Eating Disorders Exam 1

eating disorders

• form of mental disorder characterized by problems w/ eating

• distinguished from normal variations in eating based on at least one of the following criteria:

  • distress → worrying, anxiety, upset, suffering

  • impairment → interfering w/ daily life, harder to perform roles/responsibilities, harder to do what you like, etc.

anorexia nervosa

1. restriction of energy intake leading to significantly low body weight

2. intense fear of gaining weight or becoming fat, or persistent behavior that interferes w/ weight gain

   1. ex: excessive exercise, fasting, etc.

3. disturbance in experience of body weight, undue influence on self-evaluation or denial of the seriousness of low weight

   1. many deny being skinny b/c they genuinely believe it

   2. some think they’re generally thin by specific points are “fat”

   3. individual self-worth reliant on self-concept/perception

low body weight

what does it mean to have this?

• for adults, general guideline is BMI < 18.5 kg/m²

• for children, general guidelines is below the 5th percentile for age, gender, height on growth curve

anorexia nervosa subtypes

both meet the same criteria 1-3

• restricting

• binge/purge subtype; more comorbidity cases, more impulsivity, more chronic course

bulimia nervosa

1. recurrent episodes (occurring at least 1/week on avg. for three months) of binge eating characterized by both:

   1. eating within a 2-hour period an amount of food that’s definitely larger than most people would eat in similar conditions

   2. sense of loss control during the episode → feeling like you can’t stop once started/couldn’t have stopped episode ahead of time

      1. “autopilot” ; “50/50 in/out of control is still loss of control)

2. recurrent (occurring at least 1/week on avg. for three months) inappropriate compensatory behaviors in order to prevent weight gain

3. undue influence on weight/shape on self-evaluation

4. no low weight (not anorexia)

binge eating disorder

1. recurrent (occurring at least 1/week on avg. for three months) episodes of binge eating (same core features as BN required)

2. binge episodes accompanied by 3 or more associated symptoms:

   1. eating much more rapidly than normal

   2. eating until feeling uncomfortable full

   3. eating large amounts of food when not feeling physically hungry

   4. eating alone b/c of feeling embarrassed by how much one’s eating

   5. feeling disgusted w/ oneself, depressed, very guilt afterward

3. distress regarding binge eating is present

4. not low weight/no compensatory behaviors (it’s not AN or BN)

   1. infrequent/non-recurring compensatory can sometimes be overlooked

large food amount

what does this mean? → definition differs based on situation

• holidays, special occasions, etc. often leads to eating lots of food

• calorie count as a guideline; meal should be >1000 avg.

• usually if something’s served as one (ex: one plate) it’s not large (objectively)

OSFED

disordered eating that doesn’t meet criteria for AN, BN, or BED or feeding disorders (pica, rumination, ARFID)

atypical AN

all criteria for AN met, except that, despite significant weightless, the individual’s current weight is in the normal range

BN of low frequency/limited duration

all criteria for BN met except that binge eating and ICB occur at a frequency of less than 1/week or duration of < 3 months

BED of low frequency/limited duration

all criteria for BED met except that binge eating occurs at a frequency of less than 1/week or duration of < 3 months

purging disorder

recurrent purging in the absence of binge eating

night eating syndrome

recurrent night eating (nocturnal eating or excessive intake after evening meal) of which the person is aware

protecting men from EDs

• potentially through the way EDs are defined

  • AN/BN defined by body image disturbance related to weight/shape

  • BED not defined by body image disturbance

    • this is much more prevalent in men compared to AN/BN

• societal ideals of how men and women should look like

  • men → muscular

  • women → thin

muscle dysmorphia

• '“reverse anorexia”, “bigorexia”

• dietary manipulations to increase muscle mass/decrease body fat

• excessive exercise to build muscle mass

• misperception of size: perceive body as puny despite their well-muscled physique

• abuse of anabolic-androgenic steroids

steroids

• human-made derivatives of testosterone

  • increase protein synthesis/muscle mass

    • reason for abuse: desired for increased strength, improved athletic performance, enhanced appearance

• negative effects:

  • damage to the musculoskeletal, cardiovascular, endocrine/reproductive, liver systems

  • increased mood lability, anger, physical outbursts

amenorrhea

loss of menstrual cycle

acculturation

assimilation to a different culture, typically the dominant one

acculturative stress

conflict between cultural values

• Hispanic individuals had higher levels when it came to EDs

• no evidence of this being a catalyst in Asian individuals

refeeding syndrome

reintroducing too much food too quickly to a person in a state of starvation

point prevalence

statistic evaluates the percentage of a population that has a disorder at a given time

incidence

number of new cases of an illness per 100k people per year

set-point theory

theory that argues that bodies have evolved weight-defending mechanisms in order to to survive for longer periods of famine that make it harder to lose weight

William Gull

coined the term “Anorexia Nervosa”

sir Richard Morton

1869 → credited as having described the first case description of anorexia

AN over time

• “Holy Anorexia" → self-starvation as penitence, path to religious piety and purity

• in the early stages, anorexia was more of something that was done due to moral superiority than it was because of body image issues

• “miraculous maids” → spiritual/mystic beliefs

Gerald Russell

• first published clinical paper on “bulimia nervosa”

• “ominous variant of anorexia nervosa”

  • only ED that would come to mind before this was AN (other ones weren’t invented yet)

prevalence

proportion (%) of a population with the illness

lifetime prevalence

proportion that has EVER has the disorder in their lifetime

12-month prevalence

proportion with the disorder in the past year

weight stigma

• refers to the negative attitudes, beliefs, stereotypes, and discriminatory behaviors directed towards individuals on their body weight/size

  • stereotyping

  • prejudice

  • discrimination

  • internalized stigma 

• elementary school experiment

stereotyping

• beliefs

  • involves applying generalized beliefs about a group of individuals without considering their personal characteristics, behaviors, or experiences

  • these can often be negative, inaccurate, and harmful

    • ex: lazy, poor health, lack of intelligence

  • ex: an employer assumes someone with a larger body is less energetic

prejudice

• feelings

  • negative feelings/attitudes towards people based on their membership in a group

  • ex: feeling disgusted/irritated by someone b/c of their weight

discrimination

• behavior

  • unfair treatment of people based on their group membership

  • ex: patient w/ knee pain is told to “just lose weight” rather than being properly evaluated for their injuries

  • this is an action/behavior done

internalized weight stigma

• when a person absorbs/believes negative societal stereotypes about their weight + applies it to themselves

• they begin to judge themselves harshly based on body size

  • undue influence of shape weight on self-evaluation

grillot/keel (2018)

• most of what we know about who suffers from EDs is based on who seeks treatment for their problems

• Q: why are men less likely to seek treatment for ED?

  • most people never seek treatment for their problems → especially men

  • most people don’t recognize they have a problem w/ their eating

    • men/women equally bad at recognizing they have an ED

Becker et al. (2002)

• Q: does exposure to Western media increase disordered eating in non-Western cultures?

  • introduction of TV to Fiji showed that yes this is the case

  • vomiting went from no one at the start of the study to a significant increase at the end of it

Watson et al. (2017)

• Q: how has disordered eating changed over time in sexual minority boys/girls? do they differ from straight counterparts? have disparities changed over time?

  • improvements in straight adolescents regardless of sex

    • changes in gay adolescents depended on sex, especially purging

      • improvement in males

      • worsening in females

  • differences in sexual majority/minority groups

    • more disordered eating in gay/bi adolescents compared to straight ones

    • no ED behaviors more common in straight kids compared to gay ones

rodgers et al. (2017)

• thin ideal promoted by modeling

• would models endorse the pressure by agents/industry? more likely to use UWCB?

  • majority of models endorses pressures to lose weight

  • weight control behaviors more common in models, and all weight control behaviors but vomiting were associated w/ pressures to lose weight for work

  • models who are most likely to be helped by policy changes evaluates them least positively

keys/colleagues (1950)

• recruited healthy young men

  • initial weight loss occurred rapidly

  • continued weight loss slowed dramatically

    • bodies were resisting the additional weight loss thought their basal metabolic rate

  • weight loss made men experience

    • increased depression, apathy

    • food related rituals/obsessions

      • onset of BE episodes in 29% of men after the study

vartanian et al. (2018)

• Q: how do everyday experiences of weight stigma affect people’s mood/motivation to diet, exercise, lose weight?

  • weight stigma in daily life undermines health-related motivation rather than encouraging changing behavior

  • diminished positive affect following stigma experiences drives reduced motivation

  • effects amplified for those high in internalized weight bias, have experienced frequent prior stigma, and women

marques et al. (2011)

• do racial/ethnic groups differ in ED prevalence?

  • EDs occur across all ethnic/racial groups

  • Latino + African American individuals at increased risk for BN

    • statistically significant

    • acculturative stress may play a role in this (specifically for Latinos)

  • 12-month prevalence still statistically significant

Jackson et al. (2006)

• is western culture the only source of cultural influence on EDs?

  • the NK/KI/KA study

  • measure of acculturation was not associated w/ levels of disordered eating in KA or KI women

    • worse eating pathology in KI/NK over KA

    • suggests that western culture is not the only source of cultural influences that may contribute to EDs