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chapter 15

Terms in this set (26)

eating disorder types
anorexia nervosa, bulimia nervosa, binge eating disorder, unspecified eating disorder
eating disorders are
mental illness not a choice
anorexia nervosa
Restriction of energy intake relative to requirements, leading to a significantly low body weight

Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight

Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
subtypes anorexia nervosa
restricting types, binge eatin/pursing type
restricting type
: during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
binge eating/purging type
the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (self-induced vomiting, laxatives, diuretics, or enemas)
common notes about anorexia nervosa
Prevalence of AN is ~0.4% among young females
10:1 female-to-male ratio
Commonly begins during adolescence or young adulthood, but can occur at any age
Onset is often associated with a stressful life event
5% mortality rate
Comorbidity is very common, especially bipolar, depression, anxiety, and OCD
atypical anorexia
A diagnosis for individuals who do not fit the criteria for AN because despite significant weight loss, the individual's weight is within or above the normal range

Diagnosed as: "Other Specified Feeding or Eating Disorder"
bulimia nervosa
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (<2 hours), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
A sense of lack of control over eating during the episode (cannot stop eating or control what or how much one is eating)
Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
The binge eating and inappropriate compensatory behaviors both occur, on average, at least 1x/week for 3 months
Self-evaluation is unduly influenced by body shape and weight
The disturbance does not occur exclusively during episodes of Anorexia nervosa
bulimia nervosa facts
Typically normal weight or overweight
Prevalence of BN among young females is ~1.0-1.5%
10:1 female-to-male ratio
2% mortality rate
binge eating disorder
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (<2 hours), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances
A sense of lack of control over eating during the episode
The binge-eating episodes are associated with 3 (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed or very guilty afterward
Marked distress regarding binge eating is present
The binge eating occurs, on average, at least 1x/week for 3 months
The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in BN and does not occur exclusively during the course of BN or AN.
prevalence of BED
Prevalence of BED among US adult females and males is 1.6% and 0.8% respectively
unspecificed eating disorder
This category applies to presentations in which symptoms characteristic of an eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders.

Often used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific eating disorder, likely due to insufficient information at the time (first visits, emergency room settings, etc.)

(Formerly "EDNOS")
recent changes in diagnostic criteria
Change from DSM-IV to DSM-V in 2013
Greater than ½ of hospitalized patients with eating disorders did not fit diagnostic criteria (thus lacking coverage)
Changes:
Anorexia Nervosa
Amenorrhea no longer a requirement
Change from "expressed fear of gaining weight" to "persistent behavior that interferes with weight gain"
Bulimia Nervosa
Frequency of behaviors for diagnosis reduced from 2x/week to 1x/week
Binge Eating Disorder
Was not previously a diagnosi
theories of etiology
"Brain Disorders"
53-83% of eating disorders can be accounted for by genetic factors
Chromosomal regions
Reward centers
Altered serotonin, neuropeptide, and neurocircuitry systems are seen in both AN and BN
risk factors
The biggest risk factor is gender. Females have a 10x greater risk of developing an eating disorder than males.
Being an athlete does not place a person at increased risk for an eating disorder.
Dieting is an established risk factor for eating disorders
injury or off season wt gain being told to lose weight diet
Personality traits: low self esteem, self critical, impulsivity, addiction
dual diagnosis
EDs frequently exist with psychological comorbid conditions such as depression, anxiety, borderline personality disorder, OCD, and substance use.
spectrum disorder
Eating Disorders are spectral disorders; they exist on a continuum of severity and often become more severe the longer they are present
nature of eating disorders
People do not choose to have EDs
EDs have an emotional/behavioral component and a neurophysiological/genetic component.
The NP/G component sets the stage for ED development. A "trigger" will begin the process.
The E/B component begins with the trigger, such as weight loss
Many ED psychological symptoms resolve with physical restoration.
Often very resistant to treatment, and prone to deception, which leads to very slow progress.
Individuals with EDs are not purposefully attempting to be uncooperative or manipulative
ED's often co-exist with other psychiatric illnesses, especially anxiety related disorders. Dual-diagnosis is very common.
Physical restoration alone does not constitute recovery
observations
spontaneity and flexibility concerning po
participation in social situations with food
Abnormal speed of po
Inability to define or eat a balanced meal
Disproportionate time spent thinking about food
Excessive use of condiments
Cutting food into very small pieces before eating
"debiting" po
effects on sports performance
Decreased performance may not occur for some time, and the athlete may wrongly believe that the disordered eating behavior is harmless.
Endurance performance is likely to deteriorate if liver and muscle glycogen levels are low or if the athlete becomes dehydrated or anemic.
Dehydration is common in both AN and BN, this can also lead to loss of motor skill and coordination. The athlete will also experience difficulty maintaining comfortable body temperature.
Electrolyte disturbances are detrimental to muscle function, and with time, a loss of lean body mass will reduce strength and power.
effects on athletes health
Energy and macronutrient deficiency in people with anorexia may affect mood, endocrine status, growth, reproductive function, and bone health.
Inadequate intakes of calcium, iron, and B vitamins are of serious concern for female athletes.
Depression is a common symptom
Stunted growth in adolescent athletes may occur during prolonged periods of inadequate energy. (gymnasts, wrestlers).
Delayed onset of puberty.
female athlete triad
The 3 conditions that are prevalent in female athletes- amenorrhea, disordered eating, and osteoporosis- are collectively known as the Female Athlete Triad Syndrome

The Female Athlete Triad can occur in any athlete, including those without clinical ED's
theories in treatment
Multidisciplinary approach is absolutely necessary. This team includes nutrition, medical, and mental health professionals. This provides counseling, diet education, medication management, lab monitoring, etc. And also tackles the issue of "splitting"
Maudsley Method: family-based therapy approach found provide effective treatment for individuals <18 y/o, with AN and BN of short duration (<3 years)
Research with college-aged individuals and couples
Levels of Care:
Residential
Inpatient
Partial Hospitalization
Intensive Outpatient
Outpatient
ancel keys, early starvation study
Minnesota Starvation Study (1950's)
Physically and psychologically healthy male volunteers
Many of the symptoms that might have been thought to he specific to anorexia nervosa and bulimia nervosa are actually the results of starvation
It is absolutely essential that weight be returned to "normal" levels so that psychological functioning can be accurately assessed
maintenance period
Return to Normal" period
Begins after an individual is physically and nutritionally restored
Long/prolonged duration d/t persistent psychological disturbances (years)
RD's remain instrumental during this period
Weight maintenance
Caloric adjustment as exercise is resumed/increased
Relearning normal eating patterns
Engaging in social eating activities
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