Eating Disorders

Question 1

Anorexia Nervosa

WHAT/ FACTS

Answer 1

• Purposeful maintenance of a significantly low body weight, intense fears of becoming overweight + has distorted views of her shape and weight

2 ways of maintenance:

1) purging after eating
2) restricting food intake

• *95% females @ around 14-25.
• High death rate
• normally starts from slightly overweight –> dieting (losing weight)

Question 2

AN clinical picture - important points

Answer 2

• fear provides motivation
• Preoccupation w food
• distorted views

Question 3

Bulimia Nervosa WHAT + FACTS

Answer 3

• Binges = limited period of time where a person would eat much more than most people during a similar time span. Normally in BN its 1-30 binge episodes per week.
• Followed by self blame/shame
• 15-20
• can lead to AN
• normally begins after a period of dieting (praise/ good feelings about self)
  QUITE INVOLVED WITH DESIRE TO PLEASE PEOPLE

Question 4

Binge eating disorder - WHAT

Answer 4

• Repeated binges with feeling of no control (APA, 2013)
• NO COMPENSATORY BEHAVIOUR
• 2-7% of pop have it
• Preoccupied with weight + food (like AN + BN)
• Bodily dissatisfaction & MH probs
• doesn’t nec begin with dieting**

Question 5

BN - 1 binge a week; normal?

Answer 5

One difficulty in knowing whether you have Binge Eating Disorder is that no-one knows exactly what kind of eating constitutes a “binge”. One man’s binge may be just another man’s hearty meal.
- grand misunderstanding of how many times a week constitutes to a disorder (some websites say 3+) but DSM 5 = 1

• ED is not about choosing to eat extra-large portions, nor are people who suffer from it just “overindulging” – far from being enjoyable, binges are very distressing. -
• Sufferers find it difficult to stop during a binge even if they want to, and some people with binge eating disorder have described feeling disconnected from what they’re doing during a binge, or even struggling to remember what they’ve eaten afterwards (dissociative)

Question 6

comorbidity of AN

Answer 6

• bipolar
• depression/anxiety
• substance abuse
• OCD

Question 7

Psychodynamic theories of ED

Answer 7

CONTAINS A LOT OF COGNITIVE THEORIES: sensations/perceptions of control

Ego deficiency:

• distorted mother-child relationships lead to serious ego deficiencies in the child. Poor regulation of the child’s needs
• ** independence and control become problematic
• Grow up confused about their needs; gain control by controlling weight and food.

Question 8

evidence around psychodynamic approach to ED? // BIOSOCIAL EXPLANATION

Answer 8

support:

• the same for BPD: if parents don’t teach their children how to respond accurately to their feelings or needs (internal cues) they may never learn to id hunger
• **large number of people with ED have an BPD
• ED sufferers interpret their internal cues (emotional cues inc) inaccurately — i.e. when some are anxious or upset they just think they’re hungry. Find it hard to interpret their feelings (alexithymic)

against:
?????????????????

Question 9

Cognitive aetiology of ED

Answer 9

Deficits in their perceptions and sensations (as seen in psychodynamic). This deficit leads to broad distortions in thinking/perceptions (weight + control)

Question 10

Eval of cognitive aetiology of ED

Answer 10

• don’t think these are the cause of ED but may be the maintenance of it

Question 11

ED & depression – does depression set the stage for ED?

Answer 11

a) Many people with the diagnosis for an ED also qualify with a diagnosis of MDD than do in the general population
b) Close relatives of people with ED seem to have a higher rate of depressive disorders than those without ED
c) ED can be helped by anti depressant drugs used depression
* **cause or consequence???????????????

Studies of the temporal onset of EDs and depression suggest that EDs tend to precede the development of depression and that depressed mood improves with weight restoration
BUT DOES SEEM TO BE BIDIRECTIONAL; COS ALSO = Past researchers (Heatherton & Baumeister, 1991) have proposed that disordered eating is a compensatory mechanism to reduce negative mood states.

HOWEVER it is anxiety that seems to preceded ED
** both of these does increase the persistence of ED symptoms

Question 12

Biological aetiology for ED

Answer 12

• genetic component: 70% identical twins (an>bn)
• Low serotonin in ED (linked w carb craving)
• Positive feedback (mainly in animal models) when the rat was given high fat/sugar diet –> wanting responses & then it was TAKEN AWAY –> anxiety like symptoms & compulsive seeking REGARDLESS of consequences (mainly for BED)
• hypothalamus role: weight thermostat
• it isn’t just this though –> they haven’t found genes which link together; maybe it more to do with families?

Question 13

Weight thermostat - what?

Answer 13

• homeostatic feedback control system
  in rats (easier cos no society pressure) - found there was a “metabolic propensity” for their rats to regain weight after a period of caloric restriction and subsequent weight loss, both by an increased appetite and a decrease in resting metabolic rate.
• regulation of fat is more inconsistent in humans –> due to “genetic, gender, perinatal, developmental, dietary, environmental, neural, and psychosocial factors.”
  Hypothalamus:
  Early eating habits + genetic inheritance = help determine a person’s weight set point; when weight falls below this the lateral hypo induces hunger and slows metabolic rate and vice versa for gaining weight
  SO IN DIETING - brain tries to regain weight when its lost.
  SOME GAIN TOTAL CONTROL OF THERMOSTAT - AN (restriction) + BN (binging/purging)

Question 14

Eval of bio ED

Answer 14

genetic component + identical twins IS THIS SOCIAL INFLUENCE?????

a) Adoption study – female sibling pairs; Our findings bolster those from twin studies and provide evidence of significant genetic effects on disordered eating symptoms (2009) THE ONLY ADOPTION STUDY

Weight thermostat – v accepted but v debated???

Question 15

Society aetiology in ED

Answer 15

• Western standards make ED more likely
• Social media
• “Fat shaming” in western culture

Question 16

Social media + ED

Answer 16

• Social networking is positively related to body image concerns and disordered eating.
• Photo-based activities are particularly salient.
• Relationships hold for both women and men.
• Internalization and appearance comparison mediate the relationship.
• Promotion of things like “thinspiration” that catches on
• interventions on social media sites: inaffective + have very low participation
• Indegenous Fiji - mass media not been around for long but ED seen an increase since its beginning

Question 17

Family environment

Answer 17

• aspirations of thinness in families = influences onset of AN/BN
• abnormal family communication
• enmeshed family systems - involved in each others business (desire for control)

Question 18

Eval of family environment + ED
(4)
what should a model include?

Answer 18

• No consistent research showing that this one type of family = ED; families of AN and BN vary massively
  BUT contirbuting factors:
  a) parental control + perfectionism: associated with ED in offspring. Fathers control predicted the most.
  b) insecure attachments: trouble with the expression of feelings; muted responses + low key pattern of affective expression
  c) parental attitudes: mothers w EDs impact on children (& vice versa). High amount of talk/action of dieting in families with ED
  ***thus, families can have an effect BUT will differ for each family
  Model should include: development of obsessive, perfectionist personality –> ED, distress that leads to ED, family make up + how AN becomes consolidated as way of managing distress

Question 19

Multicultural factors – race + ethnicity

Answer 19

• used to be a difference in ethnicities with the rate white> other minorities BUT the gap is closing
• **acculturation; Those who orient themselves more w white culture = higher ED rate

Question 20

Men + ED

a) why might there be differences in the two?

Answer 20

• weight loss favoured by the two: males = exercise + women = dieting (w dieting often preceding ED)
• Job pressure
• Society
• There seems to be an invalid approximation of body image dissatisfaction levels in males due to the traditional focus on weight (and not muscle like men stuff with) need assessment scales for men.
• -Men also report less of a sense of being out of control during a binge than women do and that anger can trigger a binge episode, while women seem to binge in order to restrain their sense of anger
• The use of assessment tools, which places emphasis on compensatory behaviors, binge habits, attitudes about food, and emotional triggers in males, would likely improve accuracy of reporting by males, as well as lead to the development of appropriate interventions.

Question 21

Muscle dysmorphia

Answer 21

Men
- feeling of shame
“bigorexia” - trivalised? – “something gone wrong in the brain” - ??

Question 22

Treatments for AN - family therapy

what + eval

Answer 22

Family therapy: -Meet with a family as a whole, points out troublesome family patterns + helps them make changes (shown to be effective but don’t know why)

EVAL
Although FBT does not appear to be superior to individual treatment at end of treatment, there appear to be significant benefits at 6–12 month follow-up for adolescents suffering from eating disorders.
- needs more work on the model; not may therapists feel confident with it
- works best for early stages of ED
- less optimistic for late onset ED (adult ED)

Question 23

CBT for AN/BN/BED

Answer 23

• included in most treatments + longer lasting changes
• needs other stuff to be effective tho
• change thoughts and behaviours.
  a) cognitive –> taught different coping strategies + that they wont be judged for their weight and control abilities
  b) Behavioural –> patients required to keep a diary of feelings, hunger levels and food intake + the relationship between these

Question 24

Treatment for BN antidepressant

Answer 24

• BN are helped a lot by these drugs (AN not so much). Can help up to 40% of patients
• reduce body image and weight concerns, in addition to reducing depression and anxiety, which are commonly experienced in people who have bulimia
• bulimia have a chemical imbalance of the neurotransmitter Serotonin, which is responsible for regulating emotions, mood, and appetite; The imbalance of serotonin levels in the body can increase urges to binge and purge

Question 25

comorbidity of BN

Answer 25

• most experience at least one other disorder; its common in BN
• mood disturbances (some say its a result of BN)
• BPD
• substance use disorder

Question 26

Alexithymia + ED

Answer 26

WHAT = inability to identify and describe emotions in the self
Control of food + weight in order to to avoid their emotions?
- it is not a by product of depression or distress caused by the disorder as some suggest
a) can vary in severity even when depression is stable
- Need emotional aspect to therapy to help reduce Alex. BUT alexithymia scores still remain elevated compared to control scores at post-treatment, suggesting that more intensive treatment focused on emotion regulation may be needed

Question 27

CBT-E

Answer 27

• CBT that is used to treat eating disorders is called CBT-Enhanced (CBT-E) –> Originally intended for bulimia nervosa specifically, it was eventually extended to all eating disorder
• A key turning point came when CBT for bulimia was developed into an effective transdiagnostic approach across the eating disorders, CBT-E(f/b), taking into account the common ‘overvaluation’ of eating, weight, and shape (and the control of those things).
• “f” focused = eating habits
• “b” broad = non-eating habits i.e. mood (included stuff about self esteem, emotions, perfectionism etc)
• • Fascinatingly people who had these additional problems did better with the broad CBT-E, whilst people who didn’t responded better to the focused form.