Task 7: Eating Disorders

Question 1

Anorexia Nervosa

Answer 1

• people with anorexia nervosa starve themselves, subsisting on little or no food for very long periods of time, yet they remain convinced that they need to lose more weight
• their weight is significantly below what is minimally normal for their weight
• distorted image of their body, believing that they are disgustingly fat
• feel good and worthwhile only when they have complete control over their eating and when they are losing weight

Question 2

Amenorrhea

Answer 2

= the extreme weight loss often causes women and girls who have begun menstruating to stop having menstrual periods

–> not a distinguishing feature anymore

Question 3

DSM-5 Criteria for Anorexia Nervosa

Answer 3

A Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or for children and adolescents, less than what is minimally expected

B Intense fear of gaining weight or of becoming fat, or of persistent behavior that interferes with weight gain, even though at a significantly low weight

C Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Question 4

restricting type

Answer 4

= during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior
–> weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise

Question 5

binge-eating/purging type

Answer 5

= during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior
–> self-induced vomiting, misuse of laxatives, diuretics, or enemas

Question 6

Prevalence of Anorexia Nervosa

Answer 6

• 0.9-4% in adult women
• 0.3-0.8% in adolescent girls
• 0.3% in men
• cultures that do not value thinness in females have lower rates of anorexia nervosa than those in the US
• the incidence of anorexia nervosa has increased substantially since the early part of the 20th century

Question 7

Comorbidity of Anorexia Nervosa

Answer 7

• death rate: 5-9%
• cardiovascular complications
• kidney damage
• impaired immune system functioning

Question 8

Bulimia Nervosa

Answer 8

• uncontrolled eating/bingeing, followed by behaviors intended to prevent weight gain from the binges
• no control over their eating
• feel compelled to eat even though they are not hungry
• constantly dissatisfied with their shape and concerned about losing weight

Question 9

DSM-5 Criteria for Bulimia Nervosa

Answer 9

A Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances
2. A sense of lack of control over eating during the episode

B Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise

C The binge and inappropriate compensatory behaviors both occur, on average, at least once per week for 3 months

D Self-evaluation is unduly influenced by body shape and weight

E The disturbance does not occur exclusively during episodes of anorexia nervosa

Question 10

Cognitive behavioral theory of maintenance of bulimia nervosa

Answer 10

1. Clinical perfectionism
2. Core low self-esteem
3. Mood intolerance
4. Interpersonal difficulties

Question 11

Dieting in Bulimia nervosa

Answer 11

• weight loss diets, weight maintenance diets, and successful dietary restriction produce significant decreases in bulimic symptoms
• rather than healthy dietary behaviors, unhealthy behaviors, such as meal skipping, lead to the onset of bulimic pathology
• weight maintenance dieting results in decreases in negative affect

Question 12

Prevalence, Course, and Comorbidity of Bulimia Nervosa

Answer 12

• 1%
• 0.5% in adults
• 0.9% in adolescents
• more common in females than in males
• 2.6% in women
• onset in late adolescence - 16-20 years
• triggered by stressful life events and possibly dieting

Comorbidity
- depression, anxiety, and bipolar disorder
- affective disorders, and alcohol/substance abuse

Question 13

Binge-Eating Disorder

Answer 13

• resembles bulimia nervosa, except that a person with binge-eating disorder does not regularly engage in compensating behavior for binging
• significantly overweight and disgusted with their body
• ashamed of bingeing
• history of frequent dieting, membership in weight-control programs, and family obesity

Question 14

Dieting in Binge-Eating Disorder

Answer 14

• individuals with BED are not currently dieting
• individuals with BED are reporting that, when they do go on a diet or when they dieted in the past, they tended to have rigid rules for dieting and set unrealistically high standards for sustaining that diet
• there still exists a high level of concern and discomfort with food issues

Question 15

DSM-5 Criteria for Binge-Eating Disorder

Answer 15

A Recurrent episodes of binge eating. An episode of binge eating is characterized by both the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances
2. A sense of lack of control over eating during the episode

B The binge-eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of feeling embarrassed by how much one is eating
5. Feeling disgusted with oneself, depressed, or very guilty afterward

C Marked distress regarding binge eating is present

D The binge eating occurs, on average, at least once a week for 3 months

E The binge eating is not associated with the current use of inappropriate compensatory behavior and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

Question 16

Prevalence, Course, and Comorbidity of Binge-Eating Disorder

Answer 16

• 2-3.5% in the US - lower in other countries
• more common in women
• high rates of depression, anxiety, alcohol abuse, and personality disorders
• mean duration is 8-14.4 years

Question 17

Instability of Eating Disorders

Answer 17

• low diagnostic stability
• low remission rate
• flux between anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified

Question 18

Restrained and Unrestrained Eating

Answer 18

The eating behavior of low restrained subjects is characterized by “internal” regulation of intake such that a larger preload results in decreased subsequent consumption

High restrained subjects behave in a manner that appears to be largely “external”, the presence of attractive food cues, once restraint has been abandoned, served to trigger additional eating which apparently defies the laws of caloric homeostasis

Question 19

Causes: Biological

Answer 19

• heritability ranges between 50-83%
• 56% heritability for anorexia nervosa
• 41% heritability for binge-eating disorder
• genes carry a risk factor
• changes in hormones at puberty (in girls)
• starvation shrinks the brain
• hypothalamus: disordered eating behavior might be caused by imbalances in/dysregulation of the neurotransmitters and hormones involved in this system or by structural/functional problems in the hypothalamus –> sends messages when nutritional needs are met
• anorexia nervosa: lower hypothalamic functioning + abnormalities in serotonin and dopamine
• bulimia nervosa: abnormalities in serotonin

Question 20

Causes: Central Control of Appetite

Answer 20

Homeostatic system:
- integrates peripheral metabolic markers with information from the gastrointestinal tract to affect subjective states of hunger, satiety, and autonomic nervous activity

Drive system:
- registers the reward value associated with food
- involved in the motivation to seek food and eat

Self-regulation system:
- top-down control contextualizes appetite within life goals, values, and meaning

–> abnormal changes in all three of these systems have a role in the risk and maintenance of eating disorders

Question 21

Causes: Social Pressure and Cultural Norms

Answer 21

• the ideal shape for women in many developed nations has become thinner and thinner
• women who internalize the thin ideal promoted by the media are at risk for eating disorders
• medial portrayals of male beauty: muscularity
• peers are the effective carriers of appearance-related messages
• athletes, especially those participating in sports in which weight is considered an important factor in competitiveness, are at increased risk for disordered eating
• male bodybuilders tend to have a pattern of eating and exercising as obsessive as that of men with eating disorders, but focus on muscle gain

Question 22

Causes: Cognitive

Answer 22

• body dissatisfaction, perfectionism, and low self-esteem
• concerned with the opinions of others
• conforming to others’ wishes
• obsessive thoughts
• greater impulsiveness
• all-or-none thinking

Question 23

Causes: Emotion Regulation Difficulties

Answer 23

• maladaptive strategies for dealing with painful emotions
• depressive symptoms –> higher risk

Question 24

Causes: Family Dynamics

Answer 24

• anorexia nervosa often occurs in “good girls” - high achievers, dutiful, compliant, “perfect”
• families of girls with eating disorders have high levels of conflict, discourage the expression of negative emotions, and emphasize control and perfectionism
• girls fear separation and involvement with peers
• controlling food intake –> control over life and concern from parents
• especially mothers are influencing: think that their daughter needs to lose weight, are eating disordered themselves, are dissatisfied with the family dynamic

Question 25

Causes: Individual Risk Factors

Answer 25

- abuse - trauma - teasing

Question 26

Treatment: Psychotherapy for Anorexia Nervosa

Answer 26

- resistant to therapy - do not seek treatment - initial period of recovery and relapse into bulimic or anorexic behaviors Cognitive-Behavioral Therapies (CBT): - confront client's overvaluation of thinness and rewards are made contingent on the person's gaining weight Family Therapy: - Maudsley model: 10-20 sessions, over 6-12 months; parents are coached to take control of their child's eating and weight

Question 27

Treatment: Psychotherapy for Bulimia Nervosa

Answer 27

CBT: - the therapist teaches the client to monitor the cognitions that accompany her eating, particularly the binge and purging episodes - confront these cognitions - develop more adaptive attitudes toward weight/shape - including forbidden foods back into the diet - effective in 50% --> reduces binges as well as overconcern with weight, shape, and eating in people with binge-eating disorder Interpersonal therapy: - the client and the therapist discuss interpersonal problems related to the client’s eating disorder, and the therapist works actively with the client to develop strategies to solve these problems Behavioral therapy - the client is taught how to monitor her food intake, is reinforced for introducing avoided foods into her diet, and is taught coping techniques for avoiding bingeing

Question 28

Treatment: Transdiagnostic Approach

Answer 28

1. Intensive initial stage, engaging and educating patient, obtaining maximal behavioral change 2. Detailed review of progress so far and barriers to change and formal assessment of each of four additional maintaining mechanisms 3. Emphasis on modifying the patient’s psychopathology and addressing additional processes 4. Ensuring that progress is maintained after the treatment ends

Question 29

Treatment: Binge-Eating Disorder

Answer 29

1. individual assessment 2. assess what role dieting has played for the individual in the past 3. achieving confidence in one's ability to refrain from binge-eating while developing a mindset that food can be safely handled 4. Appetite Awareness Training: client learns to monitor hunger and satiety

Question 30

Treatment: Biological

Answer 30

- SSRIs: reduce binge-eating and purging behaviors, but often fail to restore the individual to normal eating habits - antidepressant medication increases the rate of recovery by 50% - atypical antipsychotic (olanzapine): increases in weight gain in people with anorexia nervosa

Question 31

Treatment: Extinction Therapy for Anorexia Nervosa

Answer 31

= fear reduction operates via mechanisms of inhibitory learning, which is an active learning process in which the violation of expected feared outcomes results in the new learning on nonthreat associations relating to the originally feared stimulus, which in turn serves to inhibit anxiety