Final Exam Study Guide Abnormal CLP4143 April 30 Thursday 7 30 9 30 a m Room PDA D0201 Chapter 11 Eating Disorders Eating disorders severe disturbances in eating behaviors such as eating too little or eating too much Often accompanied by Over preoccupation with weight Severe fear of fat Distortions in body image Extreme distress associated with eating and weight 3 Types 1 Anorexia Nervosa Characterized by a pursuit of thinness that leads to self starvation Amenorrhea not required for diagnosis Either an intense fear of gaining weight or of becoming fat or persistent behavior that interferes with weight gain even though significantly low weight Onset early to middle teen years and is usually triggered by dieting and stress mean age 17 years Women 10x as likely to develop disorder as men Often comorbid with depression OCD phobias panic alcoholism and PDs Physical Symptoms Low blood pressure heart rate decreases kidney and gastrointestinal problems loss of bone mass brittle nails dry skin hair loss lanugo soft downy body hair and deletion of potassium and sodium electrolytes which can cause tiredness weakness and death 50 70 eventually recover but it may take 6 to 7 years and relapse is common It is life threatening Death rates 10x higher than general population and 2x higher than other psychological disorders 2 Bulimia Nervosa Characterized by a cycle of bingeing followed by extreme behaviors to prevent weight gain such as purging Onset late adolescence or early adulthood 90 women Comorbid with depression PD s anxiety substance abuse and conduct disorder In bulimia suicide attempts completions are higher than in general population but much lower than in anorexia nervosa Bulimics typically have normal BMI Compensatory Recurrent inappropriate compensatory behavior in order to prevent weight gain such as self induced vomiting misuse of laxatives diuretics or other medications fasting or excessive exercise Frequency The binge eating and inappropriate compensatory behaviors both occur on average at least once a week for three months Self evaluation is unduly influenced by body shape and weight The disturbance does not occur exclusively during episodes of Anorexia Nervosa Severity Mild An average of 1 3 episodes of inappropriate compensatory behaviors per week Moderate An average of 4 7 episodes of inappropriate compensatory behaviors per week Severe An average of 8 13 episodes of inappropriate compensatory behaviors per week Extreme An average of 14 or more episodes of inappropriate compensatory behaviors per week Physical Symptoms Menstrual irregularities potassium depletion from purging laxative use depletes electrolytes that can cause cardiac irregularities loss of dental enamel from stomach acids in vomit and has a 4 mortality rate 75 recover and 10 20 remain fully symptomatic 3 Binge Eating Disorder Characterized by regular bingeing but do not engage in purging behaviors This occurs at least once a week for three months There is an absence of weight loss and is therefore associated with obesity different from Bulimia Binge eating episodes include at least three 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 the binge BMI 30 Not all obese people meet criteria for binge eating disorder they must report binge eating episode and a feeling of loss of control over eating to qualify Approximately 2 25 of obese people qualify Risk Factors Childhood obesity early childhood weight loss attempts having been taunted about their weight low self concept depression and childhood physical or sexual abuse Physical Symptoms Increased risk of Type II diabetes Cardiovascular disease Breathing problems Physical ailments joint muscle pain Sleep problems Anxiety Depression Irritable Bowl Syndrome and Early menstruation in women About 60 between 25 82 recover This is the most common eating disorder and lasts the longest on average 14 4 years episode Anorexia Subtypes Subtypes specified for past three months rather than just current Restricting type Weight loss is achieved by severely limiting food intake with no binge eating purging during the last three months Binge eating purging type The person has also regularly engaged in binge eating and purging during the last three months Risk Factors for an Eating Disorder First degree relatives of individuals with both disorders more likely to have the disorder are all heritable etiology Higher MZ monozygotic concordance rates for both anorexia and bulimia Body dissatisfaction desire for thinness binge eating and weight preoccupation Environmental factors e g family interactions play an even greater role in Low levels of endogenous opioids Substances that reduce pain enhance mood and suppress appetite and are released during starvation They may reinforce restricted eating of anorexia Low levels of opioids beta endorphins in bulimia promote craving Reinforce binging Treatments Low levels of serotonin metabolites in anorexics and bulimics Serotonin related to feelings of satiety feeling full Antidepressants Effective for bulimia but not for anorexia and dropout and relapse rates are high Limited research suggests that antidepressant medications are not effective in reducing binges or increasing weight loss in binge eating disorder Clinical Management anorexia Must focus on three primary issues restoring weight modifying distorted eating behavior and addressing the psychological and family issues Treatment methods typically include nutritional rehabilitation psychotherapy and medication Family Based Therapy A problem focused therapy that aims to change behavior through unified parental action The family in FBT is not viewed as the cause of the disorder but rather as a positive resource in the adolescent s weight restoration and return to normal eating and health Cognitive Treatments Challenges societal ideals of thinness beliefs about weight and dieting and all or nothing beliefs about food one bite of high calorie food does not have to lead to bingeing Increase self assertiveness skills to improve interpersonal relatedness Increase regular eating patterns three meals a day CBT more effective than medication Adding Exposure and Ritual Prevention ERP increases effectiveness of CBT in the short term Psychodynamic View Personality characteristics impact eating Perfectionism lack of
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