Anorexia Nervosa

A typical cutoff BMI associated with anorexia nervosa is

17.5

T/F Individuals with anorexia nervosa do not get hungry, allowing them to easily restrict their caloric intake.

False

A typical cutoff BMI associated with anorexia nervosa is

17.5

T/F Individuals with anorexia nervosa do not get hungry, allowing them to easily restrict their caloric intake.

False

T/F Anorexia is associated with a significant increase in risk of death.

True

T/F Eating disorders occur with equal prevalence in males and females.

Flase, women are 10x more likely to develop eating disorders

T/F The presence of amenorrhea is a defining symptom of eating disorders, especially in males.

False

Diagnostic criteria for Anorexia Nervosa

• Refusal to maintain weight of at least 85% of expected weight of a persona with their characteristics  

• Intese fear of gaining weight, though underweight 

• Disturbance in body image perception 

• Criteria of BMI < 17.5 is often also used as part of a cutoff for Anorexia 

Note: Amenorrhea (elimination of menstruation) was included in the DSM4, but has been removed due to lack of relevance and useful when diagnosing AN

Amenorrhea

The absence of menstration

What changes were made from the DSM4 to the DS5 regarding Anorexia

Amenorrhea was removed due to lack of relevance and usefulness when diagnosing AN

What are the common characterisitcs in AN

• An is often complicated by other traits and psychopathology that complicate the picture 

  • Depression and anxiety symptoms

    • Some develop these symptoms

    • Some cases it’s a result of their starvation state

  • Obsessional features

  • Perfectionism

  • Low self-esteem

  • Social withdrawal

  • Physical complications

  • Lack of insight into / acceptance of need for treatment

What is the prevelence of AN

• 0.5% lifetime prevalence in females 

• 10x more common in females than males

What is the course for Anxiety

• Onset typically in mid to late adolescence 

• Highly variable course and outcome

What is the mortality of AN

• Number of mortality rates for AN range between 0% and 20%

  • More sophisticated analyses of mortality estimate rates of 0.56% per year (Sullivan, 1995)

• Mortality for females age 15-24 = 0.0045% per year

• Mortality for female psychiatric inpatients = 0.021% per year

• Suicide rate in general population = 0.00002% per year

What are the predictors of mortality in AN

• Severity of alcohol use and substance use were correlated with mortality

• A regression model incorporating Duration of Illness, Affective Disorder During Hospitalization, Suicidality, and Severity of Alcohol Abuse was significant in predicting mortality.

What is the Cognitive-Behavioural Conceptualisation of Anorexia Nervosa

• Earliest application of Beck’s CT principles to AN in early 1980s (Garner & Bemis, 1982)

• Vitousek (1997)

  • Overvalued ideas about personal implications of body shape and weight originating out of personality variables such as perfectionism, etc.

• Sense of Control (Slade, 1982)

  • Stressed need for control as central feature of AN

  • Success in dieting reinforces sense of control

  • The complex nature of control in AN is elaborated in Surgenor (2002, 2003)

CBT Theory of AN Onset

• Need for self-control in context of low-self esteem, perfectionism, and sense of ineffectiveness

• Control over eating is focused on as an experience of success/control

  • Dietary restriction provides immediate evidence of self-control

  • Control over body shape/weight especially salient to ascetics

  • Controlling eating has a strong effect on those in the environment, which may already be clouded with dysfunctional relationships

    • Influences the relationships around them

      • Example: Child doesn’t eat dinner 

  • Controlling eating provides a mechanism of arresting or reversing pubertal changes

  • Western society values dieting to control shape and weight.

CBT Theory of AN Maintenance

• Dietary restriction enhances the sense of being in control

  • Amount eaten, types of foods, times of eating

  • Success at dietary restriction is a potent reinforcer

  • Control over eating as expression of control and worth

• Aspects of starvation encourage further dietary restriction

  • Hunger perceived as threat to control over eating → increases anxiety →  increases dietary restriction 

  • Impaired concentration may heighten sense of chaos/uncontrollability 

    • Lack of concentration can further perpetuate a lack of control 

    • Since control is generally important to those with anorexia may lead to doubling down on controlling diet  

• Extreme concerns about shape and weight encourage dietary restriction

  • Especially prominent in Western society

What are the three major theories for AN maitenance based on CBT

• Dietary restriction enhances the sense of being in control

• Aspects of starvation encourage further dietary restriction

• Extreme concerns about shape and weight encourage dietary restriction

What’re the Thin commandments/Pro ANA/AN movement

Organisations or indivudals that perpetuates the illness using reinforcments, compliments and verbalising beliefs

Treatment outcome of AN

• Viewed as difficult to treat, increased optimism for treatment in the past 20 years 

• Steinhausen (2002)

  • Meta-analysis of 119 patient cohorts

  • Total of 5590 patients

  • Variety of different treatment methods.

    • Differences between treatments not assessed

  • Mean dropout rate of 12.3% across all studies.

Relevant Nonpredictors

• • Weight loss at presentation

  • Hyperactivity

  • Dieting

  • Obsessive Compulsive Disorder

  • Socioeconomic status

Predictors of Good Outcome of AN

• Short duration of symptoms

• Good parent-child relationship

• Histrionic Personality features (attention-seeking behaviour)

Predictors of Poor Outcome

• Vomiting

• Bulimia

• Purgatory behaviour

• Premorbid developmental abnormalities

• Eating disorders in childhood

• Chronicity - duration of illness 

• Obsessive Compulsive Personality Disorder

Treatment for Anorexia

• MOTIVATIONAL ENHANCEMENT THERAPY (MET)

• COGNITIVE BEHAVIOUR THERAPY (CBT)

  • Stage 1: Establish a supportive relationship and create a meal plan to normalize eating and weight behaviors.

  • Stage 2: Challenge dysfunctional beliefs about food, weight, and broader psychological issues like self-esteem and perfectionism.

  • Stage 3: Prepare for treatment termination by developing strategies to prevent relapse and recognize early warning signs.Stage 1: Establish a supportive relationship and create a meal plan to normalize eating and weight behaviors.

    Stage 2: Challenge dysfunctional beliefs about food, weight, and broader psychological issues like self-esteem and perfectionism.

    Stage 3: Prepare for treatment termination by developing strategies to prevent relapse and recognize early warning signs.

• Family therapy

Bulemaia treatment

CBT, MTI