Eating Disorders Flashcards
According to ICD-10, what are the main eating disorders?
- Anorexia Nervosa
- Bulimia Nervosa
- Atypical AN/BN
DSM also recognises BED.
What are the two types of Anorexia Nervosa?
Restrictive type: Behaviours around food are principally restrictive, will deny themselves food or over exercise.
Binge-eating + Purging type: Marked by cycles of restriction, loss of control, binging, and subsequent purging.
What are the ICD-10 criteria for anorexia?
5 points:
- Refusal to maintain or achieve a normal body weight (defined as >17.5)
- Intense fear of gaining weight or becoming fat
- Body shape Disturbance
- Undue influence of weight and shape on self-evaluation
- Amenorrhoea
What behaviours might someone with AN engage in to keep their weight down?
Restriction:
- Restrict food intake by eating small meals or ignoring hunger
- Compensate for eating with exercise
- Diabetics may omit or reduce insulin dose.
Purging:
- Self-induced vomiting
- Laxatives
- Use of diuretics
- Use of OTC slimming aids or fat blockers
- Amphetamine like drugs
Rule making:
- Calorie limits (e.g. no more than 1000 a day)
- Food groups to be avoided
- Always eating less than others
- Never eating in front of others
What cognitive biases reinforce feelings of AN?
Body Dysmorphia:
- People know they’re thin but feel fat
- Feeling fat = a complex mix of physiological states and emotions
Will also constantly compare to others, constantly check their bodies. Avoidance behaviours are also common.
What are the diagnostic criteria for Bulimia Nervosa?
- Recurrent episodes of over eating (binges)
- Persistent preoccupation with eating and a strong desire to eat (cravings)
- Attempts to counter act the fattening effects of food by compensatory behaviours
- Self-perception of being too fat, with an intrusive dread of fatness.
+/- Purging e.g. self-induced vomiting, exercise, laxatives
What are the main behaviour used to differentiate AN and BN?
Binging and Cravings.
People with AN do not have this sort of relationship to food, are more avoidant of it. People with BN obsess over food.
Define a binge?
- Large amounts of calorie laden, previously forbidden foods
- Importantly: Patients feels a Subjective Loss of Control!
- Feel like they’re ‘in a bubble’ and ‘just can’t stop’
- Associated guilt afterwards
- Normally done secretively, alone
- Will hide the evidence
What factors can contribute to the development of an eating disorder?
- Genetics
- Family history or culture of fitness/slimness
- Social and cultural factors
- Psychological distress and vulnerability
What are the main psychological processes underlying AN?
- Fearing loss of control over food
- Therefore restriction over food
- Therefore patient becomes preoccupied with food
- Which increases their fear of losing control etc etc…
What are the psychological factors underlying BN?
- Preoccupation with size and weight, over-evaluation of link between size and self-esteem causes….
- Restriction and rules, Forbidden foods
- The stress of restrictions paired with the general stress of life cause binge eating, vomiting, and over-exercising.
What personality factors might make someone more likely to develop an ED?
- Perfectionistic
- Obsessional
- Poor inter-personal styles, struggling to recognise cues and emotional states of others.
What cognitive factors might make someone develop an ED?
Thinking styles: cognitively rigid, all or nothing thinking, can’t see bigger picture
Emotional processing styles:
difficulty recognising own emotional state of others
What is Sick Euthyroid Syndrome
- Body down regulates T4 levels to reduce metabolic rates and adjust to starvation
- Causing reduced body temperature, bradycardia and reduced metabolic rate
- With time this causes damage to numerous systems/organs, causing many of the physical complications of ED?
What physical complications can occur as a result of having an ED?
- CV issues (myocardial thinning, bradycardia, hypotension, arrhythmias, cardiomyopathy, mitral prolapse, heart failure)
- Electrolyte deficiencies (sodium, calcium, magnesium)
- Bone marrow suppression!
- GI issues (delayed gut motility, constipation, Mallory Weiss teats, hepatitis, pancreatitis)
- Osteopenia –> fractures
- Dental issues, cavities
- Endocrine (amenorrhoea, sick euthyroid syndrome)
- Liver damage!
Biggest = Death (e.g. from refeeding or cardiac arrest), highest death rate of any psych condition.
