Eating Disorders

What is the prevalence of anorexia?

What is the prevalence of anorexia?

Highest mortality rate of any psychological disorder

What is the death rate of anorexia?

• Deaths by suicide (1/2) or starvation + related complications (1/2)

• 20% of people with anorexia attempt suicide

What are the problems with anorexia?

• vast majority of their time meal planning, exercising, and sleeping (sleeping 15+ hours/day)

• May go days without eating (water/juice only)

What is the theory that lack of eating?

all consuming distraction that allows you to detach > so distracted by calorie counting, etc, that that you can avoid dealing with real life

What are staravation problems?

• Cognitive problems

• Emotion dysregulation

• Obsession with food

What are the DSM symptoms of anorexia?

• Restricted food intake that leads to significantly low body weight

• Intense fear of gaining weight or becoming fat

• Disturbance in how one’s weight is experienced OR Undue influence of weight on body evaluation OR Persistent lack of recognition of the seriousness of current low body weight

What is the manifestation in anorexia?

External manifestation of an internal struggle

What is the BMI cutoff for anorexia?

< 15

How little food do you need to eat when considered to have anorexia?

< 1,000 per day

What is the restricting type?

• Eat very little

• Tightly controlled

What is binging and purging?

• Binge: Out of control consumption of large amount of food

• Purge: Removing food from body: Vomiting, Laxatives, Excessive exercise

What are restricting behaviors in anorexia?

• Cut food into tiny pieces

• Cover with salt or hot sauce

• Chew many (30+) times

What is egosyntonic behavior?

When your behavior is in line with your “ideal”, or with how you want to be

What is the cultural influence of anorexia?

Societal beauty standards: “Thin =ideal” —> higher in white people

What are the protective effects of anorexia in terms of Black people?

higher body satisfaction, lower risk of anorexia

What is the DSM definition of bullmia?

• Recurrent binges (i.e., eating a lot and feeling little control over it)

• Purging to prevent weight gain

• Binging and purging occurs at least 1x week for 3 months

• D. Self-evaluation is unduly influenced by weight

How much is a binge?

Eating, in a discrete period of time (for example, within any two-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

How successful is CBT in treatment of eating disorders?

“Gold standard” treatment = more successful for bulimia

What are the improvement rates for CBT?

• Treatment drop out is relatively high (ego syntonic)

• 2 years of psychoanalytic therapy = 15% reached remission

• 5 months of IPT —> 33% reached remission

What is the pattern and recovery rate for eating disorders?

• Often a pattern of remission then relapse

• “Recovery” is rare; may struggle with food forever, even when symptom free

What is the tracking method?

• Track what you ate

• Track thoughts and emotions right after (“I felt guilt; I pictured getting fat”)

What is the exposure method?

• To feared foods! —> Gradually, work up from less feared (banana) to more-feared (cupcake) foods

How do we replace binging + purging behaviors?

• Practice delaying 30 minutes at a time

• Find alternative behaviors that provide the “benefits” of binging or purging

What is another method of CBT?

meal planning

How do you thought track and challenge?

• track thoughts when you don’t want to eat = “If I don’t eat this food, I get to stay distracted and unemotional”

Challenge those thoughts = “That may be true, AND ultimately I want to recover, and eating is how to do that”

How long is residental treatment for?

• Many months (sometimes 5+)

What does residental treatment entail?

Very invasive, very controlled environment

• E.g., staff come with you to the bathroom

• E.g., must finish food in a certain amount of time

How do you gradually earn autonomy?

Starts very controlled —> show symptom improvement —> eased back into control over your life

• Meals prepped for you = prep own meals

• Staff always come bathroom —> staff only come to bathroom for 1 hour after meals

What is the long length of time beneficial for?

useful + allows for gradual return to normal life

Why is insurance a common problem in residential treatment?

shorter inpatient stay (e.g., 3-6 weeks)

• Jump from no control at all (in hospital) to full control (life

• No gradual return

What is ARFID?

Avoidant/restrictive food intake disorder, an extreme picking eating disorder typically in children

What can ARFID look like?

Anorexia

• Low body weight

• Restrictive eating

What does ARFID lead to?

• Failure to gain weight

• Dysfunction (e.g., socializing is seriously impacted by food-related behaviors)

• Nutrient deficiencies (e.g., iron, vitamin A)

What are the reasons that people with ARFID don’t eat?

• Genuine lack of interest

• Sensory issues: food taste, texture, temperature, or smell is aversive

• Fear of consequences: choking, vomiting, nausea, allergies

What is binge eating disorder according to the DSM?

• Recurrent binges (i.e. eating a lot and feeling little control over it)

• The binges are associated with 3+ of the following:

  • Eating more rapidly than normal

  • Eating until uncomfortably full

  • Eating large amounts when not physically hungry

  • Eating alone b/c of embarrassment about amount of food

  • Feeling disgusted with self, depressed, or guilty afterwards

• Marked distress about binges

• Binges happen at least 1x/week for at least 3 months

• Binges are not followed by purges

What is the age of onset of anorexia?

15-19 as young as 7

What is the age of onset of bulimia?

20-24

What is the age of onset of binge eating?

30-50

What is the lifetime prevalence of anorexia?

<1%

What is the lifetime prevalence of bulimia?

1%

What is the lifetime prevalence of binge eating disorder?

2%

What is the gender prevalence across all eating disorders?

Female:Male = 3:1 to 10:1

• higher prevalence in gay men

What group is higher in “disordered eating?”

athletes

• In weight-related sports (wrestling, rowing, horseracing, cross country)

• In aesthetic sports (gymnastics, figure skating)

• 1/3 of men and 2/3 of women in the above sports report disordered eating (though lower rates of eating disorders

What is the clinical cutoff for obesity?

BMI > 30

Why is our food environment important for the changing obesity?

• changing price differentials

• constant food cues from marketing

• processed foods

• portion sizes

Why is our friends important for the changing obesity?

If a close friend becomes obese, your chance increases by 171%

Why is our evolutionary predisposition important for the changing obesity?

• Eating calorie-rich foods has been useful to us through most of evolutionary history

• Our brain has evolved to seek calorie density (“Eat more!”)

• Our “old” brain can’t handle the ”new” food environment

What is the relation of exercise and diet?

• Tracked diet but not told to change it

• Exercise caused healthier food choices (e.g., less red meat, processed meat, fried foods, soft drinks, breads) even when food wasn’t explicitly targeted!

What is the relation of a healthy hypothalamus to food?

Hypothalamus impacts food intake —> It coordinates signals to the body telling it when it’s full enough

What causes inflammation to the hypothalmus?

High fat/sugar diets + Sedentary lifestyle

Why is inflammation bad to the hypothalamus?

disrupt the hypothalamus’ regulation of food intake, leading to unhealthy eating