PSYC 134: Eating Disorders – Flashcards

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3 Types of AN
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AN-R: primary behavior is not eating; no regular B/P or use of laxatives, diuretics, or enemas AN-BP: binging and purging (if someone is not eating much and then they are purging) (purging can be exercise, laxatives, vomiting, etc) Atypical AN: all the criteria but no low body weight
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Who characterized AN and when
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William Gull 1873
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DSM-V Anorexia Nervosa
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In a >= 3 month time span: -Occasionally binging that lead to low body weight for their age, sex, developmental and physical health -Associated with eating rituals like calorie counting, reading labels, fear of certain types of food -Must have low weight to qualify as AN but they still think they are fat -Slow pulse rate -Skin changes -Amenorrhea -Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) . -Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight). -Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. Eating disorder "rules" Calorie/fat counting, reading labels Significantly reduced variation in types of foods eaten "Good foods" vs "bad foods (fear foods)" leading to similar food choices every day Vegetarian/vegan (avoid red meat and animal fats) Ritualistic, obsessive qualities, often odd food combinations Slow eating, cutting food into small pieces Obsessive interest in food (cooking for others, etc) Specifiers: In partial remission, in full remission, current severity (based on BMI)
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Who characterized BN and when
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Gerald Russell 1979
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DSM-V Bulimia Nervosa
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-Recurrent episodes of binge eating. -An episode of binge eating is characterised by both of the following: A) Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. B) A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating). -Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. -The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months. -Self-evaluation is unduly influenced by body shape and weight. -The disturbance does not occur exclusively during episodes of Anorexia Nervosa. -Eating rapidly, secret eating behaviors (hiding food, eating alone, eating in car, fasting during day) -Excessive or secretive exercise routines -Prioritizing other compensatory behaviors over other activities (i.e. social plans, school or job responsibilities) -Emotional dysregulation Cycle: Tensions and Cravings --> Binge Eating --> Purging to avoid gaining weight --> Shame and disgust --> Strict dieting --> Tensions and Cravings Specifiers: in partial remission, in full remission, severity (based on average episodes per week)
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Dysorexia
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impaired or deranged appetite
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Cynorexia
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overeating followed by spontaneous vomiting
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Polyphagia
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inability to feel satiated resulting in frequent overeating
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Bulimia
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"Violent hunger attacks" quelled by small amounts of food
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Wulff's case studies
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4 cases with oral symptom complex
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Hyperorexia
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picking or nibbling behavior in response to feelings of faintness
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Minnesota Semi-Starvation Study (KEYS) A) What was it? B) How long was the starvation period? C) What was the immediate result? D) What happened to these patients after the study ended? E) What were some conclusions and impacts for the scientific world?
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A) Study that proved caloric intake was the only way to reduce starvation/hunger -Starved 36 men to determine how they could nourish them. B) 24 week program in Nov 1944 and Dec 1945 C) The men became depressed (after losing 25% of their body weight) and became bad workers during starvation period which proved that food gives people energy and fuel to keep working. D) -Food preoccupation -Even after 12 weeks of refeeding, men frequently complained of increased hunger immediately following large meal -Binge eating and compensatory purging D) -Marked psychological distress, loss of control eating developed -Offered insights on the biological and psychological effects of starvation -prolonged semi-starvation produces significant increases in depression, hysteria and hypochondriasis -most of the subjects experienced periods of severe emotional distress and depression -extreme reactions to the psychological effects during the experiment including self-mutilation (one subject amputated three fingers of his hand with an axe, though the subject was unsure if he had done so intentionally or accidentally) -Participants exhibited a preoccupation with food, both during the starvation period and the rehabilitation phase. Sexual interest was drastically reduced, and the volunteers showed signs of social withdrawal and isolation - participants reported a decline in concentration, comprehension and judgment capabilities, although the standardized tests administered showed no actual signs of diminished capacity -marked declines in physiological processes indicative of decreases in each subject's basal metabolic rate (the energy required by the body in a state of rest), reflected in reduced body temperature, respiration and heart rate -Some of the subjects exhibited edema in their extremities, presumably due to decreased levels of plasma proteins given that the body's ability to construct key proteins like albumin is based on available energy sources.
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DSM-V Binge Eating Disorder
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(1991) A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances a sense of lack of control over eating B. The binge-eating episodes are associated with three (or more) of the following: eating much more rapidly than normal eating until feeling uncomfortably full eating large amounts of food when not feeling physically hungry eating alone because of feeling embarrassed by how much one is eating feeling disgusted with oneself, depressed, or very guilty afterwards C. The binge eating occurs, on average, at least once a week of 3 months. D. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior. -correlated with weight status
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BED characteristics vs. non-BED controls
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More frequent parental depression Greater vulnerability to obesity More exposure to negative comments about shape, weight, and eating Greater perfectionism Negative self-evaluation
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BED vs. Obesity
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Greater weight and shape concerns More personality disturbance Greater likelihood of mood/anxiety disorders Lower quality of life
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BED Treatment
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Empirically-based Treatment Modalities: >Cognitive Behavior Therapy (CBT) #1 >Interpersonal Psychotherapy (IPT) Goal: Reduce binge eating episodes and psychopathology Phase I: Behavioral Phase II: Cognitive Phase III: Maintenance and Relapse Prevention
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What does the history of studying ED tell us?
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-Core behavioral features have been described for centuries -Biological impact of those behaviors -Treatment implications
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In 1200 AD, holy anorexia & fasting came to rise: which 2 medieval saints gained the most attention & what happened?
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Saint Catherine: afflicted with symptoms of not eating and extreme exercising at 16 Saint Veronica: started binge eating at 18
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What name did Ernest-Charles Lasègue give AN that didn't gain traction?
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L'Anorexie Histerique
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Why are eating disorders so important?
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-increased over the past several decades -serious health consequences -low recovery rates -highest mortality rates than other psychiatric disorders
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DSM-V Pica
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Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. The eating behavior is not part of a culturally supported or socially normative practice. If the eating behavior occurs within the context of another mental disorder (e.g., intellectual disability, autism spectrum disorder, schizophrenia or medical condition [including pregnancy], it is sufficiently severe to warrant additional clinical attention.
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DSM-V Rumination Disorder
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Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. If the symptoms occur in the context of another mental disorder, they are sufficiently severe to warrant additional clinical attention.
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DSM-V Avoidant-Restrictive Food Intake Disorder (ARFID)
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A. An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one or more of the following: a) Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). b) Significant nutritional deficiency. c) Dependence on enteral feeding or oral nutritional supplements. d) Marked interference with psychosocial functioning. B. Disturbance not better explained by lack of available food or a culturally sanctioned practice. C. Does not occur exclusively during the course of another eating disorder and there is no evidence of a disturbance in body weight or shape. D. Not attributable to another mental disorder or medical condition.
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Orthorexia (NOT official DSM-V)
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Obsession with eating "pure", "perfect", "clean" eating Not officially a diagnosis, debated, overlap with other diagnosis Differs from healthy eating in that people with Orthorexia show significant signs of social, occupation, and/or nutritional problems Neglect other areas of life Inordinate amount of time thinking about food, excessive guilt/compensatory behavior if "imperfect" Differs from Anorexia Nervosa, in that goal and effect may not be "thinness"
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Purging Disorder
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Recurrent purging behavior to influence weight or shape in the absence of binge eating
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Unspecified Feeding or Eating Disorder
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This diagnosis applies to presentations in which symptoms characteristic of one of the aforementioned disorders that cause clinically significant distress or impairment predominate but do not meet the full criteria for any of the diagnostic classes. This diagnosis is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific disorder and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g. emergency room or urgent care settings)
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Psychiatric Comorbidities
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Affective disorders - Depression - Bipolar Anxiety disorders - OCD - Social Anxiety - Generalized Anxiety (GAD) - PTSD Personality disorders - Borderline Personality Disorder (BPD) Substance abuse Suicidality
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Comorbidity Prevalence
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AN-R: 15-50% have MDD (compared with ~17% in general population) AN-BP: 46-80% have MDD BN: 50-65% have MDD 30-60% of ED sufferers are victims of rape or childhood abuse 37% of AN patients had comorbid OCD vs. 3% of BN patients 54% of patients with BPD have some ED (Zanarini et al., 2004) 22% AN 24% BN 28% EDNOS
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Suicide & Eating Disorders
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AN: 20% attempt suicide; up to 4% commit suicide BN: 35% attempt suicide; Actual suicide rates are no higher than non-BN population SECOND MAIN cause of death
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Medical Consequences of Eating Disorders
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Physical symptoms reflect degree of malnutrition • Amenorrhea • Stomach pain/Constipation • Fatigue • Cold intolerance • Light-headedness • Signs of emotional/cognitive blunting CNS (Brain changes) Cardiovascular (heart) Cardiac dysfunction, arrhythmias, prolonged QT interval Bradycardia
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