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55 Cards in this Set

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What are eating disorders?

Eating disorders are severe disturbances in eating behaviors, such as eating too little are eating too much.

What are the current DSM - IV Eating Disorder Diagnostic categories?

1) Anorexia Nervosa

2) Bulimia Nervosa

What are the DSM 5 changes for eating disorders?

1) Eating disorders likely to become a part of "feeding and eating disorders group".

1a) Eating disorders such as Pica

(eating non food substances for extended periods) and Rumination disorder( repeated regergetation of foods) are currently categorized in DSM -IV under Disorders usually first diagnosed in Infancy, Childhood, or Adolescence.

What is the DSM IV diagnostic criteria for anorexia nervosa?

1) Refusal to maintain normal body weight

1a) Less than 85%

2) Intense fear of gaining weight and being fat

2a) Can't be 'too thin'

3) Distorted body image or sense body shape

3a) Feel "fat" even when emaciated

4) Amenorrhea

4a) loss of menstrual period

What is the DSM 5 criteria for anorexia nervosa?

1) Restriction of behaviors that promote healthy weight; body weight is significantly below normal

1a) BMI (Body Mass Index) less than 18.5 for adults

2) Intense fear of gaining weight and being fat

2a) Can't be "too thin"

3) Distorted body image or sense of body shape

3a) Feel "fat" even when emaciated

(Amenorrhea not required for diagnosis)

What are the two subtypes of anorexia nervosa distinguished by DSM-5?


1a) weight loss is achieved by severely limiting food intake, with no binge eating/ purging during the last 3 months

2) binge-eating/purging

2a) the person has also regularly engaged and binge-eating during the last three months.

Longitudinal Research suggests questionable validity of subtypes.

What are the changes made from DSM-4 in DSM-5?

1) Restrictions of behaviors that promote healthy weight rather than a "refusal to eat"

2) In addition to fear of weight gain, a focus on behaviors that interfere with weight gain

3) Loss of menstral period no longer required for diagnosis

4) Subtypes specified for past three months rather than just current episode.

When does the onset of anorexia nervosa typically begin?

Early to middle teen years, usually triggered by dieting and stress.

What is the lifetime prevalence for anorexia nervosa?

Less than 1%, and it is 10 times more frequent in women than in men.

Symptomatology in men similar to that of women.

What is anorexia nervosa often comorbid with?
Depression, OCD, phobias, panic, alcoholism and PDs
In men, comorbid with substance dependence, mood disorders, or schizophrenia
What are the suicide rates in Anorexia?
Suicide rates are high in anorexia.

-5% completing

-20% attempting

What are physical changes that occur in anorexia?
1)Low blood pressure, heart rate decrease

2)Kidney and gastrointestinal problems

3) Loss of bone mass

4) Brittle nails,dry skin, and hair loss

5) Lanugo (Soft, downy body hair)

6) Depletion of potassium and sodium electrolytes can cause tiredness, weakness, and death.

What is the percentage of recovery for anorexia and how long does it take?
1) 50%-70% recover and it may often take 6 or 7 years.

2) Relapse is common

What is the most difficult thing to modify in those with anorexia?
Distorted view of self, especially in cultures that highly value thinness.
What type of illness is anorexia nervosa?
It is a life threatening illness.

1) Death rates are 10x's higher than the general population

2) Death rates 2x higher than other psychological disorders

What is Bulimia Nervosa?
Uncontrollable eating binges followed by compensatory behaviors to prevent weight gain.
Compensatory behaviors: vomiting, fasting, excessive exercise

What are the 2 characteristics for binge defined by the DSM-5?

1)It involves eating an excessive amount of food in under 2 hours

2) It involves a feeling of losing control over eating as if one cannot stop; continues until uncomfortably full

3) recurrent compensatory behaviors to prevent weight gain (e.g., vomiting)

4) Body shape and weight extremely important for self evaluation

When does binge eating and compensatory behaviors occur?
They both occur on average, at least once a week for 3 months
What are the two subtypes of Bulima nervosa?
1)Purging (vomiting, laxatives)

2)Non-purging (fasting, excessive exercise)

What does research say about the validity of the two subtypes?

1) Research distinguishing the two are mixed

2) Difficulty distinguishing non-purging bulimia from binge eating disorder

3) Non-purging type removed from DSM 5

What are key changes made from DSM IV in DSM 5 for diagnosing of eating disorders?
1) Minimum frequency of binging/purging changes to once/ week instead of twice a week for at least 3 months

2) Non purging subtype removed

It is difficult to distinguish the nonpurging bulimia type from binge eating disorder.
What are the typical food choices for eating binges?
Cakes, cookies, ice cream, other easily consumed, high calorie foods.
1)Avoiding craved foods can later increase likelihood of binge.

2) Reports of losing awareness of dissociation

3) Shame and remorse often follow

What are the differences between anorexia and bulimia?
1) Extreme weight loss in anorexia

2)At or above normal weight in bulimia

When does the onset of bulimia occur?
1)Late adolescence or early adulthood

2) 90% women

3) 1-2% prevalence among women

What is bulimia nervosa comorbid with?
Depression, PDs, anxiety, substance abuse, conduct disorder.
What are the rates for sucide attempts in bulimia?
Suicide attempts and completions higher than in general population but much lower than in anorexia nervosa.
What is the BMI for individuals with bulimia?
They typically have normal BMI
What are physical changes that occur in those with bulimia?
1) Menstural irregularities

2) Potassium depletion from purging

3) Laxative use depletes electrolytes, which can cause cardiac irregularites

4) Loss of dental enamel from stomach acids in vomit

5) Mortality rate of 4%

What is the prognosis for bulimia?

1) 75% recover

2) 10 to 20% remain fully symptomatic

3) Early intervention linked with improved outcomes

4) poor prognosis when depression and substance abuse are comorbid more severe symptomatology

What does the DSM 4 considered binge eating to be and what is it now included to be in the DSM 5?

The DSM-IV considers binge eating disorder to be a diagnosis in need of further study: Binge eating disorder is now included in DSM 5 as a diagnosis.

What is the dsm-5 criteria for Binge Eating Disorder?

1) Recurrent episodes of binge-eating; on average, at least once a week for 3 months

2) Binge eating episodes include at least three of the following:

- eating more rapidly than normal

- eating until uncomfortably full

- eating large amounts when not hungry

- eating alone due to an embarrassment about large food quantity

- feeling disgusted, guilty, or depressed after the binge

3) No compensatory behavior is present

What are the changes made from the DSM IV in the DSM 5 for diagnosis of Eating Disorders?

1) Eating disorders in the new category in the dsm-5

2) This was in the Appendix in DSM-4- TR as a category in need of further study; additional research supports its addition to the DSM 5

What is the difference between Binge Eating Disorder vs Anorexia?

Absence of weight loss and Binge Eating Disorder

What is the difference between Binge Eating Disorder vs Bulimia?

Absence of compensatory behaviors ( purging, fasting, or excessive exercise) in Binge Eating Disorder

What is binge eating disorder associated with?

1)It is associated with obesity and a history of dieting.

1a) Body Mass Index(BMI)> 30

Do all people meet the criteria for binge eating disorder?

1)Not all people meet criteria for binge eating disorder

1a) must report been cheating episodes in a feeling of loss of control over eating to qualify

1aa) approximately 2-25 % of obese may qualify

What are the risk factors for binge eating disorders?

Childhood obesity, early childhood weight loss attempts, having been taunted about their weight, low self concept, depression, and childhood physical or sexual abuse.

Equally prevalent online Euro-, African-, Asian-, and Hispanic - Americans.

What are problems associated with obesity and binge eating disorder?

1) increased risk of type 2 diabetes

2) cardiovascular disease

3) breathing problems

4) physical ailments (joint/muscle pain)

What are problems independent of obesity in binge eating disorder?

1) Sleep problems

2) Anxiety / depression

3) Irritable bowel syndrome

4) Early menstruation in women

What is the prognosis of binge eating disorder?

1) About 60% (between 25 and 82%) recover

2) Binge Eating Disorder is the most common and lasts the longest of the three eating disorders

2a) Last on average: 14.4 years

How does genetics affect eating disorders?

1) Family and twin studies support genetic link

1a) first-degree relatives of individuals with both disorders more likely to have the disorder

1aa) Higher MZ concordance rates for both anorexia and bulimia

2) body dissatisfaction, desire for tennis, binge eating, and weight preoccupation all heritable

3) Environmental factors (e.g., family interactions) play an even greater role in etiology

3a) Further research on genetic/ environmental interaction is needed

What are neurobiological factors of eating disorder?

-Hypothalamus not directly involved

-Low levels of endogenous opioids

1) Substances that reduce pain, enhance mood, and suppress appetite

2) Released during starvation

- may reinforce restricted eating of anorexia

3) Excessive exercise increases opioids

4) Low levels of opioids (beta-endorphins) in bulimia promote craving

-Reinforce binging

- Serotonin related to feelings of satiety (feeling full)

1) low levels of serotonin metabolites in anorexic and bulimics

2) Antidepressants that increase serotonin often effective in treatment of eating disorders

-Dopamine related to feelings of pleasure and motivation

1) Anorexics feel more positive and rewarded when viewing pictures of underweight women

What is the cognitive behavioral view for Anorexia?

1) Focus on body dissatisfaction and fear of fatness

2) Certain behaviors (e.g., restrictive eating, excessive exercise) negatively reinforcing

2a) Reduce anxiety about weight gain

3) Feelings of self control brought about by weight loss are positively reinforcing

4) Perfectionism and personal inadequacy lead to excessive concern about weight

5) Criticism from family and peers regarding weight can also play a role

What is the cognitive behavioral view of bulimia?

1) Self-worth strongly influenced by weight

1a) low self esteem

2) Ridgid restrictive eating triggers lapses, which can become binges

2a) Many "off limit" foods

3) After binging, disgust with oneself and fear of gaining weight lead to compensatory behavior

3a) e.g., vomiting, laxative use

4) Purging temporarily reduces anxiety about weight gain

4a) Negative feelings about purging led to lower self esteem, which triggers further binging

5) Stress, negatively effects trigger binges

6) Restrained eating play central role in bulimia

6a) restraint scale measures dieting and overeating

What are sociocultural factors that affect eating disorders?

1) American society values thinness in women, muscularity and man

2) dieting, especially among women, has become more prevalent

2a) often precedes onset

3) body dissatisfaction and preoccupation with thinness also predict eating disorders

4) societal objectification of women

4a) women viewed as sexual objects

5) unrealistic media portrayals

5a) women may feel shame when they don't match the ideal

6) overweight individuals are viewed with disdain, creating more pressure to be thin

What are gender factors in eating disorders?

-Objectification of women's bodies

1) women defined by their bodies; men defined by their accomplishments

2) Societal objectification of women lead to "self objectification"

2a) women see their own bodies through the eyes of others

2b) lead to more shame when fall short of cultural ideas

-Aging and changes in life roles (having a life partner, or having children) associated with decreased eating disorder symptoms.

What are cross cultural factors in eating disorders?

1) Anorexia found in many cultures

1a) Even those not under Western influence

1b) May not include fears of getting fat

2) In some cultures, how you wait is a sign of fertility and healthiness

3) As countries become more like Western cultures, eating disorders increase

4) Bulimia more common in industrialized societies than non- industrialized.

What are ethnic factors in eating disorders?

White women compared to women of color

1) Gap in rate of eating disorders between white women and women of color is diminishing, particularly with bulimia

1a) greatest gap in college women

2) more dieting and body dissatisfaction in white teens

2a) BMI increases linked to greater body dissatisfaction

- Body dissatisfaction and symptoms of bulimia strongly correlated with high acculturation stress

- Prevalence of binge eating disorder and bulimia in Latin women comparable to Caucasian; anorexia is more rare.

What are some other factors that affect eating disorders?

-Eating behaviors impact personality

1) semi starvation leads to preoccupation with food and personality changes

-Personality characteristics impact eating

1) perfectionism, lack of introceptive awareness, and negative affect predicted disordered eating

1a) perfectionism remains high even after treatment

-Family characteristics

1) Self-report indicate high levels of family conflict

1a) Parental reports don't always indicate family problems

2) One observational study showed parents had no greater levels of negative statement than controls

3) More observational studies needed

What is the etiology of eating disorders in child abuse?

1) Self-reports of high rates of childhood sexual and physical abuse

2) Report of abuse not specific to eating disorders

2a) Also found in other diagnostics categories

3) Presence of abuse may be too general variable

3a) Age and type of abuse maybe more significant

What are some treatments used in eating disorders?

A) Antidepressants

1) Effective for bulimia but not anorexia

2) Dropout and relapse rates high

3) Limited research suggests that antidepressant medications are not effective in reducing binges or increasing weight loss in binge eating disorder

What treatments are used for anorexia?

1) immediate goal is to increase weight to avoid medical complications and avoid death

1a) second goal is long-term maintenance of weight gain


1) Reductions in symptoms through 1 year

Family based therapy found to be effective

1) Anorexia viewed as an interpersonal, rather than individual issue

2) Use of "family lunch" sessions

3) Early results show improved outcomes over individual therapy

What treatments are used for bulimia?

1) Challenge societal ideals of thinness

2) Challenge beliefs about weight and dieting

3) Challenge all or nothing believe about food

3a) One bite of high calorie food does not have to leave to binging

4) Increase self assertiveness skills to improve interpersonal relatedness

5) increase regular eating patterns (three meals a day)

6) CBT more effective than medication

6a) adding Exposure and Ritual Prevention (ERP) increases the effectiveness of CBT in the short term

What are treatments used for binge eating disorder?

1) CBT shown to be effective treatment modality

1a) Teaches restrained eating through self-monitoring, self control, and problem solving skills

2) CBT more effective than medication

3) Interpersonal Therapy (IPT) equally as effective as CBT

4) Behavioral weight loss programs may promote weight loss, but not curb binge eating

What can be done to prevent eating disorders?

1) Psychoeducational approaches

1a) Educate early about the dangers of eating disorders

2) Deemphasize sociocultural influences

2a) Dissonance reduction intervention to deemphasize socio-cultural influences

3) Risk factor approach

3a) Healthy weight intervention to develop healthy weight and exercise program