Feeding and Eating Disorders Flashcards Preview

Spring Semester > Feeding and Eating Disorders > Flashcards

Flashcards in Feeding and Eating Disorders Deck (84):
1

Feeding & Eating Disorders

1. Anorexia Nervosa
2. Bulimia Nervosa
3. Binge Eating Disorders

2

Anorexia Nervousa

persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, & physical health)

3

anosgnosia

lack of insight

4

Anorexia Nervosa thoughts

-either an intense fear of gaining weight or becoming fat, or PERSISTENT behavior that interferes with weight gain
-disturbance in the way ones body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

5

Two subtypes of Anorexia Nervosa

-Restricting type
-binge-eating/purging type
(can bounce between the two)

6

Restricting type

lose weight by cutting out sweets and fattening snacks, eventually restricting nearly all food
-show almost no variability in diet

7

Binge-eating/purging type

lose weight by vomiting after meals, abusing laxatives or diuretics
like those with bulimia nervosa, people with this subtype may engage in eating binges

8

Additional Signs/ Symptoms of Anorexia

Avoid eating with others
Unusual eating habits, rituals
“I’m just trying to be healthy”
Extreme self-discipline in other areas of life
Food as expression of autonomy (can't force ppl to eat- I am the boss of me)
Compulsive exercise
Isolation from friends/family
OCD, depression and substance use often
comorbid
alcohol

9

Physiological Symptoms of Anorexia

Heart Muscle Shrinkage
Amenorrhea (loss of 3 menestrual cycles)
Dry skin, sallow complexion
Brittle hair, nails, purple nail beds
Sensitivity to/intolerance of cold
Lanugo
Low blood pressure/heart rate (slow &irregular hr)

10

Lanugo

peach fuzz around torso or jawline (body's bid for thermoregulation)

11

blood pressure

65-75bpm is normal
anorexics can get as low 30 bpm
athletes can get to 45 bpm

12

The clinical picture of anorexia nervosa

Despite their dietary restrictions, people
with anorexia nervosa are extremely
preoccupied with food
--This includes thinking and reading about food
and planning for meals
--It may be the result of food deprivation, as
evidenced by the famous 1940s “starvation
study” with conscientious objectors

13

Anorexia Nervosa quote

The mind may make the body sick, but only the body can help the mind be well again
(like talking to a drunk and telling them to stop drinking) it's all about weight restoration

14

AN Stats

Prevalence: up to 1% of adolescent
girls/young women
-- About 90%–95% cases female
-- Bimodal onset; ages 12-18
--May be overweight initially
--Highest mortality rate of any DSM
disorder: ~ 10-20% (depending on study)
--1:5 of those deaths are from suicide

15

Rates of Recovery

--1/3 recover after
initial episode
--1/3 fluctuate with
recovery and
relapse
-- 1/3 suffer chronic
deterioration

16

Bulimia Nervosa

Bulimia nervosa, also known as
“binge-purge syndrome,” is
characterized by binges:
-- Bouts of uncontrolled overeating during a
limited period of time
--Eat objectively more than most people
would/could eat in a similar period

17

Which disorder has the highest mortality rate?

Anorexia Nervosa
but BN are more likely to self report/objective and are insightful

18

What does bimodal mean?

two peaks-- early puberty can be a risk factor or transitions like going to college

19

DSM-5 Signs/ Symptoms of Bulimia Nervosa

Binge/compensatory behaviors >1/week
for at least 3 months

20

what is a binge?

a) eat large quantity in 2 hours , and
b) loss of control

21

what is compensatory behavior?

(DSM5 removes subtypes)
a) purging – vomiting, laxative, diuretics
b) non-purging – exercise, fasting
-- Do not meet weight criteria for AN
--Self-Evaluation unduly influenced by body
size, shape, and weight

22

Binge episodes

People with bulimia nervosa may have between 1 and 30 binge episodes per week
Binges are often carried out in secret
--Binges involve eating massive amounts of food very rapidly with little chewing
--Usually sweet, high-calorie foods with soft texture
--Binge-eating food consumption can be as many as 10,000 calories per binge episode

23

Compensatory behaviors

Attempt to compensate for and "undo" the caloric effects
--Vomiting: fails to prevent the absorption of half the calories consumed during a binge & repeated vomiting affects the ability to feel satiated -->greater hunger and bingeing
Most people fall within 10% of normal weight

24

Other signs & symptoms of bulimia

Mood swings
Fear of being fat
Shame/guilt
Eats in secret
hoards food
Alcohol/substance abuse common Anxiety disorders common Depression seems to follow BN -hard to treat

25

Physiological effects of BN

Salivary and/or lymph gland enlargement
Irregular menstrual cycle (about 1/2)
Corrosion of teeth(top teeth)
Dehydration, weakness, fatigue
Bleeding, infection of throat
Electrolyte imbalance: cardiac arrhythmia,seizures, coma
renal failure
Colon damage from laxative abuse
Raspy voice
Digestive/intestinal problems
Muscle spasms and headaches

26

can you be comordid with BN & AN?

No you cannot

27

BN Stats

~90%–95% of bulimia nervosa cases occur in females
--Peak age of onset is between 15 and 21 years
--Symptoms may last for several years with
periodic letup
--In minority populations, risk higher with
higher degree of acculturation, social class

28

acculuration

how much you culture to where you are ---> western standards

29

what are judge sports?

diving, ballet, cheerleading

30

Research suggests that bingeing often occurs after...

strict dieting
Study of binge-eating behavior in a low calorie
weight loss program found that 62%
of patients reported binge-eating episodes
during treatment

31

Bulimia Prognosis

33% remit every year
--But another 33% relapse into full
criteria
--Adolescent-onset better prognosis
than adult-onset
--Death-rate = 1%

32

BN vs. AN similarities

! Onset after a period of dieting
! Fear of becoming obese
! Drive to become thin
! Preoccupation with food, weight, appearance
! Feelings of anxiety, depression, obsessiveness,
perfectionism
! Substance abuse
! Distorted body perception
! Disturbed attitudes toward eating

33

BN vs. AN differences

People with BN = more worried about
pleasing others, being attractive to others,
and having intimate relationships
! People with bulimia nervosa tend to have
libido/sex life.
! Approximately half of women with bulimia
nervosa experience amenorrhea vs. almost
all women with anorexia nervosa

34

Binge Eating Disorder

Binge eating without compensatory behavior
! Between 2 and 7% of the population display binge eating disorder
! Eating large amounts of food
! Eating rapidly during binge episodes
! Large amounts of food when not physically hungry
! Eating alone because embarrassed about how much one is eating
! Feeling disgusted with oneself, depressed, or guilty when overeating
! Feeling that your eating behavior is out of control
! Frequently eating alone
! Hoarding food
! Hiding empty food containers
! Feeling depressed, disgusted or upset about your eating
Note: Most obese people do not have BED

35

Overvaluation Shape/Weight

Current specifiers are severity based
on number of binge episodes per
week
! Overvaluation of shape/weight is
associated with significantly elevated
eating disorder pathology and
psychological distress.
! Predicts treatment outcome

36

Binge Eating Disorders... Fun fact

1 in 4 survey participants secretly create concoctions.
-no difference in concocting susceptibility between sexes or ethnicities

37

food concoting

making unusual good mixtures
(mashed potatoes with Oreo
cookies, frozen vegetables mixed with
mayonnaise, and chips with lemon, pork
rinds, Italian dressing and salt)

38

Binge Eating Disorder vs. Obesity ***

Runs in families (not a simple familial variation of obesity).
! Males, older age, and a later age of onset.
! Greater concerns about shape and weight, higher likelihood
of psychiatric comorbidity in the form of mood disorders and
anxiety disorders.
! Lower quality of life than obesity.
! More positive response to specialty treatments than to
generic behavioral weight loss treatments.
! clinical utility of the BED diagnosis in terms of treatment
selection; for example, antidepressant medication is useful in the treatment of BED, but is not generally useful in the
treatment of obesity.

39

Etiology of Eating Disorders

genetic
family dynamics
societal, cultural
biological
media factors
individual temperament (impulsive)

40

Risk Factors for EDs

! Perfectionism for AN
! Early Puberty
! Failed attempts to lose weight
! Antecedent illness with weight loss
! Discovery that purging, fasting or exercising can
compensate for binging
! Athletics
! Beginning a diet
! Family history of eating disorder, substance abuse
or mood disorder

41

Biological factors

Genetics
! Lifetime risk: 10X higher if family member has
eating disorder
• MZ twins with anorexia: 70% (DZ:20%)
• MZ twins with bulimia: 23% (DZ: 9%)
! Increased risk if family hx of: anxiety,
depression, or alcohol dependence
! Serotonin Imbalance
! Anorexia Nervosa: Elevated 5-HTP; abnormal
5HTP (2a) receptor
! Bulimia Nervosa: Depleted 5-HTP

42

Cognitive/Behavioral Explanations

Eating Disorders seem to be propelled primarily through cognitive distortions
--Control (out of control?)
--Belief that popularity and self-esteem are
determined by weight and body shape
Behavioral explanations:
--Observational learning
--Operant conditioning

43

Family Environments

--Lack communication skills? Low support?
--High pressure, driven, concerned about
appearance
--Discomfort handling conflict, tolerating/
discussing emotions
(family harmony when Jane was sick/malnourished)

44

Societal Factors

--Media Influence
--54% of men and 75% of women are unhappy with their physical
appearance and wish that their bodies were different
--Most fashion models are thinner than 98% of American women
--Peer group norms
--Athletic team norms
--Degree of adopting western standards of beauty

45

What causes Eating Disorders? Multicultural Factors: Gender Differences

--Males account for only 5% to 10% of all
cases of eating disorders
--The reasons for this striking difference are not entirely clear, but Western society’s double standard is, at the very least, one reason
--A second reason may be the different
methods of weight loss favored:
--Men are more likely to exercise
--Women more often diet
"It's just as hard to be Ken as it is to be Barbie"

46

Body Image and the Media

Average American woman
5’4”,140 lbs
--Average American model
5’11”, 117 lbs
--80% American women
dissatisfied with their
appearance
-->50% of high school girls
want smaller hips, thighs,
and/or waists

47

The Role of Dieting

--95% of eating disorders start with
diets
--Dietary restraint leads to
preoccupation with food
--Food restriction interferes with
serotonin

48

Dieting in Anorexia

Weight lossreinforcing
--Symptoms may
provide relief from
family conflicts/
other stressors

49

Dieting in BN

two parts: restriction and then binge eating

50

Restriction becomes

Binge eating
Malnutrition lowers serotonin levels: depression
and triggers binge behavior
--Bingeing may reduce stress/anxiety

51

Binge eating becomes

Purging
Increased endorphins reinforces vomiting
--Purging provides psychological relief

52

How are eating disorders treated?

--Eating disorder treatments have two main
goals:
-Correct dangerous eating patterns
-Address broader psychological and situational
factors that have led to, and are maintaining,
the eating problem
---This often requires the participation of family and
friends

53

Treatment of Eating Disorders

Multidisciplinary Team Approach:
! Individual therapist
! Group therapist
! Physician
! Nutritionist
! Psychiatrist

54

Treatment for Anorexia Nervosa

Hospitalization
- Weight gain (recover from malnourishment)
-Necessary weight gain is often achieved in 8 to 12 weeks
- Address dysfunctional anxious cognitions
about becoming obese, losing control of
eating, thinness as marker of self-worth
- Family therapy
-Maudsley Method
- Intuitive Eating

55

AN Treatment

No evidence-based psychotherapy for
Anorexia Nervosa in adults
-- No evidence-based pharmacologic
treatments

56

Treatment for Bulimia

Immediate aims:
• Eliminate binge-purge patterns
• Establish good eating habits
• Eliminate the underlying cause of bulimic patterns
Medications: SSRIs
--- May enhance psychological treatment
--- No long-term efficacy
--- Cognitive-Behavior Therapy
--- Develop normal patterns of eating
--- Self-monitoring
--- Address perfectionism and maladaptive thoughts
--- Develop alternative coping strategies

57

Appetite Awareness Training

Appetite Awareness
! Become aware of your appetite signals
! Become aware of other triggers to eat
besides hunger/fullness
****Practice starting at moderate hunger and
stopping at moderate fullness

58

Treatments for BN more so

• Left untreated, bulimia nervosa can last
for years
• Treatment provides immediate,
significant improvement in about 40% of
cases
• An additional 40% show moderate response
• Follow-up studies suggest that 10 years
after treatment about 75% of patients
have fully or partially recovered

59

interesting thing about binges

every eating disorder we have involves a binge

60

Planning to eat can prevent

binge eating behavior in part

61

Diet Binge Purge cycle

Rules/Dieting >> Slips, breaks rule >> AVE (Abstinence Violation Effect) >>Binge >> Guilt/Shame >>(Purging) >>Renewed Resolve

62

Abstinence Violation Effect

I blew it, fuck it
where one cig becomes the whole pack

63

Fear of becoming obese-Why?

Different because heart disease runs in the family to there are social reasons
Anorexics have a nigh need for perfectionism

64

perfectionism

chronic state of stress because nothing is perfect

65

what is the difference between BN people and AN people?

BN=people pleasers
AN=more isolation, less nourished, shut down sex drive to survive

66

BED

is largely behavioral
great deal of shame

67

severity

mild, moderate, severe depends NOT on how many binge episodes but how much they value appearance body size& shape

68

out of body experience

can be seen in AN

69

operant conditioning role

purging feels good after uncomfortable fullness
-getting asked out on dates during bingeing and purging >>what is level of confidence

70

FDA approved

there are no FDA approved meds

71

highest eating pathology

sport: Jockeys (horse racing)

72

Timeframe

AN been around since the beginning BN more culturally bound

73

Psychological Factors

Personality
-perfectionism
-obsessive compulsiveness
-emotional instability
-harm avoidance
-persistence, low novelty seeking (AN)
-impulsivity sensation seeking (BN)
Poor Self Image

74

orthorexia

obsession with nutrition

75

An integrative model

Restriction of Eating

76

Group therapy on eating disorders

group therapy great for BN depends on AN

77

when people start eating and they get gassy and start bloating

"I'm allergic"
Wrong just reintroducing after restricting it

78

weight restoration

main idea for AN cause it will increase insight--must go slowly

79

refeeding syndrome

blood sugar & insulin secretion, electrical activity, could lead to seizures, really sick, ruptured stomach, could be deadly

80

residential facilitates

have the highest relapse once they leave

81

Maudsley method

is effective for young (15 years and younger) where the therapist goes in with the family

82

SSRI medications

are like a volume knob

83

Do you have food rules or do food rules have you?

Her daughter when given the choice between a cookie and an apple she will listen to her body because she hasn't been exposed to society standards

84

Food monitoring

get away from it, " how do you feel"-Eating in the green
-appetite cues are disturbed from binging and purging