PSYB32: Eating Disorders
Myths about ED
- They are a choice
- Only overweight people
- Only adolescent women
- Only anorexia
- Only about food
- Can be cured after treatment
Eating disorders definition
extreme emotions, attitide and behaviours surrounding weight and food issues.
Who are the victims of eating disorders?
Anyone
Anorexia nervosa
Restriction of energy intake leading to low body weight.
When does AN start?
After dieting or life stress episode
Types of AN
Restricting: no binge earing or purging episodes
Binge-eating/purging type: recurrent episodes of binge eating or purging behaviour
Bulminia nervosa
Recurrent episodes of binge eating and purging that are compensatory behaviours preventing weight gain and not due to anorexia nervosa.
Must have to happen at least once a week for 3 months.
Binge eating disorder
Recurrent episodes of uncontrollable binge eating with no compensatory behaviours for once a week for at least 3 months.
Binge eating associated with at least 3 symptoms:
- Eating rapidly
- Eating alone out of embarrassment
- Eating when not hungry
- Eating until uncomfortably full
- Guilt, disgust and depression.
Avoidant/restrictive food intake disorder (ARFID)
Eating disturbance manifested by failuare to meet nutritional/energy needs associated with at least 1:
- Significant weight loss
- Significant nutritional deficiency
- Dependence on external feeding or oral supplements
- Interference with psychosocial functions.
No disturbance in body shape/weight experience.
Not due to lack of avaliable food.
Not due to other medical condition.
Rumination disorder
Repeated regurgitation of food for at least one month.
Not due to other condition or occur exclusively in other condition.
Pica
Eating of nonfood stuff for at least one month that is not socially appropriate.
Other specified feeding or eating disorder (OSFED) and examples.
Symptoms of other eating disorders but do not meet full criteria.
They are atypical, mized or subthreshold.
Ex: atypical anorexia nervosa, low frequency bulimia nervosa, purging disorder, night eating disorder, etc.
Unspecified feeding or eating disorder (UFED)
Symtoms of eating disorders not categorizable into any categoires but still impairs social functioning.
Tripartite influence model of body image and eating disturbances
Sociocultural factors (parents, peers and media) leading to internalization or social comparision, then to body dissatisfaction.
Cognitive behavioural theory of eating disorders
Fear of being fat is a motivating factor for weight loss behaviour which reduces anxiety.
The eating disorder is negatively reinforced with weight loss and positively reinforced with a sense of control.
It also develops from personality and socialcultural variables.
Ex: perfectionism leads to appearance obsession.
Psychodynamic theory of eating disorder
Old theories focus on conflicts, new theories focus on how it helps you cope with your deficits.
Eating disorder fulfill needs caused by bad relationships with parents. The child is ineffective and has no sense of control because the parents imposing their own wishes on their kids so they restrict/control their eating gain a sense of control.
Family systems theory of eating disorder
ED is better studied under the context of a family dysfuction and dynamic. It is promoted by family in a pshysiologically vulnerable child because ED symptoms helps the family avoid conflicts by replacing those conflicts.
Stages of change
Precontemplation: sees no problem with ED behaviour.
Contemplation: aware of problem and thinking of recovery.
Action: engaging in recovery.
Maintenance: sustaining change with new behaviour replacing the old.
Relapse: falling back into old patterns of behaviour.
Treatments
Psychotherapy. nutritional counseling, medication, hospitalization
Increase in levels of care
Day hospital: spends all day with a group to rebuild relaitonship with food.
Residential: higher day/medical care than day hospital but not to the point you need to be watched constantly.
Inpatient: care for those that are medically unstable to the point when organs are shutting down.
Medication
Has mixed effects.
Fluoxetine: only one offical medication for eating disorder.
Other anidepressants can be used to tackle other cormorbid or underlying conditions.
Warning signs
Dressing in a lot to hide weight and stay warm, food rituals, excused to avod mealtimes, excessive exercise, withdrawal from friends and actvities, don't want to eat in public.
Types of prevention
Universal: to promote healthy understanding of ED to the general public and stop it from developing in people.
Targeted: for those beginning to develop ED to stop it from getting more serious.
What is the most common eating disorder?
Eating disorder not otherwise specified (EDNOS)/ unspecifiec feeding or eating disorder (UFED)
Purging disorder
Type of bulimia including self-induced vomiting or laxative for at least once per week for 6 months.
Features of AN
- Restriction of energy intake resulting in significantly low body weight compared to average.
- - Used to be refusal to maintain normal weight and weigh less than 85% of what is normal.
- Fear of weight gain not relieved by weight loss, meaning they will never be thin enough.
-Disorted view of their body shape, seeing themselves as fat when they are underweight.
--Amernorrhea: loss of mentral period.
Overevalutaion of appearance
AN tendency to link thinness with positive self-esteem and self-evaluations. Lower weight means more self-esteem. Being thin will make them feel better.
AN assessment methods
Eating disorder inventory (EDI), Body image test
Body image test
Someone has to choose which body they think they have and which they would want to have. The body they think they have will be fatter than they actually are and their ideal body would be thin.
AN cormobidity
Substance use disorders.
Physical changes and symptpms of AN
falling blood pressure, slower heart rate, gastrointestinal problems, dry skin, weaker bones, bad nails, smaller brain size, losing hair, mild amnesia, changing hormone levels, altered electrolyte levels, etc.
How much % of people with AN will recover?
70%
An average recovery time?
6-7 years
Disorder with the highest mortality rate and for which victims will death be shorter?
Anorexia bulimia, with it being more chronic, lat onset and relationshipless victim.
Binge eating
excessive amounts of intake of food with a lack of control in a dissociative state. It is shameful and occurs in secret. Amount of calories eaten vary.
What triggering binge eating episode?
Stress and accompanying negative emotions, especially bad social interactions, which they are very sensitive to.
Purging
undoing caloric effect of binge such as vomiting, excessive exercise, laxatives, etc caused by disgust, discomfort and fear of weight gain.
Self-evalution in BN
Influenced by body shape/weight where they fear fat. It relied heavily on maintaining normal weight.
Fat talk
Tendency for friends to criticize their own bodies to eachother.
When does BN start?
Late adolescence, early adulthood, after dieting when thry were overweight beforehand.
Diagnose crossovers
When symptoms in someone shift so that they meet the requirments of a different disorder.
Happens between AN and BN.
Side effects of BN
- Potassium depletion from purging
- Diarrhea, changes in electrolythes, irregular heartbeat from laxatives.
- Stomach throat tissue tearing, dental problems from vomiting
How binge eating disorder differ from AN
No weight loss.
How binge eating differs from BN
No compensatory behaviours.
What might binge eating disorder induce?
Impaired work, refuced social functioning, depression, low self-esteem, substance use, dissatisfaction with body.
Risk factor of binge eating disorder
Chilhood obesity, comments about being overweight, depression, low self-concept, childhood abuse, etc.
Duration of binge eating disorder
14.4 years
Genetics of eating disorders
They run in families with greater concordance in monozygotic than dyzygotic twins.
But the underlying genetic mechanisms are unknown.
Eating disorders and hypothalamus
It controls eating and hunger.
Leisons seen in people unweight due to not eating a lot, but it is because they have no interest in food, not because they refuse to eat, but still want it.
Hormones produces by hypothalamus are abnormal in those with eating disorder, but it might be a consequence instead of cause of starvation.
Endogenous opioids
Substances produced by the body for pain sensations, enhance mood, suppressed appetite, etc in those with low body weight.
They are released in starvation and produce a euphoric state that reinforces starvation in those with AN and in exercises in those with eating disorders.
Low levels in bulimia that builds craving and produced un bingeing that reinforces the behaviour.
The worse the BN is, the lower the endogenous opioids.
Neurotransmitters
Serotonin deficits in those with BN.
Genetics limits serotonin amounts at birth and a further limited by bad parenting styles and enviornment.
Makes people likelier to gain weight.
Downsides of biochemical factors of eating disorders
Only accounts for hunger, eating and satiety, not other features like fat fear.
Ideal body shape in modern society
Thin, influences by barbie dolls and video game characters that are thinner or buffer than normal.
What causes increas of symptoms in 3 years?
introduction to unrealistic bodies in TV.
Population more vulnerable for ED
Women because they are more likely to worry about being thin, diet, etc.
They feel more pressure to look beautiful, more values for their appearance.
What portion of girls feel they are too fat by 15?
1/4
Scarlett O'Hara effect
Women eat lightly to project ther feminity
Muscle dysphoria
Obsession with not being as muscular as desired.
Obesity in modern day societies
It is increasing due to human tendency to eat a lot of story energy to prepare for when there is no food.
Where does fear of fat come from?
The socio-cultural ideal of thinness.
Being fat has many negative connotation of being lazy, no self-control, stupid, etc.
This bias is even in fat people.
What cultures are eating disorders more prevelant in?
Western, industrial societies. But rates are increasing in other societies as well.
Women immigrating to these societies are more vulnerable to eating disorders.
It is not known whether eating dsiorder symptoms present differently across cultures.
What dissatisfaction with body is due to according to the cognitive-behaviour
- Media portray of thinness as ideal
- Being fat
- Tendency for comparisom
-Criticism from others
Thinspiration effect
People looking at people of other thin people and feeling thinner themselves, motivating then to lose weight and distress when they don't.
Characteristics of families with a child with an eating disorder
- Enmeshment: thinking you know them so well you speak over/for them.
- Overprotectiveness: extreme concern for eachother's well-being.
- Rigidly: tendency to maintain the status quo and avoid dealthing with stuff that require change.
- Lack of conflict resolution: avoiding or in a state of conflict
6 personalities putting people at risk for ED
- Avoidance motivation
- Low extraversion
- Low self-directedness
- Neuroticism
- Perfectionism
- Sensitivity to social rewards
Dimensions of perfectionism and what EDI focuses on
Self-oriented perfectionism: high standards for the self.
Other-oriented perfectionism: high standars for others.
Socially-perscribed perfectionism: perception that high standards are imposed on the self by others and social pressure for unattainable physical perfection.
Perfectionistic self-presentation
Creating perfect image of themselves and minimizing mistajes made in front of others, focusing on self-image goals, high in self-conciousness and concerned with how others view them.
Eating disorders and personality
6 personalities that predict ED
ED can manifest/affect personality and behaviour like starvation making people preoccupied with food.
Narcissism and ED
High narcissism sometimes found in people with ED, persisting even when the ED is in remission. Predicts greater treatment drop out rate.
Difficultues of treatment
Denial that they have it, need to make sure they eat, highly likely for relapse.
Therapy for anorexia process
Helping people gain weight, then helping them keep on gaining weight.
Cognitive-behavioural therapy for AN
Centre is the need to control eating. Show that you can gain satisfaction from other things and that controlling eating won't always give you satisfaction so focus of control can shift away.
Family therapy
Minuchin family therapy: bringing up other conflicts in the family so that the victim no longer has to have ED to distract from it. This is not used anymore.
Maudsley family therapy: parents help feed their kids and restore their weight in creative ways. They aren't to blame for the ED but should help.
Overall goal for BN treatment and how it is achieves.
Develop healthy eating patterns/habits bu changing irrational beliefs, the most common of which is that you need to be thin to be valuable to men.
CBT methods for BN and it's effectiveness
- Eating small amounts of forbidden food
- Relaxation to trat vomiting
- Challange irrational beliefs
- Determin and learn to deal with thoughts, feelings and behaviours that trigger binge eating.
Almost half relapses.
Schema-focused CBT (SFCBT)
Extension of CBT where you identify deeply ingraded core belief systems reflecting cognitive schemas and replacing the negative aspects of self with positive ones.
What idea is interpersonal therapy based on?
ED is caused by negative interpersonal interactions and feelings about the self and the world.
Why might recovery be locked?
Cormorbidity with other disorders.
Prevention of ED
There is not enough help for eating disorders so it is important to prevent them before they start.
Prevention programs are not reliable or effective at the moment, but they have been put in placed.