Feeding and Eating Disorders
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What is the key behavior associated with Binge-Eating Disorder that characterizes its diagnosis?

  • Continuous dieting without success
  • Avoidance of eating in social situations
  • Compulsive exercise to offset food intake
  • Binge-eating at least once a week for 3 months (correct)

    • Which of the following is NOT a common medical consequence of Binge-Eating Disorder?

  • Anorexia (correct)
  • Type 2 Diabetes
  • Hypertension
  • Joint pain

    • What is a significant psychological cost associated with Binge-Eating Disorder?

  • Increased social interactions
  • Enhanced self-esteem
  • Extreme weight loss
  • Shame and guilt at bingeing behavior (correct)

    • Which is an effective treatment option for Binge-Eating Disorder?

    <p>Cognitive Behavioral Therapy</p> Signup and view all the answers

    Which factor is a risk factor for developing Binge-Eating Disorder?

    <p>Childhood obesity</p> Signup and view all the answers

    What is a unique attribute of the treatment for individuals with Binge-Eating Disorder compared to Bulimia Nervosa?

    <p>Increased consideration of medication like semaglutide</p> Signup and view all the answers

    How does dieting generally affect individuals with Binge-Eating Disorder?

    <p>Worsens binge-eating disorder</p> Signup and view all the answers

    What is a common progression for individuals developing Bulimia nervosa?

    <p>Restrictive dieting followed by binge eating and then purging.</p> Signup and view all the answers

    Which of the following personality disorders is most closely associated with Bulimia nervosa?

    <p>Narcissistic Personality Disorder</p> Signup and view all the answers

    What is a common behavior after binge eating in individuals with Bulimia nervosa?

    <p>Purging via vomiting or using laxatives.</p> Signup and view all the answers

    What factor is commonly associated with the prevalence of Bulimia nervosa among college students?

    <p>Pressure to avoid the 'Freshman 15' weight gain.</p> Signup and view all the answers

    What abnormality is observed in brain studies of individuals with Bulimia nervosa?

    <p>Numerous abnormalities in multiple brain systems.</p> Signup and view all the answers

    Which of the following behaviors is NOT typically associated with Bulimia nervosa?

    <p>Regular meal patterns.</p> Signup and view all the answers

    Which demographic is most significantly affected by Bulimia nervosa?

    <p>Females aged 15 to 18.</p> Signup and view all the answers

    Which demographic groups are noted to have a higher prevalence of anorexia nervosa?

    <p>Male wrestlers and dancers</p> Signup and view all the answers

    What family-related factor is associated with an increased risk of developing anorexia nervosa?

    <p>Mothers with a history of food disorders</p> Signup and view all the answers

    What behavioral characteristic is commonly observed in adolescents with anorexia nervosa?

    <p>Desires for perfection and academic success</p> Signup and view all the answers

    Which of the following describes a common behavior in the restrictive type of anorexia nervosa?

    <p>Establishing irrational food rules</p> Signup and view all the answers

    What psychological condition is most commonly comorbid with anorexia nervosa?

    <p>Obsessive-Compulsive Disorder (OCD)</p> Signup and view all the answers

    Which of the following is a potential trigger for the onset of anorexia nervosa?

    <p>Stressful life events with loss of appetite</p> Signup and view all the answers

    What is a characteristic of the binge-eating/purging type of anorexia nervosa?

    <p>Binge-eating accompanied by excessive exercise</p> Signup and view all the answers

    During what age range does the majority of anorexia nervosa cases begin?

    <p>13 to 18 years old</p> Signup and view all the answers

    Which of the following are potential physical health risks associated with Binge-Eating Disorder?

    <p>Hypertension and stroke</p> Signup and view all the answers

    How does the occurrence of Binge-Eating Disorder relate to the obesity epidemic?

    <p>It is rising amid the current obesity epidemic.</p> Signup and view all the answers

    What kind of therapy is recommended for treating Binge-Eating Disorder?

    <p>Therapy focused on healthy eating and impulse control</p> Signup and view all the answers

    What is a common misconception about dieting for individuals with Binge-Eating Disorder?

    <p>Dieting typically worsens the disorder and increases weight.</p> Signup and view all the answers

    Which type of eating behavior is a primary diagnostic criterion for Binge-Eating Disorder?

    <p>Repeated episodes of binge eating without compensatory behavior</p> Signup and view all the answers

    What is a key emotional response experienced during a binge for individuals with Bulimia nervosa?

    <p>Guilt and shame</p> Signup and view all the answers

    Which psychological condition frequently co-occurs with Bulimia nervosa?

    <p>Obsessive-Compulsive Disorder</p> Signup and view all the answers

    What typically triggers the onset of Bulimia nervosa in individuals?

    <p>Failure of restrictive dieting</p> Signup and view all the answers

    What is a common compensatory behavior following binge eating episodes in Bulimia nervosa?

    <p>Using diet pills</p> Signup and view all the answers

    At what age range do females typically show the peak prevalence for Bulimia nervosa?

    <p>15 to 18 years</p> Signup and view all the answers

    Which family-related factor is associated with an increased risk of developing Bulimia nervosa?

    <p>Familial history of eating disorders</p> Signup and view all the answers

    What is a notable gender demographic for Bulimia nervosa?

    <p>80% female</p> Signup and view all the answers

    What is commonly observed about emotionality in individuals with Bulimia nervosa?

    <p>Emotional impulsivity and instability</p> Signup and view all the answers

    Which gender is observed to have a higher prevalence of anorexia nervosa in specific groups such as athletes and dancers?

    <p>Females</p> Signup and view all the answers

    Which comorbid psychological disorder is most commonly associated with anorexia nervosa?

    <p>Obsessive-Compulsive Disorder (OCD)</p> Signup and view all the answers

    What behavior is characteristic of the restrictive type of anorexia nervosa?

    <p>Developing food rituals</p> Signup and view all the answers

    At what age range does the majority of cases of anorexia nervosa typically begin?

    <p>13 to 18 years</p> Signup and view all the answers

    What factor can potentially trigger the onset of anorexia nervosa in adolescents?

    <p>Positive feedback on weight loss</p> Signup and view all the answers

    Which demographic is noted to have a significantly higher chance of developing anorexia nervosa due to genetic factors?

    <p>Families with history of eating disorders</p> Signup and view all the answers

    Which statement accurately describes the binge-eating/purging type of anorexia nervosa?

    <p>Binge sizes are usually small and purging often involves excessive exercise</p> Signup and view all the answers

    Study Notes

    Introduction to Psychopathology

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    Feeding and Eating Disorders

    • Avoidant/Restrictive Food Intake Disorder (ARFID): picky eating or lack of interest in food leading to significant weight loss.
    • Anorexia nervosa: significantly low body weight with intense fear of gaining weight, body image distortion.
    • Bulimia nervosa: recurrent binge eating with a loss of control over binging and compensatory behaviors to prevent weight gain.
    • Binge-Eating Disorder: recurrent binge eating with a loss of control over bingeing, without compensatory behaviors.

    Avoidant/Restrictive Food Intake Disorder (ARFID)

    • Commonly develops in infancy/early childhood, persists into adulthood.
    • No apparent sex difference in diagnosis.
    • Disinterest in food due to extreme sensitivity to food qualities (e.g., appearance, color, smell).
    • A normal period of food neophobia (dislike of new foods) exists in 1-3 year olds.
    • Eating patterns can lead to significant weight loss, nutritional deficiencies, and dependence on supplemental feeding.
    • Can occur after incidents of choking or vomiting, and often occurs alongside other medical or mental health conditions (e.g., learning difficulties, ADHD, Autism Spectrum Disorder).
    • Treatment typically includes nutritional counseling, CBT, appetite stimulants, and anti-anxiety medications.

    Except for ARFID, Most Eating Disorders Are...

    • Primarily affecting females.
    • Frequently comorbid (co-occurring) within families, at rates higher than in the general population.
    • Often accompanied by anxiety and substance use disorders.
    • Primarily found in Western cultures.
    • Related to Western conceptions of food and femininity.
    • Increasing in non-Western countries due to Westernization, including more women entering the workforce, and thinness seen as a sign of wealth and status.
    • Western movies and television contribute to disordered eating in non-Western cultures.

    Relative Prevalences of DSM-5-TR Eating Disorders

    • Anorexia: 95% in females, 5% in males.
    • Bulimia: 80% in females, 20% in males.
    • Binge-Eating: 50% in females, 50% in males.

    Why Are Eating Disorders Overwhelmingly Female?

    • Males are more likely to carry additional weight.
    • Women's magazines and online content emphasize physical attractiveness, often associating food with these standards.
    • Dieting advice is far more common amongst female-targeted advertising.
    • Male athletes in certain sports may experience disordered eating (e.g., wrestlers, bodybuilders).
    • Rates of eating disorders may be increasing among males due to the growth of "metrosexuality."

    Changed Standards of Female Attractiveness

    • Visual representations of attractive female figures changed over time.
    • Some images show a preference for the hourglass figure.
    • Current images present significantly different views of female attractiveness.

    Changed Standards of Male Attractiveness

    • Visual standards of attractive males have changed over time and are impacted by cultural ideas and beliefs.

    General Fallacy

    • Females engage in dieting more than males.
    • Dieting is frequently a gateway to disordered eating.
    • Diets frequently do not result in long-term, successful weight loss; they often cause weight to return (or even increase) due to changes in metabolic rate.
    • Long-term weight management requires a consistent healthy lifestyle approach.

    Anorexia Nervosa

    • Limiting food intake to below normative standards for age and physical health, resulting in significantly low body weight (BMI of less than 17 kg/m²).
    • Intense fear of weight gain or "becoming fat."
    • Relentless dietary and other habits to prevent weight gain.
    • Distorted body image with the perception of being overweight (even when underweight).
    • In females, amenorrhea (cessation of menstruation) can occur; in males, loss of sexual desire can be seen.

    Who Develops Anorexia Nervosa?

    • Lifetime prevalence: 0.9-1.4% in women, 1/10 that for men.
    • More common in post-industrialized, high-income countries.
    • May be more frequent in female athletes, dancers, wrestlers, and those in other high-performance sports.
    • Typically begins in adolescence (peak ages 13-18).
    • Runs in families; has a high heritability (about 0.5 - 0.8).

    How Does Anorexia Nervosa Begin?

    • Often develops from picky eating in childhood.
    • Adolescents may exhibit perfectionistic tendencies, social avoidance, and lack of interest in sex.
    • Commonly begins with a period of dietary restriction and negative feedback about one's body weight.
    • Mothers with food issues or existing eating disorders may encourage/enable the disorder in their children by criticizing their weights.
    • Stressful life events or compliments about physical appearance can trigger and/or exacerbate the disorder.

    Altered Eating Habits in Anorexia Nervosa

    • Obsessive thinking about food, establishing strict food rules.
    • Development of food rituals.
    • Binge-eating-purging type, with binges and purging activities, often excessive exercise.

    What Goes Wrong in Anorexia Nervosa

    • Old psychoanalytic view associated food with sexuality.
    • Risk factors: hypothalamus and pituitary abnormalities, brain serotonin abnormalities.
    • Neuroadaptation to starvation (e.g., ANGPTL6 protein changes).
    • Emotional reactivity and obsessive tendencies.

    Other Signs/Sx of Anorexia Nervosa

    • Falling off growth curve.
    • Frequent bathroom use following meals.
    • Statements indicating a negative body image.
    • Anxiety or depression.
    • Physical abnormalities (e.g., dry skin, thin hair, brittle nails, cold intolerance, cyanosis).
    • Chronic constipation, enlarged salivary glands, dental erosion.
    • Chest pain, muscle wasting, and osteoporosis.

    Course and Prognosis of Anorexia Nervosa

    • 40% achieve complete recovery in 4-7 years.
    • 30% achieve partial recovery with relapses.
    • 30% persist with anorexia.
    • Poor prognostic indicators include poor social/occupational functioning, chronic illness, advanced age at onset, and the binge/purge subtype.
    • High rates of suicide among sufferers.

    How is Anorexia Nervosa Treated?

    • A patient's denial of illness is an important impediment that hinders treatment.
    • Medical management is essential to address any physical health complications related to starvation.
    • Hospital refeeding may be necessary (IV fluids or nasogastric tube, followed by oral refeeding with support).
    • A combination of inpatient and outpatient therapy is often necessary, with the goal of restoring weight and addressing underlying psychological problems.
    • Medications such as SSRIs (e.g., Prozac) may be useful to manage mood and anxiety issues that contribute to the disorder.

    Bulimia Nervosa

    • Recurrent binges (eating large amounts of food in a short time with a feeling of loss of control).
    • Compensatory behaviors (purging, emetics, laxatives, diuretics, or excessive exercising).
    • Episodes of binging and compensatory behaviors occur at least once a week for 3 months.
    • Preoccupation with body image and weight.
    • Loss of control over eating.

    Bingeing

    • Consuming significantly more than average portions within a 2-hour period.
    • Feeling of loss of control.
    • May be interrupted by physical discomfort, tiredness, or lack of food.
    • Typically involves high-calorie foods commonly avoided under normal circumstances.
    • Potentially large amounts of food consumed quickly (e.g., 2,000-3,000 calories in an hour).

    Social or Solitary Bingeing with Secret Purging

    • Initial pleasure during a binge can shift into guilt and shame, due to purging.

    Who Gets Bulimia Nervosa?

    • Predominantly affects adolescent females (80%).
    • Peak ages 15-18 (young adults) in females and 18-26 in males.
    • Often have a previous history of anorexia.
    • May involve high rates of bingeing in higher education establishments.
    • Often associated with stress, emotional instability, and mental health disorders.

    Emotionality and Bulimia Nervosa

    • Some studies associate Bulimia nervosa with early sexual abuse, chaotic childhoods, family history of eating disorders and/or pressure to maintain an attractive figure.
    • Impulsivity, emotional instability, and personality disorders (particularly borderline, histrionic, or narcissistic personality disorders) are possible risk factors.
    • Often comorbid with OCD.

    How Does Bulimia Nervosa Start?

    • Often triggered by dieting and not achieving desired weight or other health objectives.
    • Compensatory behavior via purging, medication (pills and fast-acting products), or exercise follows periods of bingeing.
    • Cycles of dieting → bingeing → purging.
    • May reinforce the binge-purge cycle through classical conditioning.

    Self-Injurious Behavior

    • Can occur in severe cases of Bulimia Nervosa, due to low self-esteem and impulsivity.

    What Is the Damage in Bulimia Nervosa?

    • Damage from repeated vomiting (e.g., stomach/esophageal rupture).
    • Damage associated with loss of electrolytes from vomiting (e.g., potassium).
    • Erosion of teeth and damage to mouth lining, as well as complications for oral health.
    • Severe hormonal issues (e.g., loss of periods)
    • Heart damage.
    • Other health concerns (e.g., bone loss, swollen salivary glands).
    • Increased risk of pregnancy complications.
    • Co-morbidity with other substance use disorders.
    • Potential association with other harmful behaviors (e.g., cutting, drug/alcohol abuse).

    How is Bulimia Nervosa Treated?

    • High doses of particular antidepressant drugs (SSRIs, such as Prozac) have been shown to reduce frequency of bingeing and purging (by up to 70% and 60% respectively)
    • Often requires long-term therapy (e.g., Cognitive Behavioral Therapy).
    • Treatment focuses on stopping bingeing/purging, developing healthy eating habits, and managing emotional distress.
    • Support groups can be helpful for shared experience.
    • Relapses are possible and ongoing treatment is often recommended.

    Binge-Eating Disorder

    • Most common eating disorder.
    • Point prevalence of 50:50 between genders (mildly obese individuals)
    • Commonly occurs in people engaging in dieting in weight loss programs.
    • Occurring at least once a week for 3 months, without compensatory actions.
    • Preoccupation with body size and weight, associated with loss of control.
    • Risk factors include childhood obesity, maternal focus on food, and/or a family history of restricted/unhealthy intakes.

    How is Binge-Eating Disorder Handled?

    • Diets may exacerbate Binge-Eating Disorder.
    • Binge-Eating Disorder presents several health-related problems.
    • Treatment often utilizes the same strategies employed for Bulimia Nervosa (such as psychotherapy, support groups and medication).
    • Treatment may potentially include treatments used for obesity (e.g., medications, bariatric surgery).

    Semaglutide/Tirzepatide

    • Medications that reduce appetite.
    • Approved for other conditions (e.g., diabetes or weight loss).
    • Significant weight reductions have been shown in trials.
    • Potential side effects (e.g., nausea, vomiting, diarrhea)
    • May be utilized within weight loss programs.

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