Flashcards in eating disorders REVISE Deck (57)
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
¬ 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
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 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?
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
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
what are the 5 factors clinicians look for to understand how to treat their patient with an ED?
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?
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