L23 | Eating Disorders
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Questions and Answers

Which of the following eating disorders is characterized by repeated overeating without compensatory behaviors?

  • Binge eating disorder (correct)
  • Night eating disorder
  • Anorexia nervosa
  • Bulimia nervosa
  • What distinguishes avoidant/restrictive food intake disorder from anorexia nervosa?

  • Includes extreme weight loss criteria
  • Avoids certain foods due to texture and taste preferences (correct)
  • Is only diagnosed in children
  • Involves significant fear of weight gain
  • Which category does pica fall under in the DSM V?

  • Other specified feeding or eating disorders (correct)
  • Bulimia nervosa
  • Anorexia nervosa
  • Binge eating disorder
  • What is one potential physiological link mentioned for night eating disorder?

    <p>Malfunctioning leptin levels (A)</p> Signup and view all the answers

    In which population is binge eating disorder most commonly found?

    <p>Obese females (C)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of bulimia nervosa?

    <p>Eating small, frequent meals to maintain body weight (D)</p> Signup and view all the answers

    What is the primary defining feature of rumination disorder?

    <p>Regurgitation and re-chewing of food (C)</p> Signup and view all the answers

    Which eating disorder is characterized by eating non-food substances, like soil or paint?

    <p>Pica (C)</p> Signup and view all the answers

    What is the significant characteristic of Anorexia Nervosa?

    <p>Restriction of energy intake relative to requirements (C)</p> Signup and view all the answers

    Which subtype of Anorexia Nervosa involves purging behaviors?

    <p>Binge-eating/purging subtype (C)</p> Signup and view all the answers

    What is the estimated lifetime prevalence of Anorexia Nervosa in women?

    <p>0.5-2% (C)</p> Signup and view all the answers

    At what age does Anorexia Nervosa typically appear?

    <p>Around 12-13 years, post menarche (A)</p> Signup and view all the answers

    Which of the following is a common medical consequence associated with Anorexia Nervosa?

    <p>Diminished libido and amenorrhea (A)</p> Signup and view all the answers

    What behavioral change often marks the onset of Anorexia Nervosa?

    <p>Abandoning desserts, then meats, followed by all fats (B)</p> Signup and view all the answers

    Which group has higher rates of Anorexia Nervosa prevalence?

    <p>Individuals in dance, fashion, and elite sports (A)</p> Signup and view all the answers

    Which of the following defines the severity of Anorexia Nervosa?

    <p>Body Mass Index (BMI) classification (C)</p> Signup and view all the answers

    What is a characteristic behavior of individuals with restrictive Anorexia Nervosa?

    <p>Progressive reduction in caloric intake (D)</p> Signup and view all the answers

    What psychological impairments are often associated with Anorexia Nervosa?

    <p>Neuropsychological impairments in learning and memory (C)</p> Signup and view all the answers

    Which trait is commonly associated with Anorexia Nervosa due to serotonin metabolism abnormalities?

    <p>Inflexibility (A)</p> Signup and view all the answers

    What impact does chronic high cortisol levels have on the body?

    <p>Hippocampal damage (D)</p> Signup and view all the answers

    What psychological factors are heightened in parents of children with Anorexia Nervosa during pregnancy?

    <p>Anxiety (D)</p> Signup and view all the answers

    Which component of the HPA axis releases cortisol in response to stress?

    <p>Adrenal gland (A)</p> Signup and view all the answers

    What is a common heritable trait associated with Anorexia Nervosa?

    <p>Perfectionism (A)</p> Signup and view all the answers

    How much higher is the incidence of prematurity and birth trauma in children with Anorexia Nervosa compared to matched controls?

    <p>2-3 times (B)</p> Signup and view all the answers

    What role does the HPA axis play in relation to stress?

    <p>Regulates blood glucose and immune function (C)</p> Signup and view all the answers

    Which behavior is a tendency observed in individuals predisposed to Anorexia Nervosa?

    <p>Excessive exercise (B)</p> Signup and view all the answers

    What effect does maternal stress during pregnancy have on the developing fetus, in terms of HPA functioning?

    <p>It weakens the HPA axis (B)</p> Signup and view all the answers

    What characterizes chronic anxiety in relation to Anorexia Nervosa?

    <p>Serotonergic abnormalities (B)</p> Signup and view all the answers

    What is one consequence of abnormal HPA axis function in individuals with Anorexia Nervosa?

    <p>Increased vulnerability to stressors (A)</p> Signup and view all the answers

    What is an abnormal satiety response linked to Anorexia Nervosa?

    <p>Reduced feelings of fullness (C)</p> Signup and view all the answers

    Which attachment style is more prevalent among parents of children with Anorexia Nervosa?

    <p>Dismissive attachment (D)</p> Signup and view all the answers

    What generally triggers the onset of Anorexia Nervosa, according to research?

    <p>Severe life events (C)</p> Signup and view all the answers

    Flashcards

    Anorexia Nervosa (AN)

    An eating disorder characterized by a distorted body image and an intense fear of gaining weight. Individuals with AN restrict their food intake severely.

    Bulimia Nervosa (BN)

    An eating disorder characterized by episodes of binge eating followed by compensatory behaviors, such as purging (vomiting).

    Other Specified Feeding/Eating Disorder

    A category for those with eating disorder symptoms who don't fit the criteria for anorexia or bulimia.

    Binge Eating Disorder

    Characterized by repeated episodes of eating large quantities of food in a short period of time, without compensatory behaviors.

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    Night Eating Disorder

    A suspected disorder where people eat significantly during the night, often linked to circadian rhythm abnormalities.

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    Pica

    An eating disorder where individuals eat non-nutritive substances like paint, dirt, or hair.

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    Rumination Disorder

    Repeated regurgitation and rechewing of food, often seen in children with developmental issues.

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    Avoidant/Restrictive Food Intake Disorder

    Eating disorder where people avoid or restrict certain types of food, not because of fear of weight gain.

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    Prader-Willi Syndrome

    A rare genetic condition causing compulsive overeating and often leading to obesity-related health issues.

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    Gourmand Syndrome

    A syndrome related to brain injury (especially stroke or damage to frontal lobes) that leads to excessive appetite.

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    Hyperphagia

    Characterized by excessive eating.

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    Anorexia Nervosa (AN)

    An eating disorder marked by a severe restriction of food intake, intense fear of gaining weight and a distorted perception of body image.

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    Restricting type AN

    A type of anorexia nervosa where weight loss is achieved through dieting, fasting and exercise.

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    Binge-eating/purging type AN

    A type of anorexia nervosa where weight loss is achieved through purging behaviors like vomiting, laxative abuse, and diuretics.

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    Anorexia Nervosa Sub-types

    Anorexia nervosa can be classified into restricting and binge-eating/purging types by the method used to limit calorie intake.

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    Prevalence of AN

    Anorexia nervosa is more prevalent in women with 0.5-2% lifetime prevalence rate, predominantly found in middle-to-upper classes.

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    Onset of AN

    Anorexia nervosa typically begins in adolescence with incremental restriction of food groups then progresses in restricting diet.

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    Medical consequences of AN

    Severe restriction can lead to multiple, potentially life-threatening medical consequences (low blood pressure, heart rate irregularities, osteoporosis and loss of libido etc..).

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    Predisposing Factors (AN)

    Factors that increase the likelihood of developing anorexia nervosa (AN), but do not guarantee it.

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    Serotonin Metabolism (AN)

    Abnormal serotonin metabolism is linked to characteristics like perfectionism, inflexibility, restraint, abnormal satiety, and anxiety in AN.

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    Perfectionism (AN)

    A personality trait characterized by a strong need for order and flawlessness, often involving rigid control over one's life and appearance, in AN.

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    Abnormal Satiety (AN)

    An abnormal ability to feel full. People with AN may not experience satiety signals as normal.

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    HPA Axis

    Hypothalamic-Pituitary-Adrenal axis; a complex system in the brain that regulates the body's response to stress.

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    Pregnancy/Childbirth complications & AN

    Parents of children with AN often report more obstetric complications and higher levels of anxiety than average.

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    Abnormal Attachment Styles

    parents of children with AN are more likely to exhibit dismissive or insecure attachment styles, which affect emotional expression and bonding, potentially also impacting stress response.

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    Birth Trauma

    Premature birth or other significant trauma at birth has been shown to be more common in children who develop AN.

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    Developmental Consequences (AN)

    Factors like abnormal attachment, maternal stress, birth trauma and serotonin issues have similar negative effects on the body and brain's stress response mechanisms.

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    Hypothalamus (PVN)

    Part of the brain that initiates the stress response via Vasopressin (AVP) and Corticotrophin Releasing Hormone (CRH).

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    Cortisol

    A hormone that is released by the adrenal gland in response to stress which helps with stress response, but high levels lead to various health problems.

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    HPA Dysfunction (AN)

    Problems with the HPA axis (stress response system) are seen in individuals with AN, often causing abnormal stress responses and risk during puberty.

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    Puberty and AN

    Changes in the HPA axis during puberty are considered a risk factor, as they create vulnerability to the development of AN, potentially combined with fears about menarche.

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    Severe Life Event (AN)

    A major stressful life event often directly precedes the onset of AN.

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    Lean Sow Disease

    Animal model demonstrating stress-related anorexia resulting from HPA dysfunction, in AN.

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    Diminished Hunger Cues

    A reduced sensitivity to signals that indicate when the body needs food. It is a trait/risk factor in AN.

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    Study Notes

    Eating Disorders Overview

    • This lecture focuses on anorexia nervosa (AN) and bulimia nervosa (BN).
    • Other less-studied eating disorders include other specified feeding or eating disorders (OSFED) and binge eating disorder (BED).
    • OSFED is a category for individuals not fitting AN or BN criteria, but exhibiting characteristics of one or both.
    • BED is characterized by repeated overeating without compensatory behaviors.
    • Night eating disorder is linked to abnormal circadian rhythms and possibly leptin dysfunction.
    • Rumination disorder involves repeated regurgitation and re-chewing of food, often in children.
    • Avoidant/Restrictive Food Intake Disorder (ARFID) is similar to anorexia but without fear of weight gain.

    Anorexia Nervosa (AN)

    • Clinical definition: Restriction of energy intake relative to requirements, leading to significantly low body weight (judged by BMI relative to age, gender, and health). Intense fear of gaining weight, persistent behaviors preventing weight gain, and distorted body image.
    • Subtypes: Restricting (dieting, fasting), or binge-eating/purging (vomiting, laxatives).
    • Specification: Severity is based on BMI, ranging from mild (BMI 17) to extreme (BMI < 15). Conditions can be full, partial, or in remission.

    Anorexia Nervosa (AN) Prevalence

    • Lifetime prevalence is 0.5–2% in women.
    • Primarily affects women, with a sex ratio between 10-20 to 1.
    • Common in middle to upper-middle class Caucasian women.
    • More common in those involved in dance, fashion, and elite sport.
    • Typically appears in adolescence (around 12–13 years), post-menarche, but range is 10–60 years.

    Anorexia Nervosa (AN) Onset

    • Begins with minor dietary changes, often starting with eliminating desserts, meat, and fat.
    • Vegetarianism is sometimes adopted as a justification.
    • Increasing focus on safe foods (e.g., lettuce, fruit).
    • Restriction of fluids is often seen.
    • Eating speed and food frequency decreases.
    • Gradual decrease in caloric intake, often not apparent to family initially.
    • Body thinness becomes the dominant goal.

    Anorexia Nervosa (AN) Clinical Consequences

    • Overactivity and cold sensitivity (fidgeting, excessive walking).
    • Multiple endocrine abnormalities (e.g., Type 1 diabetes possible).
    • Low blood pressure and slow heart rate.
    • Diminished libido and amenorrhea (absence of menstruation).
    • Increased risk of osteoporosis.
    • Neuropsychological impairments (learning/memory/hippocampal volume).
    • Increased risk of anxiety and depression.
    • Highest mortality rates of any psychiatric condition. (Estimates of lifetime mortality rate 5-10%)

    Anorexia Nervosa (AN) Causes

    • Earliest documentation in 15th and 16th centuries.
    • No single cause but multiple interacting factors including genetics, biological, psychological, and social/cultural variables.
    • Pre-disposing traits may include obsessive-compulsive personality traits, heightened sensitivity to hunger, and tendency for high levels of exercise.

    Anorexia Nervosa (AN) Development

    • 25 percent of parents of children with AN have experienced complications in pregnancy/childbirth and loss.
    • Parents report increased anxiety levels during their children's pregnancy.
    • High rate of prematurity/birth trauma in children with AN parents.
    • Parents who tend to be controlling and overprotective.
    • Abnormal attachment styles are often observed in families with AN.

    Anorexia Nervosa (AN) HPA Axis

    • The hypothalamic-pituitary-adrenal (HPA) axis regulates stress responses in the body.
    • Chronic high cortisol levels can lead to muscle wasting, high blood glucose, impaired immune function, and hippocampal damage.
    • HPA function is abnormal during the course of AN and may be abnormal following recovery with multiple biological causes.

    AN and BN Maintenance

    • AN is often highly resistant to treatment because individuals may deny that there's a problem (egosyntonic).
    • Several biological factors may maintain AN behavior, including:
      • Heightened body-weight awareness and the feeling of loss of control
      • Complex, ritualistic behaviors around food and weight maintenance.
      • Potential biological addiction to the process of weight loss, especially increased levels of b-endorphins.

    Bulimia Nervosa (BN) Clinical Definition

    • Recurrent episodes of binge eating (eating a large amount of food quickly, with a lack of control over the behavior.)
    • Recurrent inappropriate compensatory behaviours to prevent weight gain (e.g., self-induced vomiting, laxatives, diuretics, or excessive exercise).
    • Both behaviors occur at least once a week for 3 months.
    • Self-evaluation unduly influenced by body weight and shape.
    • BN occurs independently of periods of Anorexia Nervosa (AN)

    Bulimia Nervosa (BN) Prevalence and Consequences

    • Lifetime prevalence: 1–3% in women.
    • Predominantly a female disorder, with a significantly smaller number of cases in males.
    • Medical consequences include: dental erosion, swelling of the parotid glands, electrolyte abnormalities, esophageal tears.

    Bulimia Nervosa (BN) Cause and Predisposing Factors

    • BN may share some genetic risk factors with AN.
    • Early experiences of dieting and critical comments about body weight may lead to onset.
    • A history of AN is a predisposing factor, but it does not affect all patients diagnosed with BN.
    • Childhood experiences, family environment, and critical comments about weight can also play a significant role.

    Bulimia Nervosa (BN) Prognosis and Treatment

    • 50% of patients appear to have full recovery from BN, with 30% experiencing occasional relapse, and 20% chronic BN.
    • Treatment often involves a combination of Cognitive Behavioral Therapy (CBT) and antidepressants.

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    Description

    This quiz provides an overview of various eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder. It also covers lesser-known conditions like OSFED and ARFID, explaining their characteristics and clinical definitions. Test your knowledge on the complexities of eating disorders and their classifications.

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