Week 7 - Eating Disorders Flashcards
(19 cards)
ED diagnostic crossover
If someone meets criteria for one disorder, they likely meet criteria for another (AN restricting + AN B-P, BN + binge eating, etc.)
Potential signs of ED
Excessive exercise, weight preoccupation, abnormal electrolyte levels, fear of weight gain, large food intake, anxiety/avoidance of eating
Anorexia Nervosa
A. Restriction of energy intake > less than minimal normal weight (BMI 17)
B. Intense fear of weight gain or behaviour that interferes with weight gain
C. Disturbance in weight experience, influence of weight in self-evaluation, denial of low weight
Specify:
- Restricting or binge-purge
- In partial/full remission
- Mild (<17), moderate (16-17), severe (15-16), extreme (<15)
Atypical Anorexia Nervosa
ED symptoms cause distress/impairment but don’t meet full AN criteria
Individual remains in ‘normal’ weight range
AN prevalence
1% F, 0.3% M (6-7% F university, 20% in ballet performers)
Women 12x more likely to be diagnosed
Onset - usually 16-20 YO
Majority are white, female, high SES (develops in non-West after moving to West/media)
AtypAN prevalence - 0.2-4.9%
- Females more likely than males
- Males more likely for AtypAN than AN
- Whites more likely than non-whites
- Non-whites more likely for AtypAN than AN
Ave BMI for AtypAN (19.6-21.9)
Ave BMI for AN (16-17)
In clinical trials - 90% female, YA average age
AN comorbidity
Most have comorbid disorders - 70% lifetime depression, sexual dysfunction common, higher OCD rates, substance use (purge type)
Eating-related psychopathology more common in AtypAN, no difference in other psychopathology
Cardiac measures, bone density, CNS more abnormal in AN
Life impairment and QOL similar
AN key features and consequences
Key features - begins with dieting, disturbed weight experience, no eating in front of others, many in denial
Consequences - borrows energy from internal organs > organ damage/ cardiac arrest, electrolyte imbalance, amenorrhea, cold sensitive, lanugo, dry skin, brittle hair/nails, anaemia, joint issues, kidneys, hormone problems
Mortality rate - 5x higher than similarly aged females, 18x more likely for suicide than same aged peers, 5% die within 4 years of diagnosis (highest mortality of all disorders)
Minnesota starvation experiment
Weight loss and physical changes plus:
- Personality changes (depression, apathy)
- Social changes (loss of interest)
- Food preoccupation
Recovery took months to years
Bulimia Nervosa
A. Recurrent binge eating episodes (more than usual, lack of control)
B. Recurrent inappropriate compensatory behaviours
C. Both ^ occur on average once a week for 3 months
D. Self-evaluation unduly influenced by shape or weight
E. Disturbance not due to anorexia
Specifiers:
- In partial/full remission
- Severity - mild, moderate, severe (depends on compensation behaviours)
BN prevalence
1% (1.5% F, 0.5% M)
Onset - 21-24 (F)
Most have comorbid disorders - 50-70% mood disorder, 80% anxiety (PTSD, SAD, OCD), 2 in 5 substances
BN key features and consequences
Key features
- binges up to 4800 calories
- most individuals within 10% of normal weight
- CBs - purging (vomiting, laxatives), non-purging (exercise, fasting, restriction)
- Overly concerned with body, weight, guilt/shame
- 25-30% attempt suicide
- Similarities between BN people and those who only purge (no binge) in terms of behaviour frequency and mental symptoms
Consequences
- Less lethal than AN but 2x mortality compared to peers
- Erosion of enamel, mouth ulcers, puffy face, electrolyte imbalance, kidney fail, heart issues, seizures, intestine problems, colon damage
Binge Eating Disorder
A. Recurrent binge eating episodes
B. Binge eating associated with 3+:
- rapid eating, eating till uncomfortably full, eating when not hungry, eating alone to due embarrassment, guilt/disgust/depressed
C. Marked distress
D. On average 1 day/week for 3 months
E. No AN or BN or compensation
Specifiers:
- In partial/full remission
- Severity - mild, moderate, severe, extreme (based on binge #)
BED prevalence
1.3% (lifetime) - 1.5% F, 0.3% M (both may be a bit higher)
Higher rates in obese sample (6.5-8%), up to 30% in obese people seeking weight loss treatment
Most patients between 30-50
Comorbidity - anxiety (65%), mood (46-70%), substance (23%)
BED key features and consequences
Key features - more concern about weight/shape than other obese people, typical binge 1900 calories, poor impulse control disorders often comorbid
Consequences - shame, anxiety, depression, GI distress, obesity (CV disease, blood pressure, cholesterol, diabetes, arthritis, sleep problems, cancer)
Biological factors
Some genetic component - 4-5x more likely in relatives (possibly trait inheritance)
Low serotonergic activity in EDs (cause or consequence)
High ovarian hormones trigger emotional binge eating
Sociocultural and family factors
Media, social pressures for thinness (high SES), diet culture, body standards
Family - parents with distorted perception may restrict child intake, perfectionistic parents, families of anorexics (high achieving, appearance focused, critical, motivated to maintain harmony)
Psychological and behavioural factors
Psychological - internalised thin ideal, negative body image, low SE, perfectionism, negative emotion, mood intolerance, interpersonal difficulties
Behavioural - dieting, emotional eating
Transdiagnostic Formulation of EDs
Looks at underlying mechanisms of all EDs
Over-evaluation of shape and weight are key
Low SE > over-evaluation of shape/perfectionism > dieting/control behaviour > low weight or binge eating (and compensation) - moon intolerance and interpersonal difficulties affect outcomes
Treatment
Many don’t receive treatment for years (don’t see need to change, deeply ingrained, fear)
Psychological treatments equally effective - CBT, interpersonal therapy, family therapy
SSRIs may help binge-purge in bulimia, but no long impact
