Biopsychosocial Aspects Of Eating Disorder And Obesity Midterm

Front 1

What is an Eating Disorder?

Back 1

1-A persistent disturbance in eating behavior or behavior intended for weight control
2-not secondary to any medical or psychiatric disorder.

Front 2

Rank the 3 primary disorders from largest to smallest prevalence

Back 2

Largest-->Binge eating DisorderB
Bulimia nervosa
Anorexia Nervosa

Front 3

What is the main criteria for an Anorexia Diagnosis?

List the 2 subtypes

Back 3

1-A refusal to maintain normal body weight
2-Intense fear of gaining weight
3-Disturbance in the way shape/weight is experienced-high influence of body weight over self eval; denial or low weight
4-Amenorrhea (no period for 2-3 monthes)

Restricting type and Binge-eating (subjective)/Purging type

Front 4

What Psychological symptoms are associated with anorexia? What happens when weight is normalized?
How could u spot an anorexic person?

Back 4

1-Affective disturbace (anxiety, depression)
2- Substance abuse
3-Personality Features-perfectionist
4-Social isolation

result of the disorder, normalizes when disordered eating behavior adn weight is normalized.

Front 5

What physical symptoms are associated with Anorexia?

how could u spot an anorexic person

Back 5

1-Cardiovascular-heart problems-->death
2-Gastrointestinal
3-Endocrinological-->menstral, fertility
4-Dermatological-->Skin problems, rashes
5-Skeletal, bone density problems

Front 6

What cultures are more likely to have higher prevalence rates of anorexia?

What is the prevalence rate of anorexia?

Back 6

Industrialized societies-->
cultures where there is abundant food and thinness is valued.

.5-1% in females; males is 1 tenth of that

Front 7

Describe the typical course of Anorexia? (when does it normally begin and y).
Based on this, when is intervention best?

Back 7

Begins during adolescence(14-18 years) when puberty starts and weight gain commences. What happens after is highly variable

as early as possible, during the first 3 years of AN, after that it gets tough, especially by 5 years

Front 8

List the differential diagnosis' for Anorexia/what shouldnt a person have for a diagnosis of anorexia?

What r they more likely to have?

Back 8

1-General medical conditions
2-Major depressive disorder
3-Schizophrenia

Social phobia
OCD
Body dysmophic disorder (although not all)

Front 9

Define Binge Eating. Try to imagine what this would look like.

Back 9

eating in a discrete period of time (within 2 hrs) an objectively large amount of food, more than most would eat in similar time period and circumstance.

Sense of lack of control over eating during episode

w/in 30 mins-->whole cheesecake, pint fro yo, 20 oatmeal cookies

Loss of control + objectively large amount of food

Front 10

List key factors in Bulimia Nervosa Diagnosis

What are the types?

Back 10

1-Reoccurent episodes of binge eating
2-recurrent inappropriate compensation behavior to prevent weight gain (laxative abuse, vomiting)
3-binge eating and compensory occur at least 2wice a week for 3 monthes
4-undue influence of wight and body shape on self eval

Purging and nonpurging (excessive intake + normal body weight.

Front 11

What psychological symptoms are associated with bulimia?

Back 11

1-Depressive symptoms
2-mood disorders
3-anxiety disorders
4-substance abuse
5-personality features

Front 12

What physical symptoms are associated with bulimia?

Back 12

Cardiovascular
Gastrointestinal
Endocrinological
Dental

Front 13

Whats the prevelance of bulimia?

Back 13

90% are women, more men in sports where weight significant and gay men

1-2%, males one-tenth

Front 14

What is the typical course of bulimia?

Back 14

Begins in late adolescence or early adult life, binging usually occurs after episode of dieting and persists for several years

Front 15

What other disorders should be looked at for differential diagnosis?

Back 15

1-AN, binge-eating/purging type
2-certain neurological and general medical conditions
3-Major depressive disorder,
4-Borderline personality disorder

Front 16

Give examples of eating disorder not otherwise specified

Back 16

1-All criteria for AN but reg menstration
2-AN criteria but normal weight
3-use of inapprotpr compens beh after small amnt of food
4-repeatedly chewing and spitting out but notj swallowing large amounts
binge eating disorder

Front 17

List key criteria for binge eating disorder

Back 17

1-recurrent episodes of binge eating
2-bed episodes assoicated with atlesat 3 behavioral indicators of loss of control
3-marked distress after binging
4-occurs 2 days a week for at least 6 months
doesnt occur only during course of an or bn

Front 18

Whats the difference btw bn and bed?

Back 18

both involve binge eating behaviors But bed is for 2xweek for 6 monthes and bn is 3monthes
bn-->overconcern for shape or weight, but BED is just marked distress
Bed has 3 indicators of loss of control

Front 19

Whats the psychological symptoms assocaited with BED

Physical

Back 19

See AN and BN

Overweight
Type II diabetes

Front 20

Whats the onset and prevelance of BED?

Back 20

Onset-->20, presentation is 30-40 years

affects more females than males
2-3% females, 15-33% weight loss clinic attendees

starts in adolescence

Front 21

List the differential diagnosis for BED

Back 21

1-general med condition
2-BN non purging
3-Major depressive disorder

Front 22

What is a genetic disease? Gx

Chromosome disease? Gx

Gx of a non genetic disease

Back 22

diseases that are strongly inherited from parents or taht are casued by genes-->cystic fibrosis

diseases caused by major error in DNA-->down syndrome

virus or bacterial infection-->aids

Front 23

What is a polygenic disease? Gx

Back 23

disorders where multiple geners are invovled where it does not have a high level of genetic causes but theres a slight familial inheritance

eating disorders and particularly obesity

Front 24

What is an obesigenic environment and how does it predict obesity?

how can behaviors be genetic?

Back 24

environmental context where there's a food culture, eating promoted (midwest/south) vs. Restrictive environment (west, california)-->overeating isnt promoted

in people with high BMI, environmental context impacted whetehr or not they actually became obese.

instead of metabolic, the eating beh may be genetic-->binge eating may have a genetic component

Front 25

What regulates the appetite?

Back 25

Physiological events (satiety)
neurochemical events
human beh (psycholoical and environmental)

Front 26

What is the possible pathophysiology of eating disorders?

Back 26

Dysregulation of neurochemical pathways that modulate feeding and impulse control. Contributing to AN

Front 27

Describe personality factors that may lead to an or bn, which one more? hOW DO YOU KNOW?

Back 27

Perfectionism
Trait anxiety
both higher in AN but still significant with BN, rates still high even after recovery

Front 28

What is Serotonin (5-ht) responsible for?

What is its role in AN?

Back 28

1-mood regulation
2-Pain sensitivity
3-Blood pressure
4-Sleep patterns
5-Satiety-->appetite, meal size, food preferences

Brain imaging studies show dysregulated serotonin receptor activity, still complex and poorly understood reaction

Leads to anxiety, obsessionality and perfectionism

Front 29

Breifly explain the biopsychological model of AN
Gx

Back 29

Biological alterations lead to behavior traits that cause An vulnerability
Tryptophan theory

Front 30

What is tryptophan needed for?

Why does this help to explain why not eating feels better to AN's

Back 30

Needed for serotonin

Lowered tryptophan in ANs briefly reduces the anxiety caused by altererd serotonin levels.

Front 31

Summarize the food and mood theory of AN, or restrictive eating behaviors/interaction between serotonin and tryptophan

Summarize tryptophan theory

Back 31

Starvation leads to decreased serotonin levels and increased 5-ht which increases anxiety perfectionism adn overall discomfort.

Starvation leads to increased tryptophan which briefly reduces anxiety and discomfort associated with lowered serotonin levels (+5HT), not eating actually feels better which leads to incresed need for restriction. Dangerous cycle

an's starve to reduce 5ht neuronal activity and dysphoric behavioral state

Front 32

List 5 things that disturbed serotonin are associated with (relating to eating behaviors.

What disorder does serotonin dysregulation lead to?

Back 32

1-Depression
2-Increase potential for addiction
3-Lower impulse control
4-Cravings for carbs
5-Reduced sensitivity to satiety
6-increased appetite

Binge eating disorder

Front 33

Explain the heritability of AN and BN
Problems with this?

Back 33

Strong genetic heterogeneity, theres no single gene but many genes impacting each other.

EST-->.5-.8

not able to determine what percent is environment and is rare

Front 34

Summarize genetics and eating disorders

Back 34

heterogenetic, mulitiple genes interacting with the environment to lead to disorder, no specific geners have been identified. Genes load the gun adn enviornment pulls the trigger

Front 35

What is the difference between a risk factor and a maintaining factor?

Gx4 each

Back 35

rf-->exert influence b4 onset, important for prevention (perfectionism)

mf-->intrumental after onset-->treatment (serotonin dysregulation). Easier to measure and find

Front 36

List 5-6 factors that might cause eating problems to begin

Back 36

1-social factors
2-gender-->female
3-Ethnic grp
4-social class
5-age
6-obesity
7-eating problems in fam
8-childhood psychiatric disorders(pic
9-childhood trauma
10-personality
11

Front 37

What, exactly, is a risk factor?

Back 37

precedes the disorder, associated with one disorder only,

Front 38

What is a cross sectional study?
list 1 advantage and 1 disadvantage

Back 38

longitunidnal study where cohort can be examined. study certain ages as they grow older

ad-->identifies possible risk factors
dis-->doesnt allow conclusions to be drawn abt sequence of characteristics

Front 39

List advantages and disadvantages of case control studies

Back 39

ad-->good when disorder is rare
dis-->biases in comparison of controls and cases
-->more casses adn controls in clinic vs actual community

Front 40

list ad and disad of cohort studies

Back 40

ad-->control of quality of data
dis-->need large numbers, very longterm, extremely expensive

Front 41

List the specific risk factors of AN

Back 41

1-Perfectionism;
2-negatve self evaluation and 3-Obsessive Compulsive Disorder

Front 42

List the specific risk factors for BN

Back 42

1-Childhood obesity,
2-social phobia,
3-Parental alcoholsim; parental obesity' family environmental factors;
4-negative self evaluation

Front 43

List the 3 risk factors for Binge Eating Disorder

Back 43

1-Adverse childhood experiences
2-Vulnerability to obesity
3-Repeated exposure to negative comments abt shape, weight and eating

Front 44

Do people with BED binge first of diet first?

Back 44

About half and half, earlier onset binge first, later diet first

Front 45

Describe the two risk factor models of Binge Eating

Back 45

Restraint Model (cog-beh)-->
1-emphasis on shape and weight n social network
2-internalized thinness and beauty expectations
3-Body image concerns
4-Extreme dietary restraint
5-Binge eating

Interpersonal Vulnerablity Model-->
1-Disturbance in early child-caretaker relationship
2-insecure attachment
3-disturbance in self, low SE or social self disturbance
4-affective dysregulation
5-binge eating

Front 46

Briefly describe the cumulative model for risk for eating problems-->Binge eating

Back 46

Some women only need modest levels of dieting to trigger binge eating. These women are particularly sensitive to societal perceptions as thinness and beauty, which results in negative affect leading to more eating. (Interpersonal vulnerabilty model) when this is less, more severe dieting is needed to result in binge eating

Front 47

Name some specific risk factors for women with BED

Name non specific

Back 47

1-Exposure to overeating by fam member
2-obesity prior to index age
3-high parental demands

1-childhood physical and sexual abuse
2-negative self evaluation

Front 48

what are some adolescent precipitants to anorexia?

wat abt late onset AN. How does this differ from precipitants to BN

Back 48

significant family conflict
change in school or home
increased academic pressure

family conflict or loss
medical illness

BN invovles interpersonal sensitivity and threat to physical safety, life changes similar to those for BED

Front 49

What are the mortality rates for AN in comparison to other psychiatric disorders? how does the cost of treatment compare?

Back 49

higher than any other psychiatric disroder. about 5% per decade, half being suicide and the other half to physical complications

very expensive, cost is more than that for schizophrenia-->17 thou per

Front 50

List at least 4 distinctive features of anorexia

Back 50

1-pride and sense of specialness
2-competitiveness
3-moral certitude
4-Effortfulness
5-symptoms as end in themselves
6-Disinterest in removal of fear (functional for acheivement->think of curve)

Front 51

Explain the course of AN. Do an's actually become bulimics

Back 51

is highly varible with recover largely depending on age of onset and exaggeration of other psychological disorders or problems

abt 29% recovered do.

Front 52

List the treatment goals for AN.

Back 52

1-restore healthy body weight
2-restore healthy eating patterns
3-treat medical complications
4-Modify maladaptive thoughts and attitudes regarding weight
5-enlist family and social support
6-prevent relapse

Front 53

Summarize the stepped care approach to treatment for anorexia. When is the most extreme necessary?

Back 53

Start with the lowest priced and level treatment necessary for disorder and gradually move up as needed
1-Outpatient
2-Day hospital treatment
3-Inpatient

when extreme or rapid weight loss, medical danger, manage associated risks, poor home environment, failure of outpatient treatment

Front 54

What outpatient therapys are most approved for adolescent vs adult anorexics?

Back 54

Adolescece-->family therapy
conjoint family therapy
separated family therapy (good for parents with high levels of criticisim)

adult-->individual therapy. Much poorer prognosis though

Front 55

Summarize the findings of inpatient therapy effectiveness. Gx

Back 55

It works, at least temporarily
BUT: high cost, disrupts normal life, and interferes with adolescent soical development

Behavioral programs and dietary counseling

Front 56

Is there a current medical cure for an?

Back 56

no, although meds may help for secondary symptoms like depression

Front 57

Explain cognitive behavioral therapy using its goal and strategies

Back 57

Goal is to reduce eating disordered symptomatology

Strategies:Pyschoeducation, provide rationale and advice for restoring normal nutritian and body weight, self monitorin and eating, meal planning, modifying dysfunctional beliefs thru cognitive restructuring and behavioral experiments, relapse prevention

Front 58

Briefly explain the concept of motivational enhancement therapy. What is it based on? When is it used?

Back 58

treatment designed to get patients motivated to help themselves, low emphasis on behavioral change. Get patients to develop descrepancy between current attachment to symptoms and broader life goals

right b4 the patients agrees to do therapy

Front 59

Explain family therapy with research

Back 59

designed to reduce eating disorderd sympomalogy by giving parental control over eating, providing support fof parents, and support for patient gradually reassuming control of lfie. found effective with adolesncets

Front 60

List a couple reasons y AN only has 11 research based treatments

Back 60

because its a unique and rare illness with ethical considerations in that you can thave a real control group

Front 61

Describe the Maudsley approach to treatment for anorexia. Explain the 3 phases

Back 61

Makes no assumptions about the cause of illness, instead focuses on initial symptoms and put parents in control of weight restoraton. Talk about what parents think is best instead of what therapist thinks. Getting parents to take charge of eating environment

Phase I-->parents normalize eating disordered beh
Phase II-->Transfer control back to adolescent
Phase III-->work on adolescent development issues

Front 62

Summarize general observations for inpatient vs outpatient treatment for anorexia vs supportive/developmentally target therapy for adolescnets

Back 62

Inpatient treatment gains are not maintained after discharge and is no more effective than outpatient care, whidch is better than developmentally target therapy

Front 63

Summarize the overall treatment findings for An

Back 63

key is to treat and prevent early. There is scant literature on treatments with exception of family therapy which has been found good for those under 18 and within 1st 3 years of illness

Front 64

What is an good way to study AN experimentally?

What is the current, most promising treaatment for adolescentAN?

Back 64

use mulitple site designs to combat the rareity of disorder and An specilization centers. BUT this is expensive and there may be collaboration problems

a combination of systems family therapy, behavioral family therapy that focused parents on refeeding their child.

Front 65

Summarize Behavioral family therapy for AN

Back 65

Primary concern is to unite parents towards refeeding the adolescent. Therapist makes a direct observation of family eating patterns adn interactions around eating

Front 66

Summarize Systems Family Therapy for Anorexia

Back 66

Focuses on the family as a system and patterns of behavior and beliefs to understand how normal family functioning can be restored

Front 67

List 4 treatments for Bulimia
What is the preferred treatment?

Back 67

Behaviral therapy
Cognitive behavioral therapy
Nutritional counseling
Stress management
interpersonal pscyhotherapy (ipt)

CBT-->with exception of IPT

Front 68

Summarize the typical, manual based CBT for Bulimia nervosa.
CBT vs. Antidepressant meds

Back 68

1-16 to 20 sessions of indvidual therapy over 4 to 5 month period
2-Specialized treatment
3-Sessions are structured and focused
4-Emperically supported strategies employed
5-Treatment described in detailed therapist manuel

CBT more acceptable with lower droppout rates. BUT combo of both MAY be better than CBT alone in reducing anxiey and depression

Front 69

What's special about IPT for BN?

Back 69

suggests treatment doesnt have to focus on eating behaviors to be effective in decreasing binge eating or associated psychopathology

Front 70

Why does CBT work?

Back 70

By reducing dietary restraint and increasing patients self efficacy for coping with eating, negative affect adn body shape and wieght concerns. Therapeutic alliance has no evidnece in mediating outcome

Front 71

Explain breifly the outcomes of IPT, CBT and BT in treating BN

What do these results mean?

Back 71

BN cessasion rates drop off in the long term

IPT significantly less effective at post treatment but indistinguishable from CBT at other followups

Front 72

Whats teh difference between remission and recovery

Back 72

Rec->no longer have disorder
rem-->long term recovery

Front 73

What is IPT? What does it assume and focus on?

Explain the typical course and phases

Back 73

treatment used in mood disorders and eating disorders. Assumes disordered eating patterns developed within certain interpersonal context and is influenced by it. Focuses on identifying and altering the interpersonal context in which the eating pattern was developed and maintained.

15-20 sessions over 4-5 month period.

Initial phase identifies probelm area in significant relationships

Intermediate phase works on the target problem areas

Termination phase consolidates work adn prepares patients for future work on their own

Front 74

List the 4 social domains that IPT works on

Back 74

1-Grief
2-Role disputes (second highest)-famConflict etc
3-Role transitions
4-Interpersonal Deficits (highest)

Front 75

What happens during the initail phase of IPT

Back 75

During first 5 sessions, the disorder is given a name, IPT rationale and nature and described

Front 76

Explain breifly the outcomes of IPT, CBT and BT in treating BN

What do these results mean?

Back 76

BN cessasion rates drop off in the long term

IPT significantly less effective at post treatment but indistinguishable from CBT at other followups

Front 77

Whats teh difference between remission and recovery

Back 77

Rec->no longer have disorder
rem-->long term recovery

Front 78

What is IPT? What does it assume and focus on?

Explain the typical course and phases

Back 78

treatment used in mood disorders and eating disorders. Assumes disordered eating patterns developed within certain interpersonal context and is influenced by it. Focuses on identifying and altering the interpersonal context in which the eating pattern was developed and maintained.

15-20 sessions over 4-5 month period.

Initial phase identifies probelm area in significant relationships

Intermediate phase works on the target problem areas

Termination phase consolidates work adn prepares patients for future work on their own

Front 79

List the 4 social domains that IPT works on

Back 79

1-Grief
2-Role disputes (second highest)-famConflict etc
3-Role transitions
4-Interpersonal Deficits (highest)

Front 80

What happens during the initail phase of IPT?

Back 80

During first 5 sessions, the disorder is given a name, IPT rationale and nature and described.

In next sessions, the problem area is identified from a detailed interpersonal inventory associated with onset or maintenance of disorder

Disorder is examined in terms of relationships

Front 81

Describe the intermedaite phase of ipt

Back 81

sessions 6-15,
1- implement strategeis specific to identified problem areas
2-Encourage adn review work on specific problem area adn illuminate connections between symptoms and interpersonal events during the week
3- Work with patient to identify and manage negative and/or painful affects associated with their interpersonal problem area

Help them change context of relationship behaviors adn increase abliity to cope so binging will stop

Link onset of disorder to 1/4 problem areas

Front 82

Describe the Termination phase of IPT

Back 82

sessions 16-20; Discuss termination of treatment and identify as potential time for grieving, identify emotions
Review progross to foster feelings of accomplishment and competence
Outline future goals adn formulate specific plans for continued work after termination of treatment

Front 83

Explain the role of the therapist in IPT

Back 83

Help the patient drive teh treatment by altering interpersonal context in whch binging developed.
1-inquire about the treatment goals each session
2-redirect unfocused discussions to key issues
3-assist the patient in drawing conncetions

Good therapeutic alliance is important

Front 84

What are some IPT techniques

Back 84

1-Encouragement of affect (emotion)
2-Exploratory techniques
3-Clarification/developmnt of awareness
4-Communication analysis
5-Use of therapeutic relationship

Front 85

summarize IPT

Back 85

1-Review past interpersonal inventory
2-Examine current interpersonal functioning
3-access interpersonal precipitants of binge eating (ie, being alone)
4-Provide feedback on interpersonal problem area
5-Collaboratively develop treatmnt goals