anorexia test

Eating Disorders

Restrictive disorders involve inadequate food intake; bingeing involves eating large amounts in a short period.

Anorexia Nervosa (AN)

Eating disorder involving extreme restriction, low body weight, intense fear of weight gain, and body-image disturbance.

Bulimia Nervosa

Binge eating followed by unhealthy attempts to prevent weight gain, such as purging.

Muscle Dysmorphia

Obsession with having a muscular body; classified under body dysmorphic disorder in DSM-5.

ABCS of Anorexia

Affective: depression, self-hatred. Behavioral: dieting, exercise. Cognitive: perfectionism, denial. Somatic: low weight, low BP, dehydration.

Van Eeden et al. (2021)

Overall anorexia incidence was relatively stable, but cases among children under 15 increased. Could reflect earlier detection or onset.

Prevalence of Anorexia

Class estimates: 0.3-1% of females and 0.1-0.3% of males. Van Eeden suggested lifetime prevalence up to 4% in females.

Anorexia Risk Factors

Social pressure to be thin, perfectionism, adverse childhood experiences, genetic vulnerability, and certain appearance-focused activities.

DSM-5 Criteria for Anorexia

1. Food restriction causing low weight. 2. Intense fear of weight gain or resistance to it. 3. Body-image disturbance or denial of severity.

Why Is Anorexia Difficult to Diagnose?

Denial, changing symptoms, cultural differences, comorbidity, no definitive test, and reliance on self-reporting.

Pathognomonic Symptom

A symptom that definitively identifies a disorder; anorexia has no single pathognomonic symptom.

Holistic vs. Reductionist Approach

Holistic considers biological, psychological, and social factors; reductionist focuses on fewer factors.

Comorbidity

Two or more disorders occurring together, such as anorexia with depression, anxiety, or OCD.

Point Prevalence

Proportion of a population experiencing a disorder at one specific point in time.

One-Year Prevalence

Proportion of people experiencing a disorder at any time during the past year.

Lifetime Prevalence

Proportion of a population that has ever experienced the disorder.

Incidence vs. Prevalence

Incidence counts new cases; prevalence measures how widespread a disorder is.

Limitations of Prevalence Research

Underdiagnosis, small samples, inaccurate self-reporting, outdated information, and cultural differences.

Forrest et al. (2017)

Only about 20% of adolescents with eating disorders obtained help. Females were 2.2 times more likely than males to seek treatment.

Help-Seeking and Stigma

Low health literacy, self-stigma, and lack of diagnosis can prevent treatment and underestimate prevalence.

Gender Bias in Eating Disorder Research

Female-focused research and stereotypes may lead to male eating disorders being overlooked.

Five Diagnostic Methods

Self-report questionnaires, clinical interviews, behavioral observations, third-party reports, and physiological testing.

EDE-Q

Eating Disorder Examination Questionnaire; 28 items assessing restraint, eating concern, shape concern, and weight concern over 28 days.

EDE-Q Reliability

Moderate test-retest reliability of r = 0.60-0.85; lower reliability in adolescents than adults.

Self-Report Strengths and Limitations

Strength: efficient and reveals private thoughts. Limitations: denial, social desirability bias, Western assumptions, and no direct assessment of medical risk.

SCID

Structured Clinical Interview for DSM Disorders; semi-structured interview with moderate-to-high inter-rater reliability.

Clinical Interview Strengths and Limitations

Strength: follow-up questions and detailed assessment. Limitations: time-consuming, requires training, interviewer and cultural bias.

Behavioral Observations

Observe eating habits, appearance, mood, and behavior. Strength: detects hidden patterns. Limitations: subjectivity, clinical bias, and patients hiding behaviors.

Third-Party Reports

Family and friends confirm symptoms and timelines. Strength: data triangulation. Limitations: bias, denial, confidentiality, and patient mistrust.

Physiological Testing

Uses medical measurements to identify health risks. Strength: objective data. Limitation: cannot diagnose anorexia independently.

Data Triangulation

Using multiple sources or methods to improve the credibility of research or diagnosis.

Reliability vs. Validity

Reliability = consistency of findings. Validity = accuracy in measuring what is intended.

Test-Retest vs. Inter-Rater Reliability

Test-retest measures consistency over time; inter-rater measures agreement among different observers.

Social Desirability Bias

Participants give socially acceptable answers instead of fully honest responses.

Biological Explanation of Anorexia

Genetic inheritance and differences in brain functioning may increase vulnerability to anorexia.

Five Genetic Study Methods

Pedigree studies, twin studies, adoption studies, associative/linkage studies, and GWAS.

Twin Studies and Concordance

Compare identical and fraternal twins; concordance measures how often both twins have the disorder.

Holland et al. (1988)

45 female twin pairs: 25 identical, 20 fraternal. Concordance: 56% identical vs. 5% fraternal; supports genetic influence.

Holland et al. (1988) Evaluation

Strength: evidence of inherited vulnerability. Limitations: small female sample, self-reporting, shared environments, and no causation.

Klump et al. (2001)

Compared 123 adopted female sibling pairs with 56 biological pairs. Biological sisters showed more similarity, supporting genetic influence.

Klump et al. (2001) Evaluation

Supports heredity, but genetic and environmental influences are difficult to separate. Raises ethical responsibilities toward symptomatic participants.

GWAS

Genome-wide association studies compare DNA between people with and without a disorder to identify associated genetic variants.

Scott-Van Zeeland et al. (2014)

Studied over 1,200 anorexia patients and nearly 2,000 controls; found genetic variants associated with anorexia.

Watson et al. (2019)

Large GWAS supporting the role of genetic vulnerability and biological influences in anorexia.

Strengths of Genetic Explanations

Twin research provides consistent evidence, modern studies identify candidate genes, and researchers recognize environmental interaction.

Limitations of Genetic Explanations

Correlation does not prove causation; samples may lack population validity; environmental influences cannot be ignored.

Gene-Environment Interaction

Genetic vulnerability and environmental pressures can interact to influence anorexia development.

Biochemical Explanation of Anorexia

Altered brain chemistry may be associated with anxiety, obsessive thinking, appetite, and reward-related behaviors.

Bailer & Kaye (2011)

Compared recovered anorexia patients with healthy controls; found differences in brain responses to taste and reward.

Foerde et al. (2015)

Found that habitual decision-making processes may help explain restrictive food choices in anorexia.

Biochemical Explanation Evaluation

Strength: uses scientific methods and brain imaging. Limitations: correlational, inconsistent findings, and differences may result from malnutrition.

Bidirectional Ambiguity

Uncertainty about whether biological differences cause anorexia or are consequences of the disorder.

Sociocultural Explanation

Family, media, peers, social expectations, and cultural ideals influence anorexia development and symptoms.

Westernization and Globalization

Spread of Western beauty ideals and cultural values through media, technology, migration, and worldwide connections.

Cultural Differences in Anorexia

Some cultures show restrictive eating without the Western emphasis on fear of weight gain, complicating diagnosis.

Castillo (1997)

Class reading describes anorexia in Hong Kong where restriction may be explained through fasting or nutritional beliefs rather than fear of fatness.

Lee & Lee (2000)

Surveyed 796 Chinese high-school girls in Hunan, Shenzhen, and Hong Kong. Hong Kong students reported greater body dissatisfaction.

Lee & Lee (2000) Evaluation

Supports Westernization as a possible influence, but questionnaires and cross-sectional comparisons cannot establish causation.

Becker et al. (2002) Method

Natural experiment comparing Fijian schoolgirls in 1995 and 1998 after television was introduced; used EAT-26.

Becker et al. (2002) Results

Reported EAT-26 increase from 12.7% to 29.2% and purging reports from 0% to 11.3%.

Becker et al. (2002) Additional Findings

1998: 69% reported dieting, 74% felt too big/fat, and 77% believed television influenced body-image ideas.

Becker et al. (2002) Evaluation

Suggests media and globalization influence eating attitudes. Limitation: other cultural changes could explain results.

EAT-26

26-item Eating Attitudes Test measuring attitudes and behaviors associated with eating disorders.

Khandelwal et al. (1995)

Indian teenager restricted food severely but reported no fear of weight gain or body-image disturbance.

Mendhekar et al. (2009)

Indian teenager restricted eating following family conflict and later disclosed fear of becoming fat.

Indian Case Studies Comparison

Both involved food restriction, but their reported motivations differed; shows why culturally sensitive diagnosis matters.

Cultural Relativism vs. Ethnocentrism

Cultural relativism considers behavior within its culture; ethnocentrism judges another culture using one's own standards.

Biomedical Treatment

Uses medication or other biological treatments to reduce symptoms, but may neglect underlying psychological and social causes.

SSRIs

Antidepressants sometimes prescribed for anorexia; research suggests limited benefit for core symptoms and weight restoration.

Holtkamp et al. (2005)

32 females; 19 received SSRIs and 13 did not. Relapse/readmission: 36% vs. 31%, showing no clear benefit.

Olanzapine

Antipsychotic medication studied as an additional treatment to support weight gain and reduce anxiety.

Dennis et al. (2006)

Five adolescents received olanzapine and psychotherapy; all improved BMI but experienced morning sedation.

Dennis et al. (2006) Evaluation

Very small sample with no control group, so improvement cannot be confidently attributed to medication.

Norris et al. (2011)

Retrospective matched-group study of 86 female patients. No significant weight-gain difference between olanzapine and comparison groups.

Spettigue et al. (2018)

32 adolescents; 22 chose olanzapine. Greater weight-gain rate (p = .012), but 31.8% discontinued due to side effects.

Spettigue et al. (2018) Evaluation

Promising weight-gain findings, but participant self-selection creates possible bias and weakens causal conclusions.

Randomized Double-Blind Placebo-Controlled Trial

Participants randomly assigned to medication/placebo groups; neither participants nor researchers know group assignments.

Double-Blind vs. Open-Label

Double-blind conceals treatment assignments; open-label makes treatment known to participants and researchers.

Drug Therapy Strengths and Limitations

Strengths: relatively rapid symptom relief, may support psychotherapy. Limitations: side effects, relapse, reductionism, and limited effectiveness.

Iatrogenic Effect

Harmful or unintended negative effects resulting from treatment.

rTMS vs. DBS

rTMS is noninvasive brain stimulation; DBS is invasive, experimental, and usually considered for treatment-resistant cases.

CBT

Cognitive Behavioral Therapy changes unhealthy thoughts and behaviors using restructuring, exposure, and coping strategies.

CBT Main Assumption

Thoughts, feelings, and behaviors are interconnected; changing one influences the others.

Cognitive Restructuring

Identify automatic thoughts, examine evidence, challenge distortions, reframe beliefs, and test alternatives.

Graded Exposure and Homework

Gradually face feared situations; homework reinforces skills through thought records, food diaries, and structured tasks.

Three Phases of CBT

Behavioral: stabilize eating. Cognitive: change distorted thoughts. Maintenance: develop coping skills and prevent relapse.

Pike et al. (2003)

33 patients randomized after hospitalization to CBT or nutritional counseling; relapse was 22% with CBT vs. 53% with counseling.

CBT Strengths and Limitations

Strengths: coping skills, autonomy, no drug side effects. Limitations: requires motivation and time; severe cases need additional medical support.

Family-Based Therapy (FBT)

Treatment especially effective for adolescents where family members help supervise meals and weight restoration.

Maudsley Method

Parents initially take responsibility for eating and gradually return control to the adolescent as recovery progresses.

Paulson-Karlsson et al. (2009)

32 adolescent females received family therapy. At 36 months, 75% achieved complete remission; no control group.

Robin et al. (1999)

37 adolescents received family therapy or CBT. Both improved, but family therapy produced greater weight gain.

FBT Strengths and Limitations

Strengths: effective for adolescents, holistic, personalized. Limitations: depends on family support and commitment; may not fully address trauma.

Monteleone et al. (2022)

Reviewed 20 meta-analyses. FBT showed evidence for weight gain in younger patients; high relapse and limited medication benefits were found.

Token Economy

Behavioral treatment using rewards to reinforce desired behaviors through operant conditioning.

Therapeutic Alliance

Supportive therapist-patient relationship that may contribute to treatment improvements.

Therapy and Causality

Treatment improvement may result from placebo effects, therapeutic alliance, spontaneous remission, or extraneous variables.

Spontaneous Remission

Improvement in symptoms over time without the treatment necessarily causing it.

Eclectic Therapy

Combines multiple therapeutic approaches, making it difficult to identify which element caused improvement.

Ethics and Responsibility

Psychologists balance consent, autonomy, cultural sensitivity, confidentiality, and responsibility to prevent serious harm.