337 post-M2

Question 1

EDs HiTOP diagnostic migration

Answer 1

• high rates of migration: moving from one category to another which suggests that current categorization may not be appropriate (underlying dysfunction)
• bulimia and BED have characteristics that look externalizing, and anorexia has more internalizing characteristics

Question 2

key symptoms in EDs

Answer 2

• cognitive restraint: intent to restrict food consumption
• dietary restriction: actual decrease in energy intake (amount, types of food)
• binge eating: consuming an objectively large amount of food in a discrete period of time with a feeling of loss of control
• compensatory behaviours: purging and non-purging
• weight/shape concern:

Question 3

binge eating episodes

Answer 3

• consuming an objectively large amount of food in a short period of time, accompanied by a sense of loss of control
• distinguished from a subjective binge eating episode - for some people, any amount of food can be considered ‘large’ and they’ll feel like they’ve lost control

Question 4

compensatory behaviours

Answer 4

• purging: physically removing food (vomiting, laxatives, diuretics)
• non-purging: counteract the ingestion of food indirectly (restriction, compensatory exercise)
• purging behaviours provide short-term relief, but ineffective at removing calories from your system and have negative effects health effects

Question 5

weight/shape concern

Answer 5

• body dissatisfaction
• preoccupation with weight/shape
• over-valuation of weight/shape
• weight/shape play an important role in determining self-worth (primary factor for being happy)

Question 6

ED DSM diagnoses

Answer 6

• anorexia nervosa: introduced in 1830s by William Gull, “lack of appetite” + anxiety (restricting food intake has been around for centuries without anxiety), there have been case studies of AN for a while
• bulimia nervosa: more recent, Gerald Russell found case studies engaging in binge eating, then purging + concern with weight (which didn’t fit into AN conceptualization)
• binge eating disorder
• avoidant/restrictive food intake disorder
• other specified feeding and eating disorder
• unspecified feeding and eating disorder

Question 7

anorexia nervosa

Answer 7

• necessary features: weight (BMI under 17.5), dietary restrictions
• typically present: body dissatisfaction, weight concern, weight/shape influence on self-esteem, denial about being considered underweight
• sometimes present: binge eating, compensatory behaviours (purging excessive exercise)
• subtypes: restrictive only or binge-purges
• BMI used to classify severity
• ‘atypical’ anorexia being researched: lacking BMI, but other features present
• distress NOT a requirement

Question 8

bulimia nervosa

Answer 8

• core features: binge eating, compensatory behaviours (occurring once/week for 3 months), large influence of weight/shape on self-esteem
• typically present: body dissatisfaction, weight concerns, dietary restrictions
• more typically a normal weight or overweight
• severity: frequency and severity of compensatory bx
• BMI differentiates binge-eating AN from BN
• no requirement of distress or impairment

Question 9

binge eating disorder

Answer 9

• core features: binge eating (absence of compensatory behaviours)
• sometimes present: body dissatisfaction, weight concerns, dietary restrictions
• must have significant distress
• within normal or overweight BMI
• severity based on frequency and severity of binge episodes

Question 10

ARFID

Answer 10

• failure to meet energy needs + weight loss/failure to meet weight gain goals + nutrient deficiency (reliant on supplements) + impairment
• food is available, they’re not consuming it
• not related to weight or shape concerns
• often seen in kids

Question 11

OSFED and USFED

Answer 11

• OSFED: subthreshold AN, BN, BED
• OSFED: atypical AN
• OSFED: purging disorder: purging without bingeing
• OSFED: night eating syndrome
• both OSFED and USFED associated with higher risk for later disorders
• 50% of treatment-seeking individuals are OSFED/USFED
• even at subclinical levels, disordered eating and compensatory behaviours can cause health and psychological problems

Question 12

ED diagnostic migration

Answer 12

• individuals meeting criteria for one disorder are very likely to move into another category
• AN restrictive becomes unsustainable moves into AN binge-purge, then gaining weight so they move into BN

Question 13

epidemiology of AN

Answer 13

• prevalence 0.7%
• 10 women: 1 man
• age of onset: adolescence
• mortality: 5.1% (health-related or suicides)

Question 14

epidemiology of BN

Answer 14

• prevalence 1-3%
• 10 women: 1 man
• onset late adolescence/early adulthood
• mortality 1.7%

Question 15

epidemiology of BED

Answer 15

• prevalence 2-5%
• 2 women: 1 man
• onset early-mid adulthood
• more research needed about mortality

Question 16

SWAG EDs

Answer 16

• skinny white affluent girls stereotype
• only 6% of ED population is underweight
• males account for 25% of ED population (gender disparity could be due to differing presentations and diagnostic bias)
• sexual, gender, ethnic minorities have high rates of EDs (multiracial and Indigenous have the highest rates)
• no relationship between high SES and EDs (but there is an association with food insecurity - malnourishment driving binge episodes)

Question 17

DDx EDs

Answer 17

• body dysmorphic disorder (there is a distorted sense of body in BDD, but not eating behaviours)
• obsessive-compulsive disorder (comorbidity is very common - compulsive ‘undoing’ behaviours)
• anxiety disorders (GAD, SAD)
• depression
• psychosis-spectrum disorders (what is the focus of the break with reality? just weight or broader?)
• effects of malnutrition: low mood, anhedonia, insomnia, preoccupation and rituals about food (which sx are due to the malnutrition)

Question 18

ED comorbidities

Answer 18

• mood, substance, personality, anxiety

Question 19

depression ED comorbidity

Answer 19

• AN: 25-50% concurrent depression, 50-70% lifetime history of depression
• BN: even higher than AN

Question 20

personality disorders ED comorbidity

Answer 20

• 50-70%
• AN-restrictive: cluster C PDs
• AN-binge/purge: cluster B and C
• BN: cluster B

Question 21

ED heritability

Answer 21

• AN, BN, BED around 50% heritability
• disordered eating symptoms = 50% heritability
• increased family risk (AN = 4x risk)
• 0% genetic contribution before puberty (Mz twins not more likely to be concordant = genes must interact with environment)
• 50% emerges after puberty (ovarian hormones interacting with genetic liability to produce heritability)
• we also see concordant changes in eating patterns over menstrual cycle - estradiol playing an important role

Question 22

ED gene-environment interaction

Answer 22

• short allele of 5-HTTLPR interacting with intrusive/critical/detached parenting OR with physical/sexual abuse to produce AN, BN symptoms and drive for thinness
• genetic vulnerability MUST interact with the environment

Question 23

socio-cultural factors EDs

Answer 23

• appearance ideals over time
• contributing to the thin-ideal internalization (degree to which someone buys into/is affected by the ideal that being thin is better + engages in bx to promote this ideal in ourselves)
• fat talk in self, family, peers
• weight stigma and bullying
• media

Question 24

eating disorders in boys

Answer 24

• gender disparities driven by diagnostic bias and varying presentations
• more muscle dysphoria in boys (focus on gaining the ‘right’ kind of muscle)
• more likely to exercise as a compensatory behaviour instead of purge (not healthy exercising)
• report less loss of control

Question 25

fat talk

Answer 25

- disparaging comments about body image and weight (eating and exercise habits, fear of gaining weight, appearance and behaviour comparisons, strategies to lose weight) - very common and casual - parental fat talk toward the self (75%): associated with parental psychopathology - parental fat talk toward the child (43%): associated with child psychopathology (binge/overeating, secretive eating, overweight)

Question 26

weight bullying/stigma

Answer 26

- teasing about weight, implying that weight is related to character (lazy, undisciplined) - being overweight = more frequent teasing from peers (also underweight more than 'normal' weight, but less than overweight) - widespread idea that it's ok to tease someone about weight because 'it's a deficit' - people teased by peers, at home, and especially both = more thoughts of suicide

Question 27

media EDs

Answer 27

- sense that the thin ideal is tied to media exposure - Fiji natural experiment - in 1995, no TVs and no EDs - in 1998 (after introduction of TV and magazines), 11.3% report purging behaviours and 74% report feeling 'too fat' - in 2007, 45% report purging behaviours - no random assignment, difficult to assume causality, but still a good temporal correlation

Question 28

dual pathway model to EDs

Answer 28

- sociocultural pathways + thin-ideal internalization = body dissatisfaction = negative affect + restrained eating = eating disorders - thin-ideal internalization is often the norm, you need the dissatisfaction + negative affect + restrained eating for it to become a disorder

Question 29

abstinence violation effect

Answer 29

- fuck it effect, also seen in SUDs - mentality that it's all or nothing, so if you have a lapse you might as well go all out - start diet and restrict calories = body rebels & feelings of hunger & desire high-calorie foods = eat 'forbidden foods' = overeat because you already broke the diet (binge and break your code) = guilt = restart the diet

Question 30

maintenance factors EDs

Answer 30

- perfectionism: fear of failure, high standards, self-criticism - omnipresent and unconditional low self-esteem (this is a treatment obstacle, difficult to go out of your way to feel good about yourself) - emotion regulation: high negative urgency (negative mood is intolerable, so you need to act) can trigger binges (also NSSI) - interpersonal difficulties: isolation (lots of socialization occurs around food, so if you have strict rituals about food, you're likely to isolate yourself further), negative interactions precede binges, especially when combined with negative urgency - these can also be risk factors, but once you're ill they help maintain illness

Question 31

psychotherapy

Answer 31

a process in which a professionally-trained therapist systematically uses techniques derived from psychological principles to relieve another person's psychological distress or promote growth

Question 32

major schools of psychotherapy

Answer 32

- psychodynamic - CBT - humanistic-experiential - integrative/eclectic

Question 33

RCTs

Answer 33

- establish efficacy, tells us whether a Tx has a beneficial effect - waitlist control ethics for people who are acutely ill - different therapists could give different 'doses' - patients are usually uncomplicated cases (not comorbid) - highly controlled treatments (formulaic, standardized which isn't what therapists do in the real world) - unclear about effectiveness/external validity

Question 34

empirically supported therapies

Answer 34

- specific psychological treatments that have been proven to be effective in controlled research for specific conditions - gold standard specific psychological treatments (should be meeting certain criteria to show their efficacy) - argument against: we should be relying on clinical judgment, experience - humans tend to make judgment errors with unconscious biases and memory biases, so having a structure helps you evaluate in a more systematic way

Question 35

evidence based practice

Answer 35

- integration of best available research and clinical expertise within the context of patient characteristics, culture, values, and treatment preferences - not strict reliance on one therapy, but integration (not just using EST, but also patient variables + clinical judgment + progress) - minimizing harm, using peer-reviewed research, respect of individuals, monitor client reactions and progress, willingness to alter tx plan

Question 36

three waves of behaviour therapy

Answer 36

- first: classic bx therapies (classical/operant conditioning, systematic desensitization - focus on bx not thoughts) - second: incorporation of cognitions (CBT) - third: new ideas and approaches (ACT, mindfulness-based cognitive therapy, DBT - variations of CBT that incorporate other elements)

Question 37

exposure therapy basic principles

Answer 37

- relying on behavioural principles (like first wave) - expose to fear stimulus, learn to habituate and develop new ways of thinking and behaving (to break the avoidance and negative reinforcement cycle) - anxiety must peak at some point - must learn that it cannot go one forever (have people reach their natural peak, then decrease = mastery over anxiety) - contingent on not performing safety behaviours

Question 38

exposure therapy types

Answer 38

- systematic desensitization: in vivo - imaginal if the patient cannot be exposed to the stimulus directly - flooding (starting with the thing you're most afraid of): not tolerated well, rarely used - graded exposure: build a hierarchy and move upward - interoceptive exposure: systematic exposure to feared bodily symptoms (panic disorder) - exposure and response prevention (OCD, can also be used for PTSD): exposure + refraining from compulsions that would relieve distress (operates according to pavlovian extinction) - for GAD: you should do imaginal exposure by writing a narrative of all the feared things then listen to it until you're bored - therapist does all the feared things with the client, they should never ask the patient to do something that they can't do - getting people to go to the extreme and do things no one would do = helps them feel in control of anxiety and behaviour - VR can be a helpful adjunct

Question 39

cognitive triangle

Answer 39

- part of the second wave (cognitions) - thoughts influence behaviour influence feelings ++ - the way we behave (staying inside) = our feelings = how we think about things (overestimation of probability of danger, treating thoughts as facts)

Question 40

cognitive distortions

Answer 40

- all or nothing (if i'm not perfect, i failed) - overgeneralization (drawing broad conclusions from single events) - mental filter (only paying attention to certain evidence) - discounting the positive - jumping to conclusions: mind reading and fortune telling - magnification (catastrophizing) and minimization - emotional reasoning: assuming that feeling in truth - should/must statements which increase guilt - labelling ('i'm a loser' 'they're an idiot') - personalization: blaming yourself for things that aren't your fault or blaming others for things that are your fault

Question 41

CBT thought record

Answer 41

- where were you: inciting event - how you were feeling in that situation, what thought you had (pulling apart thoughts and feelings) - negative automatic thought: train people to recognize these - evidence that supports or doesn't support the thought: questioning things that seem irrefutable in the moment (what else can you consider that isn't the fear you feeling that's making you think you're going to die) - generate an alternative thought, then re-evaluate your feelings - changing thoughts = changing feelings (cognitive triangle)

Question 42

depression Tx

Answer 42

- incorporating behavioural activation (adding positive reinforcement to your environment) and cognitive restructuring through thought records

Question 43

anxiety and OCD Tx

Answer 43

- cognitive re-structuring + exposure (in-vivo, imaginal, interoceptive, ERP)

Question 44

acceptance and commitment therapy

Answer 44

- third wave - instead of disputing thoughts, foster acceptance of unwanted thoughts and feelings (the more you struggle against them, the stronger they get until they structure your life) - stimulate action that improves circumstances of living (value clarification: what do you want to be guiding your life instead of fear/sadness/etc) - discourage experiential avoidance - encourage willingness to experience negative things - let go of struggle against them - index card fears - easier to focus on current task when you let them fall instead of trying to catch/pay attention to everything (help de-center from thoughts, just let them be there)

Question 45

Chambless criteria

Answer 45

- based on review of RCTs or equivalent - Strong/well-established: well-designed studies conducted by independent investigators converge to support a treatment’s efficacy (can also be carefully controlled single-case studies) - Modest/probably efficacious: one well-designed study or two or more adequately designed studies support a treatment’s efficacy (can also be single-case studies) - controversial: conflicting results or a treatment is efficacious but claims about why the treatment works are at odds with the research evidence

Question 46

Tolin criteria

Answer 46

- based on review of meta-analyses - very strong: treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings - strong: improves symptoms or functional outcomes; not a high risk of harm; reasonable use of resources - weak: low or very low-quality evidence for meaningful effects, gains from the treatment may not warrant resources involved - insufficient evidence: no meta-analytic study or not sufficient quality

Question 47

common factors theory

Answer 47

- different psychotherapeutic approaches in psychotherapy share common factors that account for a portion of the efficacy of a given treatment

Question 48

EBP with indigenous populations

Answer 48

- integrating culture-based EBP - wellness viewed as holistic (vs. EBP which focuses treatment on a target) - clinicians tend to ignore the problem altogether or overcorrect and assume EBP isn't applicable - collaborative goal-setting and management of outcomes (esp. with people who have culture-based knowledge)