Full Test Bank Eating Disorders Summerfield Chapter 3

Chapter 3

Eating Disorders

Learning Objectives

Upon successful completion of this chapter, students should be able to:

1. Distinguish between “normal” and disordered eating.
2. Characterize anorexia nervosa, bulimia nervosa, binge eating disorder, pica, nocturnal eating disorders, muscle dysmorphia, and gourmand syndrome.
3. Describe cardiovascular, digestive, endocrine, and musculoskeletal comorbidities associated with eating disorders.
4. Outline the various theories that propose predisposing factors explaining the development of eating disorders.
5. Discuss the treatment options available for persons with eating disorders, and comment on the prognosis for recovery.
6. Apply the public health concepts of primary and secondary prevention to the prevention of eating disorders.

Chapter Outline/Summary

I. Introduction to eating disorders

A. Characteristics of eating disorders:

Diagnostic criteria for eating disorders are published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Eating disorders may be characterized by restrained eating, binge eating, and inappropriate compensatory behaviors.

B. What is “normal” eating:

Many different eating patterns constitute “normal” eating behavior.

C. Anorexia nervosa:

Characterized by significant weight loss, intense fear of becoming fat, distorted body image, and, sometimes, amenorrhea. Affects 2-4% of the population, typically between ages 15-19 years.

D. Bulimia nervosa:

Characterized by repeated episodes of binge eating and inappropriate compensatory behaviors (vomiting, laxative abuse, excessive exercise). Affects 1-3% of the population, most of whom are female.

E. Binge-eating disorder:

Characterized by consumption of large amounts of food in a short period of time, feeling out of control while eating, and guilt, shame and depression after eating. Affects 4-7% of the population.

F. Other types of disordered eating:

Other, less well-known, eating disorders which have medical consequences may cause significant disruption in affected people’s lives. These include pica, nocturnal eating, muscle dysmorphia, and gourmand syndrome.

II. Comorbidities of eating disorders

1. Effects on the cardiovascular system:

The most common cardiovascular complications of eating disorders are slowed heart rate (bradycardia), cardiac myopathy, fluid and electrolyte imbalances, hypertension or hypotension, iron deficiency anemia, and dyslipidemia.

1. Effects on the digestive tract and kidneys:

Most commonly affected are the teeth and gums, esophagus, and gallbladder. Rarely, stomach dilation and kidney damage may occur.

1. Effects on the endocrine system:

Amenorrhea, sexual dysfunction, reduction in thyroid hormones, and glucose intolerance may occur. Type 1 diabetics who have an eating disorder may experience severe complications.

1. Effects on the skeletal system:

Reduced bone formation may lead to osteopenia and osteoporosis, particularly in anorexia nervosa. Stunted growth and skeletal myopathy are also possible complications.

III. Predisposing factors for eating disorders

1. Psychological profile:

Depression, anxiety, impulse control problems, obsessive-compulsive disorder, phobias, and body image distortion are among psychological conditions seen in some individuals with eating disorders.

1. Eating disorder personality:

Several personality traits are shared by individuals with eating disorders: difficulty expressing emotions, problems with interpersonal relationships, a high degree of self-control.

1. Biologic causes:

Some neurotransmitter imbalances have been noted in individuals with eating disorders, which might explain food restricting and bingeing behavior.

1. Family risk factors:

Inherited factors and family dynamics may play a role in eating disorders. Family members may pass along their own food issues to their children.

1. Cultural factors:

Eating disorders are rare in racial/ethnic groups in which the concept of attractiveness embraces larger people.

1. Athletes and eating disorders:

Eating disorders are more prevalent among male and female athletes than the general population. Athletes in certain sports are at greatest risk (those with weight classifications or where appearance is important). The female athlete triad encompasses three problems often seen together: eating disorder, amenorrhea, and osteoporosis.

1. Role of dieting:

Dieting, particularly severe dieting, is a predictor of both disordered eating and development of an eating disorder. Dieting almost always precedes binge eating.

1. Diabetes and eating disorders:

Some individuals with type 1 diabetes deliberately avoid injecting needed insulin as a form of weight control, because insulin is needed to store fat. This can lead to very serious health problems.

IV. Treatment and prevention

1. When is hospitalization required:

Hospitalization is only recommended when there is a risk of suicide, dangerous medical complications exist, the individual is severely malnourished and/or refuses to eat, family conditions necessitate removal from the home, type 1 diabetes requires close monitoring of blood glucose, or no outpatient facility is available.

1. Nutritional treatment:

An immediate goal of treatment is to restore good nutrition. Specific goals vary depending on the type of eating disorder. The refeeding period can be very dangerous for severely malnourished individuals, who may experience cardiac complications.

1. Psychotherapeutic approaches:

Cognitive behavioral therapy, interpersonal psychotherapy, and family therapy have been successfully used in treatment of eating disorders.

1. Other treatments:

Pharmacotherapy may be effective in bulimia and binge eating disorder. Fitness programs can help with weight management and body image.

1. Prognosis for recovery:

About half of individuals with anorexia or bulimia are successfully treated, and treatments for binge-eating disorder are also effective. Relapse is common, and the time to recovery can be substantial.

1. Prevention of eating disorders:

The social-ecological framework introduced in Chapter 1 helps illustrate that eating disorders result not only from individual factors but from environmental influences. Recognizing this can help target prevention efforts.

Suggested Activities and Applications

Application 3.1 The Freshman 15

This application is a case study of a first-year student named Jean. Students can be put into groups to work on the case study during class, or students can be expected to complete the case study individually in advance of class and be prepared to discuss their responses during the class session.

Answers:

• Jean’s BMI in August is 19 if using Table 1 in Appendix A. It is calculated using the formula [(weight in lbs X 703)] ÷ (height in ins)².

[(110) X 703] ÷ (64)² = 77330 ÷ 4096 = 18.8.

• According to Table 1 in Appendix A her current BMI at a weight of 97 lbs (44 kg) falls below 18. It is calculated using the formula [(weight in lbs X 703)] ÷ (height in ins)².

[(97) X 703] ÷ (64)² = 68191 ÷ 4096 = 16.6.

• What criteria for an eating disorder does Jean meet? Compensatory behaviors: vomiting after eating, excessive exercise. Occasions of restricted eating. Low body weight. Irregular menstrual cycles might also be an indicator of hormonal changes resulting from weight loss.
• Jean could certainly benefit from an intervention at this point. A skilled nutritionist can work with her to develop a structured meal plan that helps her recognize hunger and satiety and that can dispel notions about “good” and “bad” foods. Cognitive restructuring might help her develop more reasonable beliefs about eating. She could even work with a personal trainer to devise a healthy exercise program.

Application 3.2 Societal Influences on Eating Disorders

In this application, students refer back to the social-psychological framework introduced in Chapter 1. Students can work in groups to brainstorm factors in our society that have an influence on disordered eating and activity behaviors. Then they should suggest how these societal factors might be counteracted.

Examples:

Application 3.3 The Freshman 15

This application continues the case study of Jean, which was introduced in Application 3.1. Students may benefit from doing outside research to answer some of these questions.

Answers:

• Some food options that the nutritionist might suggest for Jean include: (1) foods that are by their nature single portion. For example, single-serving containers of yogurt or dried fruit; a baked potato or sweet potato rather than a pot of pasta or rice; frozen dinners; chicken pieces rather than a whole chicken. (2) raw vegetables, fruit, and salad, which are nutrient-rich and take time to eat. (3) whole-grain, unprocessed breads and cereals, which contain fiber and promote a feeling of fullness.
• Physiological issues of concern with low caloric intake and vomiting: tooth erosion, esophageal damage, endocrine imbalance, electrolyte imbalance, cardiac arrhythmia, constipation.
• Treatment approaches that might help Jean recover include, in addition to nutritional strategies: mental health counseling, cognitive behavioral therapy, and perhaps, medication.
• A number of eating disorder prevention programs are aimed at college students. Use the internet to search for eating disorder programs aimed at college students. Summarize the preventive approaches used in that program.

Chapter 3 Test Bank

True/ False

1. Eating disorders are seen in men, minorities, and people of all ages; however, they are most prevalent in young white females.

2. According to the results of the 2011 Youth Risk Behavior Survey of American high school students, almost half (46%) were trying to lose weight.

3. The DSM-5 provides specific criteria for determining whether or not an individual is significantly underweight.

4. Symptoms of bulimia are often very subtle.

5. Individuals with bulimia do not always lose significant amounts of weight.

6. About one in five people with anorexia die from suicide.

7. Bulimia nervosa is seen in about 1-3% of the U.S. population and is seen at about the same rates in all high-income nations.

8. Individuals diagnosed with bulimia nervosa tend to be older than those diagnosed with anorexia nervosa.

9. The mortality rate for bulimia nervosa is low.

10. As many as half of the people in weight control programs have a binge eating disorder.

11. Unlike anorexia and bulimia, binge eating disorder is common in all racial and ethnic groups.

12. Among adults, women are more likely than men to be diagnosed with Pica.

13. Cardiovascular complications are the leading cause of death among those with eating disorders.

14. A Glamour magazine survey of 16,000 women found that almost half of the sample (40%) were unhappy with their bodies.

15. Psychologists have identified several personality traits that are shared by people who develop eating disorders.

16. Opioids may play a role in the development of bulimia in some people because purging stimulates the release of opioids (similar to a runner’s high).

17. To date, no pharmacological treatment for anorexia has been found to be effective.

Multiple Choice

18. The prevalence of eating disorders has _________ over the past three decades.

A. increased

B. decreased

C. stabilized

D. stabilized for women but increased for men

19. People with ______________ experience significant weight loss, intense fear of becoming fat, and distorted body image.

A. anorexia nervosa

B. bulimia nervosa

C. Binge Eating disorder

D. All of the above

20. The prevalence of anorexia is between __% and ___% of the general U.S. population.

A. 1% and 3%

B. 2% and 4%

C. 5% and 7%

D. 6% and 8%

21. The median age of onset of anorexia nervosa is ________.

A. 14

B. 16

C. 17

D. 20

22. ________________ is characterized by repeated episodes of binge eating and inappropriate compensatory behaviors adopted to prevent weight gain.

A. Anorexia nervosa

B. Bulimia nervosa

C. Pica

D. All of the above

23. Individuals with ___________ consume large amounts of food in short periods of time; feel out of control when eating; and experience guilt, shame and depression after eating.

A. anorexia nervosa

B. bulimia nervosa

C. Binge eating disorder

D. All of the above

24. This is the time period that is typically used/suggested as the time frame to define a binge eating period.

A. 30 minutes

B. 1 hour

C. 2 hours

D. 4 hours

25. The prevalence of pica in the population is unknown but is believed to be ____________.

A. increasing

B. decreasing

C. stabilizing

D. stabilizing for women but increasing for men

26. Pica is most common in _____________.

A. childhood

B. adolescence

C. young adulthood

D. adulthood

27. This part of the brain regulates both sleep and appetite and is suspected to be involved in Night Eating Syndrome.

A. Amygdala

B. Hippocampus

C. Hypothalamus

D. All of the above

28. This disorder is a relatively common syndrome characterized by excessive concern with one’s muscularity. Sometimes this condition is referred to as “reverse anorexia.”

A. Gourmand Syndrome

B. Binge Eating Disorder

C. Muscle Dysmorphia

D. Pica

29. _________________ is a heart rate slowed to 50 or fewer beats per minute (bpm) during the daytime and 46 bpm at night.

A. Bradycardia

B. Cardiac Myopathy

C. Hyponatremia

D. Hypokalemia

30. ________________ is a condition in which bone mineral density is reduced by 1-2.5 standard deviations below average bone density for a healthy adult.

A. Hypoglycemia

B. Osteoporosis

C. Osteopenia

D. Skeletal Myopathy

31. This is a powerful appetite stimulant produced in the hypothalamus.

A. Neuropeptide Y (NPY)

B. Peptide YY (PYY)

C. Leukopenia

D. All of the above

32. Not a component of the female athlete triad is:

A. eating disorders

B. dehydration

C. osteoporosis

D. amenorrhea

Fill in the Blank and Short Answer

33. How do you think our culture promotes body dissatisfaction and disordered eating?

34. Why would it be important for weight management professionals to understanding eating disorders? How are clients with eating disorders similar to those who are overweight or obese?

35. The most common eating disorders are:

1) _________________________

2) _________________________

3) _________________________

Answer (see p. 60 Anorexia Nervosa; Bulimia Nervosa; Binge Eating Disorder)

36. ______________ occurs when caloric intake is severely reduced either all of the time or sporadically. Fasting is common.

37. ________________ is the consumption of large quantities of food over a limited period of time. This is typically followed by feelings of guilt, remorse, and self-loathing.

38. _________________ include excessive exercise or abuse of laxatives, diuretics, and/or other drugs to compensate for caloric intake from eating.

39. Describe normal eating.

(see p. 61).

40. _______________ is the absence of menstruation for at least three consecutive cycles.

41. List two characteristics of anorexia nervosa:

1)________________________________________________________________

2)________________________________________________________________

42. List two characteristics of bulimia nervosa:

1)________________________________________________________________

2)________________________________________________________________

43. List two characteristics of binge eating disorders:

1)________________________________________________________________

2)________________________________________________________________

44. An example of a compensatory behavior is:________________________________

45. What are the differences and similarities, if any, between bulimia nervosa and

binge eating disorder?

46. This eating disorder is characterized by intense craving for and consumption of non-foods: _______________.

47. Briefly describe one of the two most common nocturnal eating disorders.

48. Describe one of the effects of eating disorders (consuming very little food, periodic food binges, abuse of laxatives and/or self-induced vomiting) on the digestive tract.

49. _________________ is a complication of diabetes in which nerves in the hands and feet degenerate. Diabetics with eating disorders are much more likely to experience this type of complication.

50. Describe one of the effects of having an eating disorder on the endocrine system.

51. Describe one of the effects of having an eating disorder on the skeletal system.

52. How does social interaction influence body image?

53. List two psychological comorbidities that often accompany eating disorders:

1)________________________________________________________________

2)________________________________________________________________

54. How do family issues relate to the development of eating disorders?

55. List and briefly describe at least three causal factors for the development of eating disorders in general, or for a specific eating disorder.

56. What are the three components of the problems included in the female athlete triad?

1)______________________________

2)______________________________

3)______________________________

57. Describe the relationship between dieting and eating disorders.

58. List two goals for treating an eating disorder:

1)________________________________________________________________

2)________________________________________________________________

59. Why is family therapy used more frequently to treat anorexia than bulimia?

60. Discuss the treatment options available for persons with eating disorders. Comment on the prognosis for recovery for the three most common types of eating disorders.

61. Provide an example of a primary and a secondary prevention effort for treating eating disorders.