Eating Disorders Midterm

Anorexia Nervosa Restricting Subtype (ANR)

During the last 3 months the individuals has not engaged in recurrent episodes of binge eating or purging behavior. Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

Anorexia Nervosa Binge-eating / Purging (ANBP)

During the last 3 months the individual has engaged in recurrent episodes of binge eating or purging behavior (self induced vomiting, misuse of laxative, diuretics, or enemas).

Anorexia Remission Specifiers: In Partial Remission

After full criteria for AN were previously met, criterion A (e.g., low body weight) has not been met for a sustained period, but either criterion B (e.g., fear of weight gain) or C (e.g., distorted body image) is still met.

Anorexia Remission Specifiers: In Full Remission

After full criteria for AN were previously met, none of the criteria have been for a sustained period of time.

Severity in Anorexia Nervosa: Mild

BMI = 17 - 17.99

Severity in Anorexia Nervosa: Moderate

BMI = 16 - 16.99

Severity in Anorexia Nervosa: Severe

BMI = 15 - 15.99

Severity in Anorexia Nervosa: Extreme

BMI < 15

DSM-5 Anorexia Nervosa Criteria A

Restriction of intake leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health

DSM-5 Anorexia Nervosa Criteria B

Intense fear of weight gain, persistent behavior to avoid weight gain, despite significant low weight

DSM-5 Anorexia Nervosa Criteria C

Disturbance in the way one's body weight or shape is experienced, and persistent lack of recognition of seriousness of current low body weight

DSM-5 Anorexia Nervosa Criteria D

Amenorrhea is no longer a requirement for diagnosis

DSM-5 Bulimia Nervosa Criteria A ( 1 + 2)

Recurrent episodes of binge eating

1. Eating, in discrete period of time (2hrs) amount of food that is definitely larger than most people would eating during that time

2. Sense of lack of control over eating during episodes

DSM-5 Bulimia Nervosa Criteria B

Recurrent inappropriate compensatory behavior to prevent weight gain

DSM-5 Bulimia Nervosa Criteria C

A+B occur on average of once a week for 3 months

DSM-5 Bulimia Nervosa Criteria D

Self-evaluation is unduly influenced by body shape and weight

DSM-5 Bulimia Nervosa Criteria E

Disturbance does not occur exclusively during episode of anorexia nervosa

Bulimia Remission Specifiers: In Partial Remission

After full criteria for BN were previously met some but not all of the criteria have been met for a sustained period

Bulimia Remission Specifiers: In Full Remission

After full criteria for BN were previously met, none of the criteria have been for a sustained period of time

Severity in Bulimia: Mild

1 - 3 compensatory behaviors per week

Severity in Bulimia: Moderate

4 - 7 compensatory behaviors per week

Severity in Bulimia: Severe

8 - 13 compensatory behaviors per week

Severity in Bulimia: Extreme

14 or more compensatory behaviors per week

DSM-5 Binge Eating Disorder Criteria A

Recurrent episodes of being eating characterized by (1) eating within a 2 hour time period an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances and (2) a sense of lack of control over eating during the episodes

DSM-5 Binge Eating Disorder Criteria B

Binge episodes are associated with three (or more):

1. Eating much more rapidly than normal

2. Eating until feeling uncomfortably full

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

4. Eating alone due to embarrassment of how much one is eating

5. Feelings disgusted, guilty, or depressed after overeating

DSM-5 Binge Eating Disorder Criteria C

Marked distress about binge eating

DSM-5 Binge Eating Disorder Criteria D

Bingeing occurs on average at least once a week for 3 months

DSM-5 Binge Eating Disorder Criteria E

There are no compensatory behaviors and does not occur during the diagnosis of BN or AN

Atypical Anorexia Nervosa

Despite significant weight loss individuals are NOT underweight

Atypical Anorexia Nervosa

Exhibits significant restriction and weight loss but weight is within or above normal range

Atypical Anorexia Nervosa

Exhibit body image disturbance that characterizes AN

Bulimia Nervosa of low frequency or limited duration

Exhibits episodes of binge eating and inappropriate compensatory behaviors for: less than once a week, less than three months, or both

Bulimia Nervosa of low frequency or limited duration

Experience undue influence of weight and shape on self evaluation

Binge Eating Disorder of low frequency or limited duration

Exhibit episodes of bing eating for: less than once a week, less than three months, or both

Binge Eating Disorder of low frequency or limited duration

Report at least 3 of the 5 features associated with BED diagnosis

Binge Eating Disorder of low frequency or limited duration

Marked distress over binge eating

Purging Disorder

Use of self induced vomiting, laxatives, diuretics, or other medications to purge after consuming normal amounts of food

Purging Disorder

Individuals are NOT underweight

Night Eating Disorder

Recurrent episodes of night eating after awakening from sleep: wake in middle of the night to eat large amounts of food, able to recall excessive eating, cause distress and/or functional impairment, and not due to hunger/missing a meal

Pica

Consumption of nonfood substances lacking nutritional value: e.g., dirt, glue, chalk, paper, consumption of non food for at least one month, consumption is inappropriate for age, consumption is not part of culturally supported tradition, and present in those with intellectual disabilities

Rumination Disorder

Regurgitation of food that has been swallowed. Food may be partially digested, re-chewed and re-swallowed or simply spit out

Avoidant/Restrictive Food Intake Disorder (ARFID)

Inadequate food intake due to: lack of interest in food or eating, avoidance of food because of sensory issues, and fears of negative consequences (e.g., choking or gagging). Significant weight loss, nutritional deficiencies, a need for tube feedings or nutritional supplements. Does not have AN or BN or body image disturbance

Obesity

Being extremely overweight, leading to harmful effects like cardiovascular disease, diabetes, pancreatic, colon, and breast cancer, etc.

What is Body Image?

Perception: seeing or feeling bodily dimensions, e.g., "I feel fat"; "I look fat"

What is Body Image?

Cognition: evaluation and thoughts related to body, size e.g., "I should lose weight"

What is Body Image?

Affect: emotions related to weight or shape, e.g., "I must be then to be happy"; "When I am unhappy I feel fat"

Media and Its Role in Body Image

Positive correlation between media exposure to the thin ideal with body dissatisfaction, internalization of the thin ideal, and disordered eating and beliefs. Positive correlation in adolescent girls between time spent watching music videos, soap operas, and movies with body image dissatisfaction

Society's Take

Thin = Good; Fat = Bad

Society's Take

Women hold more negative stereotypes about obesity than do men. Obese individuals viewed as "lazy, stupid, lonely, inept, weak, and dependent." Belief that weight can be controlled leaves people blaming obese individuals

Dieting Industry

Resting metabolic rate: Weight control is a balance between energy intake (eating) and energy expenditure (activity). Weight loss programs are a billion dollar industry. Total amount of money on weight loss programs has steadily increased while rates of obesity declining

Set Point Theory

Belief that brain mechanisms regulate body weight around a genetically predetermined "set point."

Men and Eating Disorders

10-15% of anorexia and bulimia suffers are male. There has been a 66% increase in hospital admissions for eating disorders in men

Risk Factors for Boys

Unlike girls puberty places boys closer toward the masculine ideal except for those who are overweight or gain extra weight during puberty. Major risk factor for boys is being overweight or heavy (e.g., chubby, "huskie jeans")

Characteristics of ED in Men

Instead of engaging in traditional compensatory behaviors like vomiting or abusing laxatives, men instead are more likely to exercise compulsively. Small percentage do purge (e.g., wrestlers). Approximately 40% of BED is diagnosed in men most common ED in men

Homosexuality

Higher incidence of ED in gay male culture. May be because there is greater emphasis on thinness as being attractive

Bogorexia

Muscular Dysmorphia: Obsession with gaining muscular mass and losing non-lean weight. Symptoms: Self perception of being thin despite muscular frame. Excessive concern for the body. Many hours a day spent thinking about the body. A considerable number of hours spent in the gym. Abandonment of other habitual activities, etc.

EDs in Caucasians

Data suggest that patients with EDs are more likely to be white and female. Studies show that 90% of the sample is white and female

African American Women

Generally believed that the African American women were protected from ED because the ideal image of beauty in this culture is a more voluptuous curvy woman. African Amercian women less likely to experience body dissatisfaction, disordered eating and BN compared to Caucasian women

Asian Women and ED

Asian women report less dieting and binge eating in comparison to Caucasian women. Asian women did not differ from Caucasian women in levels of body dissatisfaction. However, Asian women were thinner than Caucasian women in this sample and they selected a thinner ideal

Hispanic Women

ED in Hispanic cultures equals those found in Caucasians. Risk Factors:acculturation to US values is associated with higher levels of ED. 13.6% of highly acculturated Hispanic females diagnosed with ED. 0% of non-acculturated Hispanic females diagnosed with ED

Athletes and EDs: High risk sports

Aesthetic Sports: skating, dance, gymnastics. Weight Division Sports: judo, boxing, wrestling. Gym Sports: body building. Endurance Sports/Low Weight Sports Sports: distance running, cycling, swimming, horse racing, motorcycling

Real Weight

the individual's objective weight (e.g., the number on the scale)

Ideal Weight

marked by medical criteria established in terms of height, sex, age, and body constitution (e.g., healthy BMI)

Sports Weight

ideal weight for participating in a particular sport (e.g., weight needed to do well/excel in sports)

Female Athlete Triad: The Three Components

Eating disorder, Lack of menstrual periods, and Osteoporosis

Ideal weight = Sports weight

Consider their weight as ideal and is matched with sporting discipline

Ideal weight > Sports weight

Believe that healthy BMI would put them at a disadvantage when competing

Ideal weight < Sports weight

Believe that a healthy BMI is too low for what is needed to help them compete

Ego-syntonic

Behaviors, thoughts, and values are consistent with a person’s self-image and beliefs, often feeling natural and acceptable to them, even if they are maladaptive.

Ego-dystonic

Behaviors are in conflict with a person’s sense of self, causing distress, guilt, or anxiety because they feel repugnant, unacceptable, or “off.”