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Psychology Final- Eating Disorders
Terms in this set (90)
what are the DSM 5-criteria for anorexia nervosa?
1. restriction of behaviors that promote healthy weight, body weight significantly below normal- vmi less than 18.5 for adults
2. intense fear of gaining weight or being fat- can't be 'too thin
3, distorted body image or sense of body shape- feel fat even when emaciated
-Amnorrhea not required for diagnosis
what are examples of rumination disorders?
-avoidant/restrictive food intake disorder
-binge eating disorder
-other specified feeding or eating disorders
is obesity listed as a mental disorder
-a lot of genetic factors
-can be a side affect of a psychiatric disorder
define eating disorder
-disruption in eating behavior that affects physical, psychological, and social functioning
what are the 2 subtypes of anorexia nervosa?
2. binge eating/purging
-lose weight by severely limiting food intake
does restricting involve binge eating/purging?
- no binge eating or purging during the last 3 months
-person regularly engages in binge eating and purging during the last 3 months
what changes have been made to the DSM-5 regarding anorexia nervosa?
-rather than "refusal to eat" classified by restriction of behaviors that promote healthy weight
-rather than just fear of gaining weight, focus on behaviors that interfere with weight gain
-no longer need to lose of menstrual period
-subtypes specified for past 3 months, not just current episode
-getting ride of criteria allows more people to get diagnosed. ex. men don't get periods
when does anorexia nervosa typically onset?
-early to middle teens
what typically triggers anorexia nervosa?
-dieting an stress
women are ___x more likely to develop anorexia nervosa than men
10x; however, symptoms are similar in men and women
Anorexia nervosa is often comorbid with...
depression, OCD, phobias, panic, alcoholism, and PD (?)
in men, anorexia nervosa is comorbid with
-substance dependence, mood disorder, schizophrenia
sucide rates for anorexia- completing/attempting
what physical changes occur with anorexia?
-low blood pressure (hypotension) and HR (irregular)
-kidney and GI problems
-loss of bone mass
-brittle nails, dry skin, hair loss
-depletion of potassium and sodium electrolites- causes tiredness, weakness, and death
-soft, downy body hair
-even present on persons face
what percent of individuals with anorexia recover?
-may take 6 or 7 years
what is the most difficult part to treat when treating anorexia nervosa?
-ddistored view of self, esp in cultures that highly value thinness
death rates associated with anorexia nervosa
-10x higher than general population
-2x higher than other psychological disorders
define bulimia nervosa
-uncontrollable eating binges followed by compensatory behavior to prevent weight gain
DSM criteria for bullimia
1. recurrent episodes of binge eating
-excessive amounts of food consumed in under 2 hours
-felling loss of control over eating
-as if one cannot stop; continues until uncomfortably full
2. recurrent compensatory behaviors to prevent weight gain
3. body weight and shape are extremely important for self eval
4. binge eating and compensatory behaviors both occur on average once a week for 3 months
compensatory behaviors of bulimia
-purging (vomiting). fasting, excessive exercise, use of laxatives and diuretics
what triggers bulimia?
-stress or negative emotions or negative social interactions
food intake choices with bulimia
cakes, cookies, ice cream, other easily consumed, high calorie foods
-avoiding a craved food can later increase likelihood of binge
-typically occur in secret
eating binges often lead to
-shame and remorse
-lose of awareness or dissociation
when does bulimia typically onset?
-late adolescences or early adulthood
what percent of individuals with bulimia are women?
what percent of the female population develops bulimia?
-typically overweight, leads to dieting?
what disorders are comorbid with bulimia?
-depression, PD's, anxiety, substance abuse, conduct disorder
suicide in bulimia
-suicide attempt and completion higher than general pop but much lower than anorexia
do bulimics usually have a high, low or medium BMI?
what physical changes occur with bulimia?
-potassium depletion from purging
-laxatives deplete electrolytes- can lead to cardiac irregularities
-loss of dental enamel from stomach acids in vomit
mortality rate for bulimia
what percent of bulimics recover?
what percent of bulimics remain fully symptomatic?
what affects prognosis of bulimia?
-early intervention --> improved outcomes
-poor prognosis when depression nd substance abuse are comorbid or more severe symptoms
DSM criteria for binge eating disorder
1. recurrent episodes of binge eating; on average, at least once a week for 3 months
2. binge eating episodes include at least 3 of the following
-eating more rapidly than normal
-eating until uncomfortably full
-eating large amounts when not hungry
-eating alone due to embarrassment about large food quantity
-feeling disgusted, guilty or depressed after binge
3. no compensatory behavior present
-set bar low to catch people early
key changes from the DSM-5 for binge eating disorder
-has been made its own new category
-was previously in the appendix as a category in need of further research
binge eating disorder is associated with...
-obesity, history of dieting
do all obese people meet criteria for binge eating disorder? what percent do?
-no, must report binge eating episodes and a feeling of loss of control over eating to qualify
-2-25% may qualify
what risk factors are associated with binge eating disorder?
childhood obesity, early childhood weight loss attempts, having been taunted about weight, low self concept, depression, childhood physical and sexual abuse
is there variations in prevalence of binge eating disorder when comparing euro, african, asian and hispanic?
no, equal prevalence
what percent of individuals with binge eating disorder recover?
about 60% (between 25-82%)
which eating disorder lasts the longest?
-binge eating disorder, lasts an average of 14.4 years
differences between anorexia nervosa and bulimia (3)
-veiw of disorder
-feelings of control
similarities between anorexia nervosa and bulimia (3)
-SES, age, gender
associated clinical features:
-gender ratio: 10 to 20:1 females to males
-personalitiy traits: greater harm avoidance, persistence, conscientiousness, perfectionism
-associated clinical features: compulsivity, over control
associated clinical features:
-gender ratio: 10:1 females to males
-personality: greater novelty seeking, negative emotionality, social insecurity, feelings of ineffectiveness, stress reactivity, perfectionism
-associated clinical features: affective dysregulation, impulsivity, under control
view of disorder:
feelings of control
- eating/weight: extreme diet below minimally normal weight
-view of disorder: denial of anorexia, proud of diet
-feelings of control: comforted by rigid self control
view of disorder:
feelings of control
-eating/weight: binge eating/ compensatory behavior, normal weight
-view of disorder: aware of problem, secretive/ashamed
-feelings of control: distressed by lack of control
do people with binge eating disorder lose weight?
difference between binge eating disorder and bulimia
- no compensatory behavior in binge eating disorder like purging, typically overweight
-people with binge eating disorder may be happy with their body image or be unaware
similarities between bulimia and binge eating disorder
-both have lack of control over how much you're eating
biological factors of the biopsychosocial model of bulimia
- genetic factors
-disturbances in serotonergic and noradrenergic systems
-reduced sexual noradrenergic activity
psychological factors of the biopsychosocial model of bulimia
-negative self eval, low self esteem: result in increased importance of ones body size
-rigid cognitive style, all or nothing thinking ex. some foods are good, some bad (sets you up for binging bc if you eat one bad food might as well eat everything)
-75% increase in lifetime risk of developing mood disorder
social factors of the biopsychosocial model of bulimia
-cultural norms emphasis on thinness and ideal body shape, body determines self acceptance
-certain sports equate body size to ability to suceed- ex. jockey, wrestling, dance
if you are a female and have a family member with an eating disorder you are at a ______ higher risk
what have twin studies found about the genetic links associated with eating disorders?
-first degree relatives of infibiduals with both disorders are more likely to have the disorder
-higher monozygotic concordance rates for both anorexia and bulimia
what heritable personality traits are cause eating disorders?
-body dissatisfaction, desire for thinner, binge eating, weight preoccupation
does environment influence eating disorders?
-yes, environmental factors like family interactions play an even greater role in etiology
-children learn eating habits from their parents and TV
is the hypothalamus directly involved in eating disorders?
how can endogenous opioids influence the etiology of eating disorders?
-substances that reduce pain, enhance mood, and suppress appetite
- released during starvation: may reinforce restrictive eating of anorexia
-excessive exercise increases opioids
-low levels of opioids (beta endorphins) in bulimia promote craving- reinforce binge
what is serotonin related to?
-feeling of satiety (Feeling full)
are levels of serotonin metabolites high or low in anorexia and bulimia
-5HT under activity in anorexia and 5HT deficit in bulimia prevents sense of satiety
are antidepressants effective in treating eating disorders?
-antidepressants that increase serotonin are often effective
-possibly due to comorbity of MDD
-some should be prescribed to people w eating disorders because they increase appetite
how is dopamine related to eating disorders
-anorexics feel more positive and rewarded when viewing pictures of underweight women
-related to pleasure and motivation
what is the cognitive behavioral view of anorexia?
-focus on body dissatisfaction and fear of fatness
-certain behaviors (restrictive eating, excessive exercise) negatively reinforce- reduce anxiety about weight gain
-positively reinforced by feelings of self control brought upon by weight loss
-perfectionism and personal inadequacy--> excessive concern about weight
-criticixm from fam and friends about weight
what is the cognitive behavioral view of bulimia?
- self worth strongly influenced by weight- low self esteem
-rigid restrictive eating triggers relapse, which becomes binges (many off limit foods)
-after binging disgusted on self, fear of gaining weight --> compensatory behavior
-purging temporarily reduces anxiety about weight gain, but negative feelings bout purging trigger low self esteem --> further binging
-stress- negative affect- trigger binge
schematic of cognitive behavior theory of bulimia nervosa
1. low self esteem, negative affect
2. dieting to feel better about self
3. food intake restarted to severely
4. diet is broken
6. compensatory behavior reduce fear of weight gain
what sociocultural factors contribute to eating disorder etiology?
-america society values thinness, masculinity in men
-dieting more prevalent- precedes onset
-body dissatisfaction and preoccupation w thinness predict eating disorders
-unrealistic media portrayals- women feel ashamed they don't match it
-over weight individuals viewed w disdain, more pressure to be thin
how does objectification influence eating disorders in women?
-women are defined by their body, men defined by their success
-societal objectification leads to self objectification
-women see their own body through the eyes of others
-leads to more shame when they fall short of cultural ideals
how does age affect eating disorders?
-increase in older ED among older people
-aging and changes in life role (ie. having kid, getting married) associated w decrease
is anorexia found in many cultures?
-yes!, even those not under western influence
-may not include fear of getting fat
-as countries become more like western cultures eating disorders are increasing
-bulemia more common in industrialized societies
higher weight meaning in some cultures
-sign of fertility and healthiness
how does child abuse relate to eating disorders?
-higer rates of childhood sex and physical abuse --> higher risk
how do eating disorders impact personality?
-semi starvation --> preoccupation food and personality changes
how do personality characteristics impact eating?
-perfectionism, lack of interoceptive awareness, and negative affect --> eating disorder
-perfectionism high even after treatment
what family characteristics impact eating disorders?
-high levels of fam conflict
hospitalization as a treatment for anorexia
-goal is to prevent person from dying, stabilize them
-hospital stay has been reduced from 5 months in 1980 to 3 weeks in 1998
what medications have been used to treat anorexia?
serotonin enhancing meds
psychological treatments for anorexia
-fam therapy, psychodynamic psychotherapy, cognitive behavioral therapy
psychological treatments for bulimia
-cognitive behavioral therapy, interpersonal therapy, dialectical behavioral therapy
what meds are used to treat bulimia
SSRI's, also use self help manuals
what therapy combo prevents relapse for individuals with bulimia?
-CBT combined with meds
-binges are learned response to emotional state
-in therapy encouraged to eat in front of others
interpersonal therapy for bulimia
-focus on interpersonal relationships
-negative affect --> binge, often have to do with interpersonal relationships
dialectical therapy for bulimia
-treat emotional volitidy and impulsive behavior that is common in people with borderline personality disorder (hallmark is impulsivity)
- 20 week program- significantly less likely to purge
what do studies of behavioral, cognitive behavioral, and IPT reveal for bulimia?
behavior therapy, CBT and ITP were all effective in reducing binges
-data showed gains were maintained by CBT, about half gains from BT were lost, improvement continued to increase with ITP
what treatment methods are used for binge eating disorder?
-CBT shown to be effective: teach restrained eating through self monitoring, self control, and problem solving skills
-IPT = CBT
-behavioral weight loss programs may promote healthy weight loss but don't impact binge eating
how can we prevent eating disorders?
psychoeducation- educate early of danger
de-emphasize sociocultural influences
risk factor approach- healthy weight intervention to develop healthy weight and exercise programs
This set is often in folders with...
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