Stress and Eating_Disorders - 2015.pptx

Stress and Eating Disorders  Dr. Syd Miller Jessica Diener Lily D Jiménez-Dabdoub Unhealthy Eating Cues      Social Cues Situational Cues Negative Thoughts Negative Feelings Social Cues 1.  Often eating is the primary activity in social settings. 2. Wanting to fit into social settin...

Stress and Eating Disorders  Dr. Syd Miller Jessica Diener Lily D Jiménez-Dabdoub Unhealthy Eating Cues      Social Cues Situational Cues Negative Thoughts Negative Feelings Social Cues 1.  Often eating is the primary activity in social settings. 2. Wanting to fit into social settings. 3. Peer pressure SITUATIONAL CUES  1. Seeking comfort during crisis/loneliness 2. Avoiding negative feelings 3. Reward NEGATIVE THOUGHTS AND FEELINGS  The Cycle of Automatic Eating: 1. Unpleasant situation 2. Automatic negative thoughts 3. Negative feelings 4. Eat our emotions Body Mass Index           Adults Women Men anorexia < 17.5 underweight <19.1 <20.7 in normal range 19.1-25.8 20.7-26.4 marginally overweight 25.8-27.3 26.4-27.8 overweight 27.3-32.3 27.8-31.1 very overweight or obese>32.3 >31.1 severely obese 35 - 40 morbidly obese 40 - 50  super obese 50 - 60 Facts   It is estimated that approximately 5 million Americans have a diagnosable eating disorder.     anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified (EDNOS) Among teenagers and adolescent the rate of obesity is 17% (APA) Risk Factors  • • • • • • • Gender Race or ethnicity Childhood eating and gastrointestinal problems Elevated shape and weight concerns Sexual abuse Negative body image and self-evaluation General psychiatric comorbidity (Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004). Anorexia Nervosa(AN)  Symptoms:  Rapid weight loss  Excessive concern with body shape and weight  Preoccupation with food and calories  Decrease in variety of foods eaten  Skipping meals  Ritualized eating and food preparation  Menstrual irregularities  Excessive exercise  Can result: anemia Anorexia Nervosa   Important features  A refusal to maintain a minimal body weight  A pathological fear of gaining weight  A distorted body image  Weight loss is often viewed as an important achievement and weight gain as a significant loss of self-control   Afflicts mainly adolescent women Onset: early- middle teens following either a period of life stress or an intense period of dieting Anorexia Nervosa   Ten times more females than males are afflicted by the disorder  Increasing trend towards early-onset anorexia in girls between 8 and 13 years of age  Lifetime prevalence: 0,5 %    Two types of anorexia:  Restricted type of anorexia nervosa: a type of anorexia nervosa in which self-starvation is not associated with concurrent purging  Binge-eating/purging type AN: a type of eating disorder in which the sufferer regularly engages in purging activities to help control weight again Obsessive and perfectionist traits Low self-esteem Anorexia nervosa and stress   Dysregulation in the HPA- axis  But: difficulty in establishing whether the HPA axis abnormalities are related to starvation and weight loss or to AN itself!  Stress leads to the hypersecretion of CHR (which is known to be a potent anorexic agent)  But: common presence of major affective disorders and other psychological or behavioral symptoms could be responsible for these abnormalities  Most researchers nevertheless found that these abnormalities do not correlate with depressive symptoms or body weight and BMI  Some researchers propose malnutrition as the main determinant responsible for HPA axis alterations  No direct relationship between stress and AN! (Lo Sauro et al., 2008) AN & Stress   Anorectic individuals are able to ignore physiological and psychological hunger cues. (Roberts et al., 2007). Anorexia and Stress  Bulimia Nervosa (BN)  Symptoms:  Fear of loss of control over eating  Excessive concern with body shape and weight  Feelings of shame and secrecy concerning bulimic behaviors  Consuming large amounts of food at one time (bingeing)  Self-induced vomiting  Abuse of laxatives, diuretics of diet pills        Bulimia Nervosa BN  main features: recurrent episodes if binge eating followed by periods of purging or fasting Characterized by fear of weight gain and a distorted perception of body shape Purging sub-type BN  The individual regularly engages in self-induced vomiting or the misuse of laxatives Nonpurging sub-type BN  The individual attempts to compensate for binge eating by indulging in excessive fasting or exercise Onset: in late adolescence or early adulthood  90% are female Life-time Prevalence: among women is approximately 1-3% Ten times more female than men are afflicted Bulimia Nervosa continued   lost control over their eating patterns    usually become ashamed of their binges binges tend to occur in secret, taking foods that are normally quick and easy to consume, such as sweets, ice cream, cakes, bread and toast  Binge episodes are often well planned in advance, and can be triggered by periods of dysphoric or depressed mood, interpersonal stressors or intense hunger following an extended period of dietary restraint  Bulimia displays significantly fewer physical symptoms than anorexia     permanent loss of dental enamel (vomiting) Menstrual irregularity Is significantly more common than anorexia Is often found to be comorbid with other axis I and Axis II disorders  major depression is the most commonly diagnosed comorbid disorder, with between 36% and 63% of bulimia sufferers being diagnosed with depression Bulimia nervosa and stress   Studies have shown that the activation of the HPA-axis is a result of both psychological stress and the physiological stimuli caused by ingestion of large meals   Peak rise in cortisol during bingeing is proportionally comparable to that of healthy women consuming a large meal (Lo Sauro et al.)    Purging behavior does not alter cortisol levels Therefore, hyperactivation of the HPA axis in BN patients seems to be related to psychological stress and the chronic and repeated ingestion of large amounts of foods Normal weight patients in BN were indistinguishable from controls on most measures of HPA activity, suggesting that psychological and behavioral disturbances are insufficient to significantly alter HPA activity ( Walsh et al.)   These factors promote the hyperactivation of the HPA-axis leading to increased cortisol secretion Studies suggest that bingeing and vomiting do not influence hormonal secreation Unlike AN patients, BN patients do not display a clear association between the eating disorder symptomatology and HPA- axis dysfunction Bulimia nervosa and stress continued   Study of Levine et al. demonstrated that stressors did not significantly alter the consumption of women with bulimic symptoms relative to healthy women  Both BN and healthy women increased food intake of carbohydrates following the stressor • Stress has been associated with the onset of BN. Bulimia nervosa and stress continued   Figure 2: Total calories eaten for symptomatic (BUL) and control (CON) subjects by condition (Levine et al.) Binge eating  Symptoms:  Fear of loss of control over eating  Bingeing  recurrent episodes of binge eating without purging or fasting (as associated with BN)  Feelings of disgust  Poor self-esteem  Tend to be overweight  long history of failed attempts to diet and lose weight  feelings of lack of control ----- that causes distress Binge eating continued   Onset: during late adolescence or early adulthood  Prevalence: 1-3%  Associated with high levels of depression  Impaired social functioning  Dissatisfaction with body shape  Majority of sufferers are women, but the incidence of binge-eating disorder in women is only 1,5 times higher than in men! Binge Eating and Stress   Restrained eaters and emotional eaters over eat in response to stress.  Patients are more emotional eaters.  Moderate heritability (0.5, Gluck, 2005).  Binge eating serves as an escape from aversive self-awareness or an attempt to elevate mood.  Over weight Obesity   Classification on the International Classification of Diseases (ICD), but not DSM-IV Stress and Obesity   BED women showed greater cortisol response to stress compared to normal subjects. (Lo Sauro, 2005).  Obese women show alterations in the HPA axis.  Increased cortisol levels + related to central fat distribution.  Increased cortisol level can produce insuline resistance and in turn promote visceral fat accumulation. Coping Mechanisms   Coping: thoughts and behavior and individual uses to manage, tolerate or reduce internal or external demands. Strategies.  Poor coping skills may lead to a rise in stress, which result in a reduction in dietary restraint forming a spiral relationship and ultimately leading to weight gain or loss.  Women are more likely to use food to deal with stress, whether men tend to use alcohol consumption or smocking. (Torres et al., 2007). Coping   ED women: Less optimistic Cognitive avoidance BN blame themselves Less mastery in response to crisis Less effective coping styles Positive relationship between eating pathology and avoidant or emotion-focused coping strategies.       (Troop et al. 1997). References  • http://www.apa.org/about/gr/pi/advocacy/2008/eating-disorders.pdf • • • • O’Connor. Effects of Stress on Eating Behavior Gluck, M. (2005). Stress Response and Binge Eating Disorder. Appetite 46, 26-30). • Roberts, C., Troop, N., Connan, F., Treasure, J. and Campbell, i. (2007). The effects of Stress on Body Weight: Biological and Psychological Predictor of change in BMI. Obesity, 15, 3045-3054. • Troop, N., Holbrey, A. and Treasure J. (997). Stres, Coping and Crisis Support in Eating Disorders. 98, 020157-10. • Levine, M. and Marsha, M.S. and Marcus D. (1997). Eating Behavior Following Stress in Women with and without Bulimic Symptoms. The Society of Behavioral Medicine, 19, (2), 132-138. • LoSauro , C., Ravaldi C., Cabras, P.L. and Faravelli, C. (2008). Stress, Hypothalamic-Pituitary-Adrenal Axis and Eating Disorders. Neuropsychobiology. 57: 95-115. • Torres, S., Nutr, D. And Caryl A. (2007). Relationships between stress, eating behavior and obesity. Nutrition, 887-894. Rojo, L., Conesa, L., Bermudez, O. and Livianos, L. (2006). Psychosomatic Medicine, 68: 628-635.