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Exam 4 Study Guide EATING DISORDERS What is an eating disorder Disturbance of eating behaviors caused and influenced by o Intense fear of gaining weight o Excessive emphasis on weight and shape 3 Eating Disorder Diagnoses o Anorexia Nervosa o Bulimia Nervosa o Eating Disorder NOS Anorexia Nervosa 1 Refusal to maintain normal weight 18 5 BMI Body Mass Index kg m2 o How thin is too thin o Less than 15 of that expected for age and height BMI 18 5 o Medical complications due to malnutrition Intense fear of weight gain o Engagement in extreme weight loss behaviors o Persistent fear despite being underweight o Makes treatment very difficult o Symptom often becomes more intense as individual loses more weight 2 3 Disturbance in evaluating shape and weight o Distortions in perception of one s body weight and shape o Deny seriousness of current low weight o Undue influence of shape weight on self evaluation o Frequently overestimate size of various body parts o Often see fears as justified o Why might this criterion be problematic o o Criterion to be dropped in DSM 5 Loss of 3 consecutive menstrual periods 4 Amenorrhea Subtypes o Restricting Perfectionistic Rigid OCPD traits Impulsivity Self harm behavior o Binge Purging Clinical Features of Anorexia Nervosa o Fidgety Restless o Cold Baggy clothes o Food rituals Strict rules around eating o High cross over rate 62 Eddy et al 2002 Only 12 of women with AN did NOT report regular binge purge behavior at some point Prevalence and Course Cutting food Eat food in certain order o High comorbidity w Depression Anxiety Comorbidity is the norm 56 o 1 2 lifetime prevalence o 90 of individuals diagnosed with AN are women o Caucasian African American women o 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 Suicidality o High rates of suicide among those with AN o 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 fur o Constipation o Cold intolerance Medical Complications o Major Organ Failures Cardiovascular complications Kidney Failure o Osteoporosis related bone fractures o Impaired immune functioning Bulimia Nervosa What is a binge E g Bradycardia arrhythmia heart failure 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 Criteria DSM IV TR criteria for diagnosis 1 Recurrent episodes of binge eating 2 Recurrent inappropriate compensatory behavior in order to prevent weight gain 3 Binge eating and inappropriate compensatory behaviors both occur on average at least twice per week for three months 4 Self evaluation is unduly influenced by body shape and weight 5 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 vomiting Bulimia 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 stomach Binge 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 control B Episodes associated with 3 of the following 1 Eating more rapidly than normal 2 Eating until feeling uncomfortably full 3 Eating when not feeling hungry 4 Eating alone because of embarrassment 5 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 differences Course Chronic Mean duration of the disorder is 8 years Partial 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 NOS EDNOS 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 disorder not otherwise specified EDNOS Likely to appear in DSM V or DSM V appendix Sociocultural 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 o Chronic Exposure 3 mins of exposure to fashion mags vs mags w out models Fashion mags increased depression shame guilt stress insecurity body dissatisfaction Adolescent girls randomly get 15 month subscription to leading fashion mag OR no subscription stice et al 2001 Girls who already felt pressure dissatisfaction became more depressed Girls w out social support became more dissatisfied dieted more Psychological Facts Internalization of the Thin Ideal showed more bulimic symptoms o Contagious Dissatisfaction Study Thin confederate either complains about her body or doesn t If she does participants became more dissatisfied with their own bodies Sociocultural Context


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FSU CLP 4143 - EATING DISORDERS

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