Comprehensive Study Guide on Eating Disorders: Anorexia Nervosa and Associated Factors

Exam Timing: * The test is scheduled to begin at $09:15$ . * Students arriving at the usual time of $10:00$ should still be able to complete the exam as it is designed to last approximately one hour, but two hours are allotted for the session.
Exam Content and Format: * The exam is not cumulative. * Coverage includes Units $10$ , $11$ , and $12$ . * The format and length are identical to previous tests. * The instructor suggests that if a student does not know an answer after an hour and a half, the final $30$ minutes are unlikely to resolve the issue.

Suicide and Influences: * Discussion covered cultural influences on suicide and bullying as a contributor. * For sexual minority youth, bullying is a factor, but not the sole cause; higher rates of suicide persist even when controlling for bullying. * A lack of parental and family support is a significant additional contributor.
The TASA Study: * The TASA study (Treatment for Adolescents with Depression Study) compared medications, CBT (Cognitive Behavioral Therapy), and a combination of both. * Findings indicated that all modalities worked, but there was no control group, making it difficult to draw definitive conclusions. Further research is required.
Eating and Feeding Disorders: * ARFID (Avoidant Restrictive Food Intake Disorder): Characteristics include sensory aversions in children. * PICA Treatment: A specific "last ditch" treatment discussed is facial screening. This is a punishment-based intervention used only if all other methods fail.

There are three core features that distinguish Anorexia Nervosa from Bulimia Nervosa and Binge Eating Disorder.
Feature 1: Restriction of Energy Intake: * Restriction of food (energy) relative to daily requirements. * Leads to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. * "Significantly low weight" is defined as a weight less than what is minimally normal or expected.
Feature 2: Fear of Weight Gain: * Presence of an intense fear of gaining weight or becoming fat. * Persistent behavior that interferes with weight gain, even though the individual is already at a significantly low weight.
Feature 3: Disturbance in Body Experience: * Disturbance in the way body weight or shape is experienced. * Undue influence of weight or shape on self-evaluation. * A persistent lack of recognition regarding the seriousness of the current low body weight.

Pediatric Assessment (DSM-5): * For children and adolescents, clinicians calculate Body Mass Index (BMI). * BMI is a standard measure assessing the height-to-weight ratio. * Significantly Low Weight Threshold: Defined as a BMI score falling in the lowest $5^{\text{th}}$ percentile compared to children of the same age and gender.
Concrete Example: * A $14$ -year-old girl who is $5'2"$ (five feet, two inches tall). * A weight of $87\,lb$ (eighty-seven pounds) or less would place her in the lowest $5^{\text{th}}$ percentile for her demographic.

Physical Impacts: * Exercise and restriction lead to significantly lower bone density. * Bone density loss is greatest in the spine and the hips. * Osteopenia: Approximately $90\%$ of teens and young adults with AN show osteopenia. * Long-term Risk: Places individuals at risk for osteoporosis and hip fractures later in life. * Irreversibility: Bone loss associated with AN is generally irreversible.
Psychological Profile: Perfectionism: * A central personality characteristic of AN is perfectionism, defined as the rigid, unrealistic pursuit of absolute standards. * Historical Description (Gilberch, over 40 years ago): Adolescents with AN were described as excessively compliant, eager to please, and lacking an autonomous sense of self. * Typical Traits: Often described as perfectionistic, driven, goal-oriented, overachievers, popular, and academically successful. * Social/Emotional Traits: Conscientious about appearance; risk-averse due to fear of mistakes and losing approval; guarded and emotionally reserved. * Emotional Expression: Reluctant to express sadness, frustration, or anger directly; tendencies to hide or deny these emotions.

Individuals with AN often engage in dichotomous thinking, viewing themselves, others, and situations in binary terms (e.g., "good" or "bad").
This results in a rigid, harsh, and overly simplistic world view.
Example Thought: "If I gain one pound ( $1\,lb$ ), I am worthless" or "I am a complete failure."

Prompt: The instructor asked for examples of thoughts fitting the description of dichotomous thinking.
Olivia: Suggested an example involving culture, where funeral homes are viewed either as "super sad" or a "celebration of life," and a person with issues might only think it is a sad celebration.
Instructor Response: Noted that while it is an example of binary thinking, it is not as directly related to anorexia as other examples.
Isabella: Suggested the thought "Either I skip this meal or I can come back," representing an all-or-nothing approach to eating.
Serena: Suggested the thought "These pants are not fitting me. I'm really fat."

Heritability: * Eating disorders tend to run in families. * Females with a first-degree relative (parent or sibling) with an eating disorder are between $4$ to $11$ times more likely to develop an eating disorder compared to those with no family history. * Twin studies support the genetic component, though it is not $100\%$ .
Cross-Disorder Risk: * The increased risk is not specific to the relative's particular disorder. * A relative with Bulimia Nervosa places biological relatives at risk for all eating disorders (AN, BN, or Binge Eating Disorder), and vice versa.
Sexual Abuse as a Risk Factor: * Childhood sexual victimization is associated with the development of eating pathology, particularly Bulimia Nervosa, rather than Anorexia. * Theoretical Framework: Abuse leads to feelings of helplessness, shame, and disgust regarding the body. Girls may view their bodies as "tainted." * Coping Mechanisms: Shame may be expressed through deforming the body via starvation, binging, or purging. Some attempt to regain control over their bodies through strict dieting. * Evidence: Studies of maltreated children show an increased likelihood of developing eating disorders later in life. Chronologically, the sexual abuse typically occurs before the onset of the eating disorder.