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z. z. PSY3032 Lectures - Abnormal Psychology > Week 4 Lecture 4b - Eating Disorders (112:50) (DN) > Flashcards

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

Lecture Content Eating Disorders: Diagnosis and Prognosis  1. Anorexia Nervosa  2. Bulimia Nervosa  3. Binge Eating Disorder Aetiological Factors Genetic; Neurobiological; Psychodynamic; Environmental; Cognitive Behavioural Socio-Cultural Factors Gender; Cross-Cultural; Ethnic; Personality & Child Abuse Treatment Options Prescribed Reading Ch11 Exam based on chapter & lecture content

1
Q

Describe normal eating?

A

A pattern of eating behaviours which:

  • Maintains normal weight
  • Ensures adequate nutrition
  • Conforms with cultural/religious requirements
  • Enjoyable

1:14:50

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2
Q

What are some of the consequences of ‘abnormal’ eating?

A
  • Constant “dieting”
  • Morbid Obesity
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge Eating Disorder
  • Eating disorders are not secondary to other disorders, they are primary disorders
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3
Q

How common are eating disorders?

A
  • one of most common disorders in western world
  • alongside depression & anxiety
  • one of the most common to result in death of a patient
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4
Q

What are some of the disorders not otherwise specified in the DSM-5?

A
  • pika - eating odd things
  • rumination - eating, vomiting & re-eating it

1:18ish

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5
Q

What is the DSM-5 Criteria for Anorexia Nervosa?

A
  • 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.

slide7

1:18:50

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6
Q

What are the two sub-types of Anorexia Nervosa?

A
  • Restricting Type
    • Not regularly engaged in binge eating or purging behaviours
  • Purging Type
    • Regularly engaged in binge eating and purging behaviours.

slide7

120:30ish

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7
Q

What is the Anorexia Nervosa severity scale in DSM-5 based on?

A
  • Body Mass Index (BMI)
    121: 40
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8
Q

What are the 4 criteria on the Distorted Attitude Toward Eating Scales?

A
  1. Current
  2. Ideal
  3. Attractive (what they think is attractive)
  4. Other Attractive (what others think is attractive)
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9
Q

How would a person with anorexia most likely score on Zellner’s Distorted Body Image Scale?

A

High on Distorted Attitude

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10
Q

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?

A
  • **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
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11
Q

Are there any gender similarities/differences on the ‘Distorted Attitude Toward Eating Scale’?

A
  • No real gender difference between ideal distortions
  • Men tend to overestimate their current weight
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12
Q

What are some physical outcomes of the chronic starvation associated with in anorexia nervosa?

A
  • 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

123:10

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13
Q

What are the Psychological changes associated with anorexia

A
  • Patient is no longer rational
  • Personality changes

124:10

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14
Q

Who most typically suffers with anorexia nervosa?

What may be some early indicators in this demographic?

A
  • 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

124:30

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15
Q

What is the prognosis for anorexia?

A
  • 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

1:26

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16
Q

What is the prevalence of Anorexia In the overall poulation?

A
  • Rare disease – 1% or less of the population
    • (but 3rd most common disease in young girls)
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17
Q

What other disorders/conditions are often comorbid with anorexia?

A
  • Depression
  • Anxiety
  • Obsessive Compulsive Disorders
  • Phobias

125:25

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18
Q

Do patients swap between Anorexia & Bulimia?

i.e., cross-over disorders

A
  • Anorexia can develop into Bulimia
    • but rarely the other way around

1:27

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19
Q

What is the DSM-5 criteria for Bulimia Nervosa?

A
    1. Recurrent episodes of binge eating
      * In 2 hours food intake > normal
      * Lack of control over eating during the period
    1. Recurrent inappropriate compensatory behaviour to prevent weight gain.
      * Vomiting/laxatives/diuretics/excessive exercise
    1. Symptoms at least once a week for 3 months
    1. Self evaluation is unduly influenced by body shape and weight.
    1. The disturbance does not occur exclusively during periods of Anorexia Nervosa.

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1:27:10

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20
Q

What feature distinguishes Bulimia from Anorexia?

A
  • People suffering from Bulimia are usually of ‘normal’ weight

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21
Q

Why would someone with Bulimia maintain ‘normal’ weight?

A
  • they are not restricting their calories
    • they take in too many calories & then purge
  • whereas anorexia (severe calorie restriction)

128:00

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22
Q

Who is most typically develops Bulimia Nervosa?

A
  • Typically found in older adolescents/ young women.
    • 90% of cases are female
    • Low incidence : 1-2% of the population

slide12

1:29:15

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23
Q

How does Bulimia Nervosa usually start?

A
  • 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

129:50

24
Q

What are some secondary (comorbid) physical risks associated with Bulimia?

A
  • 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).

slide12

130:30

25
Q

How likely is recovery from Bulimia?

A
  • 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

slide12

131:10

26
Q

What is the difference between the DSM-5 severity rating for

Anorexia Nervosa & Bulimia Nervosa

A

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

27
Q

What is the DSM-5 criteria for Binge Eating Disorder?

A
    1. Recurrent episodes of binge eating
      * > food intake in 2hours
      * Lack of control
    1. 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
    1. Marked distress regarding binge eating episode
    1. Binge eating occurs 1/wk for > 3mths
    1. NO compensatory behaviour.

slide13

28
Q

What is the main difference between Bulimia & Binge Eating Disorder?

A
  • No compensatory behaviour in Binge Eating Disorder
    133: 00
29
Q

Are there any gender differences in the prevalence of Binge Eating Disorder?

If so, how does the gender disparity compare to Anorexia & Bulimia?

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

133: 20
134: 35

30
Q

How does the prevalence of Binge Eating Disorder compare to the other eating disorders?

A
  • Binge Eating Disorder is more prevalent than Anorexia & Bulimia
    133: 00
31
Q

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

Use Binge Eating Disorder as an example…

A
  • 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

32
Q

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

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

slide14

133:45

33
Q

What are some factors that may lead to BED?

A
  • Factors leading to BED:
    • Childhood obesity
    • Negative weight comments
    • Depression
    • Childhood abuse
34
Q

What are Outcomes of Binge Eating Disorder?

A

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

35
Q

What factors are considered in the aetiology of eating disorders?

A
  • Genetic factors
  • Neurobiological factors
  • Psychodynamic/Environmental factors
  • Cognitive Behavioural factors
36
Q

Genetic factors

A
  • 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

37
Q

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

A
  • 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

38
Q

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

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

1:37:15

39
Q

Neurobiological factors

A
  • 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

40
Q

What role might serotonin play in eating disorders?

A
  • 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

41
Q

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

A

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

1:41:40

42
Q

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

A
  • 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
43
Q

What environmental factors may contribute to eating disorders?

A
  • Early menarche
  • Stress in mothers during pregnancy
  • Premature birth or cephalhematoma in newborn babies
44
Q

Cognitive Behavioural factors of Bulimia Nervosa…

A
  • 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

45
Q

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

A
  • Individuals who score high on restraint scale ate more.
  • Even when preload was perceived as fattenting
  • Even when food unpleasant
46
Q

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

A

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

47
Q

Briefly describe the cycle of bulimia nervosa?

A
  • 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)
48
Q

When restrained from purging, what physical symptoms are seen in a person with Bulimia?

A
  • When restrained from purging
    • ↑ anxiety and skin conductance when eating
49
Q

How does society impact the way women see themselves?

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

A
  • 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.
50
Q

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?

A
  • 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.
51
Q

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

What are the problems with these interventions?

A
  • 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
52
Q

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

A

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
      1. Redefine issue as an interpersonal issue (not personal)
      1. Prevent parents using the disorder to prevent conflict
  • Preliminary data suggest this is effective
53
Q

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

A

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.
54
Q

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

A
  • Newly formed so data scarce.
  • CBT and IPT most effective
  • More work required!
55
Q

Lecture Summary

A
  • 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

z. z. PSY3032 Lectures - Abnormal Psychology (20 decks)

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