Week 4 - Eating Disorders

Question 1

Types of Eating Disorders: Anorexia Nervosa - what are the characteristics?

Answer 1

• Refusal to maintain body weight (self-starvation)
• Restriction
• At least 15% below normal weight
• Intense fear of weight gain
• Disturbance of body image
• Amenorrhoea (loss of period)
• Compulsive exercise

Question 2

Types of Eating Disorders: Bulimia Nervosa - what are the characteristics?

Binge-eating disorder - what are the characteristics?

Answer 2

Bulimia Nervosa:
Loss of control - overeating
Normal weight
Binging and purging cycles - vomiting and Laxative misuse

Binge-Eating Disorder:
- Obesity
- Excessive over-eating

Question 3

What are the consequences/outcomes of anorexia

Answer 3

Highest morality rate of any mental disorder
- Malnutrition, suicide, drugs, alcohol, diabetes

Organ Problems
- Bone: reduced bone density (and fractures)
- Immunity: anaemia, infections
- Cardiovascular: bradycardia, arrythmia

Question 4

How do the following factors influence eating disorders:
1) Birth/Infancy
2) Childhood
3) Adolescent

Answer 4

1) Birth/Infancy
* Female Gender
* Allergies and early feeding difficulties
* High concern parenting

2) Childhood
* Obesity
* ACEs (eg. trauma - using the ED as a coping mechanism)
* OCD

3) Adolescent
* Dieting
* Negative self-evaluation
* Sports/High level exercise
* Body dysmorphia
* OCD

Question 5

What are the effective treatments for AN?

Answer 5

Short Term: Food (weight restoration)

Family-based interventions (in Younger People)

Talking therapies (in Younger people and adults)

No NICE-approved ‘first line’ treatment

Question 6

What is family based intervention (Adolescents and children)

Answer 6

Rapid restoration of physical health (weight restoration) - parental responsibility

Responsibility of eating handed back to adolescent

Identifying and navigating developmental challenges - complex psychological work

Question 7

What are the effective treatments for BN and BED

Answer 7

BN: CBT-E (Chris Fairburn)
* Goal focused talking therapy
* Includes psychoeducation
* Example homework: food monitoring, behaviour monitoring, thought recording

BED: We don’t know

Question 8

What is the inpatient model? Include meal support and nutrition intervention

Answer 8

Inpatient Focus:
1. Restore to healthy weight (minimum BMI 20)
2. Correct and identify mechanisms that maintain the behaviors
3. Ensure the changes are lasting

Meal Supports - guiding a patient through meal times (involves staff)

Nutrition Intervention - goals of initial treatment (regular feeding, restoring weight, reducing restriction, restoring nutrition)

Question 9

What are the main dilemmas in eating disorder treatment?

Answer 9

Respecting choice and autonomy of client

Client often not insightful into self-harm caused

Enable client to reduce health risks

Context of insufficient research into what works, and why

Treatments ranging in invasiveness