Stress and Eating Disorders.pdf

Tuesday, March 19, 2024 Stress and Eating Disorders Unhealthy Eating Cues SOCIAL CUES - Often eating is the primary activity in social settings. - Wanting to fit into social settings. - Peer pressure SITUATIONAL CUES - Seeking comfort during crisis/loneliness - Avoiding negative feelings - Reward NE...

Tuesday, March 19, 2024 Stress and Eating Disorders Unhealthy Eating Cues SOCIAL CUES - Often eating is the primary activity in social settings. - Wanting to fit into social settings. - Peer pressure SITUATIONAL CUES - Seeking comfort during crisis/loneliness - Avoiding negative feelings - Reward NEGATIVE THOUGHTS The Cycle of Automatic Eating: - Unpleasant situation - Automatic negative thoughts - Negative feelings - Eat our emotions Although the DSM has eating disorders, obesity is not considered as a mental disorder/eating disorder - 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% RISK FACTORS - Gender (F>M) Race or ethnicity (more seen in white people) Childhood eating and gastrointestinal problems Elevated shape and weight concerns Sexual abuse Distorts body image Negative body image and self-evaluation General psychiatric comorbidity Eating disorders are stress-related/stress-induced disorders 1 Tuesday, March 19, 2024 Anorexia Nervosa (AN) AN: ED tends to develop in mid-teens, most likely due to social media pressures; associated with major stressors/trauma in teen years; associated with a lack of control in life = control over diet - As weight drops = positive attention = reinforcing - As weight drops even more = brain changes = develop a disordered body image (body dysmorphia) 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/loss of menses Excessive exercise Can result: anemia 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 signi cant 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 - Ten times more females than males are afflicted by the disorder Men is more about muscles Women is more about losing weight - Increasing trend towards early-onset anorexia in girls between 8 and 13 years of age - Lifetime prevalence: 0.5 % Two types of anorexia: 1. Restricted type of anorexia nervosa: a type of anorexia nervosa in which self-starvation is not associated with concurrent purging 2. 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 fi 2 Tuesday, March 19, 2024 - 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 Can also be caused by depression/anxiety (co-morbid with ED) - 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 behavioural 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! ANOREXIA AND STRESS - Anorectic individuals are able to ignore physiological and psychological hunger cues 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 behaviours Consuming large amounts of food at one time (bingeing) Self-induced vomiting (purge) Abuse of laxatives, diuretics of diet pills IMPORTANT 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 Two types of bulimia: 1. Purging sub-type BN: The individual regularly engages in self-induced vomiting or the misuse of laxatives 2. Nonpurging sub-type BN: The individual attempts to compensate for binge eating by indulging in excessive fasting or exercise 3 Tuesday, March 19, 2024 - Onset: in late adolescence or early adulthood à 90% are female Difficult for younger children to binge - Life-time Prevalence: among women is approximately 1-3% - Ten times more female than men are afflicted Perfectionistic type of people - lost control over their eating patterns usually become ashamed of their binges binges tend to occur in secret (shame) Binge on junk food - 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 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 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 - HPA axis dysregulation by stress and/or by bingeing which alters cortisol Stress > HPA axis hyperactivation > Bingeing (not true) - anyone who eats large meals = HPA axis hyper activation - Stress actually causes both HPA axis hyperactivation & bingeing Studies suggest that bingeing and vomiting do not influence hormonal secretion - Unlike AN patients, BN patients do not display a clear association between the eating disorder symptomatology and HPA- axis dysfunction Study — Bulimia nervosa and stress Both BN and healthy women increased food intake of carbohydrates following the stressor Stress has been associated with the onset of BN BN patients eat less in general, but will increase food consumption under stress 4 Tuesday, March 19, 2024 Binge Eating Disorder SYMPTOMS: - Fear of loss of control over eating Bingeing: recurrent episodes of binge eating without purging or fasting 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 ≠ obesity - obese people do not binge or have frenzied eating FACTS - 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) - Binge eating serves as an escape from aversive self-awareness or an attempt to elevate mood Obesity If increase in weight is above the waist (apple) = increased risk for diabetes Study — Stress and Obesity BED women showed greater cortisol response to stress compared to normal subjects Obese women show alterations in the HPA axis ✓ Probably the effect rather than the cause Increased cortisol levels + related to central fat distribution Increased cortisol level can produce insulin resistance and in turn promote visceral fat accumulation (risk for diabetes) 5 Tuesday, March 19, 2024 COPING MECHANISMS - Coping: thoughts and behaviour (strategies) an individual uses to manage, tolerate or reduce - internal or external demands 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 men tend to use alcohol consumption or smoking - Changing: more women alcoholics (but different than men, i.e. in secret) Coping - ED women (incl obesity): Less optimistic Cognitive avoidance (avoidance coping) BN blame themselves (more pressure) Less mastery in response to crisis Less effective coping styles Positive relationship between eating pathology and avoidant coping strategies 6