Week 4 Lecture 4b - Eating Disorders (112:50) (DN) Flashcards Preview

• 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).

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130:30

• 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.

Death rate: 0-2% (too high) but lower than Anorexia

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131:10

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

• 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.

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• No compensatory behaviour in Binge Eating Disorder

133:00

• Women: more prevalent than men
• Gender disparity is much closer than Anorexia & Bulimia

133:20

134:35

• Binge Eating Disorder is more prevalent than Anorexia & Bulimia

133:00

• Once a disorder has its own classification - an abundance of research is normally done

• Binge Eating Disorder has only just received a separate classification in DSM
  • and there is very little research in literature
  • this is likely to change with its separate classification in DSM-5 (2013)

133:40

• People with Binge Eating Disorder are likley to be obese
  • but all obese people do not necessarily have BED

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133:45

• Factors leading to BED:
  • Childhood obesity
  • Negative weight comments
  • Depression
  • Childhood abuse

Outcomes are less severe than other eating disorders

Largely Psychological issues

• impairments in
  • social functioning
  • work
  • self esteem
• more likely to engage in substance abuse

Health impacts are very different to Anorexia & Bulimia

• Directly related to the weight gain of the disorder
  • Type 2 Diabetes
  • Cardiovascular disease
  • Breathing problems
  • Sleep Apnoea
  • Joint & muscular problems

not much in the literature likely to increase over the next 5-10 years with its inclusion in the DSM-5 as a stand alone disorder

135:15

• Genetic factors
• Neurobiological factors
• Psychodynamic/Environmental factors
• Cognitive Behavioural factors

• Both major disorders are familial
• Anorexic Patients – 1st degree relatives 10 times more likely to have the same disorder.
• Bulimic Patients – 1st degree relatives 4 times more likely to have the same disorder

1:36:00

• Monozygotic - from same embryo
• Dizygotic - share 50% genetic

• Monozygotic twins ↑ concordance rate for eating disorders than dizygotic twins.
  • this is evidence for a genetic component to eating disorders

1:36:35

• Mostly a social & psychological focus in the literature.
• Some genetic factors have been identified but low power
• further work required.

1:37:15

• Role of the hypothalamus?
  • animal studies lesioned - led to decreased appetite
  • but accompanied by an indifference to food
    • (different to eating disorders where focus is on food)
• Endogenous opioids
  • enhances mood, suppresses appetite.
  • ↑ during starvation & exercise
  • Reinforcing state?
• Most severe Bulimia cases had lowest beta- endorphin 

1:37:30

• Serotonin promotes satiety thus are binges due to serotonin deficit?
• AN and BN ↓ serotonin metabolites
• AN who recover less well respond worse to serotonin agonists.
  • suggests serotonin may be playing a role in eating disorders 
• SSRIs effective for eating disorder treatment
  • question is - are you treating the disorder or symptoms e.g., depression, anxiety 

1:39:35

idea is that the core cause is a disturbed parent-child relationship.

1:41:40

• Children raised as ineffectual
  • so do not develop behaviour to gain competence, respect and effectiveness
• Failure to develop sense of self because of conflicting mother- daughter relationship
• Food symbol of relationship
• Binging/Purging is the conflict

• Early menarche
• Stress in mothers during pregnancy
• Premature birth or cephalhematoma in newborn babies

• Fear of fatness reinforced through successful dieting
• Media representations of “ideal”
  • + being overweight + comparison of self to other = body dissatisfaction 
• Troubled family/personal relationships
• Difficulty expressing emotions
• History of bullying/being teased/ridiculed for weight
  • Teased > body dissatisfaction > eating disorder
• History of physical and/or sexual abuse
• Family history of depression
• Weight loss Positively Reinforced by positive comments about weight loss

1:42:00

• Individuals who score high on restraint scale ate more.
• Even when preload was perceived as fattenting
• Even when food unpleasant

Low Restraint Pre-load No pre-load Rate Amount Measured High Restraint Pre-load No pre-load Rate Amount Measured 

• Low self-esteem & high negative affect
• dieting to feel better about self
• food intake is restricted too severley
• diet is broken
• binge
• Compensatory behaviours to reduce fears of weight gain
  • (e.g., vomiting, laxatives)

• When restrained from purging
  • ↑ anxiety and skin conductance when eating

• Women are socialized to look ‘nice’
  • pressure accompanied with that combined with other contributory factors may lead to an eating disorder
• Definition of ‘nice’ varies dramatically over time if visual records are used as a guide.
• Changes very marked during 20th and early 21st century,
  • last 25 years popular culture has settled on an ideal of very thin women.

• Yes
• Definition of ‘nice’ varies dramatically over time if visual records are used as a guide.
• Changes very marked during 20th and early 21st century,
• Circumstantial evidence suggested Rubens’ concept of beauty (full figured women) was common among his contemporaries

• Dieting is now more common
• (1950 vs. 1999: Men - 7% - 29%; women - 14% - 44%)
• Eating disorders often preceded by periods of dieting
• Body dissatisfaction
  • (for whatever reason – overweight; exposure to societal “norms” in media) are risk factors for eating disorders.
  • not causal
• last 25 years popular culture has settled on an ideal of very thin women.

• Anti-Depressants
  •  Fluoxetine ↓ binge eating and vomiting in BN compared to placebo.
  • Also ↓ depression and distorted view toward eating.
  • Problem = drop-out rate.
    • 1/3 of women dropped out of study (side effects)
  • Relapse when medication withdrawn
  • AN does not respond well to anti- depressant medication

Anorexia

• Two tiered process:
  • 1) Hospitalization immediate weight gain
  • 2) Operant conditioning to achieve healthy weight
• CBT + Hospitalization = ↓ of anorexic symptoms after 1yr 
• Family therapy
• Lunch meetings to
  • 1. Change patient role of anorexic
  • 2. Redefine issue as an interpersonal issue (not personal)
  • 3. Prevent parents using the disorder to prevent conflict
• Preliminary data suggest this is effective

Bulimia

• CBT most valid and current gold-standard
  • Cognition–i.e.challenge perception of “thin”
  • Behaviour–i.e.being taught assertiveness skills
• CBT better than anti-depressants at 1, 6 and 10-y follow up
• Purging decreases by 70-90%
• However, LARGE individual differences.
• Interpersonal therapy and family therapy options.

• Newly formed so data scarce.
• CBT and IPT most effective
• More work required!

• Anorexia nervosa and Bulimia nervosa, separate but related eating disorders of low incidence in population

• Bulimia more amenable to intervention and treatment

• Anorexia nervosa has life-threatening consequences in end stages of wasting that results

• Binge Eating Disorder – new classification in 2013.

• Aetiologies are speculative, at best, and this impedes treatment and prognosis for both groups

• Some treatment programmes report good recovery rates after one-year post-treatment, but relapses occur