Psych Ch. 13- Feeding and Eating Disorders

What type of anorexia has a higher rate of suicide?

The suicide rate is higher in persons with the binge eating-purging type of anorexia nervosa than in those with the restricting type.

2 subtypes of anorexia nervosa:

(1) restricting (2) binge/purge *Approximately half of anorexic persons will lose weight by drastically reducing their total food intake. The other half of these patients will not only diet but will also regularly engage in binge eating, followed by purging behaviors. Some patients routinely purge after eating small amounts of food. In the food-restricting category, present in approximately 50 percent of cases, food intake is highly restricted (usually with attempts to consume fewer than 300 to 500 calories per day and no fat grams) and the patient may be relentlessly and compulsively overactive, with overuse athletic injuries. In the purging subtype, patients alternate attempts at rigorous dieting with intermittent binge or purge episodes. Purging represents a secondary compensation for the unwanted calories, most often accomplished by self-induced vomiting, frequently by laxative abuse, less frequently by diuretics, and occasionally with emetics. Sometimes, repetitive purging occurs without prior binge eating, after ingesting only relatively few calories. Some persons with anorexia nervosa may purge but not binge.

Anorexia nervosa is a syndrome characterized by three essential criteria:

(1) self-induced starvation (behavioral) (2) relentless drive for thinness or a morbid fear of fatness (psychopathological) (3) presence of medical signs and symptoms resulting from starvation (physiologic)

Anorexia nervosa is associated with social phobia in what percent of cases?

22%

What % of anorexia nervosa pts achieve full recovery?

30-50% 10 to 20 percent remain chronically ill. The remainder improve but continue to struggle with certain disordered behaviors.

Binges with bulimia nervosa:

During binges, patients eat food that is sweet, high in calories, and generally soft or smooth textured, such as cakes and pastry. Some patients prefer bulky foods without regard to taste. The food is eaten secretly and rapidly and is sometimes not even chewed.

Treatment of anorexia nervosa:

Hospitalization: -restore pt's nutritional state -consider pt's medical condition and amount of structure needed to ensure cooperation

anorexia nervosa has a mortality rate as high as that associated with

any psychiatric illness.

Purging disorder:

characterized by recurrent purging behavior after consuming a small amount of food in persons of average weight who have a distorted view of their weight or body image. includes self-induced vomiting, laxative abuse, enemas, and diuretics.

Anorexia nervosa is often, but not always, associated with:

disturbances of body image, the perception that one is distressingly large despite evident medical starvation. The distortion of body image is disturbing when present; it is, however, not pathognomonic, invariable, or required for diagnosis.

We cannot make the diagnosis of bulimia nervosa if the binge-eating and purging behaviors occur

exclusively during episodes of anorexia nervosa. In such cases, the diagnosis is anorexia nervosa, binge eating-purging type

What population does anorexia nervosa disproportionately affect? When is its typical onset?

much more prevalent in females than in males (ten times more frequent in females) usually has its onset in adolescence - between ages 10-30 years

The term anorexia nervosa comes from the Greek term for ________ and a Latin word implying:

"loss of appetite" ; Latin word implying nervous origin

Common behaviors in anorexia nervosa:

- Intense fear of gaining weight and becoming obese is present in all patients with the disorder and undoubtedly contributes to their lack of interest in and even resistance to therapy. -Most aberrant behavior directed toward losing weight occurs in secret (refusing to eat w/ family or in public) -They lose weight by drastically reducing their total food intake, with a disproportionate decrease in high-carbohydrate and fatty foods. -loss of appetite is usually rare until late in the disorder. Evidence that patients are frequently thinking about food is their passion for collecting recipes and for preparing elaborate meals for others. Some patients cannot continuously control their voluntary restriction of food intake, and so have eating binges. These binges usually occur secretly, often at night, and are frequently followed by self-induced vomiting. -Patients abuse laxatives and even diuretics to lose weight, and ritualistic exercising, extensive cycling, walking, jogging, and running are everyday activities. -Peculiar behaviors surrounding food: hide food all over the house and frequently carry large quantities of candies in their pockets and purses. While eating meals, they try to dispose of food in their napkins or hide it in their pockets. They cut their meat into tiny pieces and spend a great deal of time rearranging these pieces on their plates. -If someone confronts the patient about the behavior, they often deny that it is unusual or flatly refuse to discuss it. -Obsessive-compulsive behavior, depression, and anxiety are other psychiatric symptoms of anorexia nervosa most frequently noted clinically. -Pts tend to be rigid and perfectionist, and somatic complaints (ex. epigastric discomfort) are usual -Compulsive stealing, usually of candies and laxatives but occasionally of clothes and other items, may occur. -Patients with the disorder frequently have poor sexual adjustment. -Many adolescent patients with anorexia nervosa have delayed psychosocial sexual development; in adults, a markedly decreased interest in sex often accompanies the onset of the disorder. A minority of anorexic patients have a premorbid history of promiscuity, substance abuse, or both, but during the disorder show a decreased interest in sex. -Patients usually come to medical attention when their weight loss becomes apparent. -As the weight loss grows profound, physical signs such as hypothermia (as low as 35°C), dependent edema, bradycardia, hypotension, and lanugo (the appearance of neonatal-like hair) appear, and patients show a variety of metabolic changes. -Patients with anorexia nervosa are often secretive, deny their symptoms, and resist treatment. In almost all cases, relatives or intimate acquaintances must confirm a patient's history. The mental status examination usually shows a patient who is alert and knowledgeable on the subject of nutrition and who is preoccupied with food and weight.

Hospital management of anorexia nervosa:

- weighed daily (early in am after emptying bladder) -recorded daily fluid intake and urine output -monitor serum electrolyte elvels regularly and watch for development of hypokalemia -control vomiting by making the bathroom inaccessible for at least 2 hours after meals or by having an attendant present -constipation relieved with normal intake - can use stool softeners, but no laxatives -gradually increasing caloric intake to avoid refeeding syndrome -liquid food supplement may be advisable

Anorexia nervosa is associated with obsessive-compulsive disorder (OCD) in what % of cases?

35%

Anorexia nervosa is associated with depression in what % of cases?

50%

Compared to the general population, individuals anorexia nervosa are up to ___ x more likely to die

6x

What psychological conditions are more likely to be associated with binge eating-purging persons vs restricting persons with anorexia nervosa?

Binge eating-purging persons are likely to be associated with substance abuse, impulse control disorders, and personality disorders. Persons with restricting anorexia nervosa often have obsessive-compulsive traits concerning food and other matters. Some persons with anorexia nervosa may purge but not binge.

What are binge-associated behaviors? How many need to be present for a DSM-5 diagnosis of binge-eating disorder?

Binge-associated behaviors: -eating quicker than normal -eating until uncomfortably full -eating despite not being hungry -eating alone to avoid embarassment -feeling guilty or disgusted after eating Required number of symptoms: - binge behaviors (repeated binge-eating episodes occurring w/i 2 hrs and loss of control during an episode) + at least 3 associated behaviors or reactions

Distinguishing binge-eating disorder from anorexia nervosa:

Binge-eating disorder is distinct from anorexia nervosa in that patients do not exhibit an extreme drive for thinness and are of average weight or are obese.

How do rates of recovery for bulimia nervosa compare to that of anorexia nervosa?

Bulimia nervosa is characterized by higher rates of partial and full recovery compared with anorexia nervosa

What psychological conditions are more likely to be associated with bulimia nervosa (and other considerations for comorbidities)?

Bulimia nervosa occurs in individuals with high rates of mood disorders and impulse control disorders. co-occurs with substance use disorders, particularly alcohol increased rates of anxiety disorders, bipolar I disorder, dissociative disorders, and histories of sexual abuse. Patients with bulimia nervosa who have concurrent seasonal affective disorder and patterns of atypical depression (with overeating and oversleeping in low-light months) may manifest seasonal worsening of both bulimia nervosa and depressive features. Individuals with bulimia nervosa who purge may be at risk for certain medical complications such as hypokalemia from vomiting or laxative abuse and hypochloremic alkalosis. Those who vomit repeatedly are at risk for gastric and esophageal tears, although these complications are rare.

Are bulimic sx a part of anorexia nervosa?

Bulimic symptoms can occur as a separate disorder or as part of anorexia nervosa. Persons with either disorder are excessively preoccupied with weight, food, and body shape.

Treatment of binge eating disorder:

CBT is the most effective psychological treatment for binge-eating disorder and should be considered a first-line treatment CBT combined with psychopharmacological treatments such as SSRIs shows better results than CBT alone. -> lisdexamfetamine for both weight loss and reduction of binge episodes -> Antidepressant medication: -> fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, duloxetine, and bupropion ->anticonvulsants topiramate and zonisamide Interpersonal psychotherapy (IPT) is also effective in the treatment of binge-eating disorder; however, therapy focuses more on the interpersonal problems that contribute to the disorder rather than disturbances in eating behavior. There is also some evidence for the use of dialectical behavior therapy for binge-eating disorder.

Distinguishing depression from anorexia nervosa in differential diagnosis:

Common features: depressed feelings, crying spells, sleep disturbance, obsessive ruminations, and occasional suicidal thoughts Disntinguishing features: In general, a patient with a depressive disorder has decreased appetite, whereas a patient with anorexia nervosa claims to have a normal appetite and to feel hungry; only in the severe stages of anorexia nervosa do patients have decreased appetite. In contrast to depressive agitation, the hyperactivity seen in anorexia nervosa is planned and ritualistic. The preoccupation with recipes, the caloric content of foods, and the preparation of gourmet feasts is typical of patients with anorexia nervosa but is absent in patients with a depressive disorder. In depressive disorders, patients have no intense fear of obesity or disturbance of body image.

What techniques can improve pt's cooperation to tx?

Emphasizing the benefits, such as relief of insomnia and depressive signs and symptoms, may help persuade the patients to admit themselves willingly to the hospital Relatives' support and confidence in the physicians and treatment team are essential for reinforcing the firm recommendations made on the unit. consider compulsory admission or commitment only when the risk of death from the complications of malnutrition is likely.

Treatment of bulimia nervosa (hospitalization considerations, psychotherapy, pharmacotherapy) Most effective combination of treatment:

Evidence indicates that CBT and medications (particularly fluoxetine) are the most effective combination. Most patients with uncomplicated bulimia nervosa do not require hospitalization In general, patients with bulimia nervosa are not as secretive about their symptoms as patients with anorexia nervosa. Therefore, outpatient treatment is usually not difficult, but psychotherapy is frequently stormy and prolonged when eating binges are out of control, outpatient treatment does not work, or a patient exhibits such additional psychiatric symptoms as suicidality and substance abuse—hospitalization may become necessary. Also, electrolyte and metabolic disturbances resulting from severe purging may necessitate hospitalization. CBT = benchmark, first-line treatment CBT implements several cognitive and behavioral procedures to (1) interrupt the self-maintaining behavioral cycle of binging and dieting and (2) alter the individual's dysfunctional cognitions; beliefs about food, weight, body image; and overall self-concept. Pharmacotherapy: Antidepressant medications help treat bulimia nervosa, particularly the SSRI fluoxetine. Fluoxetine can reduce binge eating and purging, independent of the presence of a mood disorder. Dosages of fluoxetine that are effective in decreasing binge eating, however, may be higher (60 to 80 mg a day) than those used for depressive disorders. -> other antidepessants may be helpful -> Bupropion is contraindicated due to risk of seizure In general, most of the antidepressants other than fluoxetine have been effective at dosages usually given in the treatment of depressive disorders.

What prompts bulimia nervosa?

For some patients, bulimia nervosa may represent a failed attempt at anorexia nervosa, sharing the goal of becoming very thin, but occurring in an individual less able to sustain prolonged semistarvation or severe hunger as consistently as classic restricting anorexia nervosa patients. For others, eating binges represent "breakthrough eating" episodes of giving in to hunger pangs generated by efforts to limit eating to maintain a socially desirable level of thinness. others use binge eating as a means to self-medicate during times of emotional distress. They may have a history of pica (eating things that are not food) and struggles during meals. Some patients with bulimia nervosa have multiple comorbid impulsive behaviors, including substance abuse, and lack of ability to control themselves in such diverse areas as money management (resulting in impulse buying and compulsive shopping) and sexual relationships (often resulting in a short, passionate attachment and promiscuity). They exhibit self-mutilation, chaotic emotions, and chaotic sleeping patterns.

inpatient vs psychiatric hospitalization for anorexia nervosa:

In general, patients with anorexia nervosa who are 20 percent below the normal weight for their height require inpatient programs, and patients who are 30 percent below their expected weight require psychiatric hospitalization for 2 to 6 months.

Distinguishing bulimia nervosa from Kleine-Levin syndrome:

Kleine-Levin syndrome consists of periodic hypersomnia lasting for 2 to 3 weeks and hyperphagia (excessive hunger) As in bulimia nervosa, the onset is usually during adolescence, but the syndrome is more common in men than in women.

Distinguishing bulimia nervosa from Kluver-Bucy syndrome:

Klüver-Bucy syndrome includes visual agnosia, compulsive licking and biting, an examination of objects by the mouth, inability to ignore any stimulus, placidity, altered sexual behavior (hypersexuality), and altered dietary habits, especially hyperphagia. The syndrome is exceedingly rare and is unlikely to cause a problem in the differential diagnosis.

Distinguishing night-eating syndrome from other eating disorders:

Night-eating syndrome is common among patients with other eating disorders, particularly bulimia nervosa and binge-eating disorder. Although we can find night eating in patients with bulimia nervosa and binge-eating disorder, it is the characteristic sign of night-eating disorder. Also, the amount of food consumed during eating episodes is usually lower in night-eating disorder than in bulimia nervosa and binge-eating disorder. Unlike other eating disorders, patients with night eating syndrome are not overly concerned about body image and weight. Patients with night-eating syndrome are also at higher risk for obesity and metabolic syndrome.

Epidemiology of night eating syndrome:

Night-eating syndrome occurs in approximately 2 percent of the general population; however, it has a higher prevalence among patients with insomnia, obesity (10 to 15 percent), eating disorders, and other psychiatric disorders. The disorder usually begins in early adulthood.

Comorbidities with binge eating disorder:

Patients with binge-eating disorder are also more likely to have an unstable weight history with frequent episodes of weight cycling (the gaining or losing of more than 10 kg). The disorder may be associated with insomnia, early menarche, neck or shoulder and lower back pain, chronic muscle pain, and metabolic disorders.

How does sexual development differ between patients with anorexia nervosa and patients with bulimia nervosa?

Patients with bulimia nervosa are concerned about their body image and their appearance, worried about how others see them, and concerned about their sexual attractiveness most are sexually active, compared with anorexia nervosa patients who are not interested in sex

Distinguishing schizophrenia from anorexia nervosa in differential diagnosis:

Patients with schizophrenia that include delusions about food rarely are concerned with caloric content. More likely, they believe someone poisoned the food. Patients with schizophrenia are rarely preoccupied with a fear of becoming obese and do not have the hyperactivity seen with anorexia nervosa Patients with schizophrenia have bizarre eating habits but not the entire syndrome of anorexia nervosa.

Characteristics of bulimia nervosa:

People with bulimia nervosa have episodes of binge eating combined with inappropriate ways of stopping weight gain (vomiting, laxatives, etc). Physical discomfort—for example, abdominal pain or nausea—terminates the binge eating, which is often followed by feelings of guilt, depression, or self-disgust. Eating binges provoke panic as individuals feel that their eating has been out of control. The unwanted binges lead to subsequent attempts to avoid the feared weight gain by a variety of compensatory behaviors, such as purging or excessive exercise.

Pharmacotherapy in anorexia nervosa:

Pharmacologic studies have not yet identified any medication that yields a definitive improvement of the core symptoms of anorexia nervosa. In patients with anorexia nervosa and coexisting depressive disorders, we should treat the depressive condition. Antipsychotics, SSRIs, and tricyclic antidepressants have been tried w/ variable results - risk assoc with low wt pt

Sleep-related eating disorder vs night-eating syndrome:

Recurrent episodes of involuntary eating characterize a sleep-related eating disorder during the night. These episodes can lead to severe consequences such as the ingesting of nonedible foods or substances, dangerous behaviors while searching for or preparing food, and sleep-related injury. The eating episodes usually occur after the patient has gone to sleep and may occur while the patient is unconscious or asleep. The sleep-related eating disorder also has high comorbidity with sleepwalking, restless legs syndrome, and obstructive sleep apnea, conditions that are rarely found among night-eating syndrome patients. Episodes of sleep-related eating disorder have been reported after the use of certain medications, including zolpidem, triazolam, olanzapine, and risperidone.

Treatment for night-eating syndrome:

SSRIs In patients with comorbid major depression and night-eating syndrome, bright light therapy has shown to decrease depressed mood. CBT has also been helpful.

Comorbid psychological disorders that can occur with bulimia nervosa:

Some patients with bulimia nervosa have multiple comorbid impulsive behaviors, including substance abuse, and lack of ability to control themselves in such diverse areas as money management (resulting in impulse buying and compulsive shopping) and sexual relationships (often resulting in a short, passionate attachment and promiscuity). They exhibit self-mutilation, chaotic emotions, and chaotic sleeping patterns. They usually meet the criteria for borderline personality disorder and other mixed personality disorders and, not infrequently, bipolar II disorder. When bulimia nervosa co-occurs with one of these disorders, we should note both diagnoses.

ICD-10 Diagnosis of Anorexia Nervosa - sx, exclusions, and what if lacking core sx?

Sx include: -deliberate weight loss induced by the pt -fear of being fat or flabby -assoc physiologic disturbances due to low weight -specific behaviors: restricted diet, excess exercise, binging behavior, use of appetite suppressants and diuretics Exclusions: loss of appetite (physical or psychological) If lacking core symptoms, the diagnosis of "atypical anorexia nervosa" is made

DSM-5 diagnosis of anorexia nervosa Sx Required number of Sx Sx specifiers Course specifiers Severity Specifiers

Sx: -food restriction leading to abnormally low wt -fear of gaining wt and behaviors to prevent wt gain -distorted body image (misperceiving wt or shape, self-eval based on thinness, lack of recognition of the seriousness of one's weight) Required # of sx: All Sx specifiers: - Restriction type (primary behaviors are dieting, fasting, and exercise for last 3 mo) -Bing eating type (binging and purging behavior for last 3 mo; can include use of laxatives or other substances to aid purging) Course specifiers: -Partial remission: sx present but no longer an abnormally low weight -Full remission: no sx for a sustained period Severity specifiers: -severity is measured by BMI level

What are the most common causes of death for pts with anorexia nervosa? What is the proportion that die due to suicide?

The majority of deaths are attributable to medical complications of low weight and malnourishment, but a smaller, yet significant, proportion of deaths (approximately 1 in 5) are due to suicide.

Hyperactive vagus nerve:

There are rare conditions of unknown etiology in which a hyperactive vagus nerve causes changes in eating patterns that are associated with weight loss, sometimes severe. In such cases, we may see bradycardia, hypotension, and other parasympathomimetic signs and symptoms. Because the vagus nerve relates to the enteric nervous system, eating may be associated with gastric distress such as nausea or bloating. Patients do not generally lose their appetite. Treatment is symptomatic. Anticholinergic drugs can reverse hypotension and bradycardia, which may be life-threatening.

Why is purging disorder separate from anorexia nervosa or bulimia nervosa?

This behavior should not be associated with anorexia nervosa (occurs in persons of average weight who have a distorted view of their wt/body image). Purging disorder is differentiated from bulimia nervosa because purging behavior occurs after eating small quantities of food or drink and does not occur as a result of a binge episode.

What features of those who practice binge eating and purging with anorexia nervosa are unique from that of restricting type/

Those who binge eat and purge tend to have families in which some members are obese, and they have histories of heavier body weights before the disorder than do persons with the restricting type. Binge eating-purging persons are likely to be associated with substance abuse, impulse control disorders, and personality disorders vs Persons with restricting anorexia nervosa often have obsessive-compulsive traits concerning food and other matters.

What distinguishes binge eating disorder from bulimia nervosa?

Unlike bulimia nervosa, patients with binge-eating disorder do not compensate in any way after a binge episode (e.g., vomiting, laxative use)

How do anorexia nervosa and bulimia nervosa differ?

Unlike patients with anorexia nervosa, those with bulimia nervosa typically maintain average body weight (do not show clinical signs of starvation)

Distinguishing bulimia nervosa from neurologic disease:

We must ascertain that patients have no neurologic disease, such as epileptic-equivalent seizures, central nervous system tumors, Klüver-Bucy syndrome, or Kleine-Levin syndrome.

Distinguishing somatization disorder from anorexia nervosa in differential diagnosis:

Weight fluctuations, vomiting, and peculiar food handling may occur in somatization disorder. On rare occasions, a patient may have both a somatization disorder and anorexia nervosa, in which case we should diagnose both. In general, patients with somatization disorder have less weight loss than patients with anorexia nervosa and do not fear weight gain. Amenorrhea for 3 months or longer is unusual in somatization disorder.

When making a diagnosis of bulimia nervosa, clinicians should explore the possibility that the patient has experienced:

a brief or prolonged prior bout of anorexia nervosa, which is present in approximately half of those with bulimia nervosa.

What factors improve prognosis for anorexia nervosa?

adolescents with a shorter duration of illness tend to have a better prognosis, emphasizing the importance of early detection and intervention. Individuals who achieve full weight-restoration on an inpatient unit and maintain their weight in the first month after discharge are, perhaps unsurprisingly, more likely to remain at a healthy weight up to a year after treatment. Lower BMI at discharge and weight loss in the first month after treatment, on the other hand, predict more unsatisfactory long-term outcomes. individuals who demonstrate an ability to consume a diet that is high in variety and energy density (i.e., a greater concentration of kcal/g) before discharge seem to do better after treatment.

Binge-eating disorder is associated with what psychological disorders?

associated with mood, anxiety, and substance use disorders.

How often do patients need to binge to meet DSM-5 criteria for binge-eating disorder?

at least once a week for 3 months

Inpatient psychiatric programs for patients with anorexia nervosa generally use a combination of:

behavioral management approach individual psychotherapy family education and therapy psychotropic medications positive reinforcers (praise) and negative reinforcers (restriction of exercise)

we should distinguish bulimia nervosa from binge-eating disorder, which typically includes

binge-eating behaviors but no compensatory or purging behaviors. (vomiting, laxative abuse, or excessive dieting.)

Which eating disorder is the most common and the least gender-divided?

binge-eating disorder n the United States, the lifetime prevalence of binge-eating disorder is about 3.6 percent for women and 2.1 percent for men rates of binge-eating disorder are particularly high in obese and overweight individuals

Characteristics of vomiting with bulimia nervosa:

binging behavior commonly precedes vomiting by about 1 year vomiting is frequent and is often induced by sticking a finger down the throat some patients can vomit at will vomiting decreases the abdominal pain and the feeling of being bloated and allows patients to continue eating without fear of gaining weight the acid content of vomitus can damage tooth enamel Depression, sometimes called postbinge anguish, often follows the episode

ICD-10 diagnostic name for binge-eating disorder:

bulimia nervosa, non-purging type

Cognitive-Behavioral therapy for anorexia nervosa::

can be applied in both inpatient and outpatient settings and have been found effective for inducing weight gain Monitoring = essential component Therapists teach patients to monitor their food intake, their feelings and emotions, their binging and purging behaviors, and their problems in interpersonal relationships. cognitive restructuring to identify automatic thoughts and to challenge their core beliefs. Problem-solving is a specific method whereby patients learn how to think through and devise strategies to cope with their food-related and interpersonal problems. These techniques can help address a patient's vulnerability to rely on anorectic behavior as a means of coping.

Night-eating syndrome:

characterized by the consumption of large amounts of food after the evening meal. Individuals generally have little appetite during the day and suffer from insomnia. night-eating syndrome includes recurrent episodes of hyperphagia (excessive hunger) or night eating. It may be associated with insomnia and a lack of desire for food in the morning. Patients with night-eating syndrome usually consume a large portion of their daily calorie intake after the evening meal. They may also wake up during the night and eat upon awakening. Some patients believe that they can only sleep if they eat. Depressed mood is common among these patients, especially during the evening and night hours.

Differential diagnosis of anorexia nervosa:

complicated, as patients often deny symptoms, are secretive about their eating habits, and resist seeking treatment. Thus, it may be difficult to identify the mechanism of weight loss and the patient's associated ruminative thoughts about distortions of body image. We should differentiate the eating disorders from one another. Attention to specific criteria, including whether the patient is of average weight, is essential. However, the two conditions can coexist. We must ascertain that a patient does not have a medical illness that can account for the weight loss (e.g., a brain tumor or cancer). Weight loss, peculiar eating behaviors, and vomiting can occur in several mental disorders.

Hypotheses of an underlying psychological disturbance in young women with anorexia nervosa:

conflicts surrounding the transition from girlhood to womanhood psychological issues related to feelings of helplessness and difficulty establishing autonomy

Patients who experience poor quality of sleep are more likely to develop:

diabetes, obesity, hypertension, and cardiovascular disease

dynamic expressive-supportive psychotherapy in the treatment of patients with anorexia nervosa

difficult w/ pt resistance Because patients view their symptoms as constituting the core of their specialness, therapists must avoid excessive investment in trying to change their eating behavior. We should gear the opening phase of the psychotherapy process toward building a therapeutic alliance. Patients may experience early interpretations as though someone else was telling them what they feel and thereby minimizing and invalidating their own experiences. Therapists who empathize with patients' points of view and take an active interest in what their patients think and feel, however, convey to patients that their autonomy is respected. Above all, psychotherapists must be flexible, persistent, and durable in the face of patients' tendencies to defeat any efforts to help them.

Family-based therapy for anorexia nervosa:

effective particularly in patients under age 18 FBT, also known as the Maudsley method, generally consists of three phases of treatment. In phase one, treatment focuses on the restoration of the patient's physical health, with decisions about what or when the patient will eat made by the parents. Once the patient has begun to gain weight and shown improvement in symptoms of anorexia nervosa, FBT moves on to phase two. In this phase, the patient gradually begins to take responsibility for decisions about eating. In phase three, the focus shifts to the patient's growth and development.

Binge Eating disorder:

engage in recurrent binge eating during which they eat an abnormally large amount of food over a short time. Binge episodes often occur in private, generally include foods of dense caloric content, and, during the binge, the person feels he or she cannot control his or her eating. Individuals with binge-eating disorder engage in frequent binges, often independent of feeling hungry.

Genetic / developmental / psychological / environmental factors affecting bulimia nervosa:

genetics likely play a role in the development of bulimia nervosa, as evidenced by twin and family studies Individuals with a family history of bulimia nervosa, mood disorder, substance use disorder, or obesity are at higher risk for developing the syndrome Neurobiologic disturbances are also present in individuals with bulimia nervosa and may increase the probability of binge eating. In particular, individuals with the disorder tend to display delayed gastric emptying, increased stomach capacity, and reduced secretion of cholecystokinin (CCK), a peptide hormone released by the small intestine that helps to signal satiety during food consumption. Together, disruptions to these neurobiologic processes may put individuals at elevated risk for overeating. Unlike individuals with anorexia nervosa, those with bulimia nervosa tend to exhibit high levels of novelty seeking and impulsivity. They also tend to display elevated levels of harm avoidance, negative emotionality, and stress reactivity. Afflicted individuals are more likely than others to experience a comorbid substance use disorder and engage in self-harm, leading to speculation that a subset of individuals with bulimia nervosa may have a propensity toward impulsivity across a range of problematic behaviors. Mood and anxiety disturbances appear to serve as risk factors for bulimia nervosa, as well. developmental and environmental factors similar to anorexia nervosa the cycle of binge eating and purging often becomes self-sustaining in bulimia nervosa

Epidemiology of bulimia nervosa:

incidence has decreased in recent years lifetime prevalence of bulimia nervosa in women is approximately 2 percent, and point prevalence is close to 0.6 percent. The average age of onset also seems to have decreased, although this finding may be an artifact of earlier detection. Like anorexia nervosa, the disorder is more common in women than in men.

Genetic / developmental / psychological / environmental factors affecting anorexia nervosa:

individuals with a family history of anorexia nervosa are much more likely than those with no family history to receive a diagnosis during their lifetime. Twin studies suggest more than family environment contribute Finally, once the illness sets in, the biologic and psychological changes to the body that occur in the starvation state, including depression and obsessionality, may help to maintain the illness. The experience of going through puberty and experiencing changes to body shape or weight may serve as a major stressor for some, triggering or worsening body dissatisfaction and low self-esteem. Additionally, several major social and psychological transitions occur throughout adolescence, including identity and role formation, increasing independence from parents, and the initiation of romantic relationships. These stressors and others may work to catalyze the eating disorder. Certain personality traits, including high levels of perfectionism, self-discipline, harm avoidance, and self-criticism, are common in individuals with the illness. Individuals with the restricting subtype, in particular, exhibit low impulsivity and are much more likely to delay rewards than individuals without the illness. Cognitive inflexibility is usually prominent, as well. In a subset of individuals, mood and anxiety disorders or symptoms precede the development of the anorexia nervosa. OCD and obsessive-compulsive personality traits also appear to serve as vulnerability factors. Activities that emphasize weight may increase the probability of developing anorexia nervosa or another eating disorder. Ballet, gymnastics, modeling, and weight-restricted sports like wrestling or light-weight rowing may lead to preoccupation with body form and unhealthy attempts to control weight. As many of these activities likely select for individuals who are higher in perfectionism, another risk factor for anorexia nervosa, they may be even more likely to contribute to illness onset. the cultural ideal of thinness, which is certainly perpetuated by the media, may fuel the overvaluation of shape and weight that marks both anorexia nervosa and bulimia nervosa. (media alone does not cause eating disorders)

Current theories on the etiology of eating disorders suggest:

individuals with eating disorders, in particular, possess a set of predisposing traits (e.g., biologic, genetic, or personality vulnerability) which, when triggered by a precipitating event (e.g., the stress of puberty, the decision to go on a diet), result in illness. Once the illness sets in, several factors work to maintain it (e.g., the social rewards of weight loss, the effects of the starvation state in anorexia nervosa).

Age of onset of night-eating syndrome:

late teens to late 20s

Etiology of binge-eating disorder and night-eating syndrome is:

limited - we know very little

What eating conditions may cause significant distress but do not meet full criteria for a classified eating disorder?

night-eating syndrome, purging disorder, and subthreshold forms of anorexia nervosa, bulimia nervosa, and binge-eating disorder.

nearly half of individuals with binge-eating disorder are:

obese and are at risk for medical complications associated with obesity

How often do pts need to have all 3 symptoms (binging episodes, compensatory behaviors, and self eval based on wt/shape) to meet DSM-5 criteria for bulimia nervosa?

occurs at least once a week for 3 months

In individuals who receive treatment for bulimia nervosa, studies have found that ________ predicts better tx outcomes.

rapid sx reduction

Epidemiology of anorexia nervosa:

rates of anorexia have been relatively stable since the 1970s significant increase in incidence rates (the number of new cases in the population over a set time) in the high-risk group of 15- to 19-year-old females in recent years. could be earlier age of illness onset or more rapid recognition and intervention lifetime prevalence: 2.4 and 4.3 percent, approximately double the rate of cases diagnosed using DSM-IV criteria point prevalence: 0.6 and 0.7 percent.

What is a long term effect in over 3% of patients with binge eating disorder?

severe obesity

The theme in all anorexia nervosa subtypes is

the highly disproportionate emphasis placed on thinness as a vital source of self-esteem, with weight, and to a lesser degree, shape, becoming the overriding and consuming daylong preoccupation of thoughts, mood, and behaviors.