Problem 7

Question 1

Anorexia nervosa

Answer 1

Refers to a condition where one starves the self + subsists on little or no food for very long periods

–> still thinking they have to lose more weight, thus developing elaborate rituals around food

Question 2

Name the requirements for a person to be diagnosed with Anorexia nervosa.

Answer 2

1. Refusing to maintain a body weight that is normal for age
2. Body weight is at least 15% below the minimum norm
   - -> <18.5 BMI
3. Fear of becoming fat; distorted image of the self
   - -> thus, e.g. engaging in excessive exercising

(4. Amenorrhea
- -> no menstruation ) - only DSM-4

Question 3

Restricting type of AN

Answer 3

Simply refusing to eat as a way of preventing weight gain

e.g.: not eating for days, eating very small amounts each day

Question 4

Binge/purge type of AN

Answer 4

Periodically engaging in bingeing or purging behaviors

e. g.: self-induced vomiting
- -> 50% of AN patients

Question 5

How is the binge/purge type of anorexia different to bulimia nervosa ?

Answer 5

1. People with anorexia are still underweight whereas bulimia patients usually have normal to overweight body weight
2. Women with anorexia usually have amenorrhea, bulimia patients do not

Question 6

Prevalence of anorexia nervosa ?

Comorbidity ?

Answer 6

1. a) 1-2% life time prevalence
   b) More caucasian women
   c) Begins in adolescence
   - -> 15-19 y/o
2. Depression
   b) OCD

Question 7

Anorexia nervosa has a death rate of 5-8%.

What are the most serious consequences of it ?

Answer 7

1. Heart failure
   - -> irregular or too slow heart beat
2. Expansion of the stomach to the point of rupturing
3. No bone strength
   - -> due to amenorrhea

Question 8

Bulimia nervosa

BN

Answer 8

Is a eating disorder characterized by uncontrolled eating/binging that is followed by behaviors designed to prevent weight gain from the binges (Compensation)

–> chronic

Question 9

Name the requirements for a person to be diagnosed with bulimia nervosa.

Answer 9

1. Binges occur over a discrete period of time
   - -> 1x/week for at least 3 months
2. Amount of food is larger than normal
3. Average binge of 3000-4,500 kcal
4. Lack of control
   - -> feeling compelled to eating even though not hungry
5. Self induced vomiting

Question 10

What is the main difference in people with anorexia vs bulimia ?

Answer 10

Their self-evaluations strongly differ

–> whereas people with anorexia might have a distorted body image, patients with bulimia have a rather realistic one

BUT: still both are unhappy with their body

Question 11

Purging type of BN

Answer 11

Involves the use of self induced vomiting or purging medications to control body weight

Question 12

Non-purging type of BN

Answer 12

Involves the use of excessive excise or fasting to control body weight

Question 13

Prevalence of BN ?

Answer 13

1. 0.5-3% life time prevalence
2. more women
3. More caucasian/westernized cultures
4. occurs in adolescence
   - -> 15-29 y/o

Question 14

Although bulimia nervosa doesn’t have a death rate as high as anorexia it does involve serious medical complications.

Name the most serious one.

Answer 14

Imbalances in the body electrolytes, which can lead to heart failure

–> result from fluid loss from the excessive vomiting

Question 15

Binge eating disorder

BED

Answer 15

Is a eating disorder that where the person can’t refrain from eating and is thus over weight

–> chronic

Question 16

Prevalence of BED ?

Comorbidity ?

Answer 16

1. a) More women
   b) No ethnic/racial differences

2.

a) Depression
b) Anxiety
c) personality disorders
d) alcohol abuse

Question 17

Eating disorder not otherwise specified/unspecified + otherwise specified (NOS + OS)

Answer 17

OS:
Individuals who have some severe symptoms of anorexia or bulimia nervosa but do not meet all criteria for either disorder will be classified as OS

NOS/Unspecified:
Having some symptoms of eating disorders but cant place it, meaning put a name on it

–> most common eating disorder

Question 18

Prevalence of NOS eating disorders

Answer 18

1. Culturally bound
   - -> wealthy developed countries, that value thinness
2. Increased in recent decades
   - -> increased availability of food
3. 5% life time prevalence

Question 19

Biological factors contributing to eating disorders

Answer 19

1. Eating disorders result from imbalances in the neuro-chemicals involved in the regulatory system of the hypothalamus (Serotonin)

–> causes individuals trouble to detect hunger vs stop eating when full

BUT: Abnormalities can also be the cause, as they sometimes disappear with weight gain

2. Genetics
   - -> heritability of 56% (AN) + 50-80% (BN)

Question 20

How does the hypothalamus regulate eating ?

Answer 20

By receiving messages about recent food consumption + sending message to cease eating when the nutritional needs are met

–> done by neurotransmitters (NE, SER, DOP) and hormones (INS, CORT)

Question 21

Social factors + cultural norms contributing to eating disorders ?

Answer 21

1. Cultural ideals that shift historically
   - -> reinforced via TV, magazines
2. Groups within a culture
   - -> athletes, models

Question 22

Eating disorder behavior may sometimes be maladaptive strategies to deal will painful emotions.

There are 2 main subtypes.
Name them.

Answer 22

1. Depressive subtype
   - -> suffer great social + psychological consequences
2. Dieting subtype
   - -> try to maintain diet but often fall of wagon to engage in binge eating

–> will become chronic

Question 23

Cognitive factors contributing to eating disorders

Fairburn

Answer 23

1. Overvaluation of ones appearance (Attention bias)
   - -> body shape is considered as the most important aspect of the self
2. Body dissatisfaction, perfectionism, low self esteem
3. Trying to conform to others wishes
4. Dichotomous thinking
   - -> things are either very good or very bad

Question 24

How can family dynamics contribute to the development of eating disorders ?

Answer 24

Over-invested + controlling parents, thus combination of

a) low parental warmth
b) high parental demands

–> will have daughters trying to please their parents, never accepting own feelings + desires

Question 25

Which forms of therapy has been proven to be most effective for Anorexia nervosa patients ?

Answer 25

1. CBT 2. Family therapy -->The main goal is to gain trust + maintain it

Question 26

Which forms of therapy have been proven to be most effective for bulimia nervosa ?

Answer 26

1. CBT - -> most effective 2. IPT 3. Supportive excessive psychodynamic therapy --> teaching the client to monitor cognitions that accompany eating + developing more adaptive attitudes towards weight + body ex.: including "forbidden" food into diet

Question 27

Which biological treatments are most effective for bulimia nervosa ?

Answer 27

Antidepressants --> namely SSRIs, which reduce binge eating + purging behaviors

Question 28

What are possible causes of the development of AN?

Answer 28

AN patients engage in a 1. Suppression mindset - -> inhibiting thoughts about food that elicit craving 2. Cognitive reappraisal mindset - -> immediately thinking about negative consequences about food => thus, these frequent exposures without eating will eventually extinguish appetite (Extinction)

Question 29

What are possible causes of the development of BED or BN?

Answer 29

Dieting, meaning the deliberate restriction of food intake e.g.: eating restraint causes overeating

Question 30

Does caloric restriction prolong life ?

Answer 30

Yes, there have been significant evidence that claims so --> mechanisms by which this occurs are similar across species BUT: specific nutrient-sensing pathways implicated in theses anti-aging effects are yet to be discovered

Question 31

There has been debate over the diagnostic instability of eating disorders. Is the assumption that the diagnoses change over time really true ?

Answer 31

Yes, It has been shown that there is considerable flux between the 3 specific eating disorder diagnoses (AN,BN,EDNOS) e.g.: patients who don't recover from AN will cross over to BN --> thus, they are best seen as a single entity, due to their commonalities

Question 32

Name the possible mechanisms by which dieting will increase the risk for BN or BED.

Answer 32

1. Unhealthy dieting behavior --> weight loss --> chronic hunger 2. Dieting depends on the reliance on cognitive controls, which might be disrupted (thus BED) 3. Dieting might result in depletion of tryptophan - -> binge eating to restore these levels

Question 33

CBT has been proven to be an effective treatment option of AN. However, there has been new evidence that dissecting the core fear of it will be even more effective. How can one go about this?

Answer 33

By engaging in 1. Inhibitory learning --> if food consumption its the core fear + weight gain the feared outcome then foods will have to be presented that don't result in weight gain 2. Weight maintenance diet, which will decrease bulimic symptoms

Question 34

``` Restraint theory (Nisbett) ```

Answer 34

Suggests that individual differences in relative deprivation (relative to set-point weight) produces corresponding eating behavior --> people have genetic/preconditioned set points

Question 35

Transdiagnostic Perspective

Answer 35

Suggests that eating disorders share the same distinctive psychopathology --> common mechanism, thus important to focus on symptoms 1. Perfectionism 2. Low self esteem 3. Mood intolerance 4. Interpersonal difficulties

Question 36

Experimental psychopathology | EPP

Answer 36

Refers to an efficient way to gain knowledge about the mechanisms of eating disorders --> found out that 1. Dieting follows binge eating not other way round 2. AN deactivates reward related brain areas - -> reduces appetite motivation 3. Treatment should involve conditioning to learn to associate body with positive social feedback

Question 37

Feeding disorder

Answer 37

1. PICA - -> eating things that are not edible 2. Rumination disorder - -> chewing on things for a longer period 3. Avoidant/restrictive food intake disorder - -> very picky eating, underweight but due to fear of food not fear of weight-gain => no weight/shape related problems

Question 38

Maintenance model

Answer 38

1. Overvaluation - -> control + body weight 2. Start of diet 3. a) Binge eating - -> leads to purging b) underweight - -> leads to starvation => more focused now on weight thus: 4. Overevaluation - -> Vicious cycle of defining yourself by how you evaluate the self

Question 39

Milkshake experiment

Answer 39

Gave people who were on a diet vs those without diet 0-3 milkshakes - -> those w/o diet that had no milkshake will eat more ice cream, but those who had milkshake will not - -> with diet still eat more ice cream, whether they had milkshake or not => Diet is the cause of binge eating