours that do not involve purging are excessive exercise or fasting.
Purge
Frequent occurrence of binge-eating episodes accompanied by a sense of loss of control of over eating and recurrent inappropriate behaviour such as purging or excessive exercise to prevent weight gain
Boulimia nervosa
Compare and contrast anorexia nervosa, binge-eating/purging subtype, and bulimia nervosa
The clinical picture of the binge-eating/purging type of anorexia nervosa has much in common with boulimia nervosa. The difference is weight. By definition, the person with anorexia nervosa is severely underweight. This is not true of the person with bulimia nervosa. Consequently, if the person who binges or purges also meets the criteria for anorexia nervosa, the diagnosis is anorexia nervosa binge-eating/purging type and not boulimia nervosa. Anorexia nervosa trumps the believe me at nervosa diagnosis because there is a far greater mortality rate associated with anorexia nervosa.
A diagnostic category reserved for disorders of eating that do not meet criteria for any other specific eating disorder
Eating disorder not otherwise specified or EDNOS
Distinct from non-purging bulimia nervosa, whereby bingeing is not accompanied by inappropriate compensatory behaviour to limit weight gain
Binge-eating disorder or BED
Characterized by eating in a discreet. Of time and amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. A sense of lack of control over eating during the episode.
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 being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating.
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least two days a week for six months
Describe the age of onset, gender differences, and prevalence of eating disorders
Anorexia nervosa and boulimia do not occur in appreciable numbers before adolescence, however, children as young as seven have been known to develop eating disorders, especially anorexia.
Anorexia is most likely to develop in 15 to 19-year-olds. The age group at highest risk for bleeding is young women falling in the age range of 20 to 24.
Binge eating disorder are older than those with anorexia or boulimia and generally between 30 and 50 years of age.
Eating disorders do ochre in males, with binge eating disorder being relatively common, however, they are more likely to be found in women. There are three females for every male with an eating disorder.
The most common form of eating disorder in clinical samples is eating disorder not otherwise specified, at between five and 10% in community studies.
Binge eating disorder – lifetime prevalence around 3.5% in women and 2% in men. Higher in obese people in the range of 6.5 to 8%.
Bulimia – 1.5% for women and 0.5% for men
Anorexia – 0.9% in women and 0.3% in men.
The risk of developing anorexia seems to have increased during the 20th century. Lifetime rates of this disorder are higher in people born after 1945 then before this time and this is not fully explained by increased awareness of the disorder and better detection by clinicians. Also a rise in cases of boulimia from 1970 to 1993.
This word comes from the Greek word bous, which means ox, and limos which means hunger. It is meant to denote a hunger of such proportions that the person could eat an ox.
Bulimia
Describe the medical complications of the various eating disorders
Anorexia has the highest mortality rate of any psychiatric disorder, more than 12 times higher than the mortality rate for females age 15 to 24 in the general US population. Most often die because of medical complications.
Malnutrition in anorexia – hair on Scott thins and becomes brittle as well as nails. Skin becomes very dry, and downy hair called lanugo starts to grow on the face, neck, arms, back, and legs. Develop a yellowish tinge to their skin, especially on the palms of their hands and bottoms of their feet. There undernourishment causes them to have a difficult time coping with cold temperatures. Have chronically low blood pressure and often feel tired, weak, dizzy, and faint. Thiamin or vitamin B1 deficiency may also be present which could account for some of the depression and cognitive changes. Increased risk for osteoporosis in later life. Die from heart arrhythmias or irregular heartbeats sometimes caused by major imbalances in key electrolytes such as potassium. Chronically low levels of potassium can also result in kidney damage and renal failure or severe enough to require dialysis.
Abuse of laxatives makes all these problems much worse because it leads to dehydration, electrolyte imbalances, and kidney disease as well as damage to the bowels and gastrointestinal tract.
Boulimia – much less lethal then anorexia but is still associated with the mortality rate that is approximately twice that founded people of comparable age in the general population. Purging can cause electrolyte imbalances, low potassium, puts the patient at risk for heart abnormalities. Damage to the heart muscle which may be due to using it the CAC syrup which causes vomiting. Patients develop calluses on their hands from sticking their fingers down there throats to make themselves sick and may tear their throat. Damage their teeth when they throw up repeatedly from the acid in their stomach. Mouth ulcers and dental cavities and small red dots around the eyes. Often have swollen parotid or salivary gland cause by repeated vomiting known as puffy cheeks or chipmunk cheeks.
After medical complications, the second most common cause of death for those with anorexia is suicide.
It is quite common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder. This is called:
Diagnostic crossover.
Many of these changes reflect transitions from anorexia or boulimia to eating disorder not otherwise specified which happens when minor clinical improvement mean that the person no longer meets diagnostic criteria for the original diagnosis.
There are also bidirectional transitions between the two subtypes of anorexia.
Shifts from anorexia to boulimia also occur, but there were no cases of direct transition from the restricting type of anorexia directly into bulimia.
Only a minority of patients with bulimia transition into anorexia.
Are is no diagnostic crossover between binge eating disorder and anorexia
Explain the comorbidity of eating disorders with other forms of psychopathologies
68% of patients with anorexia, 63% with bulimia, and 50% with binge eating disorder are also diagnosed with depression.
Abscess of-compulsive disorder is also found in patients with anorexia and bulimia. There is frequent cooccurrence of substance abuse disorders in the binge-purging subtype of anorexia as well as in bulimia. The restrictive type tends not to be associated with substance-abuse.
Personality disorders are also frequently diagnosed. The restrictive type are inclined toward the anxious-avoidant cluster. Those that involve binge/purge symptoms are associated with dramatic, emotional, or a erratic problems, especially borderline personality disorder.
People would BED have higher rates of personality disorders, anxiety disorders, mood disorders, and substance-use disorders.
Describe eating disorders across cultures
Anorexia and boulimia our clinical problems in Japan, Hong Kong, Taiwan, Singapore, and Korea. Have also been documented in India and Africa. The prevalence in Iran is comparable to the US.
Being Caucasian appears to be associated with subclinical problems that may place individuals at higher risk for developing eating disorders. Such problems include body to satisfaction, dietary restraints, and a drive for thinness.
Asian women exhibit levels of pathological eating similar to those of white women, and African-Americans are less susceptible.
A select number of the clinical features of diagnosed forms of eating disorders may also very according to culture. 50% of anorexia patients in Hong Kong are not excessively concerned about fatness but a fear of stomach bloating. Anorexia patients in Britain but who had South Asian ethnic origins also were less likely than patient with English origins to show evidence of fat phobia.
Women in Ghana who had anorexia were also not concerned about their weight but emphasize religious ideas of self-control and denial of hunger. Japanese women reported low levels of perfectionism and less of a drive for thinness then American women.
Anorexia is not a disorder that occurs simply because of exposure to western ideals, in contrast, believe me it does seem to be a culture bound syndromes and seems to occur in people of had some exposure to western ideals about fitness and you have access to large amounts of food and can purge in private
Describe the biological, socio-cultural, individual, and family risk and causal factors associated with eating disorders
Biological:
Genetics – eating disorders have been shown to run in families and the relatives of patients with eating disorders are more likely to suffer from a variety of other disorders as well.
Twin studies suggest that both anorexia and boulimia are heritable. Evidence that a gene on chromosome 1 May be linked to susceptibility to the restrictive type of anorexia, and a chromosome 10 gene may be linked to boulimia.
Link to genes that are involved in the regulation of serotonin.
Brain abnormalities- The hypothalamus plays an important role in eating and there is evidence that abnormalities in this area play a central role in eating disorders.
Set points – there is a well-established tendency for our bodies to resist market variation from some sort of biologically determined set point or wait that our bodies try to defend. Hunger is a physiological opposition designed to prevent us from moving far from our set point.
Serotonin – implicated in obsessionality, mood disorders, and impulsivity and also modulates appetite and feeding behavior. Because many patients with eating disorders respond well to treatment with antidepressants which target serotonin, some researchers have concluded that eating disorders involve a disruption in the system. Serotonin is made from Anna sensual amino acid called tryptophan which can only be obtained from food, people with anorexia have low levels of a major metabolite of serotonin maybe because they are eating so little food. These metabolites are normal and people with bulimia, but after recovery these groups have higher levels than control women do and also have higher levels than when they were in the ill state. It has been suggested that resuming normal eating makes it possible to detect abnormalities in the serotonin system that might be involved in risk for eating disorders.
Socio-cultural factors:
Young women are bombarded with images of unrealistically thin models in magazines, ads, and on the television. Social pressures towards fitness may be particularly powerful and higher socioeconomic backgrounds. Fitness became deeply rooted as a cultural ideal in the 1960s.
Family influences:
More than one third of patients with anorexia reported that family disfunction was a factor that contributed to the development of their eating disorder. They perceive their families as more rigid, less cohesive, and as having poor communication.
Many of the parents of patients with eating disorders have long-standing preoccupations regarding the desirability of thinness, dieting, and good physical appearance and also have perfectionistic tendencies. When it comes to bulimia, both white and ethnic minority adolescents with boulimia perceive their families to be less cohesive.
Individual risk factors:
Gender – more frequently found in women than in men and the greatest risk is during adolescence. Binge eating is more likely to be found in males as well as in females.
Internalizing the thin ideal – the extent to which people internalize this ideal is associated with a range of problems that are thought to be risk factors for eating disorders which include body to satisfaction, dieting, and negative affect.
Perfectionism – an important risk factor for eating disorders because these people may be much more likely to subscribe to the thin ideal and relentlessly pursue the perfect body. Perfectionism helps maintain bulimic pathology through the rigid adherence to dieting that then drives the bench/purge cycle.
Negative body image- reception will biases lead girls and women to believe that men prefer more slender shapes then they do, and women feel evaluated by other women believing that there female peers have even more stringent standards of weight and shape than they do themselves.
Dieting – nearly all eating disorders begin with the normal dieting that is routine in our culture.
Negative emotionality – negative affect or feeling bad is a causal risk factor for body to satisfaction because when we feel bad, we tend to become very self-critical and may focus on our limitations and shortcomings well magnifying our flaws and defects. This seems to be especially true of individuals with eating disorders who tends to show distorted ways of thinking and processing information received from the environment.
Childhood sexual abuse
Key structure at the base of the brain; important in emotion and motivation
Hypothalamus
The tendency of our bodies to resist efforts to bring about a marked change in weight
Set point
A neurotransmitter from the indolamine class that is synthesized from the amino acid tryptophan. Also referred to as 5 – HT, this neurotransmitter is thought to be involved in a wide range of psychopathological conditions.
Serotonin
The need to get things exactly right. A personality trait that may increase risk for the development of eating disorders, perhaps because these people may be more likely to idealize thinness
Perfectionism
The experience of an emotional state characterized by negative emotions. Such negative emotions might include anger, anxiety, irritability, and sadness.
Negative affect
