{"id":4199,"date":"2018-09-18T17:19:06","date_gmt":"2018-09-18T21:19:06","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4199"},"modified":"2019-05-26T00:16:15","modified_gmt":"2019-05-26T04:16:15","slug":"eating-disorders","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/eating-disorders\/","title":{"rendered":"Eating Disorders"},"content":{"rendered":"<ul>\n<li>Became a distinct category in DMS-IV, DSM-5: eating disorders found in \u201cFeeding &amp; Eating Disorders\u201d chapter o <strong>Pica<\/strong> = eating nonfood substances for extended periods o <strong>Rumination <\/strong>= repeated regurgitation of foods<\/li>\n<\/ul>\n<p><strong>Clinical Descriptions of Eating Disorders I. Anorexia Nervosa <\/strong>(AN) DMS-5 Criteria:<\/p>\n<p>1) Restriction of food that leads to very low body weight; body weight is significantly below normal<\/p>\n<p>BMI less than 18.5) o Weight loss achieved through dieting and perhaps purging and excessive exercise<\/p>\n<p>2) Intense fear of weight gain\/being fat or repeated behaviours that interfere with weight gain *fear not reduced by weight loss<\/p>\n<p>3) Body image disturbance *distorted body image or sense of body shape o Particularly the abdomen, hips, thighs are too fat<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Weight themselves frequently, measure themselves, gaze in the mirror critically o Often assessed via questionnaire<\/li>\n<li>Women ideal: very thin (compared to normal), overestimate their own size, Male ideal: same as normal, overestimate their own size<\/li>\n<\/ul>\n<\/li>\n<li>SEVERITY: (BMI) <strong>Mild<\/strong> = =\/&lt; 17, <strong>Moderate<\/strong> = 16-16.99, <strong>Severe<\/strong> = 15-15.99, <strong>Extreme<\/strong> = &lt;15 o Healthy BMI is between 20-25<\/li>\n<li><strong>Amenorrhea<\/strong> = loss of menstrual period, is no longer a criteria<\/li>\n<li>Term <strong>anorexia<\/strong> refers to loss of appetite, <strong>nervosa<\/strong> indicates loss is due to emotional reasons<\/li>\n<\/ul>\n<p>\uf0b7 2 subtypes:<\/p>\n<p>o\u00a0 \u00a01) Restricting type: weight loss is achieved by severely restricting food intake<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>2) Binge eating\/purging: person has also regularly engaged in binge eating and purging\n<ul>\n<li>Nearly 2\/3 who meet category 1, switched over to 2 eight years later<\/li>\n<\/ul>\n<\/li>\n<li>Typically begins in middle teenage years, often after episode of dieting an occurrence of life stress<\/li>\n<li>Prevalence: less than 1% (stable), 10x as frequent in women as men *greater cultural emphasis on women\u2019s beauty o Higher mortality from men with disorder than women<\/li>\n<li>Comorbid with: depression, OCD, specific phobia, panic disorder and personality disorders \uf0b7 High suicide rates: 5% complete, 20% attempt Physical Consequences<\/li>\n<li>Low blood pressure, slow heart rate, kidney\/gastrointestinal problems, bone mass declines, skin dries, brittle nails, mild anemia<\/li>\n<li><strong>Lanugo<\/strong> = fine, soft hair, loss of hair from scalp<\/li>\n<li>Loss of Na and K electrolytes \uf0e0 tiredness, weakness, cardiac arrhythmias, sudden death<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Prognosis<\/p>\n<ul>\n<li>50-70% eventually recover, often after 6-7 years, common relapses before<\/li>\n<li>Death rates are 10x higher than the general population, 2x as high as those with other psyc disorders<\/li>\n<li>3-5% mortality rates among women *most often from physical complications (heart failure) and suicide o Death most likely among those who have had it for the longest <strong> Bulimia Nervosa <\/strong>(BN)<\/li>\n<\/ul>\n<p>DSM-5 Criteria<\/p>\n<ul>\n<li>1) Recurrent episodes of binge eating o Eating an excessive amount of food within a short period of time\n<ul>\n<li>Accompanied by feeling of losing control over eating \u2013 feel like one cannot stop<\/li>\n<\/ul>\n<\/li>\n<li>2) Recurrent compensatory behaviour to prevent weight gain, for example, vomiting<\/li>\n<li>3) Body shape and weight are extremely important for self-evaluation<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Bulimia<\/strong> comes from a Greek word for ox hunger \u2013 rapid consumption of a large amount of food<\/p>\n<ul>\n<li>People with bulimia are distinct from anorexia because they do not lose an excessive amount of weight<\/li>\n<li>Binges occur in secret, triggered by stress and negative emotions they arouse, continue until uncomfortably full o Often involves soft, sweet foods that can be rapidly consumed: ice cream, cake o More likely to binge while alone, during morning\/afternoon o Avoiding a craved food can lead to a binge the next day o Likely to occur after negative social interaction<\/li>\n<li>Severity: (Compensatory behaviours) <strong>Mild<\/strong> = 1-3\/week, <strong>Moderate<\/strong> = 4-7\/week, <strong>Severe<\/strong> = 8-13\/week, <strong>Extreme<\/strong> = 14+\/week<\/li>\n<li>Must occur at least once a week for 3 months<\/li>\n<li>Self-esteem depends heavily on maintaining normal weight<\/li>\n<li>More accurate than normal population in reporting height\/weight<\/li>\n<li>DSM-IV-TR included subtypes which were removed<\/li>\n<li>Begins in late adolescence\/early adulthood, 90% are women, 1-2% prevalence among females<\/li>\n<li>Many are somewhat overweight before onset<\/li>\n<li>Comorbid with: depression, personality disorders, anxiety disorders, substance use disorders, conduct disorder o Increase likelihood in both directions, except bulimia usually precedes substance use disorders<\/li>\n<li>Higher suicide rates than normal population (lower than anorexia)<\/li>\n<\/ul>\n<p>Physical Consequences<\/p>\n<ul>\n<li>Typically have a normal BMI but amenorrhea can still occur<\/li>\n<li>Frequent purging can lead to K depletion, loss of electrolytes, irregular heartbeat<\/li>\n<li>Vomiting can lead to tearing of stomach tissue and throat tissue, loss of dental enamel \uf0b7 Swollen salivary glands<\/li>\n<li>Mortality rate of 4% for women<\/li>\n<\/ul>\n<p>Prognosis<\/p>\n<ul>\n<li>Close to75% recover, 10-20% remain fully symptomatic<\/li>\n<li>Earlier intervention linked to better prognosis <strong> Binge Eating Disorder <\/strong>(BED) DSM-5 Criteria:<\/li>\n<li>1) Recurrent binge eating episodes o 1+\/week for 3 months<\/li>\n<li>2) Binge eating episodes include at least 3 of the following:\n<ul>\n<li>Eating more quickly than usual, eating until over full, eating large amounts even if not hungry, eating alone due to embarrassment about large food quantity, feeling bad after binge<\/li>\n<\/ul>\n<\/li>\n<li>3) No compensatory behaviour is present<\/li>\n<li>Most often are obese (BMI greater than 30), prevalence among 2-25% of obese people o Many have a history of dieting<\/li>\n<li>Severity (# binges\/week): <strong>Mild<\/strong> 1-3\/week, <strong>Moderate<\/strong> = 4-7\/week, <strong>Severe<\/strong> = 8-13, <strong>Extreme<\/strong> = 14+\/week<\/li>\n<li>Comorbid with: mood disorders, anxiety disorders, ADHD, conduct disorder, substance use disorder<\/li>\n<li>Risk factors: childhood obesity, critical comments about being overweight, weight-loss attempts in childhood, low self-concept, depression, and childhood abuse<\/li>\n<li>More prevalent than other eating disorders, 0.2-4.7% prevalence, more common in women (less gender difference)<\/li>\n<li>Equally prevalent cross-culturally<\/li>\n<\/ul>\n<p>Physical Consequences<\/p>\n<ul>\n<li>Increased risk of type II diabetes, cardiovascular problems, chronic back pain, headaches \uf0b7 Sleep problems, anxiety, depression, IBS, early onset menstruation for women<\/li>\n<\/ul>\n<p>Prognosis<\/p>\n<ul>\n<li>25-82% of people recover<\/li>\n<li>Lasts approximately 14.4 years (longer than anorexia\/bulimia) or just over 4 years? <strong>Etiology of Eating Disorders<\/strong><\/li>\n<\/ul>\n<p>Genetic Factors<\/p>\n<ul>\n<li>Unlikely caused by 1 gene, although they do run in the family<\/li>\n<li>1<sup>st<\/sup> degree relatives of women with anorexia are 10x more likely to have the disorder, 4x for bulimia o Same for men with anorexia, but not bulimia<\/li>\n<li>Higher MZ than DZ concordance rates for anorexia and bulimia<\/li>\n<li>Environmental factors are also very important (higher proportion of bulimia due to environmental than genetic factors)<\/li>\n<li>Heritable: dissatisfaction with one\u2019s body, strong desire to be thin, binge eating, preoccupation with weight<\/li>\n<li>Genetic factors may link to negative emotionality and constraint with eating disorders<\/li>\n<\/ul>\n<p>Neurobiological Factors<\/p>\n<ul>\n<li>Hypothalamus is a key brain structure involved in regulating hunger *not dysfunctional in anorexia<\/li>\n<li>Endogenous opioids reduce pain sensations, enhance mood and suppress appetite o Released during starvation, related to anorexia, bulimia and BED **increased levels o Excessive exercise increases opioids *reinforcing<\/li>\n<li>Low levels of beta-endorphin in bulimia *not sure if this is a cause or effect<\/li>\n<li>Serotonin \u2013 related to eating and satiety (feeling full) *promotes satiety o Binges could result from serotonin deficit o Food restriction interferes with serotonin synthesis\n<ul>\n<li>Low levels of serotonin metabolites in AN and BN = underactive NTM activity o Show poor response to 5-HT agonists in AN if haven\u2019t been restored to healthy weight o Linked to comorbid depression<\/li>\n<\/ul>\n<\/li>\n<li>Dopamine \u2013 related to reward\/pleasure aspects of food o Linked to motivation to obtain food o Restrained eaters more sensitive to food cues o Ventral striatum linked to DA level and reward<\/li>\n<\/ul>\n<p>\uf0a7 More activated in people with AN when looking at images of thin women o People with AN or BN show greater expression of DA transported gene DAT o Bingeing on sucrose leads to increased release of DA in the striatum<\/p>\n<p>Cognitive-Behavioural Factors<\/p>\n<ul>\n<li>Focus on distorted body image, fear of fat, loss of control of over eating \uf0b7 Anorexia Nervosa:\n<ul>\n<li>Emphasis on fear of fatness and body image disturbance as motivating factor that reinforced weight loss<\/li>\n<li>Onset often follows a period of weight loss and dieting<\/li>\n<li>Behaviours to achieve thinness are negatively reinforced by reduction of anxiety about becoming fat\n<ul>\n<li>Positively reinforced by comments form others o Dieting and weight loss positively reinforced by sense of mastery or self-control o Perfectionism and sense of personal inadequacy may lead a person to become concerned with appearance<\/li>\n<li>Compare oneself to portrayals in media of thin ideal, being overweight and comparing to attractive others all lead to greater dissatisfaction in one\u2019s body image<\/li>\n<\/ul>\n<\/li>\n<li>Criticism from peers and parents about being overweight<\/li>\n<li>Experience many negative emotions but also positive emotions (e.g. pride) after losing weight or avoiding treats\n<ul>\n<li>Low positive emotion differentiation: may confuse this feeling with happiness or success<\/li>\n<li>Low positive emotion differentiation predicts eating disorder behaviours (same with high negative) \uf0b7 Bulimia Nervosa and BED:<\/li>\n<\/ul>\n<\/li>\n<li>View self-worth in terms of body weight and shape<\/li>\n<li>Low self-esteem, hope control over body will help feel better generally o Try to follow strict eating plan, rules are inevitably broken, escalates into binge o Feelings of disgust and fear build up after binge, leading to compensatory actions o Purging temporarily reduces anxiety but lowers self-esteem, and cycle repeats\n<ul>\n<li>Low SE and high negative affect \uf0e0 Dieting to feel better about self \uf0e0 Food intake restricted too severely \uf0e0 Diet is broken \uf0e0 Binge \uf0e0 Compensatory behaviours to reduce fear of weight gain<\/li>\n<\/ul>\n<\/li>\n<li><strong>Restraint scale<\/strong> \u2013 questionnaire measure of concerns about dieting and overeating o Bingeing helps regulate amount of negative affect, although tend to experience more negative affect after binge<\/li>\n<li>Purging is reinforced by decreasing negative affect<\/li>\n<li>Concerns about body shape and weight predict restrained eating, which predicts increased bingeing<\/li>\n<li>Attention, memory and problem solving are affected with eating disorders\n<ul>\n<li>Attention focused on food-related images\/words longer<\/li>\n<li>Remember food words more when full w\/AN<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Sociocultural Factors<\/p>\n<ul>\n<li>BMI of ideal female models has decreased over time, male BMI increased due to increased muscularity<\/li>\n<li>As cultural standards moved more towards thin ideal, more and more people were becoming overweight<\/li>\n<li>Over 2\/3 of Americans are overweight<\/li>\n<li>Dieting has become more common (29% of men and 44% of women diet)<\/li>\n<li>A 1\/3 of women 25-45 report spending over half their lifetime trying to lose weight<\/li>\n<li>Diets are equally effective whether fats, carbs, or proteins are cut as long as number of calories are reduced<\/li>\n<li>Women are more likely to diet than men<\/li>\n<li>Highest risk for developing eating disorders with high BMI and body dissatisfaction<\/li>\n<li>Sociocultural ideal of thinness leads to people learning to fear being\/feeling fat<\/li>\n<li>\u201cPro-eating disorder\u201d websites \u2013 women who visit these sites are more dissatisfied with their bodies, have more eating disorder symptoms and more likely experienced hospitalizations for eating disorders o Viewing these websites has potential to cause unhealthful changes in eating behaviours \uf0b7 Gender Influence:\n<ul>\n<li>More common in women than men<\/li>\n<li>Western culture emphasizes thin ideal more in women<\/li>\n<li>Highest among groups expected to be concerned with thinness\/weight: gymnasts, models, dancers<\/li>\n<li>Objectification of women\u2019s bodies \u2013 women are defined by their bodies, men are esteemed for their accomplishments<\/li>\n<li><strong>Objectification theory<\/strong> = prevalence of objectification message has led some women to selfobjectify *see their own body through the eyes of others\n<ul>\n<li>Causes women to feel more shame about their bodies o As women get older, become less concerned with body weight, diet less (even though they tend to weight more then)<\/li>\n<li>Changes in life roles: having a life partner, having a child associated with decreased eating disorder symptoms<\/li>\n<li>Men more concerned about body image, increased dieting \uf0b7 Cross-Cultural Studies:<\/li>\n<\/ul>\n<\/li>\n<li>AN observed in a number of cultures\/countries with very little Western cultural influence\n<ul>\n<li>Doesn\u2019t include same degree of fear of gaining weight as it does in Western culture o In other cultures higher weight has greater value, better potential for fertility and happiness o BN more common among industrialized nations<\/li>\n<\/ul>\n<\/li>\n<li>Ethnic Differences:\n<ul>\n<li>Greater incidence among white than black women *most pronounced among college students<\/li>\n<li>White\/Hispanic report greater body dissatisfaction than African American o Acculturation can be stressful\n<ul>\n<li>High levels of acculturation stress in African American and Hispanic related to greater body dissatisfaction and bulimia symptoms<\/li>\n<\/ul>\n<\/li>\n<li>Found among all levels of SES<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Other Contributing Factors<\/p>\n<ul>\n<li>Personality Factors:\n<ul>\n<li>Personality in those with AN is affected by weight loss<\/li>\n<li>Become preoccupied with food, increased fatigue, poor concentration, lack of sexual interest, irritability, moodiness, insomnia<\/li>\n<li>Before onset of AN: perfectionistic, shy, compliant<\/li>\n<li>BN: adds, histrionic features, affective instability, outgoing social description<\/li>\n<li><strong>Poor interoceptive awareness<\/strong> = extent to which people can distinguish between different biological states of their bodies<\/li>\n<li>Propensity to experience negative emotions<\/li>\n<li>Perfectionism is multifaceted and may be self-oriented (setting high standards for self), otheroriented or socially oriented (trying to conform to high standards imposed by others\n<ul>\n<li>Remains high even after successful treatment<\/li>\n<li>Mothers of girls with AN score higher on perfectionism \uf0b7 Characteristics of Families: o Self-reports reveal high level of family conflict, parental reports do not agree<\/li>\n<\/ul>\n<\/li>\n<li>Parents of child with eating disorders do not seem to differ from parents of those without in frequency of positive and negative messages\n<ul>\n<li>Parents of children with eating disorders more self-disclosing<\/li>\n<li>Lack some communication skills<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Child Abuse and Eating Disorders:<\/p>\n<ul>\n<li>Higher self-reports of sexual abuse among those with eating disorders, especially BN<\/li>\n<\/ul>\n<p><strong>Treatment of Eating Disorders<\/strong><\/p>\n<ul>\n<li>Hospitalization is frequently required for AN to increase food ingestion and carefully monitor \uf0b7 IV feeding might be necessary to save life Medications<\/li>\n<li>BN comorbid with depression, treated with various antidepressants, reduces purging and binge eating<\/li>\n<li>Many people don\u2019t maintain medication treatment<\/li>\n<li>Many relapse after medication is withdrawn (less so alongside CBT)<\/li>\n<li>Medication also used to treat AN, anti-obesity drugs show some promise with BED<\/li>\n<\/ul>\n<p>Psyc Treatment of AN<\/p>\n<ul>\n<li>2 tiered process:\n<ul>\n<li>1) Immediate goal is to help person gain weight to avoid medical complications\/possibility of death\n<ul>\n<li>Use operant conditioning behaviour therapy: provide reinforcers for gaining weight<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>*affective short term<\/p>\n<p>2) Long-term maintenance of weight gain *challenge<\/p>\n<ul>\n<li>CBT \u2013 effective after hospitalization to reduce risk of relapse<\/li>\n<li>CBT and psychotherapy + education are equally effective in reducing eating disorder symptoms and depression<\/li>\n<li>Older women with more severe symptoms benefit most from CBT<\/li>\n<li>Family therapy \u2013 interactions among members of patient\u2019s family can play a role in treating the disorder o Higher rates of remission compared to individual therapy<\/li>\n<li>Early weight gain is an important predictor of a good outcome<\/li>\n<\/ul>\n<p>Psyc Treatment of BN<\/p>\n<ul>\n<li>CBT is standard treatment o Question society\u2019s standards for physical attractiveness\n<ul>\n<li>Uncover and change beliefs that encourage starvation in order to avoid becoming overweight o Normal body weight can be maintained without severe dieting o Unrealistic restriction of food intake can trigger a binge<\/li>\n<li>All is not lost with one bite of high calorie food, snacking need not trigger a binge o *Alter the all-or-nothing thinking<\/li>\n<\/ul>\n<\/li>\n<li>Goal to develop more typical eating patterns: 3 meals a day with some snacks<\/li>\n<li>CBT therapist challenges unrealistic beliefs about ties between weight gain and self-worth<\/li>\n<li>Challenge cognitive distortions: e.g. that eating a small amount of high-calorie food = utter failure<\/li>\n<li>Reductions in bingeing\/purging in 70-90% of patients with CBT<\/li>\n<li>CBT more effective than drug treatment<\/li>\n<li><strong>ERP<\/strong> (exposure &amp; response prevention) \u2013 discouraging person form purging *more effective in addition to CBT in short term<\/li>\n<li><strong>Guided self-help<\/strong> \u2013 receive self-help books on topics such as: perfectionism, body image, negative thinking, food &amp; health o Greater confidence in one\u2019s ability to change is related to better outcomes<\/li>\n<li><strong>Interpersonal therapy<\/strong> (IPT) \u2013 did not produce results as quickly as CBT<\/li>\n<li><strong>Family therapy<\/strong> \u2013 superior to supportive psychotherapy Psyc Treatment of BED<\/li>\n<li>CBT shown to be effective<\/li>\n<li>Targets binges and restrained eating by emphasizing self-monitoring, self-control, and problem solving with eating<\/li>\n<li>Gains last up to 1 year after treatment<\/li>\n<li>IPT is as effectives as CBT and guided self-help for BED<\/li>\n<li>Having a therapist lead CBT may help keep people in treatment and reduce binges<\/li>\n<\/ul>\n<p><strong>Preventive Interventions for Eating Disorders<\/strong><\/p>\n<ul>\n<li>Intervene with children\/adolescents before onset<\/li>\n<\/ul>\n<p>1) <strong>Psycho-educational approaches<\/strong> \u2013 educate children\/adolescents about eating disorders in order to prevent them from developing symptoms<\/p>\n<p>2) <strong>Deemphasizing sociocultural influence<\/strong> \u2013 helping children and adolescents resist\/reject sociocultural pressures to be thin<\/p>\n<p>3) <strong>Risk factor approach<\/strong> \u2013 identifying people with known risk factors and intervening to alter these factors<\/p>\n<ul>\n<li>Most effective: interactive, include teens 15+ years-old, girls only, multiple sessions<\/li>\n<li><strong>Body project<\/strong> \u2013 dissonance reduction intervention focused on deemphasizing sociocultural influences \uf0b7 <strong>Healthy weight intervention<\/strong> \u2013 targets risk factors<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Became a distinct category in DMS-IV, DSM-5: eating disorders found in \u201cFeeding &amp; Eating Disorders\u201d chapter o Pica = eating nonfood substances for extended periods o Rumination = repeated&hellip; <a class=\"continue\" href=\"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/eating-disorders\/\">Continue Reading<span> Eating Disorders<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[104],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4199"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4199"}],"version-history":[{"count":2,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4199\/revisions"}],"predecessor-version":[{"id":4900,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4199\/revisions\/4900"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4199"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4199"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4199"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}