Mental Health and Eating Disorders Flashcards

Mental Health I: Individual Differences

Traditional psychology often explains individual differences based on internal characteristics, overlooking situational factors.

Traditional Psychological Perspective

Individual Differences: Variables that distinguish one person from another.

• Relevant to eating disorders and associated depression, helping identify at-risk individuals.
• 'Abnormality' is a controversial aspect within individual differences.

Models of Mental Health

• Medical model
• Psychological models: Psychopathology primarily due to psychological processes.
• Critical psychological models: Impact of power, social, and political constructs on behavior (e.g., Parker, 1990s).

Identifying Mental Health Disorders

• Common mental health disorders: Extreme forms of normal emotional experiences (e.g., depression, anxiety).
• Severity not always less than psychotic symptom conditions.
• Less common mental health disorders: Psychotic symptoms interfere with reality perception (hallucinations, delusions, paranoia).

Eating Disorders: Anorexia Nervosa and Bulimia Nervosa

Overview of Anorexia Nervosa and Bulimia Nervosa.

Both involve extreme weight loss and maintenance methods.

• Included in DSM-5 & ICD-11.
• Recognized psychiatric/mental health disorders.

Anorexia Nervosa (AN)

‘Anorexia nervosa (AN) is a mental illness with the highest rates of mortality and relapse, and no approved pharmacological treatment.’ Temizer et al (2022)

• Characterized as self-starvation syndrome.
• Major sign: Emaciation due to food refusal.
• Intense fear of weight gain.
• Body image disturbances.
• Predominantly affects women – controversial.
  • Sub-types:
    • The restricting type (ANR)
    • The binge eating/ purging type (ANBP)

Diagnostic Criteria of AN (DSM-5)

• Persistent restriction of energy intake leading to significantly low body weight.
• Intense fear of gaining weight or persistent behavior that interferes with weight gain.
• Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Primary Symptoms of Anorexia Nervosa

• Denial
• Depression
• Mood swings
• Social withdrawal
• Lack of sexual interest
• Low self-esteem

Secondary Symptoms of Anorexia Nervosa

• Constipation
• Low blood pressure
• Hypothermia
• Mortality rates (National Association of Anorexia Nervosa and Associated Disorders, USA, 2013):
  • 5-10% die within 10 years of contracting the condition.
  • 18-20% die within 20 years.
  • Only 30-40% ever fully recover.

Bulimia Nervosa

Referred to as the ‘binge-purge syndrome’ involving:

• Consumption of massive quantities of food.
• followed by measures to eliminate potential fat-producing calories.
• Debate on whether Bulimia is a separate syndrome or a manifestation of Anorexia Nervosa.

Bulimia Nervosa: DSM-5 Criteria

• Recurrent episodes of binge eating characterized by:
  • Eating a larger amount of food than most people would in a 2-hour period.
  • A feeling of loss of control over eating.
• Recurrent inappropriate compensatory behavior to prevent weight gain (self-induced vomiting, misuse of laxatives, diuretics, medications, fasting, excessive exercise).
• Binge eating and compensatory behaviors occur at least once a week for three months.
• Self-evaluation unduly influenced by body shape and weight.

Additional Information on Bulimia Nervosa

• 40% of those with eating disorders are Bulimic (Adult National Morbidity Survey ).
• 30% of women with BN have a lifetime history of AN, (Keel & Klump).
• Bulimia Nervosa exists in a wide variety of countries (National Centre for Eating Disorders).
• Age of onset is later than Anorexia Nervosa – 18.5 years.
• Linked by some researchers (Sagiv & Gvion, 2020).

Types of Bulimia Nervosa (BN)

• Purging BN (BNP): Regular use of purging methods.
• Non-purging BN (BPnP): Regular use of non-purging methods.
• Self-induced vomiting is the most common compensatory behavior.
• Binge eating episodes and compensatory behavior occur more than twice a week for three months.

Secondary Symptoms of Bulimia Nervosa

• Depression
• Mood swings
• Suicidal tendencies
• Awareness of problem
• Often ‘normal’ weight
• Cyclical nature of disorder

Consequences

• Potassium Depletion
• Weakness
• Cardiac Arrhythmia
• Renal damage

Binge-Relief-Purge-Guilt/Disgust Cycle

Depicts the emotional sequence in bulimia nervosa.

Personality Factors in AN & BN

Personalized treatments development:

• Cognitive Inflexibility (rigid patterns of thought ) may contribute to onset and persistence of eating disorders ( Schaefer et al 2024)
• Neuroticism and impulsivity are both risk and diagnostic markers (Kings College London 2024)
• Being rule-driven and Drive-for-order (KCL , 2024)
• Excessive doubt and cautiousness ( Giles et al 2021)
• Women with both AN & BN were significantly more likely to have obsessive–compulsive personality traits in childhood.
• Childhood obsessive-compulsive personality traits showed a high predictive value for development of eating disorders in adulthood (Anderluh et al., 2003).

Meta-Analysis Findings (Stackpole et al 2023)

• Perfectionism is a risk and maintaining factor for eating disorders.
• Perfectionistic strivings and concerns related to eating disorder symptoms.
• Treatment for perfectionism may hold promise for prevention and treatment.
• Eating disorders are also associated with negative affect and mood disorders are often co morbid with AN & BN. (Sierra et al 2021)
• Debate: whether mood disorder is a consequence or a cause of AN & BN.
• Low self-esteem and life satisfaction has been associated as a causal factor in the development of AN in adolescents (Pelc et al 2023)
• Some researchers argue that AN is a way of combating LSE i.e. by doing something really well (ie control food) can improve SE.

Aetiology of Eating Disorders

• No single factor responsible
• Range of Psychological, Sociological and Biological processes.
• Broad possible influences in ED, some researchers have limited themselves to defining the risk factors……. .
• Current research has a good idea of what risk factors are involved but little insight into how they are involved.

Biological/ Genetic Factors

• First-degree relatives of females with AN are more likely to develop an ED
• Research has located a gene suspected to be involved in the development of AN, this has yet to be confirmed.
• Monozygotic twins have higher concordance rates than dizygotic twins for ED development.
• Whether a person binges/vomits/restricts seems related to environmental factors, (Mazzeo et al ), thus underlining the principle of multiple causality.

Hypothalamus & Neurotransmitter Involvement

• Hypothalamus linked to controlling eating; malfunctioning may explain A.N. and B.N. (Shaikh 2011)
• Altered serotonin levels: correlations between anorexic/bulimic behavior and changes in levels of serotonin with higher levels of harm avoidance associated with higher levels of serotonin in the brain (Cloninger, 1985)
• People who have trouble regulating the amount of dopamine in their brains have higher levels of novelty-seeking (Zald et al., 2008), and that this also occurs in women with bulimia (Groleau et al., 2012).
• Diet preferentially affects females: a three-week calorie reducing diet aimed at lowering Serotonin activity will produce greater alterations in serotonin activity and lowering mood in women than in men
• Overall complex interaction research suggests may be associated with low levels of serotonin (Vanja Rozenblat et al. 2017)

Brain Abnormalities & Eating Disorders

• Brain abnormalities found in people with ED.
• Areas of the brain appear to be shrunken. Total white & grey matter sig. decreased, it is not clear whether this caused or resulted from ED, (de Zwann 2006).
• Plasticity?
• The addictive, maladaptive aspects of excessive exercise and food restriction may effect brain changes (Aoki 2021)
• Therefore occupations that demand excessive exercise / food restriction are at risk

Increased Prevalence in Specific Populations

‘Anorexia nervosa is increasing in prevalence, especially among the male population. Although recognized to be more prevalent among athletes, dancers, and models, the Department of Defense recognizes that those serving the military may also be at risk’ Aoki (2021)

Socio-Cultural Factors

• The increased incidence of AN & BN over the last 20-30 years has been connected to the portrayal of the ‘ideal’ female shape through the media in westernized societies.
• The media regularly portrays female body images as unnaturally thin
• Children's role models ?

Stereotyping

• Thinness=Beauty=Success
• Thinness= control over one’s life
• Western cultures exalt thinness and disparage/ prejudice against obesity.

Eating Disorders in Ethnic Minorities - Contradictions

• Historically thought that a strong African American cultural identity seemed to protect women from ED, which involves greater satisfaction with higher weights in black women, and that ED are associated with white women of privilege , the latter was promoted by Hilde Bruch in the 70s (The Golden Cage)
• This seems to be changing……
• Many researchers are now arguing that “eating disorders don’t discriminate,” eating disorders affect everyone!
• As we commit to diversity and inclusion, the stereotype of the thin, white woman of privilege is being challenged with the recognition of diversity of experiences and identities.

Stereotypes & Treatment Access

Stereotypes about who gets an eating disorder are preventing people from minoritized groups and people from less affluent backgrounds from seeking and getting medical treatment.

“Eating disorders are serious mental illnesses that affect people of all ages, genders, and backgrounds. We have to challenge the stereotypes and raise awareness so that everyone who needs help can get it quickly.” Beat (2019)

Themes in Disordered Eating

• the pursuit of identity
• power
• self-esteem & respect
• These themes are also pervasive in the lives of oppressed individuals as well as affluent ones.
• It is imperative that we re-examine our assumptions about who is susceptible to disordered eating and ensure that our efforts to combat these issues are inclusive of all women and men .

The Treatment of Eating Disorders

ED are very difficult to treat for a number of reasons:

• Sufferers deny they are /underweight/have a problem/ill.
• Individuals (esp. AN) need medical as well as psychological treatment, to prevent death.
• ED are highly co morbid with other psychological disorders, which may make treatment difficult and complex.

National Service Framework: Mental Health

• Sets out the government's quality standards for mental health services.
• Standards 2 and 3 of the national service framework for mental health outline the need to improve health care for patients with anorexia nervosa and bulimia nervosa
• The SCOFF questionnaire is a brief and memorable tool designed to detect eating disorders and aid treatment . It showed excellent validity in a clinical population and reliability in a student population Luck et al (2022)

SCOFF Questionnaire (Prof. J. Morgan)

• Do you ever make yourself Sick because you feel uncomfortably full?
• Do you worry you have lost Control over how much you eat?
• Have you recently lost more than One stone in a three month period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?
• A score of 2 or more positive answers = positive screen for eating disorder.

Treatment Modalities

• Physical
  • Bed rest
  • Restoration of body weight
  • Intravenous feeding
  • Maintain body weight
• Drug Therapy
• Psychodynamic- focus-alter the irrationality
• Psychotherapy
• Family therapy
• Cognitive Behavioural therapy

Pharmacological Treatments

• Both AN & BN are frequently co morbid with major depression.
• Antidepressants are used to treat.
• Pharmacological treatments have tended to be less successful with AN, although limited studies have been done.

Summary

• Anorexia Nervosa is characterized by an intense fear of becoming fat, a distorted body image and a refusal to maintain a normal body weight. Anorexia nervosa if left untreated can lead to death. Psychological, biological & familial influences have been strongly implicated in the development Anorexia Nervosa. Treatment remains complicated.
• Bulimia Nervosa is characterized by the rapid consumption of a large quantity of food in a discrete period of time while feeling out of control. It is also characterized by self-induced vomiting, use of diuretics, fasting, and vigorous exercise and over concern with body weight. Treatment is difficult but has had some success with anti depressants.
• ED have the highest mortality of all psychiatric disorders.