Eating Disorders PDF

[Eating Disorders] A diagram of a diagram Description automatically generated Some examples of **eating disorders**: **Anorexia Nervosa, Bulimia Nervosa and Binge eating disorder**. At the center of the clinical presentation of eating disorders, there are **concerns and preoccupations around body...

[Eating Disorders] A diagram of a diagram Description automatically generated Some examples of **eating disorders**: **Anorexia Nervosa, Bulimia Nervosa and Binge eating disorder**. At the center of the clinical presentation of eating disorders, there are **concerns and preoccupations around body and shape**. **OSFED** is the most **common** disorder and is utilized when people **do not meet the criteria** of a specific ED diagnosis. This could be because of insufficient symptoms or having them for too short of a time. The ED is **always specified** when clinicians describe the presentation of the behaviour with this label. **UFED** is a label used when the **diagnosis is unclear**, the presentation is mixed, and clinicians **cannot be sure what ED the behaviour mirrors.** Often used in emergency rooms, where there is **not enough information to specify** what the condition is. Some examples of **feeding disorders: Pica, ARFID and Rumination disorder**. This is more concerned with feeding rather than weight and body shape. **Pica** is when the individual **ingests non-edible food**. This is a condition that effects mostly children **below the age of 6, or pregnant** women (ice chips?). **Rumination disorder** consists of the **regurgitation of food, without intention** (effortless). This often takes place **before digestion**, a couple minutes after eating. **ARFID** is where people **restrict their food intake** considerably, often leading to dramatic **weight loss**. Mostly due to **discomfort of eating** rather than concerns about weight. This disorder has a strong **overlap with autism**. [Anorexia Nervosa:] This is a condition **where self-worth and self-identity are linked to how the body looks, shaped and weighs**. Through the **control over food intake, the body and eating there is a sense of accomplishment**. People with anorexia are often **high achieving perfectionists** which they channel into their ED. They are cognitively **rigidi** toward their life including their eating patterns, their **obsessions over food** take the **form of rituals** surrounding when they eat, how much and in how many pieces (etc.). There is a **fear of weight gain** (despite evidence showing the opposite) due to **body image distortion**, and therefore are **unable to grasp the severity** of their condition and subsequent **medical complications**. **Compensatory behaviours** are also common (in many ED), for example, **vomiting**. These behaviours occur when sufferers have **lapses of control** over their **restraint**, they feel the need to compensate. According to the **DSM-5** the **restriction of energy intake** needs to be so low that it leads to a **significantly low bodyweight** (**17.5 BMI**). There also needs to be an **intense fear of gaining weight** and a **disturbance** in the way body **weight/shape are experienced** (**over-evaluating** ourselves on that basis or **lack of recognition** of the seriousness). There are **2 subtypes**: **Restricting or Purging**. Those who are **restricting** tend **not** to have many **lapses in control**, **don't** really **binge** eat but primarily **restrict or excessively exercise**. People who purge are more likely to binge eat and then **compensate**. **Starvation** can significantly **affect cognition**, often causing people to feel dizzy or experience difficulty concentrating. It can affect your interpersonal life significantly.  [Bulimia Nervosa:] As an ED there are **concerns around body weight and shape** at the center of the disorder. There is an **attempt to engage in dietary restraint**, however **lapses of control** are more **frequent and significant**. Eating often occurs in **secrecy**, with **shame** and **guilt** attached to the act. The **DSM** states that episodes of **binge eating** are defined by **2 main features**: **eating overconsumption** in a discrete period of time & a sense of **lack of control (while they're eating).** They also engage in **recurrent compensatory behaviour to prevent weight gain**. The behaviour needs to occur **once a week for 3 months,** which **cannot occur during** **AN episodes**. Self-evaluation must be heavily influenced by body shape/weight. There are **2 subtypes**: Purging and Non-purging. People who purge use things like laxatives while **non-purgers use driven** exercise to keep their dietary restraint under control. A close-up of a chart Description automatically generated [Binge Eating Disorder:] Introduce into the DSM in 2013 (recent). There is a **sense of self-worth related to shape of body/weight**. Episodes of **binge eating occur frequently** but there is **no compensatory behavior**. This disorder has a **high correlation with obesity**. The **DSM** states for diagnosis, an individual needs to experience **recurrent episode of binge eating associated with 3 or more** of the following: **rapid eating, until uncomfortably full, eating large amounts when not hungry, eating alone due to embarrassment, feeling disgust and oneself (depressed/guilty)**. They should feel **distress** regarding binges and should binge at least **once a week for 3 months** **without any compensatory behaviour.**  [Diagnostic Migration] the thickness of the arrow indicates frequency of change An article was published about **observing diagnosis in ED patients for 2 years** (**2003**). They found over the span of 2 years, **80% change their diagnosis**. Now, this **phenomenon is considered to be less frequent** than it was initially thought to be since most patient, if they do change, change toward **OSFED** (2019) and eventually **remittance**. [Comorbidity & Epidemiology: ]  A table with text and numbers Description automatically generated It is likely that the **prevalence of EDs in males** is grossly **underestimated** and are increasing a **faster** rate than females. There is **no difference in clinical severity** of EDs between genders. One reason for the neglect against males is due to **assessment tools** primarily focusing on behaviour deviating from the **ideal female** (**focus on thinness idealization vs muscle)** and therefore does **not consider how an ED manifests in males**. Also, males general exhibit **less help seeking behaviours**, so these figures are less known to mental health services. [Aetiology:] Some **methodical challenges** faced with studying EDs are they are **not** very **common**, **difficult to detect** (only **20%** seek help), **unrepresentative** samples & **difficult to diagnose.** [Biological risk factors:] Genetic studies place **heritability** at **40-60**% and **cross-diagnostic**. They found if you have a 1^st^ degree relative with **AN**, you are **10x** more likely to develop an ED. If that relative has **BN,** you are **4-9x more likely**. This suggests the development of EDs has a **genetic component**, likely **relating to the** **regulations of functions** that are crucial in EDs. One hypothesis about the development of EDs is that **the lateral hypothalamus is damaged**, this is an are central to **appetite regulation**. **Animal studies** where lesions were made in this area found the rats/mice **lose hunger**. This is **weak** as evidence shows people with **AN** have **no brain damage and still experience hunger**. Another theory is that people with AN develop an **addiction to starvation** as when the body starves it **releases endogenous opioids** to **downregulate** **pain**. Patients may find **starvation rewarding**. However, when this **release is blocked**, researchers have found **no change** in behaviour (**weak** evidence). They suggested that those who engage in binge eating may have **low levels of serotonin and dopamine for AN (high levels of dopamine for BN)**, but this does **not** seem to be **true**. [Psychological risk factors:] **Body dissatisfaction** is considered to be the core of the condition. **Longitudinal studies** show that young people with **higher body dissatisfaction levels** were more likely to later develop a condition or an ED. This suggests that body dissatisfaction could **predict an ED** as the **increased risk** is around **4x**. This may also be the case as body dissatisfaction **leads to dieting**, which is a **precursor** to developing an ED. Intervention to help body dissatisfaction may prevent this development. **Perfectionism** and a fear of failure are key traits in **AN**. It was found that **OCD traits** in **childhood** have been shown to predict the **onset development of Anorexia and Bulimia**. The **function** the ED fulfills is the **achievement of control** for the individual. **Low self-esteem** predicts the **onset and the outcome** of EDs. The idea behind the development usually surrounds the concept of **being happier/more acknowledged after losing weight**. A lot of empirical evidence found that if **mood is manipulated**, **body dissatisfaction increases**, and the individual tends to **eat more**. They may use this **binge eating/controlled eating to shift preoccupation** away from their **emotions** that they have **difficulty regulating**. This suggests that the development of EDs may be linked to **individuals' mood intolerance**. [Culture & Body image:] **AN** can be found **globally**; however, **BN** seems to be the product of a more westernized influence. Studies show in the US, **African American women were less affected** by EDs. They concluded that this was likely due to the **different body ideals** of black and white women. For example, black men preferred heavier women and **larger bodies** were **ideal**. Over time, **black women** became the **highest referred ethnic group for EDs** (UK). **Marina Carper et al (2010)** found that ED development was **higher in fe/males** whose **body weight and shape were of significance** to them. [Social Media] **Cross sectional** studies between time **engaging in implicit messages** and risk of **developing an ED** were performed as well as studies **manipulating the amount of time** spent engaging in the media. They found that people had **increased body dissatisfaction** as a result. The **more time**, the **more dissatisfied**. However, the **strongest effect** was among those who **already experienced body dissatisfaction.** Evidence found that the **unrealistic standards** portrayed in media led to young people **internalizing ideals** such as, being seen as "**hot**" would make them **feel important** (this led to **higher rates of body dissatisfaction)**. They often were led to believe that their **beauty existed outside** of themselves and being "**fat**" was **lazy** and undisciplined. Some supporting evidence for this was that **time watching MTV or reading magazines was linked to high rates of BD**.  Social/Interpersonal factors: Research found that **Adolescence is a risk phase** for the development of EDs. Studies examined different **peer behaviours** (teasing about with, interactions about dieting and likeability) and found that a focus on **likeability was the most predictive of eating and weight concerns**. This suggests there is a **strong element of wanting to belong and seeking approval** that leads to the development of EDs. Researchers believe that families with a child that develops an ED were often overly protective, obsessive, excessively rigid and overly involved in their child's life. Now, the main familial factor is the **parents' eating problems**, often focused on **their own diet and body weight**. This suggests that **parental praise for discipline and slenderness** may play a role in the development of EDs. A white paper with black text Description automatically generated  [Treatment:] The **goals** of treatment are to **reduce the risk** of physical/medical complications, **encourage/normalize** healthy or normal **eating**, **facilitating recovery**, **reducing shame/secrecy** and **addressing relationships** with **weight** and **body** image. A group of grey squares with white text Description automatically generated Pharmalogical treatments are not often used, they are not considered particularly helpful.  A white table with black text Description automatically generated It is important for AN that the person regain weight as the effects of starvation on the brain prevent the engagement in meaningful therapeutic activity, so the weight needs to be restored. People with BN need to have patterns of eating that are more regular and structured to reduce the relationship of restraining and binging.  the treatment concerns what maintains AN. it discusses what part of the ED is cherished and valued by the individual, even allowing them to write a letter (1 positive and 1 negative) to your ED.