Eating disorders (Florence Sheen)

How does APA describe an eating disorder

a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning

When was eating disorders included into the DSM 5

1980s

• became a distinct category in 1994

• in the DSM 5 described under feeding and eating disorders

How do eating disorders affect our body

can affect every organ system in the body

• can have life-threatening conditions

What mortality rate does an eating disorder have

the highest mortality rate of any health disorder

• anorexia nervose: 5-10% mortality rate

What is obesity

a medical condition closely related to eating disorders, not a mental disorder (DSM-5)

What are the types of eating disorders

• anorexia

• bulimia

• binge eating

• restrictive food intake disorder

• pica

• rumination disorder

What are the characteristics and diagnosis criteria of Pica

• eating of one or more non-nutritive, non-food substances on a persistent basis over a period of at least 1 month

• inappropriate to the developmental level of the individual

• often comes to clinical attention following general medical complications

  • e.g. intestinal obstruction

What are the characteristics and diagnosis criteria of rumination disorder

• repeated regurgitation of food occurring after feeding or eating over a period of at least 1 month

  • regurgitated (bringing swallowed food up again to the mouth without nausea or forceful vomiting) food may be re-chewed, re-swallowed, or spit out

• not attributable to an associated gastrointestinal or other medical condition

  • e.g. reflux

• malnutrition might occur

What are the characteristics and diagnosis of avoidant/restrictive food intake disorder

• avoidance/restriction of food intake is the lack of interest in eating or food, avoidance based on the sensory characteristics of food

• significant weight loss and nutritional deficiency, growth delay

• dependence on enteral feeding or oral nutritional supplements

• commonly develops in infancy or early childhood and may persist in adulthood

  • infants may be irritable and difficult to console during feeding, or may appear apathetic and withdrawn

What are the characteristics and diagnosis of anoerexia nervosa

• characterised by distorted body image and intense dear of weight gain, which motivates the person to restrict food intake or find other ways to loose weight (e.g. excessive physical activity)

• disturbance in self-perceived weight or shape

• low body weight in the context of age, sex, development, and physical health

• depressed mood, social withdrawal, irritability, insomnia, and diminished interest in sex

• bipolar, depressive, and anxiety disorders commonly co-occur with anorexia nervosa

• 70% will recover (6-7 years), but up to 6% do not recover

  • may die from medical complications of malnutrition or by suicide

What are some of the physical changes associated with anorexia nervosa

• low blood pressure

• low body temperature

• low bone density

• cardiac problems due to electrolyte imbalances

• slowed heart rate

• kidney and gastrointestinal problems

• hormonal changes

• anaemia

• low of hair

• tooth decay

• amenorrhea (loss of menstrual period)

What are the characteristics and diagnosis of bulimia nervosa

• recurrent episodes of binge eating

  • rapid consumption of a large amount of food

  • a sense of lack control over eating

• followed by compensatory behaviour to prevent weight gain or feelings of guilt

  • e.g. fasting, vomiting, exercising

  • compensatory behaviours are driven by a negative evaluation of their own appearance, body weight, or body shape

• stress and negative emotions typically occur before binges

What is the bulimic trap

• ‘overeating and compensatory behaviours make is difficult over time for individuals to know when they are hungry or full

  • can affect homeostasis and other biological system that in turn influence the drive to eat

  • causing depressed mood, more hunger, and more frequent binging

When does bulimia nervosa occur on average and how

at least once a week for 3 months

• usually in secrecy

What are the physical changes associated with bulimia nervosa

• menstrual irregularities

• tearing of tissue in stomach and throat, gastric rupture

• potassium depletion

• cardiac arrhythmias

• loss of dental enamel

• salivary glandules swollen

What are the co-morbidity possibilities of bulimia nervosa

• often occurs with other disorders

• increased frequency of depressive symptoms, and bipolar and depressive disorders

• disorder peaks in older adolescents and young adulthood

  • 90% are women

• 70% recover

  • 10% remain fully symptomatic

What are the characteristics and diagnosis of binge eating

• recurrent episodes of binge eating, lack of control during binges

• marked distress about binging

• occurs on average once a week for 3 months

• absence of compensatory behaviours

• cultural variations: black women have higher rates of BED (5%) than white women (2.5%) (Goode et al., 2020)

• most common age of onset is 19.5 years (Solmi et al., 2021)

• common co-morbid disorders

  • bipolar

  • depression

  • anxiety

  • substance use disorders

What is the genetic cause of anorexia nervosa and bulimia nervosa

• having a sibling or a parent with eating disorders increases up to 5 times the chance that a person will develop an eating disorder

• high heritability estimates for AN (48-88%) and for BN (28-83%) derived from twin studies

• the remaining variance due to individual-specific (non-shared) environmental factors

What are the neurobiological factors that cause anorexia nervosa and bulimia nervosa

• abnormal levels of cortisol

  • regulated by the hypothalamus (consequence of starvation)

• abnormal levels of serotonin (confounds with the co-morbid depression)

• abnormal levels of dopamine

  • a ‘rise and fall’ of dopamine production in AN

    • BN and BED with differences in dopamine levels

What is the sociocultural cause of anorexia nervosa and bulimia nervosa

• social pressure to be thin

  • ‘being thin’ considered attractive in most western cultures

  • an increasing mismatch between the ‘ideal’ and the reality resulting in body dissatisfaction and negative effect

What is the family processes cause of anorexia nervosa and bulimia nervosa

• strong family attitudes towards weight and shape (Haworth-Hoeppner, 2000)

  • successful dieting = acceptance

• ineffective parenting

  • inaccurate perception of internal cues/needs

  • lack of control over their lives

What is the cause of binge eating

• pleasurable foods acts as drugs of abuse, activating the dopamine reward system (Gearhardt et al., 2011)

Explain the learning model of binge eating (Jansen et al., 1998)

• cues present at the time of the meal can associate to the rewarding effects of intake

• these cues also anticipate the effects of food and activate a compensatory response which leads to food seeking behaviour

What are possible treatments and interventions

• goals of treatment:

  • correcting dangerous eating patterns

  • working on psychological influences that may lead to these patterns

• treatments also address nutrition and physical aspects of the individual

What are the steps for treatment of anorexia nervosa

• step 1:

  • in hospital, focus on weight gain

• step 2:

  • out-patient, focus on long-term cognitive and behavioural change

What are the three types of therapy use to treat anorexia nervosa

• Cognitive behaviour therapy (CBT)

• Family-based treatment

• Conjoint and separated family therapy

How does CBT help treat anorexia nervosa

• aims to alter the cycle and develop healthy eating patterns

• challenge distortions

  • e.g. the belief that body weight is the prime determinant of self-worth

• question society’s standard of beauty

• training to realise that healthy weight can be maintained without extreme dieting

• recognise the need for independence and teach patients more appropriate ways to exercise control

How does family-based treatment for young people/adolescents help treat anorexia nervosa

• therapist identifies troublesome family patterns, and helps the members make appropriate changes

• might try to help the patient separate their feelings and needs from those of other members of their family

How does conjoint and separated family help treat anorexia nervosa

• this therapy showed considerable and similar improvements in nutritional and psychological outcomes, including family functioning (Eisler et al., 2000)

  • effects maintained after 5 years - 75% of patients showed no eating disorder symptoms

What are the three ways to treat bulimia nervosa

• cognitive behavioural approach (Fairburn, 2008)

  • replace binge eating with 3 meals a day and develop coping strategies (e.g. call a friend, play a video game)

  • eat previously avoided types of food

  • stop riding body shape

  • learning relapse prevention strategies

• education

  • develop an understanding that eating regularly will not result in weight gain

• pharmacotherapy

  • treatment with Prozac decreases binge eating and vomiting as well as depression (Walsh et al., 2000)

Ways to treat a binge eating disorder

• behavioural treatment

  • cue exposure based on extinction procedures (without food)

  • high risk of relapse

• individual or group CBT reduces binge eating and improves abstinence (restraint) rates for up to 4 months after treatment

• pharmacotherapy

  • antidepressants, appetite suppressants, and anticonvulsants

Why was there an increase in eating disorders

• an increase of eating disorders during Covid-19, the occurrence was 15.3% higher in 2020 compared with previous years (Taquet et al., 2021)

  • higher rates of suicidal behaviour among those diagnosed

• urgent and routine referrals to the diagnostic child and adolescent eating disorder services (NHS) have almost doubled

  • Solmi, Downs, & Nicholls, 2021)

Why did eating disorders increase during Covid-19

• social isolation, stay-at-home orders

• food insecurity (panic buying)

• pressure to exercise

• loss of routine and perceived control

• difficulty accessing f2f clinical services, reduced access to usual support networks

• more time on social media

How does society influence eating and body image

• society often idealises thinness, which can increase body dissatisfaction, negative mood, and dieting behaviours.

• weight stigma is also very common.

What did Griffiths et al., (2025) find

• algorithms for users with eating disorders (Eds) delivered 4343% more toxic ED videos

• ED users’ algorithms delivered 335% more dieting videos, 142% more exercise videos

• ED severity correlated with higher algorithm bias towards problematic videos