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39 terms

Eating Disorders

Abnormal Psych, Midterm 2, ch. 9
STUDY
PLAY
eating disorders
-2 characteristics
-INTENSE FEAR of being overweight/fat
-PURSUIT of thinness
anorexia nervosa
-INTENSE FEAR of gaining weight
-REFUSAL to maintain even minimally low body weight
-2 types: restricting and binge-eating/purging
-centuries old disorder
name the questionable diagnostic criteria for anorexia
-name criteria
-describe problem
-describe 3 suggested replacement criteria
-amenorrhea: lack of period
-problem: can't apply to men, women on birth control, or pre-menstruating girls
-suggested replacement criteria: hypothermia, low blood pressure, lanugo (downy hair growth)
2 types of anorexia
1) RESTRICTING type--caloric intake tightly controlled
2) BINGE-EATING/PURGING type
-difference between two concerns WAY patients MAINTAIN their low weight
binge and purge (type of anorexia)
-define both
BINGE: OUT-OF-CONTROL consumption of food
-may be followed by purge
PURGE: effort to remove food that's been eaten from body
-self-induced vomiting, misusing laxatives/diuretics/enemas
-compensatory behaviors: excessive exercise or fasting
bulimia nervosa
-5 characteristics
-2 types
-history of disorder
CHARACTERISTICS:
-uncontrollable BINGE eating & efforts to PREVENT resulting weight gain by using INAPPROPRIATE behaviors--self-induced vomiting/excessive exercise
-feeling of LACK OF CONTROL during binges
-self-evaluation influenced by weight/body shape
-self-disgust of behavior (shame, guilt)
-patients are typically of normal weight or even overweight
-2 TYPES: purging and non-purging
-recent disorder (1987)
DIFFERENCE between bulimia and binge-eating/purging type of anorexia
-Weight
-person with ANOREXIA severely UNDERWEIGHT; person with bulimia not underweight
-in other words, ANOREXIA trumps bulimia as it is more severe
2 types of Bulimia
-PURGING: most common; characterized by purgative episodes (vomiting, use of laxatives)
-NONPURGING: person may fast/exercise, but doesn't use vomitting, laxatives, or diuretics to counteract binges
Eating Disorder Not Otherwise Specified (EDNOS)
-patterns of disordered eating that don't exactly fit criteria of more specific diagnosis
-tends to reflect SEVERE and LONG-STANDING clinical problems
Binge-Eating Disorder (BED)
-characteristics
-how does it differ from Bulimia
-provisional diagnosis that is not yet officially in DSM
-patient BINGES at level comparable to bulimia patient, but there is NO COMPENSATORY behavior to limit weight gain
-much LESS DIETARY RESTRAINT
-associated w/being overweight/obese
-overvalued ideas of importance of weight/body shape
-age of ONSET in anorexia and bulimia
-prevalence men/women
ONSET:
-doesn't occur in appreciable numbers before ADOLESCENCE
-ANOREXIA: 15-19
-BULIMIA: 20-24
-BED: 30-50
PREVALENCE
-10 women to 1 man
BONUS
-reverse anorexia
-muscle dysmorphia
eating disorders that are almost exclusively in MEN
BONUS
__________ has highest mortality rate of ANY psychiatric disorder
ANNOREXIA
-3% of patients die from consequences of self-starvation (.5 for bulimia)
-3-23% will make suicide attempt
BONUS
what could account for some of the depression/cognitive changes documented in low-weight anorexia patients?
Thiamin (vitamin B1) deficiency
There is a large amount of D______________ C___________ with Eating disorders
-some bonus information
DIAGNOSTIC CROSSOVER
-bidirectional transitions btwn 2 subtypes of anorexia especially common
-shifts from anorexia to bulimia in 1/3 of patients
-binge-eating disorder and anorexia appear to be distinct
Co-morbid diagnosis with Eating Disorders
-depression
-substance abuse
-OCD
-Axis II Personality Disorders
True or False? Anorexia is a Western-culture bound syndrome.
FALSE
-not culture bound, though culture may influence manifestation
True or False? Bulimia is a Western-culture bound syndrome.
TRUE
-occurs only in people who have had exposure to Western culture/ideals
set point
-biologically determined weight our individual bodies physiologically try to "defend"
Serotonin
-NT, implicated in obsessionality, mood disorders, and impulsivity
-modulates appetite and feeding behavior
-patients w/eating disorders respond well to SSRIs
Family Influences on eating disorders
-family DYSFUNCTION, including: rigidity, parental overprotectiveness, excessive CONTROL, and marital discord
-parents of patients PREOCCUPIED w/desirability of THINNESS, dieting, physical appearance
-family members may make DISPARAGING COMMENTS
Perfectionism as risk factor for eating disorders
-need to have things exactly right
-people who are perfectionists may be more likely to prescribe to thin ideal & pursuit of "PERFECT BODY"
-men w/eating disorders are less perfectionistic than women
Body Dissatisfaction as risk factor for eating disorders
-sociocultural influence on "ideal" of female body form
Dieting as risk factor for eating disorders
-here, expectation and self-imposed high standards may be true culprit
-when our efforts to diet fall short, it is almost inevitable that we will feel NEGATIVELY about ourselves
Negative emotionality as risk factor for eating disorders
-when we feel BAD, we tend to be SELF-CRITICAL
-can promote distorted way of thinking and processing information received from environment
-binge eating may provide relief to negative emotions and in this way, be reinforced
Treatment of Anorexia
-4 main approaches
-HOSPITALIZATION: first concern: RESTORE weight to level that is no longer life-threatening; then rigorous control of patient's caloric intake
-FAMILY THERAPY
-CBT
-SSRIs
Family Therapy Treatment for Anorexia
-treatment of choice for ADOLESCENTS
-Refeeding phase, Negotiations for new pattern of relationship phase, Termination phase
CBT Treatment for Anorexia
-goal of changing behavior and maladaptive styles of thinking
-difficult since Anorexia patients view their behavior not as abnormal, but as a positive lifestyle choice
CBT Treatment for Bulimia
-2 behavioral components
-1 cognitive component
BEHAVIORAL component:
-"normalizing" eating patterns
-meal planning, nutritional education, ending binging/purging cylces
COGNITIVE component:
-changing dysfunctional cognitive distortions ("all-or-nothing" or dichotomic thinking) that initiate binge cycle
Treatment for Binge-Eating Disorder
-4 approaches
-antidepressants used
-appetite suppressants, anticonvulsant medications
-CBT
-self-help reading materials
Obesity
-defined using Body Mass Index (BMI):
under 18.5 underweight
18.5-24.9 normal
25 to 29.9 overweight
above 30 OBESITY
above 40 morbid obesity
True or False?Obesity is included as a diagnostic disorder in DSM
False.
Leptin
-what is it?
-where is it produced?
-hormone produced by FAT cells
-acts to REDUCE our intake of food
-overweight individuals are RESISTANT to leptin's effects
Grehlin
-what is it?
-where is it produced?
-hormone produced by STOMACH
-powerful appetite STIMULATOR
-Prader-Willi syndrome have very high levels of Grehlin
Sociocultural Influences on Obesity
-TIME PRESSURE
-culture of SUPERSIZING: food industry skilled at getting us to MAXIMIZE food intake
Family Influences on Obesity
-food/eating can become habitual means of ALLEVIATING emotional distress or SHOWING LOVE
-overfeeding infants/young children may cause MORE ADIPOSE CELLS that predisposes them to adult weight problems
-theory of obesity as "SOCIALLY CONTAGIOUS"
3 main Treatments for Obesity
1) lifestyle modifications (diet, exercise, behavior therapy)
2) medications
3) bariatric surgery
2 categories of medications used to treat Obesity
1) appetite suppressants that work by increasing availability of NT
2) nutrient blockers that prevent absorption of food
What is the most effective long-term treatment for people who are morbidly obese?
Bariatric or gastric bypass surgery