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Questions and Answers
What are the primary psychiatric disorders associated with underweight due to negative energy balance?
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?
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?
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?
What characterizes the energy balance in anorexia nervosa?
What is the highest death rate associated with anorexia nervosa compared to other mental illnesses?
What is the highest death rate associated with anorexia nervosa compared to other mental illnesses?
What is the expected increase in death by suicide in individuals with anorexia nervosa?
What is the expected increase in death by suicide in individuals with anorexia nervosa?
What risk is associated with underweight individuals, such as those with a BMI of 16?
What risk is associated with underweight individuals, such as those with a BMI of 16?
Which of the following is a result of energy expenditure dropping due to reduced food intake in anorexia?
Which of the following is a result of energy expenditure dropping due to reduced food intake in anorexia?
What defines the diagnostic criteria for anorexia nervosa?
What defines the diagnostic criteria for anorexia nervosa?
What distinguishes ARFID from anorexia nervosa?
What distinguishes ARFID from anorexia nervosa?
Which of the following conditions is commonly associated with ARFID?
Which of the following conditions is commonly associated with ARFID?
What is a typical characteristic of preferred foods in ARFID sufferers?
What is a typical characteristic of preferred foods in ARFID sufferers?
What type of therapy is commonly used for older individuals with ARFID?
What type of therapy is commonly used for older individuals with ARFID?
In ARFID, what do sufferers often perceive unfamiliar foods as?
In ARFID, what do sufferers often perceive unfamiliar foods as?
What is the purpose of techniques like the messy food picnic for younger children with ARFID?
What is the purpose of techniques like the messy food picnic for younger children with ARFID?
What was the purpose of developing ARFID as a diagnosis in DSM-V?
What was the purpose of developing ARFID as a diagnosis in DSM-V?
What does ARFID's severity need to exceed?
What does ARFID's severity need to exceed?
Which of the following best describes the nature of fear processing in ARFID?
Which of the following best describes the nature of fear processing in ARFID?
What is a common outcome for younger children engaging in messy food picnics?
What is a common outcome for younger children engaging in messy food picnics?
What is defined as a physiological illness secondary to chronic diseases?
What is defined as a physiological illness secondary to chronic diseases?
Which of the following is NOT a characteristic of cachexia?
Which of the following is NOT a characteristic of cachexia?
Which of the following conditions is a common associated illness with cachexia?
Which of the following conditions is a common associated illness with cachexia?
What weight loss percentage is indicative of cachexia in individuals of normal weight?
What weight loss percentage is indicative of cachexia in individuals of normal weight?
How does cachexia affect energy balance?
How does cachexia affect energy balance?
Which of the following statements about the reversibility of cachexia is true?
Which of the following statements about the reversibility of cachexia is true?
What physiological changes are often associated with low body weight in individuals with anorexia nervosa?
What physiological changes are often associated with low body weight in individuals with anorexia nervosa?
What does cognitive flexibility refer to?
What does cognitive flexibility refer to?
Which of the following hormones is typically low in patients with anorexia nervosa?
Which of the following hormones is typically low in patients with anorexia nervosa?
Which behavior is an indicator of cognitive inflexibility in anorexia nervosa?
Which behavior is an indicator of cognitive inflexibility in anorexia nervosa?
What effect does chronic starvation have on cortisol levels in individuals with anorexia nervosa?
What effect does chronic starvation have on cortisol levels in individuals with anorexia nervosa?
How can improvements in cognitive flexibility affect symptoms of anorexia nervosa?
How can improvements in cognitive flexibility affect symptoms of anorexia nervosa?
Which cytokines are consistently elevated in anorexia nervosa, indicating an inflammatory state?
Which cytokines are consistently elevated in anorexia nervosa, indicating an inflammatory state?
What is suggested about cognitive inflexibility in relation to anorexia nervosa?
What is suggested about cognitive inflexibility in relation to anorexia nervosa?
What therapeutic methods can help improve cognitive flexibility in individuals with anorexia nervosa?
What therapeutic methods can help improve cognitive flexibility in individuals with anorexia nervosa?
What psychological symptoms often present alongside anorexia nervosa?
What psychological symptoms often present alongside anorexia nervosa?
Which disorder is NOT commonly overlapped with anorexia nervosa?
Which disorder is NOT commonly overlapped with anorexia nervosa?
Which psychedelic is mentioned as being explored in clinical trials for treating anorexia nervosa?
Which psychedelic is mentioned as being explored in clinical trials for treating anorexia nervosa?
Chronic stress responses in anorexia nervosa lead to remodeling of which type of receptors?
Chronic stress responses in anorexia nervosa lead to remodeling of which type of receptors?
What role do ritualistic behaviors play in cognitive inflexibility for those with anorexia nervosa?
What role do ritualistic behaviors play in cognitive inflexibility for those with anorexia nervosa?
How does starvation affect cognitive function in individuals with anorexia nervosa?
How does starvation affect cognitive function in individuals with anorexia nervosa?
What effect does the remodeling of receptors due to chronic stress have on the body?
What effect does the remodeling of receptors due to chronic stress have on the body?
What is a significant behavior associated with cognitive inflexibility before the onset of anorexia nervosa?
What is a significant behavior associated with cognitive inflexibility before the onset of anorexia nervosa?
What do elevated ghrelin levels indicate in patients with anorexia nervosa?
What do elevated ghrelin levels indicate in patients with anorexia nervosa?
Which statement about cytokine levels in anorexia nervosa is true?
Which statement about cytokine levels in anorexia nervosa is true?
What is a common behavioral symptom associated with anorexia nervosa?
What is a common behavioral symptom associated with anorexia nervosa?
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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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