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Questions and Answers
Which eating disorder is characterized by repeated overeating without compensation?
Which eating disorder is characterized by repeated overeating without compensation?
Which eating disorder is associated with individuals having an abnormal circadian rhythm linked to obesity?
Which eating disorder is associated with individuals having an abnormal circadian rhythm linked to obesity?
Pica is often associated with which of the following?
Pica is often associated with which of the following?
Which disorder involves the repeated regurgitation and re-chewing of food, mainly observed in children?
Which disorder involves the repeated regurgitation and re-chewing of food, mainly observed in children?
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Individuals with avoidant/restrictive food intake disorder experience what key difference compared to anorexia nervosa?
Individuals with avoidant/restrictive food intake disorder experience what key difference compared to anorexia nervosa?
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What characterizes the onset of anorexia nervosa?
What characterizes the onset of anorexia nervosa?
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Which of the following is a subtype of anorexia nervosa?
Which of the following is a subtype of anorexia nervosa?
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What is an important medical consequence of anorexia nervosa?
What is an important medical consequence of anorexia nervosa?
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At what age does anorexia nervosa typically first appear?
At what age does anorexia nervosa typically first appear?
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What is not a distinguishing feature of anorexia nervosa?
What is not a distinguishing feature of anorexia nervosa?
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What can be a psychological consequence of anorexia nervosa?
What can be a psychological consequence of anorexia nervosa?
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Which statement about the prevalence of anorexia nervosa is accurate?
Which statement about the prevalence of anorexia nervosa is accurate?
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Which of the following is a common behavior seen in individuals with anorexia nervosa?
Which of the following is a common behavior seen in individuals with anorexia nervosa?
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What is a critical diagnostic feature of anorexia nervosa (AN)?
What is a critical diagnostic feature of anorexia nervosa (AN)?
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What role do complex rituals play in the behavior of someone with anorexia nervosa?
What role do complex rituals play in the behavior of someone with anorexia nervosa?
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What biological factor is suggested to help maintain the fasting behavior in anorexia nervosa?
What biological factor is suggested to help maintain the fasting behavior in anorexia nervosa?
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What percentage of individuals with anorexia nervosa may never fully recover?
What percentage of individuals with anorexia nervosa may never fully recover?
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Why is refeeding considered the first treatment goal for anorexia nervosa?
Why is refeeding considered the first treatment goal for anorexia nervosa?
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What might help contribute to the avoidance of dysphoria in individuals with anorexia nervosa?
What might help contribute to the avoidance of dysphoria in individuals with anorexia nervosa?
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What is a consequence of the highly stylized eating rituals associated with anorexia nervosa?
What is a consequence of the highly stylized eating rituals associated with anorexia nervosa?
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What is the typical caloric intake for refeeding in hospital treatment of anorexia nervosa?
What is the typical caloric intake for refeeding in hospital treatment of anorexia nervosa?
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What is a characteristic of binge eating in bulimia nervosa?
What is a characteristic of binge eating in bulimia nervosa?
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What is a common inappropriate compensatory behavior associated with bulimia nervosa?
What is a common inappropriate compensatory behavior associated with bulimia nervosa?
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What percentage of the lifetime prevalence of bulimia nervosa is estimated in women?
What percentage of the lifetime prevalence of bulimia nervosa is estimated in women?
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Which of the following is NOT a medical consequence of bulimia nervosa?
Which of the following is NOT a medical consequence of bulimia nervosa?
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How frequently must binge eating and inappropriate compensatory behaviors occur to meet the criteria for bulimia nervosa?
How frequently must binge eating and inappropriate compensatory behaviors occur to meet the criteria for bulimia nervosa?
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Bulimia nervosa primarily develops during which life stages?
Bulimia nervosa primarily develops during which life stages?
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Which of these characterizes bulimia nervosa's effect on self-evaluation?
Which of these characterizes bulimia nervosa's effect on self-evaluation?
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What unique facial condition can result from bulimia nervosa due to parotid gland swelling?
What unique facial condition can result from bulimia nervosa due to parotid gland swelling?
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What is a significant genetic risk factor associated with anorexia nervosa (AN)?
What is a significant genetic risk factor associated with anorexia nervosa (AN)?
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Which behavioral trait is associated with the genetic vulnerabilities linked to AN?
Which behavioral trait is associated with the genetic vulnerabilities linked to AN?
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What role does cortisol play when cortisol levels are chronically high due to stress?
What role does cortisol play when cortisol levels are chronically high due to stress?
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What impact does childbirth trauma have on the development of AN in children?
What impact does childbirth trauma have on the development of AN in children?
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Which factor is associated with the activation of the HPA axis in relation to AN?
Which factor is associated with the activation of the HPA axis in relation to AN?
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What are the three components of the HPA axis?
What are the three components of the HPA axis?
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How does the hypothalamus affect appetite regulation in individuals with AN?
How does the hypothalamus affect appetite regulation in individuals with AN?
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In what way do overprotective parental behaviors affect children at risk of developing AN?
In what way do overprotective parental behaviors affect children at risk of developing AN?
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Which trait is typically observed in individuals with disorders related to abnormalities in serotonin metabolism?
Which trait is typically observed in individuals with disorders related to abnormalities in serotonin metabolism?
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What biological change during puberty may contribute to an increased vulnerability for AN?
What biological change during puberty may contribute to an increased vulnerability for AN?
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What is the relevance of prematurity in relation to AN risk?
What is the relevance of prematurity in relation to AN risk?
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How does the culture of weight loss relate to the incidence of AN among populations?
How does the culture of weight loss relate to the incidence of AN among populations?
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What does chronic release of Neuropeptide Y inhibition result in for those with AN?
What does chronic release of Neuropeptide Y inhibition result in for those with AN?
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What is one of the predisposing factors for bulimia nervosa (BN)?
What is one of the predisposing factors for bulimia nervosa (BN)?
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Which physiological change is associated with the development of bulimia nervosa?
Which physiological change is associated with the development of bulimia nervosa?
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Which of the following statements about bulimia nervosa treatment is correct?
Which of the following statements about bulimia nervosa treatment is correct?
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What percentage of individuals with bulimia nervosa is likely to experience chronic symptoms?
What percentage of individuals with bulimia nervosa is likely to experience chronic symptoms?
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What is one identified potential trigger for binge eating in bulimia nervosa?
What is one identified potential trigger for binge eating in bulimia nervosa?
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How does bulimia nervosa generally compare in treatability to anorexia nervosa?
How does bulimia nervosa generally compare in treatability to anorexia nervosa?
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What change in serotonin function is associated with bulimia nervosa?
What change in serotonin function is associated with bulimia nervosa?
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Which psychological condition shows higher rates among individuals with bulimia nervosa?
Which psychological condition shows higher rates among individuals with bulimia nervosa?
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Which binge eating characteristic is true regarding bulimia nervosa?
Which binge eating characteristic is true regarding bulimia nervosa?
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What role does critical commentary about weight play in the development of bulimia nervosa?
What role does critical commentary about weight play in the development of bulimia nervosa?
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Study Notes
Eating Disorders: Overview
- This lecture focuses on anorexia nervosa (AN) and bulimia nervosa (BN).
- Other eating disorders include: other specified feeding or eating disorders (OSFED), binge eating disorder (BED), and night eating disorder.
- OSFED is a category for those who don't meet AN or BN criteria, but show characteristics of one or both.
- BED is characterized by repeated overeating without compensatory behaviors, and is common in obese individuals (9-18% of obese).
- Night eating disorder is linked to obesity and abnormal circadian rhythm potentially linked to leptin dysfunction.
- Rumination disorder involves repeated regurgitation and rechewing.
- Avoidant/restrictive food intake disorder is similar to anorexia, but without fear of weight gain.
Anorexia Nervosa (AN): Clinical Definition
- Restriction of energy intake, leading to significantly low body weight (determined by BMI relative to age, gender, and health expectations).
- Intense fear of gaining weight or becoming fat, or persistent behaviors interfering with weight gain (even at low weight).
- Disturbance of perception of shape or body weight, and denial of the seriousness of current low body weight.
- Subtypes: Restricting (dieting, fasting, exercise) and binge-eating/purging (vomiting, laxatives, diuretics, enemas).
Anorexia Nervosa (AN): Prevalence
- Lifetime prevalence of AN is 0.5-2% in women.
- Predominantly affects women in middle to upper middle class Caucasian.
- Higher rates in those involved in dance, fashion, and elite sports.
- Typically appears around 12-13 years (post-menarche).
Anorexia Nervosa (AN): Onset
- Starts with minor dietary changes, abandoning desserts, then meats, then fat-containing foods.
- Vegetarianism or "safe-foods" (like lettuce and fruit) are sometimes used to justify, with decreased eating speed and longer intervals between meals.
Anorexia Nervosa (AN): Medical Consequences
- Overactivity and cold sensitivity.
- Multiple endocrine abnormalities (e.g., type 1 diabetes).
- Low blood pressure, slow heart rate.
- Diminished libido, amenorrhea (absence of menstruation).
- Osteoporosis (post-recovery).
- Neuropsychological impairments in learning and memory.
- Anxiety and depression.
- Estimated lifetime mortality rate of 5-10%.
Anorexia Nervosa (AN): Cause
- Earliest documentation is in the 15th-16th centuries.
- No single cause identified.
- Multiple interacting factors include genetics, biological, psychological, and social/cultural factors.
Anorexia Nervosa (AN): Genetics
- Significant genetic component; female relatives 7-20x more likely to develop AN.
- Monozygotic (MZ) twins show higher concordance for AN than dizygotic (DZ) twins.
- Estimates suggest 58-76% of variance in AN is due to genetics.
- Related to certain personality traits (e.g., perfectionism, inflexibility, and restraint), abnormality in serotonin metabolism, and chronic anxiety.
Anorexia Nervosa (AN): Developmental Factors
- 25% of AN parents have a history of obstetric difficulty or loss.
- Higher incidence of prematurity and birth trauma in AN children.
- Parents of AN children report higher anxiety during pregnancy.
- Parents often controlling and overprotective.
- Abnormal attachment styles (e.g., dismissive, insecure) in AN parents.
Anorexia Nervosa (AN): HPA Axis
- The HPA axis is composed of hypothalamus, pituitary, and adrenal glands, involved in stress response.
- Stress chronically high cortisol leads to muscle wasting, high glucose, immune suppression, and hippocampal damage.
- AN shows abnormal HPA function and multiple biological causes.
- Profound changes during puberty potentially increase vulnerability.
Anorexia Nervosa (AN): Causal Synthesis
- Predisposing factors include abnormal HPA, increased serotonin, anxiety enhanced satiety, biological window, situational factors, chronic stress.
- Results in manifestation of AN.
Anorexia Nervosa (AN): Maintenance
- Weight loss initially is satisfying, but increasingly punitive measures are implemented.
- Highly stylized eating rituals develop including food types becoming restricted.
- Social avoidance increases
- Pursuit of weight loss becomes the sole goal.
- Biological factors suggest potential addiction of weight loss.
Anorexia Nervosa (AN): Prognosis & Treatment
- 50% achieve full recovery.
- 30% experience occasional relapse.
- 20% exhibit chronic AN.
- Treatment combines CBT (cognitive behavioral therapy) and antidepressants.
- CBT helps with identifying triggers for bingeing and coping mechanisms.
- Antidepressants may be effective after refeeding to prevent relapse.
Bulimia Nervosa (BN): Clinical Definition
- Recurrent episodes of binge eating (large amounts of food in a discrete period with lack of control).
- Inappropriate compensatory behaviors (vomiting, laxatives, excessive exercise) to avoid weight gain.
- Binge eating and compensation occur at least once a week for 3 months, and self-evaluation is heavily influenced by body weight and shape.
Bulimia Nervosa (BN): Prevalence and Medical Consequences
- Lifetime prevalence is ~1-3% in women.
- Typically appears in late adolescence/early adulthood.
- Benign relative to AN, but can include dental erosion, parotid gland swelling ("chipmunk face") electrolyte imbalances, and complications like esophageal tears.
Bulimia Nervosa (BN): Cause
- History of AN may be a factor in some cases.
- Potential predisposition may include dieting, childhood/parental obesity, family environment, critical comments about weight, sexual abuse, anxiety and depression.
Bulimia Nervosa (BN): Instigation and Maintenance
- A plausible model of BN onset involves dieting, preoccupation with weight, quick weight loss methods, perceived control over food/purging.
- Frequency/duration of binges and triggers generally increases.
- Physiologic changes related to abnormal satiety are observed, including enlarged gastric capacity, delayed emptying, diminished elasticity of the stomach, impaired CCK release (diminished post-meal satiety), and abnormal serotonergic function.
Bulimia Nervosa (BN): Prognosis & Treatment
- Treatment response varies but a successful outcome is achievable.
- CBT and antidepressants often provide good results.
General Conclusion
- AN and BN are common and complex eating disorders.
- Causation is not fully understood but a range of factors and interactions play a role in their onset.
- BN is generally easier to treat than AN.
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Description
This quiz covers key concepts related to eating disorders, focusing on anorexia nervosa and bulimia nervosa. It delves into various types of eating disorders, their characteristics, and clinical definitions, offering a comprehensive understanding of this critical subject.
