Eating Disorders.pdf

Study Guide Sunday, July 7, 2024 2:50 PM CHAPTER 10 – Perspectives in Psychopathology by David Dozois, 7th ed. 1. Introduction Compare and contrast binge eating disorder from bulimia nervosa - In bulimia nervosa, individuals experience binge eating episodes where they consume a amoun...

Study Guide Sunday, July 7, 2024 2:50 PM CHAPTER 10 – Perspectives in Psychopathology by David Dozois, 7th ed. 1. Introduction Compare and contrast binge eating disorder from bulimia nervosa - In bulimia nervosa, individuals experience binge eating episodes where they consume a amount of food and feel out of control while they eat, often following a period of food restriction and compensation by engaging in self-induced vomiting, laxative use, fasting, o exercise after the binge. - Binge-eating disorder is also characterized by recurrent episodes of binge eating and is associated with a variety of eating behaviours and feeling guilt/disgust about the binge ea but no compensative behaviours unlike bulimia nervosa. Compare and contrast anorexia nervosa and avoidant/restrictive food intake disorder (ARFID) - Anorexia nervosa is characterized by food restriction that leads to a significantly low wei relative to a person's age, height, and sex, as well as a fear of gaining weight. - In ARFID, individuals do not have a distorted perception of their body weight/shape and f avoidance is more focused on disinterest in eating, aversive sensory concerns about food texture), or concerns about negative consequences of eating (e.g., choking or becoming i In DSM-5 TR, eating disorders are classified together with which other disorders? - With feeding disorders 2. Typical Characteristics Describe typical characteristics of anorexia nervosa, bulimia nervosa, and binge- eating disorder - Anorexia nervosa: Intense fear of gaining weight/becoming fat, restricted amount of foo beginning with a reduction in number of calories consumed and avoidance of high calorie foods, list of forbidden foods, belief that eating forbidden foods will result in significant w gain even immediately after eating, development of maladaptive or ritualistic eating , som exhibit binge eating and compensatory behaviours, excessive exercise to achieve weight general restlessness, purging behaviours - Bulimia nervosa: Episodes of objective binge-eating followed by compensatory behaviou designed to prevent weight gain, low self-esteem, social isolation & depression, not underweight (unlike anorexia nervosa), - Binge-eating disorder: regular objective binge-eating episodes, no following compensato behaviours, significant distress about binge eating, eating rapidly, eating large amounts e when not hungry, eating alone, feeling guilty/disgusted after binge-eating episodes  large or ating ight food d (e.g., ill) od e weight me loss, urs ory even  - Bulimia nervosa: Episodes of objective binge-eating followed by compensatory behaviou designed to prevent weight gain, low self-esteem, social isolation & depression, not underweight (unlike anorexia nervosa), - Binge-eating disorder: regular objective binge-eating episodes, no following compensato behaviours, significant distress about binge eating, eating rapidly, eating large amounts e when not hungry, eating alone, feeling guilty/disgusted after binge-eating episodes 3. Incidence and Prevalence Describe the prevalence progression in the twentieth century - The prevalence of eating disorders has increased over the first two decades of the twenty century; increased from 4% between 2000-2006 to 5% between 2007-2012 to 8% betwee 2013 -2018. Why does a large proportion of individuals who meet diagnostic criteria for an eating disorder not receive appropriate mental health care? - Lack of research (?) 4. Prognosis What is the most common cause of death among those with eating disorders? - Natural causes (circulatory collapse, cachexia, multiple organ failure) and non-natural cau (suicide and accidents) Describe the treatment response among individuals with eating disorders - On average, ~22-42% are able to entirely stop these behaviours with current evidence-ba individual therapy; many show substantial partial improvements while others show less c - 31% with anorexia nervosa relapsed after treatment within the first year, half with bulim nervosa relapsed within the first year following intensive day treatment 5. Diagnosis Anorexia Nervosa o What is the central feature of anorexia nervosa and how does the DMS-5 define this? - Severe food restriction leading to a very low body weight - Defined as the restriction of energy intake leading to a body weight that is less than minim normal/expected; assessed by calculating BMI o DSM-5 diagnosis criteria - Restriction of energy intake relative to requirements leading to low body weight in terms age, sex, developmental trajectory, and physical health - Intense fear of gaining weight or becoming fat OR persistent behaviour that interferes wi weight gain even though at a significantly low weight - Disturbance in the way in which one's body weight or shape is experienced, undue influe body weight or shape on self-evaluation, persistent lack of recognition of the seriousness low body weight o Define the two subtypes of anorexia - Restricting type: individuals attain extremely low body weights through substantial food restriction and excessive exercise sometimes  urs ory even y-first en uses ased change mia mally s of ith ence of s of  body weight or shape on self-evaluation, persistent lack of recognition of the seriousness low body weight o Define the two subtypes of anorexia - Restricting type: individuals attain extremely low body weights through substantial food restriction and excessive exercise sometimes - Binge-eating/purging type: individuals engage in food restriction, possibly excessive exerc regular binge-eating and/or purging behaviours o Distinguish these two subtypes - BEP types engage in binge eating/purging while restricting types do not, BEP types have g difficulties in the ability to regulate and manage negative emotions and impulsive behavio Bulimia Nervosa o Define/describe bulimia nervosa - An eating disorder characterized by recurrent episodes of objective binge eating and inappropriate use of compensatory behaviour o DSM-5 diagnostic criteria - Recurrent episodes of binge eating ○ Binge eating = eating an amount of food that is significantly larger than what most people would eat in a similar period of time - Recurrent inappropriate compensatory behaviours to prevent weight gain (self-induced vomiting, misuse of laxatives, diuretics, fasting, excessive exercise) - Both behaviours occur on average at least once a week for 3 months - Self-evaluation is unduly influenced by body shape & weight - The disturbance does not occur exclusively during episodes of anorexia nervosa o Describe compensatory behaviours - These include any behaviours meant to “get rid of” or “make up for” the binge, including induced vomiting; use of laxatives, diuretics, or other medications; strict dieting or fasting vigorous exercise to prevent weight gain Binge Eating Disorder o Define/describe binge-eating disorder - Recurrent episodes of binge eating, but these individuals do not engage in inappropriate compensatory behaviours o DSM-5 diagnostic criteria - Very rapid eating, eating until uncomfortably full, large amounts even when not hungry, a because of the embarrassment about the amount of food eaten, feeling disgusted/depressed/guilty after binges. Binge-eating episodes must occur on average at once per week for three months Other specified/unspecified feeding or eating disorder - OSFED - For other individuals with OSFED, the eating disorder symptoms combine in a different w than in one of the three specified eating disorder categories, but are nevertheless clinical significant o What is the purpose of this diagnostic category? What other disorders does it encompass? s of cise, greater ours self- g; or alone t least way lly  - OSFED - For other individuals with OSFED, the eating disorder symptoms combine in a different w than in one of the three specified eating disorder categories, but are nevertheless clinical significant o What is the purpose of this diagnostic category? What other disorders does it encompass? - Encompasses eating disorders of clinical severity that do not meet the specific criteria for anorexia, bulimia, or BED. - Encompasses OSFED-bulimia nervosa and -BED (of low frequencies), OSFED-atypical anor purging disorder, and -night-eating syndrome o DSM-5 diagnostic criteria 6. Assessment How are assessments usually conducted? - Using a structured or semi-structured interview What does conducting a diagnostic interview for an eating disorder involve? - Gathering sufficient information from the individual being assessed about: ○ Current and past frequency and severity of dietary restriction, binge eating, purging exercise ○ Distorted attitudes and beliefs about weight, shape, and eating ○ Weight history and current & post menstrual function ○ Interpersonal functioning and potential factors that may have contributed to the development/maintenance of the ED What are the goals of conducting diagnostic interviews for an eating disorder? - To assess for the presence and absence of other psychological disorders Why is it important to conduct a medical examination in the assessment of eating disorders? - To determine the presence of any physical and/or medical complications associated with eating disorders, it is important to assess for the medical consequences of eating disorde because they should be addressed and monitored as part of treatment What other assessment tool is used to complement the information gathered through the clinical interview? - Self-report questionnaires 7. Etiology What evidence supports a genetic component of eating disorders? - Research across twin and adoption studies What other possible contributor to the development of an eating disorder has been investigated? - Dysfunctional neurotransmitter activity. In particular, the potential relationship between serotonin and the pathophysiology of eating disorders Identify and briefly describe the socio-cultural, family, and personality/individual factors that may lead to an eating disorder - Socio-cultural: internalization of body ideals - Family: children of mothers with ED history, with low education and in families with high way lly r rexia, - g, and h ers n h  - Dysfunctional neurotransmitter activity. In particular, the potential relationship between serotonin and the pathophysiology of eating disorders Identify and briefly describe the socio-cultural, family, and personality/individual factors that may lead to an eating disorder - Socio-cultural: internalization of body ideals - Family: children of mothers with ED history, with low education and in families with high exposure to stress are at increased risk - Personality: lower extraversion and higher perfectionism, neuroticism, negative urgency, avoidance motivation, sensitivity to social rewards, and self-directedness ○ high levels of constraint, perseveration, and rigidity, and low levels of novelty seeki (anorexia nervosa) ○ high impulsivity and novelty and sensation seeking, and characteristics overlapping borderline personality disorder (bulimia nervosa) Note that the etiology of eating disorders is multifactorial and that there is no one factor that can produce an eating disorder. - Risk factors: variables that occur prior to the onset of the disorder, and prospectively pre the disorder's onset - Maintenance factor: a variable that leads the symptoms to persist after their onset 8. Treatment What biological treatments have been used to treat bulimia nervosa? - Only fluoxetine or Prozac is approved around the world (only modestly effective) Compare the efficacy of antidepressants vs CBT - Antidepressants: good efficacy for BE, bulimia nervosa, not successful for anorexia nervo - CBT: the leading evidence-based treatment for EDs What are the effects of treating anorexia nervosa with pharmacological agents? - May be used as an adjunctive intervention to facilitate weight gain, but it does not appea have an effect on eating disorder psychopathology or behaviours What treatment is considered the leading evidence-based treatment for bulimia and is the treatment of choice among clinicians? - CBT What does CBT for bulimia nervosa typically involve? Describe the cognitive-behavioural model of the maintenance of bulimia. Describe a cognitive-behavioural theory of the maintenance of anorexia. What other treatment has been effective in reducing symptoms of bulimia? - Interpersonal therapy (IPT) What is the focus of IPT? - Maladaptive personal relationships and ways of relating to others because difficulties in t areas are thought to contribute to the development and maintenance of eating disorders What is the number one priority in treating anorexia nervosa? - To restore body weight to a minimal healthy level What are important components of treatment programs for eating disorders? - nutritional counselling and meal support In general, what is the focus of family therapy? n h , ing g with edict osa ar to these s  What is the number one priority in treating anorexia nervosa? - To restore body weight to a minimal healthy level What are important components of treatment programs for eating disorders? - nutritional counselling and meal support In general, what is the focus of family therapy? - Also called the Maudsley approach; focuses on stresses within the family as a whole rath than on individuals, and places responsibility for recovery on both the client and their rel How are self-help manuals used in the treatment of eating disorders? - As a brief & affordable alt to traditional approaches, provision of an accessible form of in individuals who might not otherwise have access to expert help, with guidance by anon- specialist professional (nurse, doctor, MHP), to empower individuals with Eds to begin ma changes 9. Prevention Describe the purpose of preventive intervention programs - To decrease the presence of risk factors for the development of eating disorders and ultim prevent disordered eating behaviours Case Studies Case 9: Bulimia Nervosa - Case Studies in Abnormal Psychology by Gorenstein and Comer, 3rd ed. 1. What strategies do people with bulimia nervosa use to prevent weight gain? - Compensatory behaviours 2. Which behaviours are often seen in the beginning stages of bulimia nervosa? - Body dissatisfaction, depression, and self-reported dieting 3. What does CBT treatment for bulimia nervosa involve? - Changing bingeing and compensatory behaviours, and changing distorted thinking patter 4. During her first 2 or 3 months of binge eating, how would Lilly attempt to avoid weight gain? How did this behaviour progress as Lilly’s binges became more extreme? - Fasting for a day or two, the behaviour progressed to purging 5. Describe the two components of Lilly’s treatment program. - Changing Lilly’s bingeing and compensatory behaviors - Changing her distorted thinking patterns — her assumptions, interpretations, and beliefs example — about weight, body shape, and other concerns that might cause distress and to bingeing 6. Describe the experiment Dr. Weinfurt conducted to demonstrate to Lilly that feeling fat after eating and being fat or gaining weight in reality are two different things. - Relabel the feeling that she got fatter a regular meal as feeling full, which has nothing to with a true weight gain. her latives nfo for aking mately rns s, for lead do