Eating Disorders
Eating Disorders
Overview
Introduction
DSM Diagnoses and symptoms
Myths about eating disorders:
“Reading” 11: Watch the short clips of leading ED researcher Cynthia Bulik https://www.nimh.nih.gov/news/science-news/2014/9-eating-disorders-myths-busted.shtml
Causes:
Biopsychosocial explanation
Supplemental reading: Kaye et al., 2013
Introduction
Eating disorders:
Group of disorders
Diagnoses in the Diagnostic and Statistical Manual (DSM-5, 2013) https://www.psychiatry.org/psychiatrists/practice/dsm
Background information: supplemental info
https://www.nami.org/learn-more/mental-health-conditions/eating-disorders
Introduction
Eating disorder prevention:
Primary prevention vs. secondary prevention
Traci Mann’s research: (bonus reading)
Early eating disorder prevention programs were not systematically evaluated for efficacy (before this research).
Argues that preventing eating disorders and providing support for those with symptoms require qualitatively different strategies, yet most programs combine primary and secondary prevention.
Informational interventions are not effective
Better to separate primary and secondary prevention interventions
Frequently, episodes of eating disorders are precluded by dieting.
How does this relate to other types of health education and prevention?
Diagnoses in the DSM-5
Feeding and Eating disorders in DSM-5 (2013) and their organization in the previous edition
Pica
DSM IV: Disorders first diagnosed in infancy, childhood, or adolescence
Rumination disorder
DSM IV: Disorders first diagnosed in infancy, childhood, or adolescence
Avoidant/restrictive food intake disorder
Feeding disorder of infancy or early childhood
DSM IV: Disorders first diagnosed in infancy, childhood, or adolescence
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
DSM IV: Appendix
Eating Disorders
In recent years, eating disorder research has indicated that these disorders are much more complicated than originally thought.
Also consider subclinical eating disorder symptomatology:
When researchers followed a group of 496 adolescent females for 8 years to age 20, they found:
5.2% met criteria for DSM-5 anorexia, bulimia, or binge-eating disorder
When they included nonspecific eating disorder symptoms, a total of 13.2% suffered from eating disorder by age 20
Prevalence statistics https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
Eating Disorders
Three commonly described eating disorders are:
Anorexia nervosa:
restriction of caloric intake, underweight
obsession with feeding and/or weight.
Bulimia nervosa: characterized by episodes of overeating, followed by compensatory behavior, such as purging, laxative use, or even intense exercise.
Binge-eating disorder: episodes of significant overeating, followed by distress, disgust, or guilt, but without purging or fasting behavior.
Anorexia nervosa
Greek “anorexia” = loss of appetite
Prevalence: 0.3 – 2 % of population
Approximately 25% of diagnosed cases in males
Anorexia nervosa is an eating disorder in which a person severely restricts eating and shows a preoccupation with weight or food intake
Transition from 1950s perception of disorder in high-achieving women to one that crosses gender, ethnic, geographic and socioeconomic borders
Key symptoms
Persistent energy intake restriction
Intense fear of gaining weight or becoming fat
Disturbed body perception, undue influence of weight or shape on self-evaluation
Anorexia nervosa: DSM criteria
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. (weight less than minimally normal or minimally expected)
Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Types:
Restricting type: weight loss accomplished primarily through dieting, fasting, and/or excessive exercise
Binge-eating/purging type: recurrent episodes of binge eating or purging behavior (self-induced vomiting, misuse of laxatives, diuretics, or enemas)
Severity: by BMI
Mild: ≥ 17, Moderate: 16-16.99, Severe: 15-15.99, Extreme: < 15
Anorexia nervosa
Fear of obesity, losing control of their shape
Distorted thinking
Low opinion of shape
Overestimate proportions (Farrell, Lee, Shafran, 2005)
Psychological disorders
Depression (71%)
Anxiety (up to 80%)
OCD-like patterns
Anorexia nervosa
In some instances, anorexia is caused by health conditions, rather than psychological disorder.
Infections or diseases
Alzheimer’s disease
AIDS
Drug abuse – amphetamines or other stimulants
Cancer
Loss of weight in 50% of cancer patients called wasting
Result from taste sensitivities, treatment, or cancer itself
Taste aversions
Cachexia (Source: http://www.cancer.gov/ncicancerbulletin/110111/page5)
Bulimia nervosa
1 – 3% of the population
90% of cases in females
Bulimia nervosa is an eating disorder in which period of over-eating are followed by compensatory behavior such as purging, use of laxatives, or intense exercise
Different patterns of eating: over-eaters, under-eaters, normal amount of food consumption
Difficult to detect – commonly of normal weight
Key symptoms:
Recurrent episodes of binge eating.
Recurrent inappropriate compensatory behavior in order to prevent weight gain.
Undue influence of weight or shape on self-evaluation
Bulimia nervosa: DSM criteria
Recurrent episodes of binge eating, characterized by:
Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period under similar circumstances.
A sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or enemas; fasting; or excessive exercise.
The binge eating and compensatory behaviors both occur, on average, at least once a week for three months
Self-evaluation is unduly influenced by body weight and shape.
The disturbance does not occur exclusively during episodes of anorexia nervosa.
Severity: episodes of inappropriate compensatory behavior per week
Mild: 1-3, Moderate: 4-7, Severe: 8-13, Extreme: 14 or more
Bulimia nervosa
Binges:
1-30 per week
Preceded by feelings of tension
Difficult to control
Elicits feelings of self-blame, shame, guilt, depression, fear
Associated Psychological Disorders
Anxiety in 80% of individuals with bulimia
Mood disorders (depression) co-occur in 20% of patients (typically follows onset of bulimia)
Substance abuse is common
Binge Eating Disorder
DSM-5 criteria:
Recurrent episodes of binge eating
Binge eating episodes are associated with 3 or more of the following:
Unusually rapid eating
Eating large amounts without physical hunger
Eating until uncomfortably full
Eating alone because of embarrassment
Feelings of self-disgust, depression, or severe guilt after episodes
More common than anorexia and bulimia combined: estimates up to 3.5% of population
Health Consequences
Anorexia:
Long term damage to bones, osteoporosis
Amenorrhea: decreased fertility
Cardiovascular effects
10-20% fatal (heart or other organ failure)
Bulimia: depends on compensatory behaviors
Vomiting erodes tooth enamel, depletes body of vital salts, harms esophagus, and disrupts muscle, heart, and kidney function
Laxatives destroy bowel muscle and drain salts and fluid from the body
Bingeing/Purging cycle related to irregular menstruation, disrupted bowel habits, and cardiovascular risks
Binge-eating disorder
Health complications of overconsumption and obesity
Type 2 diabetes
“Reading” 11: Nine myths
Reading 11: Nine myths
Watch all (they are only a few minutes each)
You tube link: https://www.youtube.com/playlist?list=PLV9WJDAawyhYqoNdLE-a3ydsVk-2dQfop
Cynthia Bulik – researcher: biographical information https://www.med.unc.edu/psych/directory/cynthia-bulik/
Etiology of Eating Disorders
Etiology: What causes eating disorders?
Biopsychosocial explanation
Biological: brain, neurotransmitters
Psychological: developmental influences, personality and temperament, stress and anxiety
Social: norms, media, culture
Etiology of Eating Disorders
The next four slides are from the Kaye et al., 2013 bonus reading.
Introduction: notable and paradoxical aspects of eating disorders
Narrow range of prevalence (age and gender)
Symptoms: lack of insight to being ill and body image distortions
Ongoing debate on whether the primary symptom related to appetite or other process (e.g. obsessions about body image)
Biology:
Genetic contributions:
Heredity explains 50-80% of the risk
Thus – what aspects of the disorder are potentially hereditable?
Etiology of Eating Disorders
Temperament and Personality in AN
Comorbid anxiety disorders are common and predictive of more severe eating disorder
Kaye’s research describes an overcontrol in eating, affect, and impulse:
Anhedonia and asceticism
Perfectionism, rigidity, and constrained affect
Harm avoidance: temperament trait to encompass these
Interoception and alexithymia
Brain processes to perceive hunger, taste, and pain may be altered (anterior insula)
Alexithymia: difficulty identifying emotions, satiety / disgust
Etiology of Eating Disorders
Biology:
Dopamine and serotonin dysfunction: mood and anxiety plus other symptoms
Other neuropeptides vary in the illness phase, but are likely a consequence rather than cause of the disorder
Diagram on next slide to be discussed in class
Altered interoceptive processing of taste and reward (demonstrated by decreased function of reward area of the brain and the insula)
Difficulty differentiating between positive and negative feedback (executive function and…
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