eating disorders 2 Flashcards

Bulimia nervosa
Terms Definitions
Types of bulimia
purgingnon-purging
Ghrelin
Stimulates feedingProduced in stomach and hypothalamusIncreased levels with:Weight lossReduced caloric intakeStimulates reward pathway in VTA
types of anorexia
restricting binge-eating/purging type
homeostasis
tendency towards stability in the body, a balanced steady state
non-purging type
fasting or excessive exerciseless common
Bruch explanation of eating disorders contain several ___________ features
cognitive
diet
an eating plan which restricts caloric intake
anorexia criteria
refuse to maintain normal body weightweight<85% normalintense fear of gaining weight--not reduced by weight lossamenorheadistorted sense of body shape
Body Image
Must accept body shape, identity positive traits in self, enjoy life and be aware of own weight prejudices.
Physical complaints of someone with an eating disorder:
Fatigue
excessive cold
dizziness/fainting
constipation
fullness/bloating
headaches
dry skin and hair
loss of menstruation
Food/lactose intolerance
Oceanic Feeling
the belief that everything is an extension of self, no difference btwn who you are and the world around you
Medication used to treat Anorexia Nervosa
1)Antidepressant medication (SSRIs=Prozac to reduse the occurance of rlapse)2)Atypical antipsychotics (zyprexa=to improve mood and decrease obsessional behavior)
The most popular weight-restoration technique has been a combination of:
Supportive nursing care
Nutritional counseling
A relatively high-calorie diet
Characteristics of anorexia nervosa
Refusal to maintain normal body weight Intense fear of gaining weight Disturbance in the way one’s body weight or shape is experiencedAmenorrhea
associated features of bulimia
self-esteem and daily routine centered on weight, diet, appearancevery sensitive to comments abt weight/appearanceoften comorbid w/ depression (before or after)can be comorbid w/ anxiety, pd (esp bpd) and substance abuse
DDx for Eating Disorders (4)
Schizophrenia - strange thoughts about food, paranoia
 
MDD
 
OCD - ritualistic eating behaviors
 
Medical disorders:  Kleine-Levin or Kluver-Bucy syndromes = binge eating-associated neurological disorders, differenbt from bulimia
When to hospitalize for EDs...
Trend toward fewer and shorter hospitalizationsInsurance driven vs data drivenMedical vs psychiatric issuesGeneralizability of treatmentEgo-syntonic nature of anorexia
Anorexic persons with metabolic and electrolyte imbalances are at risk of?
Heart failure or circulatory collapse
cognitive and physiological model of eating disorders
inheritied set point that regulates weight and metabolismdistorted beliefs about body shapefaulty beliefs about weight regulation
People with anorexia nervosa may also present these psychological problems
Depression, anxiety, low self-esteem, insomnia, substance abuse, OCD, including exercising compulsively
Overall Aims of Treatment for AN
Weight gain of .5 to 2lbs per weekRestoration of normal weightRestoration of normal menstruation
Physical signs that are a result of poor nutrition in people with anorexia nervosa include:
skin that is rough, dry, and cracked. Brittle nails.
Cold hands and feet that may have a bluish color.
loss of hair from scalp, and lanugo on trunk, extremities, and face
Affect Regulation
regulation of emotions,
prevelance
anorexia: .5- 1%bulimia: 1-3%all: 4-10%
Differential Diagnosis for Anorexia (what else could it be? 7 things)
Cancer
IBD
TB
Addison's disease
HIV
thyroid disease
diabetes
anorexia
refusal to maintain normal body weightsevere volunatry restriction of food intake resulting from : fear or weight gain and disturbed body image
S&S of Bulimia Nervosa
-dental caries(vomiting)-parotid swelling(increased serum amylade levels)-gastric dilation, rupture (binge eating)-scars on hand=Russell's sign (self indused vomiting) hypokalemia,hyponatremia,elec imbalance(induced vomiting,laxative)
Cognitive Behavioral Therapy for Bulimia Nervosa
Self monitoring/assessmentStructured meal planCoping skills for managing distressing emotionsSubstitute healthier behaviorsWork on identifying and altering cognitive distortions
Amygdala
-structure in brain that deals with rage/anger
onset of builimia and anorexia
late adolescence/early adulthoodhormone changesautonomy strugglessexuality problemsrxns to normal changes in weight/shape
_______ ________ fail to attend accurately to their children's biological and emotional needs.
Ineffective parents
Familial Factors in development of an ED
Family EnvironmentTrauma
bulimia teratment outcome
50% recover20% still meetCBT reduces binge/purgingcomorbid psych disorders get better toomore effective than for anorexia
Co morbidity:
- with anorexia; Cluster C d/o= avoidant and OCD -with bulimia; Cluster B and C d/o= borderline and avoidant.-Hx of sexual abuse is more common-may be related to depression
Family Environment Factors in AN
Limited Ability to Tolerate Psychological Tension or Disharmony Emphasis on Propriety and Rule-MindednessOverdirection of Child/Discouragement of AutonomyPoor Conflict Resolution Skills
Object constancy
When a baby realizes that objects are permanent and still exist even if not in plain view (e.g. mom will come back)
Eating Disorder Causes (Genetic)
Personality and biological traits that govern hormones, hunger and satiety lead to eating disorders.
Risk Factors for ED
Age 13-18Female (although # of males increasing)Obesity Avoidance/Fear of Gaining WeightEarly Puberty and MaturationRestrained EatingUnhealthy Weight Control MeasuresDifficulty Identifying and Expressing EmotionsHistory of DepressionNeed for PerfectionLow Self-EsteemLack of Adequate Coping SkillsAlcohol/Substance AbuseSexual or Physical Abuse HistoryEarly Dating/Confusion about Appropriate BehaviorIll Health or Early Pregnancy
lack of conflict resolution
avoid conflict or are in chronic conflictbulimia
Binge Eating Disorder
Binge eating at least 2 days a week for 6 months
 
Not associated w/ any of the regular compensatory behaviors (purging, fasting, exercise) of AN or BN
 
 
Eating Disorders Not Otherwise Specified (EDNOS)
Most eating disorders are grouped as EDNOS and include diseases not specifically named. This includes disorders that contain elements of anorexia and bulimia or that do not meet the weight range requirement for anorexia or the binging restriction of bulimia.
3 Layers of an Eating Disorder
1) deficits in self concept2) body image disturbances3) eating and biologic symptoms/disturbances
After forced vomiting, how many calories have ben absorbed?
About half of the calories have been absorbed.
factors: personality
neurtoticismemotionally reservedprefer orderliness, predictabilityperfectionistic
factors: cognitive
dichotomous thinkingobsession with physical appearancenegative body image
Medical Complications of Bulimia
 
HypO-calcemia, -chloremia, -kalemia
 
Metabolic alkalosis (if vomiting) or acidosis (if using laxatives)
 
Electrolyte disturbances
Serum transaminases elevated
Parotid gland enlargement, elevated amylase
 
esophageal tears (rare but serious)
anorexia subtypes
restricting type and binge eating/purging type
S&S of Anorexia Nervosa
-low weight(caloric restriction)-yellow skin(hypercarotenemia)-cold extremities(starvation)-peripheral edema (hypoalbuminemia)-low BP,P, and temp (electrolyte imbalance)-abnormal lab values (low thyroxine levels)-constipation-amenorrhea-lanugo
Leptin
Produced in fat cells In direct proportion to the amount of stored energyProvides feedback to hypothalamic appetite centersRegulates body weightPromotes satietyDecreases appetiteDecreases the synthesis of fatIncreases the body's ability to burn fatObese peopleA surplus of leptin, but unresponsive to effects
Object relations
development of relations with the objects and people around you (psychodynamic theory of development: 3 months)
AA vs Caucasion
less body dissatisfactionfewer weight concernsmore positive self-imageperceivve selves thinnger than they aregap is narrowing
______ _______ accurately respond to their children's biological and emotional needs
Effective parents
Treating Anorexia: An Evolution
The early years: Psychoanalytic models, separation of child and familyThe middle years: long hospitalizations, family systems modelsCurrently: Maudsley model, working collaboratively with families
Bigorexia
Disorder that is most common with male body builders that leads to an obsession with bodily development. Often results in the use of drugs to maximize gains.
True or false: those with bulimia are more concerned with pleasing others, being attractive, and having intimate relationships.
TRUE
Trauma etiological factors in ED
Includes Family, Authority Figures, Peers, StrangersPsychological Growth DelaySexual Abuse and Body-HateEmotional Abuse Most Clearly Influences Eating Behaviors/Pathology (Kent et al., 1999)
Body Dissatisfaction Disorder
a scale measuring the difference btwn perceived body image and desired body image. Used to determine risk for developing AN. (Basically,what you think you look like and what you want to look like)
Bulimia Nervosa Symptoms
Obviously there is tooth decay and mouth sores. Less obviously there is semi-starvation followed by binges where the binge may be more than 3500 calories in less than 2 hours that is followed by guilt that leads to purging or fasting. Over time results in inflammation, broken blood vessels from vomiting, electrolyte imbalance and menstrual irregularities.
Biogenetic Factors in AN
Increased Risk of AN in 1rst Biological Degree RelativesMay Have Increased Levels of Serotonin and May Diet in an Attempt to Decrease Anxiety, Obsessiveness and Perfectionism Starving enduces Endorphins/Cortisol
An eating disorder that is seen in men and is considered reverse anorexia nervosa
muscle dysmorphobia
Family Environment Factors in BN
Substance Abuse (Parents use to deal with problems)Obesity and/or MigrainesAffective Disorders (Depression etc.)
example of Overgeneralization
"He didn't ask me out. Ith must be because i'm fat." "I was happy when wore asize 6. i must get back to that weight."
binge eating disorder and difference between bulimia non purging
binge eating disorder has binge eating with no compensatory behavior. not even fasting or excersing like bulimia non purging
example of emotional reasoning
" i know i am fat because i feel fat." "When i am thin, i feel powerful
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