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

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How does a classification within DSM impact the literature on eating disorders?

Use Binge Eating Disorder as an example...

  • 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)




What is an important distinction when considering obesity and Binge Eating Disorder (BED)?

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





What are some factors that may lead to BED?

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


What are Outcomes of Binge Eating Disorder? 

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




What factors are considered in the aetiology of eating disorders?

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


Genetic 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




What have twin studies shown with regard to eating disorders? Nature or Nurture?

  • 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




Why is much more work needed in the area of genetic contribution?

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



Neurobiological factors

  • 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 




What role might serotonin play in eating disorders?

  • 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 




Psychodynamic factors: what is the underlying thought in the literature?

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




What elements of a parent-child relationship may be 'disturbed' when considering the psychodynamic factors in eating disorders?

  • 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


What environmental factors may contribute to eating disorders?

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


Cognitive Behavioural factors of Bulimia Nervosa...

  • 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




What were the findings of Polivy et al., 1976; 1988; 1994?

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


Briefly describe the experimental design Polivy et al., employed?

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


Briefly describe the cycle of bulimia nervosa?

  • 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, what physical symptoms are seen in a person with Bulimia?

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


How does society impact the way women see themselves?

Are Socio-Cultural Influences vulnerable to the passing of time?

  • 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.


Are Socio-Cultural Influences vulnerable to the passing of time?

If so, how have these influences changes, and is there an impact on eating disorders?

  • 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.


What pharmacological interventions have been used in the treatment of eating disorders?

What are the problems with these interventions?

  • 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


What Psychological Interventions are used in the treatment of Anorexia Nervosa?


  • 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


What Psychological Interventions are used in the treatment of Bulimia Nervosa?


  • 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.


What Psychological Interventions are used in the treatment of Binge Eating Disorder?

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


Lecture Summary

  • 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