Eating Disorders

Flashcards about Eating Disorders

What percentage of the population (over 5 years old) has an eating disorder, according to Deloitte Access Economics, 2024?

4.45%

What percentage of eating disorder cases are in the 10-19 years old age range?

27% (nearly doubled since 2012)

What is the ratio of female to male cases in eating disorders?

67% female, 33% male (with the limitation of lack of inclusion of transgender people)

Among transgender young people, what percentage have a current or previous ED diagnosis?

23%

Lifetime prevalence of Binge Eating Disorder

2.2%

Lifetime prevalence of Anorexia Nervosa

1.8%

Lifetime prevalence of Bulimia Nervosa

1.85%

What are the three eating disorders discussed?

Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED)

What are three presentations of each eating disorder?

Anorexia Nervosa: Restriction of energy intake leading to low body weight, Bulimia Nervosa: Binge & Compensation, Binge Eating Disorder: Binge without compensation

What is Criterion A for Anorexia Nervosa diagnosis (DSM-5-TR)?

Restriction of energy intake relative to requirements, leading to a significantly low body weight

What is Criterion B for Anorexia Nervosa diagnosis (DSM-5-TR)?

Intense fear of gaining weight or of becoming fat OR Persistent behaviour that interferes with weight gain, even though at a significantly low weight.

What is Criterion C for Anorexia Nervosa diagnosis (DSM-5-TR)?

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self- evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

What are the two subtypes of anorexia nervosa (DSM-5-TR)?

Restricting type and Binge-eating/purging type

What is the BMI for Mild Anorexia Nervosa severity (DSM-5-TR)?

BMI ≥17

What is the BMI for Moderate Anorexia Nervosa severity (DSM-5-TR)?

BMI 16 – 16.99

What is the BMI for Severe Anorexia Nervosa severity (DSM-5-TR)?

BMI 15 - 15.99

What is the BMI for Extreme Anorexia Nervosa severity (DSM-5-TR)?

BMI < 15

What is the typical onset age for anorexia nervosa?

Adolescence

What are the impacts of anorexia nervosa?

Brain and Nerves: can't think right, fear of gaining weight, sad, moody, irritable, bad memory, fainting, changes in brain chemistry; Hair: hair thins and gets brittle; Heart: low blood pressure, slow heart rate, fluttering of the heart (palpitations), heart failure; Blood: anemia and other blood problems; Muscles and Joints: weak muscles, swollen joints, fractures, osteoporosis; Kidneys: kidney stones, kidney failure; Body Fluids: low potassium, magnesium, and sodium; Intestines: constipation, bloating; Hormones: periods stop, bone loss, problems growing, trouble getting pregnant. If pregnant, higher risk for miscarriage, having a C-section, baby with low birthweight, and post partum depression; Skin: bruise easily, dry skin, growth of fine hair all over body, get cold easily, yellow skin, nails get brittle

What study demonstrated that many of the symptoms seen in anorexia may be a result of the effects of starvation?

Minnesota Starvation Experiment

What are some psychological impacts of anorexia nervosa?

Distractibility, Depression, Anxiety, Agitation, Sleep disturbance, Obsessionality, Compulsivity

What is the mortality rate of anorexia nervosa compared to other mental illnesses?

Highest mortality rate of any mental illness – 4%

What is a core feature of AN, which impacts its treatment?

Ego-syntonic (i.e. not experienced as symptomatic/problematic, or indeed can be valued by person)

What is considered chronic or treatment-resistant AN duration?

More than 7 years

What is Criterion A for Bulimia Nervosa diagnosis (DSM-5-TR)?

Recurrent episodes of binge eating, including Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances and A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

What is Criterion B for Bulimia Nervosa diagnosis (DSM-5-TR)?

Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

What are the BMI ranges for individuals with Bulimia Nervosa?

Normal weight or over-weight range (e.g., BMI 18.5-29)

List common compensatory behaviors used in Bulimia Nervosa.

Vomiting, Misusing laxatives, diuretics or enemas, Fasting ,Excessive exercise ,Use of any drugs, illicit, prescription and/or ‘over the counter’ inappropriately for weight control

List physical problems associated with Bulimia Nervosa

Stomach rupture, Significant dental and gum problems, Scarring/ ulceration/ rupture of the esophagus, Salivary glad enlargement, Gastrointesinal problems, Loss of normal bowel function, Dehydration, Electrolyte disturbances – irregular heartbeat, heart failure

List comorbid disorders associated with Bulimia Nervosa

Comorbid mood disorders, Anxiety disorders, Substance abuse, Personality disorders (most frequently Borderline Personality Disorder)

What is a recovery rate for Bulimia Nervosa five to 10 years after treatment?

50%

What differentiates Anorexia Nervosa and Bulimia Nervosa?

Bulimia Nervosa occurs when an individual is at a normal weight, Anorexia Nervosa is when the individual is at a significantly low weight.

What is Criterion A for Binge Eating Disorder diagnosis (DSM-5-TR)?

Recurrent episodes of binge eating, including Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances and A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

What is Criterion B for Binge Eating Disorder diagnosis (DSM-5-TR)?

The binge-eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal, Eating until feeling uncomfortably full, Eating large amounts of food when not feeling physically hungry, Eating alone because of feeling embarrassed by how much one is eating, Feeling disgusted with oneself, depressed, or very guilty afterward.

What is Criterion C for Binge Eating Disorder diagnosis (DSM-5-TR)?

Marked distress regarding binge eating is present.

What is Criterion D for Binge Eating Disorder diagnosis (DSM-5-TR)?

The binge eating occurs, on average, at least once a week for 3 months.

What is Criterion E for Binge Eating Disorder diagnosis (DSM-5-TR)?

The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

What are some associated features of Binge Eating Disorder?

BED occurs in normal-weight/ overweight and obese individuals, Cross over from binge-eating disorder to other eating disorders is uncommon

List some impacts of Binge Eating Disorder.

Social role adjustment problems, Impaired health-related QoL, Impaired life satisfaction, Increased medical morbidity and mortality, Increased health care use

What are the possible health consequences from Binge Eating Disorder?

High blood pressure, High cholesterol, Type II diabetes, Heart and gallbladder disease, Menstrual and gastrointestinal problems

Is Binge Eating Disorder the same as obesity?

No, Binge Eating Disorder is distinct from obesity. Most individuals with obesity do not engage in recurrent binge eating.

Obesity is _ a psychological disorder

NOT

What is the first-line treatment for Anorexia Nervosa in adolescents?

Family-Based Treatment (FBT, Maudsley) ( Anorexia)

What is the first-line treatment for Anorexia Nervosa in adults?

CBT-E (Enhanced Cognitive Behaviour therapy) or Specialist Supportive Clinical Management

What is the first-line treatment for Bulimia Nervosa in all ages?

CBT-E or DBT

What is the first-line treatment for Binge Eating Disorder?

CBT or CBT-E, IPT (Interpersonal Psychotherapy) or DBT

What is CBT-E?

Enhanced Cognitive Behaviour therapy for Eating Disorders, a transdiagnostic treatment for eating disorders. Targets core eating disorder symptoms: Dietary restraint, Overvaluation of shape and weight, Binge/purge behaviours and patterns

What are the stages of CBT-E

Stage One: Starting Well, Stage 2: Taking Stock , Stage 3: Addressing Maintaining Mechanisms (Body Image, Dietary Restraint, Events, Moods and Eating), Stage Four – Ending Well

What is the first line treatment for AN in children/adolescents?

Family-based treatment (FBT; Maudsley) ( Anorexia)

What are the 3 phases of Family Based Treatment (Maudsley)?

Phase 1 – Intense re-feeding (weekly), Phase 2 – Transition to adolescent control (fortnightly), Phase 3 – Adolescent issues (monthly)

Other than specialist supportive clinical management (SSCM) and CBT-E, what are other possible treatments for adults with Anorexia?

Psychodynamic or psychoanalytic therapy, Cognitive interpersonal therapy (MANTRA), Cognitive remediation therapy, Family-based therapy (Maudsley), Interpersonal psychotherapy, Exposure and response prevention, Cognitive analytic therapy