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Anorexia NervosaBulimia NervosaBinge Eating DisorderPartial-Syndrome Eating DisordersEating Disorder, NOSPurging DisorderSociocultural & Psychological Factors – Cultural Context of Eating DisordersTreatments for Eating DisordersIntoxication:Withdrawal:Abuse:Dependence:Course Specifiers:New Diagnostic CriteriaCNS DepressantsExam 4 Study Guide EATING DISORDERS What is an eating disorder?- Disturbance of eating behaviors caused and influenced by:o Intense fear of gaining weighto Excessive emphasis on weight and shape- 3 Eating Disorder Diagnoses:o Anorexia Nervosao Bulimia Nervosao Eating Disorder, NOSAnorexia Nervosa1. Refusal to maintain normal weighto How thin is too thin?  ≤ 18.5 BMI (Body Mass Index (kg/m2)o Less than 15% of that expected for age and height (BMI < 18.5) o Medical complications due to malnutrition2. Intense fear of weight gaino Engagement in extreme weight loss behaviorso Persistent fear despite being underweighto Makes treatment very difficulto Symptom often becomes more intense as individual loses more weight3. Disturbance in evaluating shape and weighto Distortions in perception of one’s body weight and shapeo Deny seriousness of current low weighto Undue influence of shape/weight on self-evaluationo Frequently overestimate size of various body partso Often see fears as justified4. Amenorrhea : Loss of 3 consecutive menstrual periodso Why might this criterion be problematic?oo Criterion to be dropped in DSM-5 Subtypes:o Restricting: Perfectionistic/Rigid OCPD traitso Binge/Purging:  Impulsivity Self-harm behavioro High cross-over rate ~62% (Eddy et al. 2002) Only 12% of women with AN did NOT report regular binge/purge behavior at some pointClinical Features of Anorexia Nervosa: o Fidgety/Restlesso Cold Baggy clotheso Food rituals/ Strict rules around eating Cutting food, Eat food in certain ordero High comorbidity w/ Depression, Anxiety Comorbidity is the norm (~56%)Prevalence and Courseo 1-2% lifetime prevalence o ~ 90% of individuals diagnosed with AN are womeno Caucasian > African American womeno Usually begins in adolescence (ages 15-19)o Often very chronic (hard to treat)o Relapse rate up to 50%o Death rate is 5-8% AN and Suicidalityo High rates of suicide among those with ANo Standardized mortality ratio (SMR) for suicide ~31 (Preti et al., 2011) Major Depression ~SMR 17.25 (Harris & Barraclough, 1997) Bipolar Disorder ~SMR 10 Symptoms of starvation:o Lanugo: fine, downy hair as a type of furo Constipationo Cold intoleranceMedical Complications:o Major Organ Failures Cardiovascular complications  E.g. Bradycardia, arrhythmia, heart failure. Kidney Failureo Osteoporosis & related bone fractures o Impaired immune functioningBulimia Nervosa What is a binge?1) Eating within a 2-hour period an amount of food that is definitely larger than most people would eat in similar conditions.2) A sense of lack of control over eating during the episode.Bulimia Nervosa CriteriaDSM-IV-TR criteria for diagnosis:1. Recurrent episodes of binge eating2. Recurrent inappropriate compensatory behavior in order to prevent weight gain3. Binge eating and inappropriate compensatory behaviors both occur, on average, at least twice per week for three months4. Self-evaluation is unduly influenced by body shape and weight5. The disturbance does not occur exclusively during episodes of anorexia nervosa Purging Type:  self-induced vomiting or misuse of laxatives, diuretics or enemas. Nonpurging Type:  Other inappropriate compensatory behaviors, like fasting or excessive exercise, but not self-induced vomitingBulimia Nervosa: Prevalence & Course• 0.5 – 3% lifetime prevalence for clinical diagnosis.• Onset between 15 and 29.• More common in women than men• More common in Caucasians than African Americans.Bulimia Nervosa: Physical Problems:- Significant medical complications (due to purging)– Electrolyte imbalance– Erosion of dental enamel– Hypersensitive gag reflex– Regurgitation/rechewing of food– Enlarged salivary glands• Results in puffy appearance of face– Ruptured esophagus– Ruptured stomachBinge Eating Disorder- Recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of BN- BINGE-EATING DISORDER IS IN THE APPENDICES OF THE DSM-IV-TR-Research Criteria:A. Recurrent episodes of binge eating characterized by both:1) Eating amount definitely larger than most people would eat in 2 hours.2) Sense of lack of controlB. Episodes associated with 3+ of the following:1) Eating more rapidly than normal2) Eating until feeling uncomfortably full3) Eating when not feeling hungry4) Eating alone because of embarrassment5) Feeling disgusted, depressed, or guilty about over eating.Prevalence:– 2-3.5% lifetime prevalence in general populations.– 30% of individuals in weight-loss programs– More common in women than in men.– No racial/ethnic differencesCourse:– Chronic• Mean duration of the disorder is 8+ yearsPartial-Syndrome Eating Disorders- Partial Syndrome eating disorders – lots of symptoms… but not enough.- Adolescents with partial-syndrome eating disorders are just as likely to have anxiety disorders, substance abuse, depression, & attempted suicide.- 90% had psychiatric disorders in their early twenties. Eating Disorder, NOSEDNOS is for disorders of eating that do not meet the criteria for AN or BN. Examples…1. All criteria for AN met, except regular menses.2. All criteria for AN met, except significant weight loss, weight is in the appropriate range.3. All of the criteria for BN met, except frequency & duration.4. Regular use of inappropriate compensatory behavior by individuals of normal body weight after eating small amounts of food.5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.Purging Disorder– Individual frequently purges, but does not binge eat• Not underweight• Individuals who meet these criteria receive a diagnosis of Eating disordernot otherwise specified (EDNOS)• Likely to appear in DSM-V or DSM-V appendixSociocultural & Psychological Factors – Cultural Context of Eating Disorders- We are aesthetically obsessed. - We have decided the human body should look a certain way.- We have learned how the human body can be manipulated…- Influence of the Media. o Immediate Effects: 3 mins of exposure to fashion mags vs. mags w/out models  Fashion mags


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FSU CLP 4143 - Exam 4 Study Guide

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