1. Describe the symptoms and diagnosis of Anorexia and Bulimia nervosa 2. What is the required

1. Describe the symptoms and diagnosis of Anorexia and Bulimia nervosa

2. What is the required for diagnosis of Anorexia and Bulimia nervosa to be made

3. Describe either the cognitive or the family relationships explanation of Anorexia and Bulimia nervosa

4. Give one strength and one weakness of your chosen explanation of Anorexia and Bulimia nervosa

5. Link one piece of research to a psychological explanation of depression of your choice. Ensure that you state which psychological explanation this is supporting (this could be additional information)

6. Using your psychological knowledge evaluate this piece of research

7. What is the diathesis stress model of Anorexia and Bulimia nervosa? (Eating disorder)

8. Outline and evaluate one or more biological explanation/s Anorexia and Bulimia nervosa include your own information here

9. Explain one strength and one weakness of the other biological explanation of Anorexia and Bulimia nervosa

10. Outline and evaluate one psychological explanation Anorexia and Bulimia nervosa include your own information here

11. Outline one piece of research from a different biological explanation of Anorexia and Bulimia nervosa (eating disorder) ensure that you state which psychological explanation this is supporting (this could be additional information)

ADDITIONAL QUESTIONS

1. Diagnostic criteria & symptoms of Anorexia Bulimia nervosa

2. What biological model – assumption, implications, evaluation

3. List 2 biological explanations (eating disorders) + evaluation

4. 1 treatment (for eating disorders + evaluation)

Treating eating disorders

Medication: anti-depressant, anti-anxiety & anti-psychotic drugs

Individual, group or family therapy

Nutritional rehabilitation & weight restoration

The Maudsley Approach

Serotonin

Serotonin is a neurotransmitter that carry messages from cell to cell in the brain and nervous system; they are released from a cell and travel across a cellular space, synapse, and attach to another cell’s receptors

Serotonin can affect sleep, eating, memory, and mood and is implicated in binge eating in bulimia and restricted eating in anorexia

Anti-depressant drugs

Selective serotonin reuptake inhibitors (SSRIs)

After carrying a message, serotonin is usually reabsorbed by the nerve cells – reuptake

SSRI’s work by blocking “inhibiting” reuptake, so that more serotonin is available to pass further messages to other nerve cells

Resultant rise in serotonin levels should work to help improve mood and enable patient to engage/respond to other treatments, eg CBT

Effectiveness of SSRIs

May take several weeks to effect change

Have been seen to be effective in elevating mood

Targets physical symptoms & are easy to administer

Can have side effects, including increasing anxiety, feeling sick or dizzy, and reducing sex drive

Does not address other cognitive or behavioural issues

Nutritional rehabilitation

May be primary goal (especially in severe weight loss cases); needs to be individualised

Professional, qualified nutritionist or dietitian is used to help return weight to normal range

Focus is on retraining diet, recognising hunger cues, setting realistic & healthy goals for exercise, healthy eating and meal planning

Used to help challenge and change the distorted thinking about food and weight

Individual psychotherapy

Addresses how/why disorder developed

Techniques used can include CBT – patient is taught to rectify faulty thinking, increase self-esteem & body image, deal with emotions

Monitoring sheets used for tracking thoughts & behaviours; diaries kept

Therapist works with patient to identify faulty thinking/irrationality

CBT – anorexia

Patient needs to examine and challenge their rigid, self-imposed expectations & perfectionism

Helped to set more realistic goals & reduce importance of weight/body image

The goal is to increase self-esteem & teach methods of self-monitoring, including “black & white thinking”

CBT – bulimia

The patient is taught to focus on themselves rather than external standards

Positive self-talk techniques learned – used as a means of thought distraction & escape from obsessions

Challenges the benefits of binge/purge cycle, and adopts more realistic view of health implications

Replaces binging with other more adaptive reinforcers, and uses chart/journal method to identify, challenge & change negative, destructive thinking that precedes binges

Group therapy

Found to be more successful with bulimics than anorexics, who are generally more competitive & distrustful

Mixed groups more successful for anorexics, who can favourably compare themselves to normal-weight bulimics

Can offer insight, support, increased empathy, sharing good practice & friendships

Family therapy

Addresses the impact of the ED on family members, as well as identifying interpersonal conflicts

Teaches family members how to respond without over-protectiveness, enmeshment & taking control from the patient

Can help members of a family develop sense of own identity, coping strategies etc

Family-based treatment of adolescent anorexia nervosa: the Maudsley Approach

Designed to prevent hospitalisation by assisting parents to help/support recovery & return to normal adolescent development through in-depth discussion

Intensive outpatient treatment – parents play active role in helping to restore weight to normal levels

Hand control over eating back to adolescent

Conducted over 15-20 sessions over 12 months

Phase 1: weight restoration

Focus is on dangers of malnutrition

Identifying family’s typical interaction pattern & eating habits

Assisting parents in re-feeding adolescent

Includes family meals, in which therapist can observe the interactions & help parents to encourage child to eat more than they were prepared to

Therapist also encourages realignment with siblings & ensures that parents are not critical of child

Phase 2: returning control over eating to adolescent

Therapist advises the parents to accept that the main issue is to return child to good physical health

Encourages parents to ensure this is done in a way that is in keeping with child’s age

Can be the time to discuss & explore issues that previously were too emotionally distressing

Phase 3: establishing healthy adolescent identity

Initiated when patient is able to maintain weight above 95% of ideal weight on their own

Focuses on impact that AN has had & explores central issues of adolescence

Increases personal autonomy, develops appropriate parental boundaries, as well as dealing with issues relating to child moving away

Evaluation of The Maudsley Approach

Trial studies have shown that approx two thirds of adolescent AN patients are recovered at the end of FBT

75-90% fully weight recovered at 5 yr follow-up

Improved psychological factors seen

Has been effective in preventing hospitalisation & assisting in recovery when parents are used as a resource & able to play an active role in treatment

Anorexia nervosa

Means “nervous loss of appetite”
People with anorexia often report normal appetite & experience intense hunger
Has cognitive, emotional, behavioural & physical symptoms & consequences

Prevalence

90% of reported cases are female
Onset between 13 – 18 yrs (adolescence)
APA (1994) anorexia occurs in 0.5 – 1% of female population
In UK it affects around 1% of schoolgirls/university students (Gelder et al 1998)
In UK around 5 – 10% of all sufferers are male

Outcomes

Course & outcomes are variable:

Approx 20% have one single episode with full recovery
Approx 60% have episodic pattern of weight gain & relapse over years
20% severely affected & require hospitalisation – mortality rate of those admitted to hospital is approx 10% with death due to starvation, suicide or organ failure

Clinical characteristics of anorexia nervosa

Body weight less than 85% of expected weight for height/age
Food intake restricted to 600 – 800 calories per day
Intense fear of becoming fat – avoidance of “fatty foods”
Amenorrhoea (3 or more cycles) – in 40% of cases this occurs prior to obvious weight loss

Ritualistic eating behaviour (eg, food cut up into small pieces)
Preoccupation with food – obsessive tendencies
Distorted body image – people with anorexia perceive themselves to be “fat”
Mood disturbances – anxiety, depression, mood swings, irritability
Denial – often the sufferers denies the severity of their condition

Physical effects of anorexia

Hair & nails get thin & brittle
Hormones fluctuate leading to amenorrhoea, difficulty in conceiving
Kidney stones & possible failure
Low heart rate/blood pressure, palpitations, heart failure
Weak muscles, osteoporosis, fractures
Biochemical imbalances, confusion, mood instability

Bulimia Nervosa – prevalence

Distinct from anorexia only since 1979
Diagnosed in around 1 – 2% of women
Onset between 16 – 40 yrs (common in 20’s) (Gelder et al, 1998)
90% of all sufferers are female – uncommon in males
Sufferers tend to be within 10% of normal weight

Outcomes

Some evidence that people with bulimia more likely to engage in self-destructive & anti-social behaviours (drug/alcohol abuse, self-harm, shoplifting) than anorexia sufferers
Less likely to die from starvation – but purging can have physical consequences
More common in UK than anorexia

Clinical characteristics of bulimia

Normal body weight (within 10% but fluctuates)
Numerous, recurrent episodes of uncontrollable overeating (binges) – often precipitated by stress & followed by guilt, disgust
Frequency – binges occur on average twice a week for at least 3 months

Compensatory behaviour includes purging (self-induced vomiting, use of laxatives, emetics, diuretics, enemas) or non-purging type involving fasting & excessive exercise
Distorted body image; overemphasis on body image for self-esteem
Mood disturbances include depression & suicidal tendencies/despair
Less likely to deny problem than people with anorexia

Physical effects of purging

Increased risk of urinary infections
Kidney disease
Tendency to develop epileptic fits
Erosion of enamel on teeth

Similarities

Distorted (& idealised) body image & weight perception
Overemphasis on importance of body weight/shape for self-esteem
Preoccupation with food – obsessive tendencies & food related anxieties
Fear of weight gain
Both considered dysfunctional (abnormal) eating behaviours; more common in females than males

Differences

Weight: anorexia < 85% bulimia within 10% normal range
Anorexia sufferers more likely to severely restrict intake (as little as 100 calories per day)
Bulimia sufferers can ingest 2000 – 10,000 calories in single, 2 hr binging episode
Onset at different ages – anorexia during adolescence, bulimia during early 20’s

Anorexiabluimia (Garner, 1986)

Overlap seen in sufferers who show characteristics of both disorders
30 – 50% of people with anorexia binge-purge; bulimics may fast
Some sufferers move between the two disorders
However, some forms entirely distinct eg, restrictive anorexia vs obese bulimia

Jennifer Iyoha

Anorexia and Bulimia nervosa questions