Chapter 10: Eating Disorders SLIDES

Whats the percentage of eating disorders in males

1 in 3 or 1 in 4 cases

Rather than Eating disorder not otherwise specified, DSM-5 now includes (2)

1) Unspecified Feeding or Eating Disorder

• Any condition that causes clinically significant distress/impairment but not enough to meet diagnostic thresholds

• Situations like emergency room

2) Other specified feeding or eating disorder

• Atypical, mixed, subthreshold conditions

• Night eating syndrome

• Purging disorder

Purging disorder

Form of bulimia that involves induced vomiting or laxative use

AT LEAST ONCE A WEEK FOR MIN OF 6 MONTHS

Anorexia definition DSM-4 criteria (2)

1) Must refuse to maintain normal body weight

2) Weight less than 85% of what’s considered normal for their age and height

Is amenorrhea a criteria in the DSM 5 for anorexia

No longer a criteria so no

When does anorexia typically begin

Early to middle teenage years (often after an episode of dieting and exposure to life stress)

There’s a link with substance use disorder with which eating disorder

Bulimia nervosa

Physical changes with anorexia nervosa

• Decrease blood pressure

• Decrease heart rate

• Decrease bone mass

• Kidney and GI problems

• Dry skin

• Brittle Nails

• Hormone levels change

• Mild anemia

Prognosis of anorexia

1) % of ppl that recover, how long it takes

2) Are relapses common

3) Death rates are __x greater than general population

4) Death rates are __x greater than patients with other psychological disorders

1) 70%, 6-7 years

2) Yes

3) 5-10x

4) 2x

Are suicide rates more elevated with anorexia or bulimia

Anorexia = suicide rates higher

Bulimia = higher suicidal ideation

Bulimia disorder and binge eating disorder criteria for diagnosis (must have symptoms for how long)

At least once a week for 3 months

Fat talk

Tendency for friends, particularly female friends to take turns disparaging their bodies to each other

When does bulimia nervosa typically develop

Late adolescence or early adulthood

1) Do many bulimia patients start overweight or underweight

2) What triggers the binge eating at first

3) How many recover (%)

1) Overweight

2) Dieting

3) 70%

Physical side effects of bulimia

• Potassium depletion

• Electrolyte imbalances

• Diarrhea

• Irregularities of heart beat

• Tearing of tissue in stomach and throat

• Loss of dental enamel

• Swollen salivary glands

Distinguishing BED from

1) anorexia

2) bulimia

1) absence of weight loss

2) absence of compensatory behaviours (purging, fasting, excessive exercise)

First degree relatives of young women with anorexia are about __x more likely than average to have the disorder themselves

4x

The _____ is a key brain centre in regulating hunger and eating

—> Does disregulation of this centre play a role in anorexia

Lateral hypothalamus

—> No

____ are substances produced by the body that

1. reduce pain sensations

2. enhance mood

3. suppress appetite

(among those with low body weight)

Endogenous opioids

1) What neurotransmitter is low in bulimia

2) Hildebrandt model

QUESTION 1:

SEROTONIN

QUESTION 2:

1. They connect serotonin, estrogen, and environment in bulimia’s development:

   • Step 1 (Birth): Some people are born with genetic differences (polymorphisms) that make their serotonin system weaker.

   • Step 2 (Childhood): If they also have harsh or unhelpful parenting, serotonin functioning may be weakened even more.

   • Step 3 (Adolescence): Environmental exposure to estrogen (a hormone that rises during puberty) can make girls gain some weight naturally.

   • Step 4 (Reaction): Because of body image pressures, this weight gain might make them start dieting.

   • Step 5: For some, dieting can spiral into excessive and disordered eating behaviours like bulimia.

1) Paintings by whom in the 17th century showcased women as chubby

2) Playboy magazines models became ____ betwewen 1959 and 1978

1) Ruben

2) Thinner

Scarlett O’Hara Effect

Women eat lightly in an attempt to project images of femininity

Anti-fat bias (that fat ppl are lazy and less smart) seems more automatic among fat or skinny people

Thinner people!

Eating disorders are more prevalent in what culture

Western

Cognitive Behavioural Theories of Anorexia

1) What’s the motivating factors (2)

2) What are the powerful reinforcers (2)

3) Reduction of anxiety about being fat is what type of reinforcer

4) Having self control to diet/starve is what type of reinforcer

1) Fear of fatness and body image disturbance

2) Self-starvation and weight loss

3) Negative

4) Positive

Thinspiration effect

Chronic dieters actually feel thinner after looking at idealized images of the thin body and this motivates them to diet

Psychodynamic Views of EDs

1) What’s the core cause

2) What are core personality traits (2)

3) Symptoms of ED fulfill what needs (2)

1) Parent child relationships

2) Low self esteem, perfestionism

3) Increasing one’s sense of personal effectiveness + to avoid growing up sexually

Psychodynamic Views of EDs: HILDE BRUCH

1) Anorexia nervosa can be a way for certain kids to take control of their lives when they’ve grown up feeling powerless.

Family Systems Theory: MINUCHIN

a) Name the 4 characteristics

EDs develop and persist partly because they help a dysfunctional family avoid addressing deeper conflicts, with the child’s symptoms serving as a distraction from other issues

1. Enmeshment (overinvolvement, parents speak for child)

2. Overprotectiveness

3. Rigidity

4. Lack of conflict resolution

Having ___ types of abuse amplifies the risk of having an eating disorder (sexual or physical etc)

3

6 personality factors linked with eating disorders

AND score high on a measure of what (2)

1. Avoidance motivation

2. Lower extraversion

3. Lower self directedness

4. Neuroticism

5. Perfectionism

6. Sensitivity to social rewards

Score high on a measure of traditionalism and narcissisms

1) Anorexia personality symptoms PRIOR to onset

2) Additional features bulimia patients face

1) Shy, compliant, perfectionistic

2) Histronic features, affective instability, outgoing social disposition

Hewitt and Flett’s multidimensional perfectionism scale assesses

** highlight the ones that are prevalent in EDs the most

1) Self-oriented perfectionism

2) Other-oriented perfectionism

3) Socially prescribed perfectionism

Stanford Duck Syndrome

—> Example of what type of perfectionism (Hewitt and Flett)

University students who respond to strong social pressures and expectations by trying to seem calm and collected on the surface but are actually hiding their anxieties fears

—> Example of self-oriented perfectionism

What is the IMMEDIATE PRIMARY goal in the treatment of anorexia

WEIGHT GAIN/RESTORATION

Relapsing is higher in clients who (3)

1. Binge-purge anorexia subtype

2. Had more OCD like checking behaviours

3. Lower motivation to recover

Which drug do we use for BN/BED

• decreases binge eating

• avoid vomiting

• decrease depression

Fluoxetine (Prozac)

What is the gold standard therapy for all EDs

CBT

Which ED is treated with family therapy

Anorexia (but most effective AFTER individual treatment)

Treatment for ED: MAUDSLEY APPROACH

1) Parents find creative ways to feed their children and restore them to a healthy weight

2) Parents are NOT to blame

Does CBT or Interpersonal therapy work FASTER for EDs

CBT does work faster