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are eating disorders historical or a relatively new phenomenon?

occured in the past but categorised as other issues:

1. renaissance - dying of a broken heart

2. taking religious orders of only bread and water or just water

3. first case of western eating disorder was a male


what are the 4 (potentially 5) types of eating disorders?

according to DSM5:
Anorexia Nervosa (AN)

Bulimia Nervosa (BN)

Eating Disorder Not Otherwise Specified (EDNOS) but now Other Specificied Feeding and Eating Disorder

Binge Eating Disorder (linked to normal or over weight)

(obesity?) but would be around 2/3 of population so huge crisis if added to list


what are the 2 main sub-types of eating disorders?

anorexia and bulimia


characteristics of anorexia nervosa?

diagnostic criteria in DSM5?

diagnostic issues in DSM4?

1. refusal to maintain body weight (self-starvation) so at least 15% below normal weight

2. restricting or binge/purge

3. intense fear of weight gain (not reduced by weight loss)

4. distorted body image

amenorrhoea (loss of periods but taken out as doesn't happen to men and periods may stop for other reasons)

used to be BMI below 18.5 (drinking a litre of water will bring you above threshold as 1kg but not recovered)


characteristics of bulimia nervosa?

loss of control over eating (2 hours) and eat an excessive amount (binge) then purge (vomiting/laxatives/diet pills/exercising)

fear of gaining weight (same as anorexia)


effective treatments of anorexia nervosa?

¬ food - side effect of feeling terrible (short term treatment)

¬ family-based interventions (most effective)
structured family meals
meal plans
family therapy

¬ no NICE improved 'first line' treatment

¬ MANTRA manualised treatment for adults e.g meal management


effective treatment for bulimic nervosa?

CBT-E (extended form of CBT) seems to be effective
very Behavioural
sitting with person and helping them find a way to eat (let cognitive processes catch up)
20 or 40 session model (a lot)


effective treatment for Binge Eating Disorder?

not known what even causes binges so no knowledge of how to treat


what percentage of females aged 15 have issues with their body image?

and why do only a small % of those develop an eating disorder?

in 90s%
in western media based society
been getting worse especially due to social media

may be another risk factor than body dissatisfaction alone


have eating disorders always been with us cross-culturally or just western concept?

fiji before and after television (body dissatisfaction 35%-85%) due to introduction of psychosocial stressor (social cultural component)

bolder, colorado fitness based and so high level of eating disorders


if eating disorders genetic why have they been continually passed down in evolution?

adaptation to flea famine hypothesis - can operate on low body weight and think straight and lead rest of people to food and water sources (advantage)


what is orthorexia?

obessession with eating 'healthy' foods
not officially classified as an ED


what are OSFEDs and examples?

umbrella term for several disordered eating behaviours which don't meet criteria for a specific eating disorder

body dysmorphic disorder


difference between DSM and ICD?

DSM5 american diagnostic system (apa) but UK increasingly using it (NICE guidance based on it)
just mental health, psychology and psychiatry

ICD10 all diseases not just mental health


difference between psychology and psychiatry?

psychology - broader view of human health and wellbeing
know more about psychology than medics

psychiatry - branch of medicine based on 'ill-health' and diseases
do medical degree first


do you need a diagnosis to get access to mental health treatment?



risk factors at birth/infancy?

parenting style

being female (different biologically and psychosocial pressures)

genetic in adolescence - 1st degree relative then 10x more likely to have AN and MZs higher concordance than DZs

early feeding difficulties (fussy)

high concern parenting - child never gets to experience hunger as so highly attuned to child


childhood risk factors?

childhood obesity - restricting and bulimic disorders

sexual abuse/neglect

OCPD - obessions around food

childhood anxiety disorders


risk factors in adolescence?

being an adolescent as when they tend to emerge

body dysmorphic disorder

high level exercise (jockeys, dancers, runners i.e any weight threshold)

dieting positively reinforced by sense of mastery and self-control


negative self-evaluation


what are the 5 factors clinicians look for to understand how to treat their patient with an ED?

predisposing factors
precipitating factors
presenting factors
perpetuating factors
protective factors


bio-psycho-social model as a cause of eating disorders


predisposing factors - epigenetics, genetics, brain and socio-cultural context which turns these factors into a vulnerability

precipitating factors - puberty (hormoal, social etc.), dieting and stress/trauma

perpetuating factors - management by parents and clinicians, trauma and stress, some perceived advantages so maintaining it e.g reduced stress when not eating


why may CBT not be the most effective treatment for eating disorders?

but how widely is it used

major cause could be due to neurobiological abnormalities causing different neuropsychological processing styles so not just the 'here and now' to treat

but CBT is the main form of psychological therpay for all the eating disorders and the most effective


what % do we know about the brain?

around 1%


neurobiological abnormalities?

abnormality persists even after recovery

left sided hypoperfusion (reduction in activity and blood flow) centered on insula which deals with hunger, body image and disgust
70% of patients have functional abnormality in insula network

if abnormality in brain due to starving the body, would expect reduced activity in all areas not just e.g insula


what is an example of a neuropsychologically informed treatment for eating disorders?

cognitive remediation therapy

not addressing what you think (processes) but how you think (content)

give homework to e.g try and be flexible at home and do something different


role of noradrenaline in eating behaviour?

positive and negative reinforcement

starving = shortage of noradrenaline which = decrease in stress levels SO reinforces the starving behaviour

nordrenaline receptors become supersensitive
SO when person eats, these receptors are flooded with noradrenaline = increase in stress levels = negatively reinforced

reinforces negative view of food side effect that it makes them feel terrible


relation between diet coke and those with eating disorders?

many drink it, presumed due to being 'diet'
may be due to the fact it contains tyrasine, which contains dopamine, which contains nordadrenaline so person is unknowingly self-medicating


which 3 networks are the focus of medication?

dopamine (reward network)
seronergic network (depressive)


relationship between buddhist monks and the insula network?

as a result of meditating for 8 hours a day for 30 years, their insula networks are larger as they practice body mapping daily


what are buddhist monks and real time fMRIs examples of?