Chapter 10 - Self-Test Questions (Eating-Disorders)

What are thethree main eating disorders defined by DSM-5?

• Anorexia Nervosa (AN);

• Bulimia Nervosa (BN);

• Binge-Eating Disorder (BED).

Can you describe the main diagnostic criteria for anorexia nervosa?

• Significanty low body weight;

• Intense fear of gaining weight;

• Distorted body evaluation or excessive influence of weight on self-evaluation.

Can you describe the main diagnostic criteria for bulimia nervosa?

• Recurrent binge episodes;

• Compensatory behaviours (purging, fasting);

• Slef-disgust;

• Low self-esteem;

• Despression;

• Strong weight/shape concerns.

Can you describe the main diagnostic criteria for binge eating disorder?

• Recurrent binge episodes without purging;

• Often associated with major depression;

• Impaired functioning;

• Low self-esteem;

• Body dissatisfaction.

What are the prevalence rates for the main eating disorders, and how do incidence rates compare between males and females?

• AN: at any given year about 0.4% of young women meet the criteria, ~10:1 female-to-male ratio.

• BN: lifetime prevalence 1-3% in women.

Females are far more likely to develop eating disorders across all types.

Both anorexia nervosa and bulimia are highly comorbid with other psychiatric disorders - which ones?

AN: major depression & OCD

BN: major depression, borderline personality disorder, substance abuse

Can you describe some examples of eating disordered behaviour that has been reported throughout history? How do these reports resemble the modern-day symptoms of anorexia and bulimia?

Cases of self-starvation recorded in classical and medieval periods (e.g., “holy anorexia” sch as St. Catherine of Siena).

Binge-purge cycles historically rare; usually occurred only in fasting contexts.

Motivations often differed (religious, spiritual, convalescence), but symptoms resembles modern anorexia.

How do historical and cultural aspects of eating disorders help us to understand these disorders?

• Cultural ideals influence prevalence; self-starvation appears across history independent of Western body-image ideals;

• Bulimia strongly tied to Western thin-ideal exposure.

How do the symptoms and incidences of eating disorders differ across cultures and ethnic groups?

• BN rarely appearn without Western influence.

• Anorexia reported even in cultures without Western ideals.

• Ethnic minorities in the US show lower rates, but rates rise with exposure to Western this ideals.

What are some of the reasons for eating disorders developing in men?

Linked to emphasis on body shape/weight in male subgroups (bodybuilders, athletes, dancers, gay men); pressures toward muscularity or leanness increase risk.

Can you name some of the important risk factors for AN and BN?

• Perfectionism;

• Coercive/hostile parenting;

• Body dissatisfaction;

• Dieting;

• Negative affect;

• Sociocultural pressure;

• Trauma;

• Genetic vulnerability.

Can you describe some of the biological factors that might be involved in the development of an eating disorder?

• Genetic influences;

• Epigenetic from stress/starvation;

• Neurotransmitter involvement (opioid, serotonin, dopamine systems).

What role might brain neurotransmitters play in the acquisition and maintenance of eating disorder symptoms?

Associated with reward pathways;

• Disruptions in serotonin;

• Dopamine;

• Opioid systems

These may influence symptom aquisition or maintenance.

Can you name some of the important sociocultural factors that influence the development of eating disorders? What evidence is there that these factors influence body dissatisfaction and attitudes to dieting?

• Media thin ideals;

• Peer influence;

• Parental attitudes;

• Occupations emphasising thinness/weight control.

Media and peer pressure increase dieting and body dissatisfaction; body dissatisfaction predicts disordered eating across groups.

What are the important dispositional factors associated with eating disorders? Do they have a causal role to play in the development of an eating disorder?

• Low self-esteem;

• Perfectionism;

• Interpersonal problems;

• Mood intolerance.

Likely maintain and contribute to onset of eating disorders.

What are the main features of the tripartite model of eating disorders?

Media, parents, and peers influence the individual → internalisation of ideals + social comparison → body dissatisfaction → disordered eating.

Can you name the three main forms of treatment for eating disorders? Which ones are more suited to bulimia or to anorexia, and why?

(1) CBT/CBT-E: most effective for BN; also used for AN.

(2) Family therapy (e.g., Maudsley, MANTRA): especially effective for AN.

(3) Pharmacological treatment: antidepressants help depression but limited effect on core symptoms.

What is the rationale for adopting a CBT approach to treatment of BN, and what are the important stages of this treatment?

BN is driven by dysfunctional weight/shape beliefs and dietary restraint → CBT targets these.

Stages:

1. Meal planning & stimulus control.

2. Cognitive restructuring of weight/shape beliefs.

3. Relapse-prevention strategies.

How succesful are pharmacological interventions in the treatment of eating disorders?

• May reduce depression and anxiety

• Limited effects on weight gain or core features

• Higher dropout and side effects compared to psychological therapies.

What are the main features of family therapy for eating disorders?

• Addresses dysfunctional family patterns (enmeshment, overprotestiveness, rigidity);

• Explores family conflicts;

• Challenges eating-disorder-maintaining roles;

• Effective esprecially for AN;

• Includes approaches such as Maudsley FBT and MANTRA.