Chapter 14 - Eating and feeding disorders

Disordered eating habits

A person’s belief that cultural standards for attractiveness, body image, and social acceptance are closely tied to the ability to control one’s diet and weight gain

 

• Western sociocultural values and preoccupation with weight and dieting

• May be internalized and expressed in children as young as age 7-10

In a study of grades 5 to 8; _____ had tried to lose weight in the past 7 days.

60%

Dieting may lead to a vicious cycle of:

• weight loss and weight gain

• Overeating

• the “false hope syndrome"

  • initial commitment to change appearance = short-term mood and self-image boost, which then decreases after failure.

• binge eating and subsequent purging.

 

 The Binge purge cycle

Purging is followed by disgust and self-recrimination, which prompts renewed vows of abstinence and sets the stage for the whole cycle of dieting, overeating, dietary failure, and affective distress to begin again

 

metabolic rate

The body’s balance of energy expenditure. Metabolic rate is determined by genetic and physiological makeup, along with eating and exercise habits.

• Individual metabolism then self-monitors and self-regulates behaviour

set point

A comfortable range of body weight that the body tries to “defend” and maintain

• 90% to 95% of those who lose weight regain it within several years

If fat levels decrease below our body’s typical range, the brain (specifically, the hypothalamus) compensates by ________

slowing metabolism.

• the body fights against weight gain by increasing metabolism and raising body temperature in an effort to burn off extra calories

Major hormonal determinants of physical growth rate during childhood are the

growth hormone (GH) and thyroid hormone

• Additional gonadal steroids kick in during adolescence to produce a further growth spurt and skeletal maturation

_______ of growth hormone production occurs after the onset of deep sleep (may explain why eating and sleep disorders coexist in some younger children)

50% to 75%

childhood obesity

a chronic medical condition characterized by an excessive accumulation of body fat relative to gender- and age-based norms.

Approximately _____ children and adolescents in the US are obese

1 in 5

_____ hormone carries instructions to the brain to regulate energy and appetite

Leptin
(Leptin deficiencies have been found with severe obesity)

Treatment for obesity

• Prevention or intervention of childhood obesity involves the individual’s health and family resources

  • Restricting diets are not usually recommended

 

• Treatment should:

  • Address the parents’ knowledge of nutrition

  • Increase the child’s physical activity

  • Should instill active, less sedentary routines for both parents and child

Avoidant/restrictive food intake disorder (ARFID)

Characterized by a sudden or marked deceleration of weight gain and a slowing or disruption of emotional and social development prior to age 6

 

• At least one of the following characteristics must be present:

 

• significant weight loss

• significant nutritional deficiency

• dependence on enteral feeding (feeding tube) or oral nutritional supplements

• marked interference with psychosocial functioning

With ARFID, some manifest by avoiding or restricting food based on __________

sensory characteristics

The cause of ARFID is …

multifactorial: biological, medical, psychological, and environmental factors—and their interaction.

 

• history of vomiting, food allergies, gastrointestinal difficulties, low interest in feeding, family eating environments, accessibility and exposure to healthy, varied food items

• Fear of eating-related issues such as choking and low appetite

ARFID is highly comorbid with

autism spectrum disorder - 21%

For treatment, a Manualized version of __________ adapted for use with ARFID patients

family-based treatment (FBT)

• Focus on eating behaviors such as increasing variety, using psychoeducation, and rewards-based behavioral therapy

PICA

The ingestion of inedible substances, such as hair, insects, and chips of paint, for a period of at least 1 month

Prevalence of PICA?

One of the more common (12%) and usually less serious eating disorders

• Affects mostly young children and adults with intellectual disabilities

• More prevalent among institutionalized children and adults

Causes of PICA?

Specific causes not isolated, usually appearing within first 2 years

 

• Often without adequate stimulation or supervision

• Suspected vitamin or mineral deficiency

• No evidence of genetic factors

Treatment for PICA?

Treatments are based on operant conditioning procedures and teaching caregivers to keep the child’s environment tidy and removing dangerous substances

Anorexia Nervosa

• Individual purposely takes in too little nourishment, resulting in body weight that is very low and below that of other people of similar age and gender

 

• Individual is very fearful of gaining weight, or repeatedly seeks to prevent weight gain despite low body weight

 

• Individual has a distorted body perception, places inappropriate emphasis on weight or shape in judgments of herself or himself, or fails to appreciate the serious implications of her or his low weight

Anorexia - Restricting type

During the past 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

Anorexia - binge eating/purging type

During the past 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Persons with anorexia are ______ below average weight

15% or more

Prevalence of anorexia is ~____ of adolescents

0.3%

Bulimia Nervosa

(A) Recurrent episodes of binge eating. (large, without control)

 

(B)Recurrent inappropriate compensatory behavior in order to prevent weight gain (vomiting; laxatives, diuretics or enemas, or other medications; fasting; or excessive exercise.)

 

(C)both occur, on average, at least once a week for 3 months.

 (D)Self-evaluation is unduly influenced by body shape and weight.

(E)The disturbance does not occur exclusively during episodes of anorexia nervosa.

Prevalence of bulimia is ___ of adolescents

~1%

Persons with bulimia are within ____ of average body weight

10%

Binge eating disorder

(A) Recurrent episodes of binge eating (large, without control)

(B)The binge eating episodes are associated with three (or more) of the following:

• Eating much more rapidly than normal

• 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.

 

(C)Marked distress regarding binge eating is present.

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

 

Prevalence of binge eating disorder is ____ of adolescents

~1.5-3%

Bulimia and BED seems to be a

culture-bound syndrome, with dominance in western region ideals

Anorexia is seen

•  across the world, but manifests differently.

  • Subtypes may be different, and unable to detect using western diagnostics.

Onset of anorexia is usually between ages

14 and 18

Rate of mortality for anorexia is _______

significant (5%)

• Of survivors: fewer than one-half show full recovery, one-third show fair improvement, one-fifth continue on a chronic course

• fluctuating pattern that involves a restoration of typical weight followed by relapse

Single best predictor or risk for developing an eating disorder is _________

being an adolescent female

Biology may contribute to the

maintenance (not cause) of the disorder in their effects on appetite, mood, perception, and energy.

It has been suggested that imbalances of ______, which regulates hunger and appetite, may be implicated

serotonin

Causes and risks of eating disorders

• Western culture self-worth, happiness, and success are determined primarily by physical appearance

• Teenage girls: weight loss and being skinny are more important than many other issues

• Mass media influences perceptions of body dissatisfaction

• Consider stress factors, including family factors, struggle for autonomy/control

Psychosocial treatments for eating disorders generally include

• Family therapy and individual therapy

• Cognitive–behavioral therapy and interpersonal psychotherapy,

• Cognitive training and dialectical behavioral therapy

• More recently, virtual or telehealth-based practices

Family based treatment (FBT) based on five principles

• The clinician holds an agnostic view of the cause of the illness

• The clinician takes a non-authoritarian stance in treatment

• Parents are empowered to bring about the recovery of their child

• The eating disorder is separated from the patient and externalized

• FBT utilizes a pragmatic approach to treatment with the focus on the present moment