426 Final Exam

Front 1

Influences on Eating Behaviors:

Back 1

1. Psychological
2. Biological
3. Environmental

Front 2

Resolutions:

Back 2

-1 in every 100 adolescent girls develop anorexia
-5 in every 100 develop Bulimia
-1 in every 6 children in US have problems with obesity

Front 3

Key Concepts in Understanding & Defining Eating Disorders:

Back 3

1. Eating patterns are irregular, idiosyncratic, or ritualistic
2. An eating disorder is functional & may serve as an adjunctive behavior, a coping behavior or way of meeting a psychological need.
3. Eating disorders are both emotionally-based & medically-based problems.
4. Eating disorders are chronic but may occur in episodes
5. Fluctuations occur between excessive consumption & overly restrictive food intake

Front 4

Medical Complications:

Back 4

1. Fluid & Electrolyte –dehydration, weakness
2. Gastrointestinal – altered gastric emptying, constipation
3. Dental – cavities, bone loss, loss of enamel on teeth
4. Cardiovascular – irregular heart beat, weakening of the heart muscle, heart attacks, heart failure
5. Endocrine –amenorrhea, lack of sexual interest, impotence, inability to have children
6. Renal – kidney problems
7. Skeletal- osteoporosis

Front 5

Obesity

Back 5

Is a medical term & not considered a mental disorder

Front 6

3 Recognized Eating Disorders:

Back 6

1. Anorexia Nervosa
2. Bulimia Nervosa
3. Binge-Eating Disorder

Front 7

Feeding & Eating Disorders of Infancy or Early Childhood:

Back 7

1. Pica
2. Rumination Disorder
3. Feeding Disorder

Front 8

Binge Eating Disorder

Back 8

Condition that May be a Focus of Clinical Attention rather than in Eating Disorders Section of DSM IV

Front 9

Pica: DSM IV Criteria

Back 9

-eating of nonnutritive substances for at least 1 month
-not part of a culturally sanctioned practice
-Onset usually 1-2 years old but may have onset in infancy
-Predisposing Factors
(MR, Poor supervision, Neglect)
-If MR, PDD or Schizophrenia, must be severe enough

Front 10

Rumination Disorder: DSM IV Criteria

Back 10

1. Repeated regurgitation & rechewing of food for at least 1 month
2.Behavior does not occur exclusively during the course of Anorexia or Bulimia
3. Age of onset – 3 to 12 months old
4. Same predisposing factors as Pica

Front 11

Feeding Disorder : DSM IV Criteria

Back 11

1. Persistent failure to eat adequately and
2. Significant failure to gain weight or significant weight loss over at least 1 month
3.Not better accounted for by lack of available food or another mental disorder
4. Onset before age 6 although common between ages 2 & 3
5. Predisposing Factors include parent-child interaction problems during feeding, parental pathology, abuse

Front 12

Anorexia Nervosa: DSM IV Criteria

Back 12

1. Refusal to maintain body weight at or above 85%
2. Intense fear
3.Absence of at least 3 periods
4. Subtypes: Restricting Type & Binge-Purging Types

Front 13

Childhood Onset Anorexia Nervosa

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1. physical symptoms
2. Obsessive-Compulsive behavior likely as is depression & poor self image

Front 14

Bulimia Nervosa: DSM IV Criteria

Back 14

1. Recurrent episodes of binge eating
2. Lack of control during the binge
3. 2 hour period eating more than peeps
4. Recurrent inappropriate behavior to prevent weight gain ( vomiting, abusing laxatives, diuretics, etc)
5. Subtypes: Purging Type and Non Purging Type

Front 15

Binge-Eating Disorder: DSM IV Criteria

Back 15

1. Recurrent episodes of binge eating
2. No regular use of inappropriate weight loss methods
3. 2 days per week for 6 months

Binge eating episodes associated with 3 or more of the following
-Eating more rapidly than normal
-Eating until uncomfortably full
-Eating large amounts of food when not feeling hungry
-Eating alone because of being embarrassed about how much one is eating
-Feeling disgusted with oneself, depressed or guilty after overeating

Front 16

Typical onset for all 3 disorders is preadolescence & adolescents

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AN onset at 12, Bulimia at 15 and BED at 19; Bulimia more prevalent than AN

Front 17

Weight-

Back 17

BED are overweight & often obese while
10% of Bulimics are overweight
90% of Bulimics normal or slightly below normal weight

Front 18

Demarcation lines fade over time

Back 18

1. 25-30% of Bulimics have past hx AN
2. 20-30% individuals with BED have past hx of Bulimia, Purging Type
3. AN, Binge-Purge Type likely to move into Bulimia at a later time, Restrictor types unlikely to move

Front 19

Eating Disorder in Males

Back 19

1. Bulimia 1st then Anorexia (opposite in girls)
2. Competitive sports (both b & an)
3. Steroid use/ supplements

Front 20

AN Restricting Type:

Back 20

social insecurity
lack of spontaneity
limited self-direction
excessive dependence
conflict avoidant
rigid, emotional denial
emotional constriction

Front 21

AN Binge-Purge Type:

Back 21

poorer impulse control
greater emotionality
higher likelihood of sexual awareness & possible sexual activity

Front 22

Bulimia Non-Purging Type:

Back 22

Low self esteem
Social competence problems
Excessive need for approval
Impulsivity
Highly variable mood
Depression & low frustration tolerance

Front 23

Bulimia Purging Type:

Back 23

same as non-purge w/: promiscuous sexual acting out, possible shoplifting, & substance abuse

Front 24

Bulimia Nervosa, Binge-Purge Type
Comorbidity:

Back 24

Borderline Personality Disorder

Front 25

Anorexia (both subtypes) Comorbid:

Back 25

Histrionic Personality Disorder

Front 26

Anorexia Restricting Type Comorbid:

Back 26

OCD, Compulsive Personality Disorder

Front 27

Common in all Eating Dx's

Back 27

Adjustment
Mood Dx's

Front 28

Binge Eating Disorder Comorbid:

Back 28

Panic & Social Phobia

Front 29

Bulimia (binge type) Comorbid:

Back 29

Drug & Alcohol Abuse

Front 30

Anorexia (both subtypes) Comorbid:

Back 30

Histrionic Personality Disorder

Front 31

Anorexia Restricting Type Comorbid:

Back 31

OCD, Compulsive Personality Disorder

Front 32

Common in all Eating Dx's

Back 32

Adjustment
Mood Dx's

Front 33

Binge Eating Disorder Comorbid:

Back 33

Panic & Social Phobia

Front 34

Bulimia (binge type) Comorbid:

Back 34

Drug & Alcohol Abuse

Front 35

Etiology of Eating Disorders:

Back 35

1. No one proven theory
2. The most vulnerable time is during the separation-individuation stage of development (adolescence).

Front 36

Crisp

Back 36

Proposed that the symptoms of AN were manifestations of fears of maturation

Front 37

Minuchin’s Psychosomatic Family Model

Back 37

Highlights the pathology of the family as the key variable.
-Enmeshment resulting in poor differentiation of self
-Rigidity resulting in lack of adaption to changing external demands
-Overprotectiveness leading to lack of autonomy
-Lack of conflict resolution skills & the family myth of unity
-Involvement of the child in parental conflicts via triangulation, parent-child coalitions or detouring

Front 38

Selvini-Palazzoli”s Model

Back 38

Belief systems in the families of AN are transmitted across generations have a constraining impact on communication patterns.
-Belief in the need to sacrifice for others
-Belief that one must not ask for anything for onesself

Front 39

Schwartz & Cohn’s Model

Back 39

Abuse-mediated.

Front 40

Stierlin & Weber’s Psychodynamic Theory

Back 40

5 transgenerational interaction patterns trigger the onset of AN
-Loose boundaries set the stage for enmeshed interactions
-Emotional bonding is the most important mode of interaction so the child with AN sublimates energies into the care of the family
-Strivings for autonomy from the family is discouraged
(Separation-individuation threatens the family/Child with AN feels betrayed by parents & family/ Child with AN seeks revenge against the family by becoming ill and also attempts to unify the family through the illness)


-Child with AN becomes the delegate of the family families and is duty bound to realize those values even when they are excessive
-Loyalty bond & self sacrificing interactions overlap generations as does a hidden rivalry between siblings

Front 41

Schwartz, Barrett & Saba’s Functional Model of Bulimia

Back 41

Applies Structural Family Theory
-A way to avoid facing distressing feelings by being obsessed the the eating disorder
-An excuse for feelings not tolerated by the family
-A passive way of rebelling
-A way to protect the parents’ marriage by distraction
-A way to provide an upper threshold for overt conflicts
-A way to get nurturing or elicit extended family unity

Front 42

Assessment Strategies

Back 42

-Medical work up (multidisc)
-Parenting and Eating Disorders Standardized Interview
-Diagnostic Survey For Eating Disorders (DSED) is inclusive on all symptoms & maladaptive patterns
-Eating Disorder Inventory (EDI) has norms and can be used as a screen or as feedback to treatment resistant adolescents