Describe normal eating?
A pattern of eating behaviours which:
- Maintains normal weight
- Ensures adequate nutrition
- Conforms with cultural/religious requirements
- Enjoyable
1:14:50
What are some of the consequences of 'abnormal' eating?
-
Constant “dieting”
-
Morbid Obesity
-
Anorexia nervosa
-
Bulimia nervosa
-
Binge Eating Disorder
-
Eating disorders are not secondary to other disorders, they are primary disorders
How common are eating disorders?
-
one of most common disorders in western world
-
alongside depression & anxiety
-
one of the most common to result in death of a patient
What are some of the disorders not otherwise specified in the DSM-5?
-
pika - eating odd things
-
rumination - eating, vomiting & re-eating it
1:18ish
What is the DSM-5 Criteria for Anorexia Nervosa?
-
Restriction of energy intake relative to requirements, leading to significantly low body weight (for age, sex, etc)
-
Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain.
-
Disturbance in the way one’s body weight or shape is experienced.
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1:18:50
What are the two sub-types of Anorexia Nervosa?
-
Restricting Type
-
Not regularly engaged in binge eating or purging behaviours
-
Purging Type
-
Regularly engaged in binge eating and purging behaviours.
- Not regularly engaged in binge eating or purging behaviours
- Regularly engaged in binge eating and purging behaviours.
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120:30ish
What is the Anorexia Nervosa severity scale in DSM-5 based on?
-
Body Mass Index (BMI)
121:40
What are the 4 criteria on the Distorted Attitude Toward Eating Scales?
-
Current
-
Ideal
-
Attractive (what they think is attractive)
-
Other Attractive (what others think is attractive)
How would a person with anorexia most likely score on Zellner's Distorted Body Image Scale?
High on Distorted Attitude
What is the main difference between a high & a low scorer
in the visual appearance of the 4 scoring criteria on the Distorted Attitude Toward Eating Scale?
-
High: the criteria are spread out
-
i.e., the difference between current & ideal weight is greater
-
Low: the criteria are more clumped together
-
i.e., the difference between current & ideal weight is much closer
- i.e., the difference between current & ideal weight is greater
- i.e., the difference between current & ideal weight is much closer
Are there any gender similarities/differences on the 'Distorted Attitude Toward Eating Scale'?
-
No real gender difference between ideal distortions
-
Men tend to overestimate their current weight
What are some physical outcomes of the chronic starvation associated with in anorexia nervosa?
-
Basal rates slow significantly
-
Blood Pressure & Heart Rate
-
Kidney and Gastro-Intestinal problems
-
Bone mass reduced significantly
-
Skin dries out
-
Neurological impairments
-
Reduction of important electrolytes (e.g. Na+, K+) (dangerous)
-
can develop cardiac arythmia
-
Endorphins may be released (may act as reinforcers for disordered behaviours in relation to eating)
-
Tiredness, fatigue, cognitively impaired
-
May lead to death
-
because of extreme physical changes
- Blood Pressure & Heart Rate
- can develop cardiac arythmia
- because of extreme physical changes
123:10
What are the Psychological changes associated with anorexia
-
Patient is no longer rational
-
Personality changes
124:10
Who most typically suffers with anorexia nervosa?
What may be some early indicators in this demographic?
-
Typically a disease of young female adolescents (90%).
-
May start off as
-
extreme & rigid dietary control
-
obsession with
-
food
-
weight gain
-
some of these people will remit from these early behaviours & others will develop an eating disorder
- extreme & rigid dietary control
-
obsession with
- food
- weight gain
124:30
What is the prognosis for anorexia?
-
Approx. 70% recover to some extent
-
takes about 5 – 7 years.
-
not treatable overnight - recovery takes a long time
-
typically only 20% will show remission within first year
-
10-20% will never recover, may remit & then fall back into disorder
-
Death rate – from physical complications and suicide is high
-
1 - 8% death rate (too high)
-
3rd most common cause of death
- takes about 5 – 7 years.
- not treatable overnight - recovery takes a long time
- typically only 20% will show remission within first year
- 1 - 8% death rate (too high)
- 3rd most common cause of death
1:26
What is the prevalence of Anorexia In the overall poulation?
-
Rare disease – 1% or less of the population
-
(but 3rd most common disease in young girls)
- (but 3rd most common disease in young girls)
What other disorders/conditions are often comorbid with anorexia?
-
Depression
-
Anxiety
-
Obsessive Compulsive Disorders
-
Phobias
125:25
Do patients swap between Anorexia & Bulimia?
i.e., cross-over disorders
-
Anorexia can develop into Bulimia
-
but rarely the other way around
- but rarely the other way around
1:27
What is the DSM-5 criteria for Bulimia Nervosa?
-
1. Recurrent episodes of binge eating
-
In 2 hours food intake > normal
-
Lack of control over eating during the period
-
2. Recurrent inappropriate compensatory behaviour to prevent weight gain.
-
Vomiting/laxatives/diuretics/excessive exercise
-
3. Symptoms at least once a week for 3 months
-
4. Self evaluation is unduly influenced by body shape and weight.
-
5. The disturbance does not occur exclusively during periods of Anorexia Nervosa.
- In 2 hours food intake > normal
- Lack of control over eating during the period
- Vomiting/laxatives/diuretics/excessive exercise
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1:27:10
What feature distinguishes Bulimia from Anorexia?
-
People suffering from Bulimia are usually of 'normal' weight
slide11
Why would someone with Bulimia maintain 'normal' weight?
-
they are not restricting their calories
-
they take in too many calories & then purge
-
whereas anorexia (severe calorie restriction)
- they take in too many calories & then purge
128:00
Who is most typically develops Bulimia Nervosa?
-
Typically found in older adolescents/ young women.
-
90% of cases are female
-
Low incidence : 1-2% of the population
- 90% of cases are female
- Low incidence : 1-2% of the population
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1:29:15
How does Bulimia Nervosa usually start?
-
similar to Anorexia
-
rigid control of diet & fear of gaining weight
-
very aware of intake
-
may meet criteria for Anorexia early on
-
but then bingeing/purging behaviour kicks in & end up moving into Bulimia
- very aware of intake
- may meet criteria for Anorexia early on
- but then bingeing/purging behaviour kicks in & end up moving into Bulimia
129:50
What are some secondary (comorbid) physical risks associated with Bulimia?
-
Suicide
-
rates are high but lower than with Anorexia Nervosa
-
Electrolyte imbalance/ depletion
-
-
from frequent purging
-
Severe dental problems
-
from frequent vomiting
-
(ph balance destroyed – excess acidic gastric secretions destroy enamel on teeth).
- rates are high but lower than with Anorexia Nervosa
- from frequent purging
- from frequent vomiting
- (ph balance destroyed – excess acidic gastric secretions destroy enamel on teeth).
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130:30
How likely is recovery from Bulimia?
-
Prognosis is more optimistic than with Anorexia
-
about 70% recover
-
more successful treatment for Bulimia
-
Recovery Depends on stage of disorder where intervention begins.
-
Comorbity with other disorders.
- about 70% recover
- more successful treatment for Bulimia
Death rate: 0-2% (too high) but lower than Anorexia
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131:10
What is the difference between the DSM-5 severity rating for
Anorexia Nervosa & Bulimia Nervosa
Anorexia: BMI
Bulimia: number of times purging during a week
mild: 1-3
extreme: >14
for exam dont think about the numbers - think about the concept
128:40
What is the DSM-5 criteria for Binge Eating Disorder?
-
1. Recurrent episodes of binge eating
-
> food intake in 2hours
-
Lack of control
-
2. The Binge eating episodes are associated with 3 or more of the following:
-
Eating more rapidly than normal
-
Eating until uncomfortably full
-
Eating large amounts when not hungry
-
Eating alone because of embarrassment
-
Feeling disgusted/guilty/upset afterwards
-
3. Marked distress regarding binge eating episode
-
4. Binge eating occurs 1/wk for > 3mths
-
5. NO compensatory behaviour.
- > food intake in 2hours
- Lack of control
- Eating more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts when not hungry
- Eating alone because of embarrassment
- Feeling disgusted/guilty/upset afterwards
slide13
What is the main difference between Bulimia & Binge Eating Disorder?
-
No compensatory behaviour in Binge Eating Disorder
133:00
Are there any gender differences in the prevalence of Binge Eating Disorder?
If so, how does the gender disparity compare to Anorexia & Bulimia?
-
Women: more prevalent than men
-
Gender disparity is much closer than Anorexia & Bulimia
133:20
134:35
How does the prevalence of Binge Eating Disorder compare to the other eating disorders?
-
Binge Eating Disorder is more prevalent than Anorexia & Bulimia
133:00