Lecture 12: Disorders of Negative Energy Balance

Questions and Answers

What are the primary psychiatric disorders associated with underweight due to negative energy balance?

Avoidant Restrictive Food Intake Disorder and Binge Eating Disorder

Anorexia Nervosa and Depression

Anorexia Nervosa and Bulimia Nervosa

Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder (correct)

How does being underweight compare in risk to being obese?

Being underweight is less risky than being obese.

Being underweight poses no risk.

Being underweight is more risky than being obese.

Being underweight is equally risky to obesity at a certain BMI. (correct)

What is the lifetime prevalence of anorexia nervosa in women?

2.0%

0.3%

0.9% (correct)

1.5%

What characterizes the energy balance in anorexia nervosa?

Restricted energy intake leading to weight loss Signup and view all the answers

What is the highest death rate associated with anorexia nervosa compared to other mental illnesses?

20% in 20 years Signup and view all the answers

What is the expected increase in death by suicide in individuals with anorexia nervosa?

32 times that expected Signup and view all the answers

What risk is associated with underweight individuals, such as those with a BMI of 16?

Same risk as obese individuals Signup and view all the answers

Which of the following is a result of energy expenditure dropping due to reduced food intake in anorexia?

Weight loss Signup and view all the answers

What defines the diagnostic criteria for anorexia nervosa?

Restriction of energy intake causing low body weight Signup and view all the answers

What distinguishes ARFID from anorexia nervosa?

Association with hyperactive fear processing Signup and view all the answers

Which of the following conditions is commonly associated with ARFID?

Autism Signup and view all the answers

What is a typical characteristic of preferred foods in ARFID sufferers?

Predictable and heavily processed Signup and view all the answers

What type of therapy is commonly used for older individuals with ARFID?

Cognitive behavioral therapy Signup and view all the answers

In ARFID, what do sufferers often perceive unfamiliar foods as?

Terrifying and frightening Signup and view all the answers

What is the purpose of techniques like the messy food picnic for younger children with ARFID?

To relieve pressure around eating Signup and view all the answers

What was the purpose of developing ARFID as a diagnosis in DSM-V?

To clarify classifications and reduce NOS usage Signup and view all the answers

What does ARFID's severity need to exceed?

What is expected from a primary disorder Signup and view all the answers

Which of the following best describes the nature of fear processing in ARFID?

It is hyperactive and intense Signup and view all the answers

What is a common outcome for younger children engaging in messy food picnics?

Gradual acceptance of some new foods Signup and view all the answers

What is defined as a physiological illness secondary to chronic diseases?

Cachexia Signup and view all the answers

Which of the following is NOT a characteristic of cachexia?

Increased caloric intake Signup and view all the answers

Which of the following conditions is a common associated illness with cachexia?

Cancer Signup and view all the answers

What weight loss percentage is indicative of cachexia in individuals of normal weight?

Greater than 5% Signup and view all the answers

How does cachexia affect energy balance?

Leads to reduced appetite and increased energy expenditure Signup and view all the answers

Which of the following statements about the reversibility of cachexia is true?

Cannot be reversed through nutritional support Signup and view all the answers

What physiological changes are often associated with low body weight in individuals with anorexia nervosa?

Amenorrhea and alterations in bone marrow morphology Signup and view all the answers

What does cognitive flexibility refer to?

The capacity to switch between different concepts or tasks Signup and view all the answers

Which of the following hormones is typically low in patients with anorexia nervosa?

Insulin Signup and view all the answers

Which behavior is an indicator of cognitive inflexibility in anorexia nervosa?

Fixation on specific foods or body parts Signup and view all the answers

What effect does chronic starvation have on cortisol levels in individuals with anorexia nervosa?

Cortisol levels increase Signup and view all the answers

How can improvements in cognitive flexibility affect symptoms of anorexia nervosa?

They are associated with improvements in symptoms Signup and view all the answers

Which cytokines are consistently elevated in anorexia nervosa, indicating an inflammatory state?

IL-1 beta, IL-6, TNF alpha Signup and view all the answers

What is suggested about cognitive inflexibility in relation to anorexia nervosa?

It may be a preexisting genetic trait Signup and view all the answers

What therapeutic methods can help improve cognitive flexibility in individuals with anorexia nervosa?

Using psychedelic drugs combined with psychotherapy Signup and view all the answers

What psychological symptoms often present alongside anorexia nervosa?

Rigid thinking and perfectionism Signup and view all the answers

Which disorder is NOT commonly overlapped with anorexia nervosa?

Bipolar disorder Signup and view all the answers

Which psychedelic is mentioned as being explored in clinical trials for treating anorexia nervosa?

Psilocybin from Australian mushrooms Signup and view all the answers

Chronic stress responses in anorexia nervosa lead to remodeling of which type of receptors?

Beta-adrenal and Glucocorticoid receptors Signup and view all the answers

What role do ritualistic behaviors play in cognitive inflexibility for those with anorexia nervosa?

They reflect rigid thought patterns and inflexibility Signup and view all the answers

How does starvation affect cognitive function in individuals with anorexia nervosa?

It causes cognitive impairment Signup and view all the answers

What effect does the remodeling of receptors due to chronic stress have on the body?

Altered response to stress hormones Signup and view all the answers

What is a significant behavior associated with cognitive inflexibility before the onset of anorexia nervosa?

Persistent patterns of thought Signup and view all the answers

What do elevated ghrelin levels indicate in patients with anorexia nervosa?

Low energy availability Signup and view all the answers

Which statement about cytokine levels in anorexia nervosa is true?

Cytokines are consistently higher, indicating inflammation Signup and view all the answers

What is a common behavioral symptom associated with anorexia nervosa?

Perfectionism Signup and view all the answers

Study Notes

Overview of Disorders of Negative Energy Balance

Underweight individuals can have psychiatric causes, such as Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder (ARFID).
Other causes of being underweight include hypermetabolism due to conditions like cancer cachexia and hyperthyroidism.
Inability to maintain tissue types can lead to conditions like lipodystrophy and sarcopenia of aging.
Being underweight poses serious health risks, comparable to obesity, with similar hazard ratios at extremely low BMI levels.

Anorexia Nervosa

Considered the deadliest psychiatric illness, with a 20% death rate over 20 years.
Mortality from physical causes is significantly elevated, being five times higher than expected for age group, and the suicide risk is 32 times higher.
Lifetime prevalence rates: 0.9% in women, 0.3% in men.
Diagnostic criteria revolve around energy intake restriction leading to significantly low body weight, relevant to one's age, sex, and health status.

Avoidant Restrictive Food Intake Disorder (ARFID)

Distinct from anorexia nervosa, as there’s no body image distortion.
Often co-occurs with conditions such as autism and ADHD.
Presentation is marked by excessive fear of unfamiliar foods, making the condition feel akin to encountering a threat.
Aims for preference toward predictable and processed food items.

Treatment Strategies for ARFID

Treatment for younger children involves non-pressure environments, allowing engagement with food safely.
Cognitive Behavioral Therapy (CBT) is favored for older patients to address food-related fears.

Cognitive and Behavioral Symptoms of Anorexia

Notable characteristics include perfectionism, rigid behaviors, and obsessive focus on details.
Significant overlap exists with anxiety disorders, obsessive-compulsive disorders, and autism spectrum disorders.

Hormonal and Physiological Changes in Anorexia

Affected individuals show low levels of leptin and insulin, with elevated ghrelin.
Chronic starvation leads to stress responses, elevated cortisol, and altered receptor remodeling impacting adrenaline responses.
Inflammatory markers (IL-1 beta, IL-6, TNF alpha) are elevated, indicating an inflammatory state counterintuitive to primary malnutrition effects.
Physiological repercussions include amenorrhea, fertility loss, and alterations in bone marrow resulting in anemia.

Cognitive Flexibility in Anorexia

Cognitive flexibility allows shifting between tasks and adapting behavior.
A marked cognitive inflexibility is common in anorexia, characterized by fixation on food and behaviors.
Research indicates cognitive inflexibility may exist prior to anorexia onset, suggesting a genetic predisposition over a starvation consequence.
Psychotherapy and emerging treatments that include psychedelic drugs like psilocybin are being explored to enhance cognitive flexibility.

Cachexia

Cachexia arises as a physiological issue linked to chronic diseases (e.g., cancer, AIDS, COPD).
Characterized by involuntary weight loss and muscle mass depletion, and cannot be reversed solely with nutrition.
Clinical criteria for diagnosis include weight loss exceeding 5% or more than 2% in those already demonstrating weight depletion according to BMI metrics.

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Description

This quiz focuses on the disorders associated with negative energy balance, particularly psychiatric conditions like Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder (ARFID). It covers the impact of these disorders on body weight and tissue maintenance. Test your knowledge on these critical mental health issues related to eating disorders.