Eating Disorders

Question 1

The main feature distinguishing bulimia nervosa from anorexia nervosa is?

Answer 1

Normal or higher-than-normal body weight.

Question 2

Which of the following causal factors appears to be required for a patient to develop an eating disorder?

Answer 2

Exposure to sociocultural pressures to be thin

Question 3

What are the criteria for anorexia nervosa?

Answer 3

• Restriction of energy intake, leading to a significantly low body weight.
• Intense fear of gaining weight or becoming fat
• Body-image disturbance

Question 4

What are the subtypes of anorexia nervosa?

Answer 4

• Restricting Type

- Binge- Eating/Purging Type

Question 5

What are the BMI cut offs for mild, moderate, severe, and extreme Anorexia Nervosa?

Answer 5

Mild: BMI ≥ 17
Moderate: BMI 16-16.99
Severe: BMI 15-15.99
Extreme: BMI < 15

*Severity can be modified based on symptoms, functional disability, and need for supervision

Question 6

What is the prevalence of anorexia nervosa?

Answer 6

• 0.4% for full disorder

- 90% women

Question 7

Describe the course of anorexia nervosa.

Answer 7

• Full recovery is very rare.
• <50% of all women treated for AN eventually maintain a near-normal body weight.
• About ¼ of treated patients do not recover.
• Mortality rate for Anorexia Nervosa is higher than for any other mental disorder except heroin dependence.
• Suicide risk for Anorexia Nervosa is higher than for any other mental disorder.

Question 8

What is the inpatient treatment for anorexia nervosa?

Answer 8

Inpatient treatment typically focuses on weight gain.

* No psychological or drug treatment is known to be effective in treating anorexia over the long term.

Question 9

What are the differences between treated and untreated individuals?

Answer 9

Treated and untreated individuals experience similar outcomes.
* i.e. little difference

Question 10

What are promising treatments for anorexia nervosa?

Answer 10

Family Therapy (for adolescents)
Acceptance and Commitment Therapy (for adults)

Question 11

What are the criteria for bulimia nervosa (a new disorder ~1960s)?

Answer 11

• Recurrent episodes of binge-eating
  
  • Eating a definitely large amount of food in a discrete period of time.
• A sense of loss of control.
• Recurrent inappropriate compensatory behavior to prevent weight gain.
• Both behaviors occur at least 2x/week for 3 months.
• Self-evaluation is unduly influenced by body shape and weight.
• Disturbance is not exclusively during episodes of AN.

Question 12

What are the criteria for mild, moderate, severe, and extreme bulimia?

Answer 12

Mild: 1-3 episodes of compensatory behavior/week
Moderate: 4-7 episodes
Severe: 8-13 episodes
Extreme: 14 or more episodes
Severity can be modified based on symptoms/disability.

Question 13

What is the prevalence of bulimia nervosa?

Answer 13

• 1-3%

- 90% women

Question 14

What is the treatment for bulimia nervosa?

Answer 14

• Cognitive-Behavioral Therapy
• Interpersonal Psychotherapy (IPT)
• Fluoxetine 60 mg/day is also effective for BN
• Both effective in treating BN.

Question 15

What are the criteria for binge eating disorder?

Answer 15

• Recurrent episodes of binge eating
• Associated with at least 3 of the following:
  
  • Eating more rapidly than normal
  • Until feeling uncomfortably full
  • Eating large amounts of food when not hungry
  • Eating alone because of embarrassment
  • Feeling disgusted, depressed, or very guilty afterwards
• Marked distress about binge eating
• At least once/week for 3 months
• No recurrent compensatory behaviors, not exclusively during AN or BN.

Question 16

How is binge eating disorder different from other eating disorders?

Answer 16

• Less emphasis on body dissatisfaction.
• More even sex ratio. (2:1 women to men)
• NOT synonymous with obesity

Question 17

What is an “Other Specified Feeding or Eating Disorder”?

Answer 17

Includes specific subthreshold instances of other the disorders

Question 18

What is an “Unspecified Feeding or Eating Disorder”?

Answer 18

• Inadequate information to make another diagnosis.

- Problematic eating that doesn’t meet criteria for the other diagnoses

Question 19

What is the relationship between obesity and mental disorders?

Answer 19

Obesity is not a mental disorder.

* Most obese people do not eat differently than normal weight people.

Question 20

What is the problem with long term obesity treatment?

Answer 20

All treatments for obesity (except bariatric surgery) have poor long-term efficacy.

Question 21

What are the health benefits of weight loss?

Answer 21

• Health benefits of weight loss, if any, are modest and inconsistent.
• Weight loss does not consistently improve health outcomes.
• Weight cycling (yo-yo dieting) worsens health outcomes.