Eating Disorders (ED) - Past Paper Notes

EATING DISORDERS (ED) Gray Atherton PSYC 422 1 Annual Review 13 December 202 4 Agenda 01. Introduction 02. Prevalence and Risk Factors What constitutes an eating disorder? How How many people have do we recognise clinical...

EATING DISORDERS (ED) Gray Atherton PSYC 422 1 Annual Review 13 December 202 4 Agenda 01. Introduction 02. Prevalence and Risk Factors What constitutes an eating disorder? How How many people have do we recognise clinical it? How do we traits? characterise this population worldwide? 03. Psychological 04. Interventions 05. Future Theories directions How do we explain why How do we improve What are the next people exhibit clinical quality of life for steps for levels of disordered people with disordered understanding this eating? eating? condition? 2 Annual Review 13 December 202 4 Introduction https://www.tiktok.com/@real_life_documentaries/video/7206067651972451590 3 Annual Review 13 December 202 4 Diagnostic criteria in the DSM-V Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Other Specified Feeding and Eating Disorder (OSFED) Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder (ARFID) Unspecified Feeding or Eating Disorder (UFED) Other: o Muscle Dysmorphia o Orthorexia Nervosa (ON) proposed criteria 4 Annual Review 13 December 202 4  Anorexia Nervosa Restriction of energy intake leads to significantly low weight ‘Significantly low weight’ means a weight that is less than minimally normal or for young people, less than minimally expected Intense fear of gaining weight or becoming fat, and behaviour that interferes with weight gain Disturbance in the way that one’s body weight or shape is experienced Often co-morbid with Major Depression Disorder (50-68%) SUBTYPES: Restricting type: Weight loss is achieved through dieting/fasting/exercise Binge-eating/purging type: During the last 3 months the Bulimia Nervosa Recurring episodes of binge eating, ie: Eating in a set period of time (e.g. 1 hour) an amount of food that is larger than what most people would eat in that amount of time in similar circumstances A sense of lack of control during the eating episode (such as not being able to stop eating or control what is being eaten) Recurrent behaviors to prevent weight gain such as vomiting; misuse of laxatives or other medications; fasting; excessive exercise Binge eating and compensatory behaviors occur on average once a week for three months Self evaluation unduly influenced by body weight/shape Does not occur exclusively during episodes of anorexia Binge Eating Disorder (BED) Recurring episodes of binge eating, ie: Eating in a set period time (e.g. 1 hour) an amount of food that is larger than what most people would eat in that amount of time in similar circumstances A sense of lack of control during the eating episode (such as not being able to stop eating or control what is being eaten) Binge eating is associated with 3 or more of the following: Eating more rapidly than normal Eating until too full Eating large amounts when no longer hungry Eating alone due to shame Feeling disgusted or guilty after eating  Avoidant/Restrictive Food Intake Disorder (ARFID) An eating disturbance such as a lack of interest in eating food, avoidance based on sensory aspects of food, or concern about adverse consequences of eating, demonstrated by: Significant weight loss or failure to achieve growth gains Nutritional deficiencies Dependence on enteral feeding or supplements Marked interference with psychosocial functioning Orthorexia Nervosa Two proposed diagnostic criteria Criterion A Obsessive focus on ‘healthy’ eating defined by a dietary theory or set of beliefs whose specific details may vary; marked distress in relationship to food perceived as ‘unhealthy,’ weight loss may occur but not the primary goal Compulsive behavior and preoccupation regarding a restrictive diet perceived as optimally healthy Violation of self-imposed rules causes exaggerated fears Dietary restrictions may escalate over time, including ‘cleanses’ Criterion B Compulsive behavior begins to result in malnutrition and weight loss “ Prevalence Key Statistics (NICE, 2020) Estimates suggest that over 725,000 people in the UK have an eating disorder. Eating disorders can develop at any age, but the risk of onset is highest for adolescents and young adults. In Western countries, between 5.5% and 18% of young females and 0.6% to 2.4% of young males have experienced a DSM-5-defined eating disorder by early adulthood. Between 2015/16 and 2020/21, hospital admissions in England for eating disorders increased by 84%. Children and young people exhibited a 90% increased rate of hospital admissions over the five-year period. A rise of 128% was observed in boys and young men. Adults exhibited a 79% increase over the five-year period. Atypical 11 eating disorders are the most common subtype, followed by binge eating disorders, then bulimia  (1) genetics, (2) gastrointestinal microbiota and autoimmune react Risk factors for (3) childhood and early adolescent experiences, developing and ED (4) personality traits and comorbid mental health con (5) gender, (6) socio-economic status, (7) ethnic minority, Barakat et al., 2023 (8) body image and social influence (9) and elite sports. 12 Annual Review 13 December 202 4  Genetic Risks There is a strong genetic component to risk of Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) Incidence rates in individuals with a parent with a history of ED have been found to be over twice as high compared to individuals with parents with no history of an ED. Familial studies have demonstrated a strong genetic association for AN in particular. An individual is 11 times more likely to develop AN if they have a relative with the disorder as compared to someone with no family history. Similarly, an individual is 9.6 times more likely to develop BN, and 2.2 times more likely to develop BED if they have 13 a relative Annual Review with 13 the December 202 disorder 4  Gut Health Endocrines produced in the gastrointestinal (GI) tract communicate with the brain to regulate functions of appetite and satiety. Given the role of these functions in EDs, it is thought that dysregulation of the gut microbiome may be partially responsible for ED psychopathology 14 Annual Review 13 December 202 4 Early Childhood and Adolescent Development Research has indicated that in-utero exposure to high levels of cortisol through maternal stress is associated with later development of ED A further study in the UK found that individuals who were born preterm had an increased risk of ED associated with structural brain alterations linked to underdevelopment Research has shown that children are more likely to develop an ED if their parents display characteristics commonly associated with ED psychopathology, such as drive for thinness and perfectionism Research has found that female individuals diagnosed with AN or BN report significantly lower perceived emotional connectedness prior 15 to disorder onset than their healthy sisters Childhood weight Several studies have reported that higher weight during childhood poses an increased risk of developing an ED in later years, including among culturally and linguistically diverse (CALD) individuals, as well as males It has been suggested that parental perception of their child as being overweight may be a more powerful predictor of ED development than the child’s weight itself 16 Annual Review 13 December 202 4 Abuse and Trauma Evidence from several studies suggests that emotional abuse is a significant predictor of binge/purge symptomology in women, while sexual abuse and physical neglect were associated with symptoms in men Studies conducted in groups of women with obesity have found relationships between binge eating and childhood abuse and neglect 17 Annual Review 13 December 202 4 Socioeconomic status Despite the pervasive view that EDs disproportionately affect more affluent groups, evidence suggests that disordered eating behaviours occur at similar rates across all income levels and regardless of employment status Recent studies in the US have found low food security to be a predictor for disordered eating behaviours High levels of parental education have also been identified as a predictor of EDs 18 Annual Review 13 December 202 4 Body image and social infl uence A systematic review of the impact of anti- obesity public health messages has found that endorsement of thin ideals and drive for thinness are exacerbated in response to exposure to messages which are stigmatising towards individuals who are overweight or obese A meta-analysis of laboratory-based experimental studies found that viewing idealised images resulted in a small but non- significant increase in body dissatisfaction. However, exposure to these images was found to have a greater impact on groups considered at high-risk for developing EDs 19 Annual Review 13 December 202 4 Elite sports, female athlete triad, and excessive exercise Engagement in activities that accept or promote strict dieting practices and endorsement of low body fat has the potential to contribute to development and maintenance of ED symptoms In relation to ED behaviours, among elite athletes (n = 224), high prevalence of clinically significant ED symptomology (22.8%) has also been found Among non-elite populations, recognising excessive physical activity or exercise levels among women in the community is particularly important in risk assessment of ED, as these 20 individuals were found to be 2.5 times as likely to have an ED diagnosis than “ Psychological theories of EDs Psychological Theories of EDs (Pennesi & Wade, 2016) Sexual Cognitive Model Cognitive- Interpersonal objectification and interpersonal model sociocultural maintenance theories model 22 Annual Review 13 December 202 4  Sexual Objectifi cation and Sociocultural Theory (Moradi et al., 2005 Objectification theory: Women’s life experiences and gender socialisation include experiences of sexual objectification that reduce women to their bodies, body parts or body functions, and that these are capable of representing women as a whole Diary studies of women support routine sexual objectification or women (whistles from cars, inappropriate comments or advances, comments about body parts) Objectification theory posits that routine sexual objectification socialises women and girls to treat themselves like objects to be looked upon In Fredrickson et al. (1998) women who tried on swimsuits vs sweaters experienced more body shame and self- objectification Internalised sociocultural standards of beauty  Cognitive model of Bulimia (Cooper et al. 2008 Negative theories about the self (I’m unlovable, I’m a failure) are expressed as negative automatic thoughts Binging or purging take place to manage distress by providing a distraction These are associated with positive beliefs about eating (binging will take away my painful feelings) Also associated with negative beliefs about the consequences (I’ll get fat) And permissive thoughts that make it easier to keep eating (this will be the last time I binge) This is a vicious cycle This model has informed the development of cognitive- based self-help treatment for BN  Cognitive-interpersonal maintenance model of AN Treasure and Schmidt, 2013 Predispositions (anxiety, OCD, particularly in connection with relationships) increase vulnerability to AN These predispositions increase maintenance of AN such as fostering pro-anorexic beliefs These traits and AN symptoms causes problems in interpersonal relationships which in turn maintains the disorder Therapy using CIM model utilises these four factors to treat the condition: Thinking style characterised by rigidity Avoidance of emotional processing Positive beliefs about the utility of anorexia Response of others close to the illness (highly expressed emotions or accommodation of the illness)  Interpersonal model of BED Wilfley et al. 2002 Theory originates from depression research Proposes that dififculties with social functioning precipitate low self-esteem and negative affect This in turn triggers binge eating to cope with negative feelings “ I nterventions for EDs Theoretically driven interventions for EDs MyBody, MyLife: Cognitive The Maudsley IPT-ED Body Image Behavioral Model Program for Therapy Adolescent Girls 28 Annual Review 13 December 202 4  MyBody, MyLife: Body Image Program for Adolescent Girls (Heinicke et al., 2007) Six weekly group sessions delivered online to teen girls facilitated by a self-help manual and trained therapist Participants read materials and completed activities corresponding to each session 90 min group session conducted online in a secure chatroom run by a trained therapist, consisting of 4-8 participants Provided a supportive environment where girls discussed body image, and eating concerns, learned strategies to enhance body image, and learned good eating behaviors Discussion board was a permanent message board for communication during the week focused on exploring relationships between teasing, fat-talk, social comparison, negative body-talk, and low self-esteem Clinical trials suggest good outcomes, including comfort with peers, improved body image and improvements on  Cognitive behavioral therapy for BN Cooper et al. 2007 Self-help, group and individual therapy plans using CBT to help individuals overcome BN Treatment begins with strategies to enhance motivation and was followed by goal setting, formulation, identification and challenging of specific automatic thoughts, and then worked on underlying assumptions, core beliefs and relapse prevention. Includes: Emphasis on enhancing motivation for change Create goals, reward self for gains Challenging negative self-beliefs Is this logical? Is this always true? Conducting behavioural ‘experiments’ Today I’m going to do X for the first time to see what happens  The Maudsley Model of AN Treatment for Adolescents and Young Adults (MANTRa) Schmidt et al. 2014 Centers around a patient workbook that addresses illness- maintaining factors including Avoidance of emotions Rigid and inflexible thinking styles Identity development Add Addresses interpersonal maintenance factors like unhelpful behavior of close others Involves parents and loved ones in treatment Involves 20 weekly sessions followed by 4 monthly booster sessions  Eating disorder-specifi c model of interpersonal psychotherapy (IPT-ED) (Rieger et al., 2010) Attachment theory is a basis of this therapy – problems with the ED are thought to develop when a person’s need for attachment is not being met Negative social evaluation plays a central role in triggering discurbance of the self and causing eating disorder symptoms As such, treatment involves to reinstate or create healthy interactions between the individual and their social world so the eating disorder becomes redundant “ Future Directions  Body image, social media (Dane & Bhatia, 2023) ‘Evidence from 50 studies in 17 countries indicates that social media usage leads to body image concerns, eating disorders/disordered eating and poor mental health via the mediating pathways of social comparison, thin / fit ideal internalisation, and self-objectification. Specific exposures (social media trends, pro-eating disorder content, appearance focused platforms and investment in photos) and moderators (high BMI, female gender, and preexisting body image concerns) strengthen the relationship, while other moderators (high social media literacy and body appreciation) are protective, hinting at a ‘self-perpetuating cycle of risk’.  Orthorexia, social media (Turner & Lefevre, 2017) Higher Instagram use was associated with a greater tendency towards orthorexia nervosa, with no other social media channel having this effect. In exploratory analyses Twitter showed a small positive association with orthorexia symptoms. BMI and age had no association with orthorexia nervosa. The prevalence of orthorexia nervosa among the study population was 49%, which is significantly higher than the general population (