Eating Disorders: Class Notes Flashcards Preview

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Flashcards in Eating Disorders: Class Notes Deck (31):

Eating Disorders, General

Most common: anorexia nervosa, bulimia nervosa, and binge-eating disorder

BMI is the most common way to judge/evaluate the presence of these disorders

Similarities between anorexia nervosa and bulimia nervosa
o An intense fear of gaining weight and a pursuit to be thin despite the consequences
• Often leading to illness, organ failure, or even death
o Grappling with perfection and control despite actual weight

3 general body types
o From skin to heavy: ectomorphic, mesomorphic, endormorphic


Anorexia Nervosa

Below expected BMI for height and age
"significantly low weight"

Disturbance in one’s shape or size--experience of weight

Intense fear of gaining weight

Some remain obsessed about food despite fear of ingesting it

Restrictive type
• Attempt to control via exercise or ingesting small quantities

Binge-eating/purging type
• Attempt to control via purging

Versus body dysmorphic disorder
• Where most energy is spend obsessing over specific bodily features


Bulimia Nervosa

Frequent episodes of excessive eating with a subjective sense of lack of control

A binge episode can be described as a quasi-dissociative state

Inappropriate compensatory behavior to negate the effects of the binge

**The anorexia exclusion
• Bulimia is only diagnosable in those who have average to above-average weight


Bulimia: 2 subtypes

• Via vomiting, laxatives, diuretics

• Via fasting, exercise


Bulimia vs Anorexia: Insight

Bulimia: lack of insight, but increased interest in the perceptions of others

Anorexia: Increased insight and less interested in the perceptions of others


Bulimia vs Anorexia: Sexual Activity

Bulimia: Increased chance of being sexually active

Anorexia: Decreased chance of being sexually active


Bulimia vs Anorexia: Weight

Bulimia: focus on maintaining weight

Anorexia: focus on losing weight


Bulimia vs Anorexia: Obsessive Personality

Bulimia:less obsessive personality traits

Anorexia: more obsessive personality traits


Bulimia vs Anorexia: Mood Swings

Bulimia: increased mood swings

Anorexia: decreased chance of mood swings


Bulimia vs Anorexia: Impulse Control

Bulimia: lack of impulse control

Anorexia: overdeveloped impulse control


Bulimia vs Anorexia: Substance Abuse

Bulimia: more likely to abuse drugs/alcohol
*typically starts with an addiction to diet pills

Anorexia: less likely to abuse drugs/alcohol


Binge-Eating Disorder

Subjective loss of control during an episode of increased food intake

No inappropriate attempt to limit or reduce the subsequent weight gain


Medical Consequences of Eating Disorders

Amenorrhea – the body needs fat in order to sustain menstrual cycle

Mouth – breakdown of teeth and gums

Hair – thins and becomes brittle

Hypokalemia – a potassium deficiency that causes irregular heart rate

Blood stream – anemia and change in blood pressure

Muscles – weaken and become swollen

Kidneys – stone development and potential failure

Bodily fluids – decreased potassium, magnesium, and sodium


Eating Disorders Onset

Anorexia typically develops between ages 15 and 19

Bulimia typically develops later, 20-24 years old

Females:males = 3:1


Eating Disorders: Prevalence

Binge-eating disorder most common: 3.5% of females, 2% of males

Anorexia is rarer, and bulimia is rarer than anorexia
• Fluidity present between eating disorder diagnoses

People tend to switch between the two anorexia subtypes
• Restrictive ↔ binge-purge

Not uncommon for those with binge-purge anorexia to become bulimic
• Binge purge anorexia → bulimia

Some with binge eating disorder may later develop bulimia
• Binge eating disorder → bulimia

No evidence that those with binge disorder develop anorexia


Eating Disorders: Comorbidity

With clinical depression, 21-91% of all eating disorder cases

Symptoms of starvation resemble those of depression, so these percentages may be inflated

Secondary symptoms of eating disorders also resemble depression

Mood disorders, in general, may predispose someone to eating disorders

High comorbidity with mood disorders

High rate of mood disorders in family members of those who have been diagnosed with eating disorders

Decreased serotonin (aka 5-HT) in those with eating disorders and mood disorders
• SSRIs help depression and those with eating disorders

Obsessive-compulsive disorder
o Particularly with anorexia

Substance abuse disorders

Various personality disorders
o Impulsivity, affectability (borderline-like)


Eating Disorders across Cultures

Originally, eating disorders were a “western-disorder”
o Specifically with Caucasian females

More recently, they have become a world-wide problem
o Still more common though in Caucasian and Asian populations


Fallon-Rozin study

Women think men find a lower BMI to be more attractive, and they currently are too heavy

Men rate the optimal body weight for women to be higher than women expect

Men tend to think the optimal body weight is their current body weight

Women prefer men that are lower than this however
• May explain why men tend to be less likely diagnosed with an eating disorder – this thinking is a defense


Eating Disorders Among Female college athletes

9% have eating disorders

~50% engage in behaviors that are affiliated with eating disorders


Family Influences

~50% of those with eating disorders come from families that emphasize thinness or control

Adolescents with anorexia come from families with strict, non-abstract, covert, conflict resolution behaviors

Some argue the eating disorder may be a defense of the adolescent to reduce the conflict between the parents – redirect their attention


Individual Factors

Internalized ideals of thinness or perfectionism

Consistent negative mood images and/or negative emotionality

History of childhood sexual abuse

Regular dieting



Dieting is the biggest predictor of binging

Adolescents who diet are 8x more likely to develop an eating disorder

As dieting becomes more regular, serotonin decreases
• Explains the feelings of being depleted while dieting


Abstinence Violation Effect

Phenomenon that occurs if one is dieting and lapses, there is a belief that one might as well continue to lapse

An all-or-nothing mentality

“I already ate a slice, I might as well eat the rest of the pie”

This behavior is also popular with those combating drug/alcohol abuse


Biological Explanations

o Controls eating, drinking, and menstrual cycle

Weight set-point theory
o Lateral hypothalamus – produces hunger when activated
• Destruction = refusal to eat

Ventromedial hypothalamus –produces satisfaction (satiety center)
• Destruction = over-eating

The hypothalamus acts like a thermometer and attempts to keep balance

May explain when one is anorexic, they experience an increase in thoughts related to food

The hypothalamus is attempting to encourage hunger to maintain the weight set-point

Eating disorders are conflicts between desire and one’s weight set-point

There is no way to discover one’s weight set-point

This is why some argue dieting is pointless

The set-point prevents one from gaining or losing weight


Hypothalamus and GLP

Glucagon-like peptide (GLP) may interact with these subsections

Activates distinct areas of the hypothalamus in order to ensure the body weight remains centered around the weight set-point

If one gains weight, GLP activates the ventromedial

If one loses weight, GLP activates the lateral


Treating Anorexia

2 paths of treatment

1. Correct eating patterns – the priority

2. Correct cognitive patterns

Supportive-nursing care

• Limited success

Family therapy
• Identify sources of stress or support
• Identify areas of familial improvement

In the past
• Hospitalization and forced feeding
o No cooperation


Treating Anorexia: Supportive-nursing care

In outpatient centers, nurses educate, encourage, and take time to confirm obesity will not occur

Then cooperatively work with patient to ensure up to 4,000 calories are ingested each day

Normal weight returns after 8-12 weeks

After normal weight returns, nurses attempt to correct faulty cognitions, including teaching to

• Recognize/trust internal hunger cues

• Address misconceptions and faulty core beliefs

• Recognize distortions


Treating Bulimia

Combination of medication and therapy

In-session meals

Groups eat meals together and then identify and express emotions and physical sensations of being full

CBT orientation is successful
• Therapists guide individuals to alter faulty thinking
• Food diaries
• Include mood, and moments of hunger
• Goal = to recognize triggers for binges

• Starting in 1996, with the approval of Prozac


Treating Binge-eating Disorder

Similar to bulimia

Teach to recognize triggers of binge episodes

Commonly include subjective moments of loss of control, and increased anxiety


Treatment Outcomes: Anorexia

Weight typically restored quickly, but psychological pathology can take years to correct

After 21 years
• 51% - fully recovered
• 21% - partially recovered
• 10% - not recovered
• 16% - have died

**Mortality rate of anorexia is high

All eating disorders are relatively high

Recovery process is not smooth

Pregnancy may help combat anorexic-inducing thoughts since they are expected to gain weight at this time

However, those with severe anorexia will not get pregnant out of fear of gaining weight


Treatment Outcomes: Bulimia + Binge-Eating Disorder

70% recover

Antidepressants help reduce behaviors by 25-30%