Eating Disorders - Midterm 3

What are the three eating disorder and what is interesting about them?

• Anorexia Nervosa

• Bulimia Nervosa

• Binge-Eating Disorder

They are all mutually exclusive, you can only meet diagnostic criteria for one

State the DSM Criteria for Anorexia Nervousa

• Significantly Low Body weight

• Intense fear of weight gain or repeated behaviours to interfere with weight gain

• Body image disturbance

What are the two different subtypes of Anorexia Nervosa

• Binge-eating-puring:

• Restricting:

Explain the binge-eating-purging subtype for Anorexia Nervosa

• Recurrent ep. of binge eating or purging (more than 2)

• Don’t have to engage in both

Explain the restricting subtype for Anorexia Nervosa

• performed in the absence of binging/purging

• Restricting diet heavily

Define binge eating

Eating in 2 hours a significantly larger amount of food and a lack of control over the binge

Define purging behaviour

Self-induced vomiting or the misuse of laxatives, diurectics, enemas

Age of onset for AN

Early teenage years, 75% before the age of 22

Difference between rates of AN in women vs men

Women 10x as likely to develop disorder as men

Why might women be so much more likely to develop AN

• Many factors

• Cultural pressures may play a strong role

• May not capture presentation in men. With the current way the disorder is defined

Effects of AN

Effects entire body, alterations in neural transmission

What is the prognosis for AN (recovery rate? Death rates?)

• 50-70% recover

• 6-7 years on average to recover

• Death rates (for any reason) are higher in those with AN

What is one aspect of AN that is really hard to change

View of self are particularly hard to modify. Stays even after treated

State the Diagnostic Criteria for Bulimia Nervous

Uncontrollable eating binges followed by compensatory behaviour to prevent weight gain

• Recurrent episodes of binge-eating characterized by both:

  1. An excessive amount of food consumed in under 2 hours

  2. A feeling of loss of control over eating

• Recurrent compensatory behaviors

• At least 1/wk for 3 months

• Self-evaluation is influenced by body shape and weight

• Does not occur exclusively during episodes of AN

What is a good way to distinguish between AN and BN

Difference is on body weight.

• Significantly low body weight = AN

• Not significantly low body weight = Bulimia

Body weight is really the only factor that distinguishes the two. Compensatory behav. present in both

Onset of BN

Late adolescence or early adulthood

Women vs Men for BN

90% of people with BN are women

What are some physical changes in BN?

• Females can experience menstrual irregularities

• Potassium Depletion

• Laxative use depletes electrolytes which can cause cardiac irregularities

Does bulima affect your entire body

Yes, brain + body are both affected

What is the prognosis for BN?

• 75% recover and 10% remain fully symptomatic

  • Long-term converts of BN

What leads to better long term outcomes with respect to BN?

Benefits of early intervention

DSM-5 Criteria for binge eating disorder (BED)

• Recurrent binges (atleast one per week for atleast 3 months)

• Loss of control during binge

• Binge can cause distress

• Absence of compensatory behaviours

What is the key difference between BED and BN

BED → no compensatory behaviours, just binging and then feeling bad about binging

What is the relation of obesity, dieting and BMI for BED

Associated with obesity, history of dieting, and BMI > 30.

Most but not all people are obese (BMI > 30)

What is the gender difference in BED

Gender difference is unclear

What are some physical changes in BED

• Problems associated with obesity

  • Cardiovascular disease

  • Physical ailments

• Problems independent of obesity

  • Sleep problems

  • Anxiety/depression

  • Early menstruation in women

Prognosis of BED

About 60% recover.

What are some risk factors with ED

• Family history (Genetics)

• Natural pain-reducing opioids

• Perfectionism

• Childhood sexual abuse

• Dieting

What is the prevalence for ED increasing while risk factors have remained the same

Largely due to sociocultural pressures. Body weight is increasing while ideal weight is decreasing

What are some effects of ED observed in children

• Difficulty starts early

• Increasing in prevalence

What are some genetic factors associated with ED

Seen to be transmitted from mother to daughter, also seen to be across multiple generations

What are some family factors involved with ED

• Maternal Commentary

• Maternal Modeling

What is maternal commentary

Comments that mothers make about both their own body and daughters body

What is maternal modelling

How mother model their interaction with food

What may the underlying factor in ED

Body dissatisfaction

What are some gender influences of ED?

• Thinness ideals

• Objectification of women’s bodies

• Misunderstanding of ED in men

Why might ED be misunderstood in men

Body dissatisfaction + dieting increases for men as they age while it decreases for women as they age

• Compensatory actions (heavy exercise) may be viewed as acceptable

How does ED affect gender-diverse individuals

• Higher prevalence

What are some factors that explain higher prevalence of ED in gender-diverse individuals

• Increased stress exposure

• Coping with environment

• Body dissatisfaction

Break down the meaning of the term Anorexia Nervious

• Anorexia = loss of appetite

• Nervosa = the lose is due to emotional reasons

What features of ED seem to be most heritable

• Body dissatisfaction

• Drive for thinness

• Weight preoccupation

State the role of the hypothalamus and why it is not a causal factor for ED

• Regulates hunger and eating

• Animals with hypothalamic lesions lose appetite; people with anorexia remain hungry yet still restrict

• Cannot account for body-image disturbance or fear of weight gain

What are endogenous opiods?

• Produced by the body; reduce pain, enhance mood, suppress appetite

Why might endogenous opioids play a role in ED

• Released during starvation → may create a positively reinforcing mood state in anorexia

• Excessive exercise also increases opioids → reinforcing cycle

What do brain imaging studies find about reward systems for anorexia

• People with anorexia show different activation patterns when viewing/tasting food

• Normal vs AN: differed in dorsal striatum (habitual choices, anxiety), but showed similar ventral striatum activation (reward)

What do brain imaging studies suggest about reward systems for anorexia

restrictive eating may become habitual and self-reinforcing

How is serotonin related to ED?

• Serotonin deficit → may prevent feeling full → promotes bingeing in bulimia/BED

• Food restriction interferes with serotonin synthesis → relevant for anorexia

• Antidepressants (SSRIs) increase serotonin and help some patients → indirect support

What is the Incentive-Sensitization Theory for ED

Dopamine drives both "wanting" (craving) and "liking" (pleasure) of food

How can environmental food cues affect ED

Environmental food cues (ads, packaging) → dopamine response → cravings → overeating/bingeing

How can classical conditioning be used to explain AN

Weight-loss behaviours are negatively reinforced (reduced anxiety about gaining weight) and positively reinforced (compliments, sense of mastery/control)

How do personality factor affect AN

Perfectionism + personal inadequacy → heightened concern with appearance → dieting becomes a potent reinforcer

How does the media contribute to AN

Media portrayals of thinness, being overweight, and social comparison contribute to body dissatisfaction

How can self-esteem affect BN and BED

Low self-esteem → focus on weight (more controllable than other self-aspects)

How can purging be classical conditioned

Purging is reinforced by negative affect reduction (negative emotion ↓, positive emotion ↑ after purging)

What biases presented in ED are hard to change

• People with anorexia and bulimia focus attention on food-related words/images more than other stimuli

• Women with ED symptoms pay more attention to and better remember other people's body sizes

State objectification theory

• Women's bodies viewed through a sexual lens; women defined by their bodies

• Leads some women to self-objectify → body shame → disordered eating

Is AN observed cross culturally?

observed in many cultures, but "intense fear of weight gain" feature may be more specific to Westernized cultures

Is Bulimia seen cross culturally

Bulimia more common in industrialized/Westernized societies; increases as cultures adopt Western practices

How do family factors relate to ED

Family troubles may be the result of an ED not the cause

Medication for BN, and what do they do?

Treated with antidepressants, reducing purging and binge eating

Why are anti-depressants often used to treat BN

Often comorbid with depression

Why does medication for BN not work

Most people relapse when antidepressants are discontinued

How can medications for BN be more effective at reducing relapse?

Relapse risk is reduced when antidepressants are combined with CBT

Medication for AN

Medications have shown little success

Medication for BED

Antidepressants (Medication in general) appear ineffective in reducing binges or weight loss

What are the two tiers of Psychological Treatment for AN

1. Immediate goal: Weight restoration to prevent medical complications/death

2. Long-term goal: Maintenance of weight gain (remains a major challenge)

When does CBT seem to be more effective for AN

CBT benefits most: older women with more severe symptoms

What is Family Based Therapy based on?

Based on the idea that family interactions can play a role in treatment.

How does FBT work

parents restoring healthy weight while supporting adolescent development.

What is the gold standard treatment for BN

CBT

How does CBT work for BN

• Challenge societal standards for physical attractiveness

• Correct beliefs that lead to starvation and bingeing cycles

Does adding ERP to CBT improve it?

Adding ERP does not significantly improve on CBT alone

What is the most effective form of treatment for BED

CBT + IPT is effective

How does CBT for BED work

CBT targets binges + emphasizes self-monitoring, self-control, problem-solving

What do CBT and IPT target

Reduce binge eating (not necessarily weight)

What is the best supported treatment for AN

CBT + FBT (esp. for adolescents)