LECTURE 11 *dpp*

the inability to indentify, explain and analyse feelings

results in altered conumption/absortion of food

imparing physical health or. psyhosocial functioning

Anorexia nervosa

Bulimia nervosa

Binge Eatting disorder

strave themselves ( no food or little food intake)

convinved they need to lose more weight

body weight signifaicantly below minimally normal for their age

women often have amenorrhea ( no period)

DSM5 eliminated amenorrhea form requirments

highly distorted body image

imense fear of becoming fat

feel good and worthwhile only if they control their eating

develop elaborated eating rituals arounf food ( yogurt)

A. Restriction of energy intake relative to requirments , leading to significantly low body weigth in context

B. Intese fear of gaining weight or becoming fat , or persistant behaviour that interferes with weight gain, even thought at a significantly low weight

C. disturbance in the way which one weight or shape os experienced , undue influence of body weight or shape on self evaluation + persistant lacl of recognition of the seriouness of the current low body weight

restrictive type

bindge eating/purging

during last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour ( self induced vomiting or the misuse of laxatives , dieuritics or enemas) weight loss is accomplished primarly trough dieting facting and or excessive exercise

during last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour ( self induced vomiting or the misuse of laxatives , dieuritics or enemas)

simply refuses to eat

go for days without eating anyting oe wat small amounts

if they eat a bit it is due to pressure form others or to stay alive

migh exercise excessivly

bindge eating behaviour after purging

misuse of laxatives

continue to be substaniatlly below healthy body weight

binges are not in large amounts

even small amounts of food intake maske them want to purge

criterion A needs a significantly low body weight

BMI indicator lower then 17 kg/m^2

severity level not based on BMI tho

facts :

*lifetime prevelence 0.9 % adult women 0.3% adolscent women / man

*old DSM at least 15% below normal weight + amenorrhea

*4% prevelnece rate

*caucasians more likey then other nations ( accept the ideal promoted media)

*anorexia has increased substantially

*motivators vary across cultures

*usaully begins in adolescene or adulthood

*onest to remission → 7 years form women and 3 years for men

*10 to 15 years after onset, 70% patients do not longer qualify

*5 to 9 percent death rate

1. cardiovascular complications ( bradycardia)
2. arrhytmia
3. hear failure
4. acute expansions of stimach
5. stomach ruptures
6. kidey damages
7. impaired imune system
8. susiced normal rate x31

uncontrolled eating or binging followed by behaviours intended to prevent weiht gain from binges

mild : 1 to 3 episodes of innaproporiate compensatory behaviour per week

extreme forms ; averege of 14 or more episodes per week

no control over thier eating

feel lesser as they break the rules set by themselves

self induced vomiting

abuse of laxatives

diuretics

fasting

excessive exercise

self evaluations based ont heir body shape and weight

"good perosn" if they are thin

do not show gross distortions in their body

(anorexia → seese themselves obsese in the mirror , here not )

somewhat realistic peroception of body

constnatly dissatisfied with shape and weight

concerned about losing weight

often discorvered by family , roomates and fronds

caught when vomiting or leave a mess

dentists recognise as well due to rotten teeth as exposed to stomach acid

A. reccurent episodes of binge eating characterized by :

1. eating in a discrete period of time ( withing 2 hours ) , an amout of food that is definetly larger than most people whould eat during similar period
2. a sense of lack of control over eationg during the episode

B. reccurent compensatory behaviours in order to prevent weight gain ( self induced vomiting , misuse of laxatives, diuretics , facting , excessive exercise )

C. the binge eating and inappropriate compensatory behaviours both occur on avaerege at least one per week for 3 months

D. self evalutions undurly infunced by body shape and weight

0.5 % adults

0.9 % in adolescents

more common in females then in males

2.6% lifetime orevelence among women

men are more likely to exercise excesivly then women

men want to become lean muscular rather then thin

mor ecommon in causasians and hispanic americans than africn american

prevence increased significanlty in the second half of the terntieh century

*mostly in adolescence

*lower death rate than anorexia

electrolyte imbalance ( fluid loss following excessive and chronic vomiting )

heart failure due to electrolye imbalance

suicide rate 7.5 time higher than genral population

chronic condition

binde eat troughout the day

large amounts of food

often in response to stress and anxiety

may eat very rapidly and appear almost in a adaze as they eat

often signifinatly oevrweight

disgusted and ashamed of their body

hitory of dieting , membership in weight control programs and family obesity

30% People in weight loss programs have binge eating disorder

2 to 3.5 % in USA

somewhat lower in other countries

more common in women than men

no ethinc differencies

higher rates if derpression and anxiety and alohol abuse

mean duration of 8 / 14 years

A. reccurent episodes of binge eating characterized by :

1. eating in a discrete period of time ( withing 2 hours ) , an amout of food that is definetly larger than most people whould eat during similar period
2. a sense of lack of control over eationg during the episode

B. binge erating episodes associated with three or mor of the following

B. binge erating episodes associated with three or mor of the following
eating much more rapidly than normal
eating until feeling uncmfortably full
eating lareg amonts of food when not feeling hisically hungry
eating alone because of feeling emarased
feeling disgusted with self depressed and guilty

C. marked distress regarding binge eating is present

1. partial syndorme eating disorder
2. atypical anorexia nervosa
3. bulimia nervosa of low frequncy and or limited duration
4. night eating disorder
5. pica
6. rumiantion disorder
7. avoidant / restrictive food intake disorder

dont meet full criteria for anorexia nevosa or bunlimia nervosa

may binge a couple of times a month but not every week

tend to be highly concerned with their weight and judge themselves

majority of girls

both adolescents and adults in their 20s

include anxity disorder , substance abuse, attempt sucide

lower self esteem , porer social relationships , poorer physical health, lower levels of life satisfaction

all criteria of anorexia besides significant weight loss

weight is normal

meet all criteria for bulimia nervos except that binge eating and innapropriate cimpensatoy behaviour occur on averege less than one a week and or for less tha 3 months

excessive eating after dinner or during night

frequnt insomia

need to eat to fall asleep

skip breakfast

often overweith and suffer from depression

persistant eating of non food during 1 month

inappororiate to indiviudall's develoomental level

not part of culturally suported socially normative practice

comorbidity : autism , schizpohrenia , medical condition , intelectual diasbility

repeated regurgitation of food more then one month

not attributet to gastrointestinal or other medical condition

not part of ant oyhrt eating diorder

comorbidity : autism , schizpohrenia , medical condition , intelectual diasbility

eating disorder, aversionm avoidance, cocnern aabout consequnces

persistent failure to meet nutritional or energy needs , puls

significant weight loss

sign nutritional deficincy

dependence on enternal feeding or nutritional supliments

interference with normal psychisocial functioning

not better explained by lack of availability

not related to DSM

common among people with binge eating diorder

gratest public health concern internationally

BMI more than 30

40 % adults and 19 % children

health risks such as : coronary diesese , hypertension , storkes , type 2 diebeties

lower quality of life

gene correlations

*56% norexia nervosa

*41 binge aeatingdisoarder

general risk for eating disorder rather than specific risk for one type of eating disorder

interact with biological changes of puberty to contribute to onset in gitls but not boys

puberty may switch 'on' a genetic risk

central rol ein regulating eating

recieves the messeges about consumption

masseges to hypothalamus are caried by multiple neurotranmitters (neopinephrine ,serotonin, dopamine ,hormones ( cortisol , insulin )

anorexia → lowered functioning of the hypothalmanus + hormone abnormalities

weter it is a cause or consequnce is not clear

bulimia → abnormalities in serotonine levels

low serotonine might crave carbohydrates

binde eating of carbohydrates

vomit as carbohidrates are knows to put on weight

ideal standard of beauty is thin

thinnes is valude more in women → big gender difference

men "should " be muscular not neccerly thin

standards → body satisfaction → disorder

the more exposure to media the more pressure on individuals

specific sports that require a certain presence incourage the pressure of thinnes

in adolescece a lot of girls reported that they felt like they will fail only due to how they look

social pressure + low self esteem + perfectionism

more concerned with the opinions of others

dichatemous thhinking ( good or bad )

organise inofrmmation about the world based on weight

people who expirince depressive syprtoms are more likely to develop eating disorders

dieting subtype or depressive subtype

insecure attachemnt →deficit in the self autonomy

they develop eating as a response of insecure attachement

way of reducing and avoiding negative affect

vicious cicle of eating and negative

negative emotions → binge eating → guilk, shame , body dissatisfaction → dieting → depression / negative affect

difficult as patients value their thinness they acieved

resistent to therapy

sometimes hospitalisd and forecd feed if thier lif eis in danger

usually not come in the attention of the therapist until malnourished/ medical crisis

therapy incovers the psychological issues causing her to starve herself

many setbacks and periods of recovery ( non liniar)

CBT most reserched tratment for anorexia nervosa

family treated as a unit

initially coached to take contril of their children's eating until stable

10 to 20 seesions 6 to 12 months

monitir cognitions

particularly binge episodes and purging episodes

therapist helps client confront these coginitions + find maladaptive ones

introduce forbidden foods

confront irrational thoughts about these foods

eat three healty meals a day

10 to 20 sessions 3 to 6 months

*half of the clients completly stop the binge purge cycle

*more effective than drug therap

interpersonal prblems

relate to child eating diosrder

talk about the problems related to the eating disorder


highly nondirective manner

taught how to monitor food intake.

reinforce introducing avoided foods
taught coping techiques for avoiding binges

1. SSRI
2. antipsychotics
3. antidepressants

selctive serotonine reuptake inhibitors

fluxonetine ( Prozac)

reduce binge eating and purging behaviours

fail to restore individual to nomral eating habits

Antidepressants

reduction of symtoms in half studies condcuted

Antipsychotic

olanzepine

increase in weight in anorexia