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Lecture 9

PSY333H1 Lecture 9

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University of Toronto St. George
Lisa Lipschitz

PSY333H1F L9 Nov 14, 2013  Pre-occupied with thoughts of food o hoard food, collect recipes, prep food for others Eating Disorders o might bake lots of food but not eat it  500, 000 Canadians reported suffering from an eating  Need to control envt, inflexible thinking, overly restrained disorder in 2005 o Scared that they’ll start binge eating if lose control  Over 85,000 people in Ontario o Might also avoid alcohol due to calories or that it  Highest mortality rate of any mental illness could disinhibit them so they eat  Dieting is a risk factor  Unrealistic perception of body weight o Most ppl diagnosed w an eating disorder were dieting  Social withdrawal  extreme diet  Multiple causes  More prevalent in industrialized societies – thin is considered o Cultural (ex. Western society media, models have attractive gotten thinner in last 20yrs), social, pressures, biolog, Begins during early adolescence (ages 13-18) genetics  Rarely occurs after 40 years old  9:1 – females (90% females) DSM V: Feeding & Eating Disorders o 1 in 200 females, 1 in 2000 males  Definition: Severe disturbances in eating bhvr (abnormal  Onset associated w stressful life event eating) o Ex. Lost weight due to illness  want to lose more 1. Anorexia Nervosa  Increased risk among first-degree biological relatives 2. Bulimia Nervosa o Also thru modelling of bhvrs 3. Binge Eating 4. Pica Treatment 5. Night Eating Syndrome  Earlier the better prognosis  Mortality – 15% of patients die 1. Anorexia Nervosa A. Restriction of energy intake relative to requirements o This is due to physical conseqs of starvation & suicide leading to a significantly low body weight in the  Various forms of treatment context of age, sex, developmental trajectory, and o Inpatient, Partial Hospitalization, Outpatient treatment physical health. Significantly low weight is defined as a  Can have meals in the hospital weight that is less than minimally normal, or, for children  Inpatient: fed thru feeding tube and adolescents, less than that minimally expected. o Family-based Therapy o Used to have to have BMI of 17 or less o Prof thinks this is a good change so that  Effective  Family members taught how to talk about food, treatment and intervention can happen what might’ve caused it earlier; shouldn’t wait til ppl reach this low o Medication BMI weight (not everyone can)  Help w anxiety, depression B. Intense fear of gaining weight or becoming fat, or o Psychotherapy persistent behavior that interferes w weight gain, even though at a significantly low weight. C. Disturbance in the way in which one's body weight or 2. Bulimia Nervosa A. Recurrent episodes of binge eating. An episode of shape is experienced, undue influence of body weight binge eating is characterized by both of the following: or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body o 1) Eating, in a discrete period of time (ex. within weight. any 2-hour period), an amt of food that is o Self-esteem dependent on body weight definitely larger than most ppl would eat o Constantly want to be skinnier during a similar period of time under similar circumstances Physical signs:  Usually 5000 calories, depends on the  Underweight person  Extreme sensitivity to cold 2) A sense of lack of control over eating during  Thinning of hair the episode (ex. a feeling that one cannot stop  Yellowish skin eating or control what or how much one is eating)  Erratic sleep habits  Don’t care what the food is, might even eat  Day revolves around restricting eating, maybe exercis frozen food straight from freezer isolated o Don’t want to go to events that require eating B. Recurrent inappropriate compensatory behaviors in o Don’t want weight and eating habits to be judged order to prevent weight gain, such as self-induced o Can easily become light-headed vomiting; misuse of laxatives, diuretics, or other medications, fasting; or excessive exercise.  Self-starvation o Purging or Non-purging bhvrs  Often accompanied by depressed mood & anxiety o Exercise to compensate for every calorie they ate o Anxiety about gaining weight, being judged (count)  Obsessive-compulsive features C. The binge eating and inappropriate compensatory bhvrs both occur, on average, at least once per wk for 3 mths. D. Self-evaluation is unduly influenced by body shape and weight. 3. Binge Eating Disorder  Types: 1) Purging & 2) Non-purging A. Recurrent episodes of binge eating.  Don’t lose as much weight as Anorexics, also don’t restrict o An episode of binge eating is characterized by both food intake as much of the following: 1) Eating, in a discrete period of time (e.g., o Anorexics can also binge, but are more restrictive o Anorexics also have much stronger delusions within any 2-hour period), an amt of food  The compensatory bhvrs don’t work that well that is definitely larger than most ppl would eat in a similar period of time under o Lose electrolytes but not necessarily other contents of food similar circumstances, 2) A sense of lack of control over eating during the episode (for example, a feeling  Can be diagnosed w Eating Disorder Not Otherwise Specified if don’t meet the exact criteria that one cannot stop eating or control what or how much one is eating) Physical Signs B. The binge-eating episodes are associated w 3 (or more) of the following:  Fluid & electrolyte abnormalities o Ex. Potassium, water 1) Eating much more rapidly than normal  Permanent loss of dental enamel 2) Eating until feeling uncomfortably full 3) Eating large amounts of food when not feeling o From acid from vomiting – so sometimes a dentist is the first to notice physically hungry  Calluses or scars on hands 4) Eating alone because of feeling embarrassed by how much one is eating  Menstrual irregularity can occur o If weight very low 5) Feeling disgusted with oneself, depressed, or very  Tears in esophagus & stomach guilty after overeating o Due to acid from vomiting  Dry skin C. Marked distress regarding binge eating is present.  Hair loss D. The binge eating occurs, on average, at least once a wk for 3 mths E. The binge eating is not associated w the recurrent use  Begins in late adolescence or early adult life o Sometimes when you go thru puberty, gain weight, of inappropriate compensatory bhvr and does not occur exclusively during the course Bulimia Nervosa notice your body is changing or Anorexia Nervosa.  Binge eating frequently begins during or after an episode of dieting – restrained eating Triggers: o Out of control eating the forbidden foods  Isolation  Often triggered by (-)ve emotions o Purging to gain back sense of self control o Won’t binge when around others  Personal problems  High rate of co-occurring depression & anxiety disorders  Low self-worth and substance use  90% are female  Unpleasant feelings  Gaining weight, feeling fat  Increased frequency among first-degree relatives o Fears of weight gain o Modeling effect, genetic makeup  Dieting, feeling hungry  Drinking alcohol  Indivs are usually within normal weight range o Disinhibiting once drinking  eating foods they  Uncommon among moderately & morbidly obese indivs wouldn’t otherwise eat  Prior to onset indivs are more likely to be overweight than their peers  Higher rates among obese indivs (30%)  Between binges typically restrict their total caloric consumption and select low-calorie foods & avoid high fat  10% of the population o More prevalent than other eating disorders foods  Not just young, white females – general population Treatment o Equally among males & females  Higher rates of most major psychiatric disorders  Early intervention = better prognosis o Depression, anxiety  Inpatient, outpatient settings  Cognitive Bhvr’al Therapy  Greater impairment in psychosocial aspects of quality of life compared to obese people w/o BED o Cognitions around body weight & shape, restructuring  Genetics & envt’al risk factors thoughts about body & food o Very helpful Treatment  Interpersonal Psychotherapy  Usually outpatient setting o Changes w relationships, communication skills o Very helpful  Cognitive Behaviour Therapy o Cognitions, restructuring  Anti-depressants o Change envt o Helps w impulsivity of binging & depressive and anxious symptoms o Work on preventing emotional eating  Binging often happens in the evenings  Often called Chronic Disease/Illness  So want to restructure a person’s evenings o Other conditions may be due to Injury or Prolonged Strain (ex back pain, repetitive strain injuries)  Behavioural weight control o Teach to monitor when hungry, what hunger & being  Might be able to manage the pain full feels like, meal schedule  Chronic conditions range from mild (partial hearing loss)  Interpersonal Psychotherapy to severe & life threatening (cancer, diabetes)  Dialetical Behaviour Therapy o Treatment options vary o Understand & learn about emotions  Sometimes might undergo more than one o Gain greater acceptance of their emotions  able to treatment process (ex. Cancer), deal w long-term tolerate & get thru anxiety side effects of treatment, monitor self when in  Pharmacotherapy remission  Involvement of support is crucial Chronic Illness  Multiple causes including bhvr’al choices or lifestyle o Family members on board to help w treatment options  Ex. Making sure certain foods are and aren’t in  Usually slow onset; disease intensity increases over time the house  Usually cannot be cured, only managed  We may hear a physician say to us that the disease cannot be 4. Night Eating Syndrome cured, only managed  Abnormally increased appetite for consumption of food in o Self-management: the involvement of the patient in all the evening (over 25% of intake) aspects of chronic illness & its implications, including  May leave bed to snack – Nocturnal ingestions medical management, changes in social and vocational  Morning anorexia roles and coping strategies o To make up for calories  Can get worse; can stay the same  Belief that one must eat in order to initiate sleep o Dif ppl can manage it differently  Feels tense, guilt, anxious, or upset while eating  Associated w insomnia Quality of Life  Injury to hypothal, mood disturbances due to hormone  Quality of Life: The degree to which a person is able to changes, low melatonin & leptin maximize his/her psychological status, physical, social, and  Persists for at 2 mths vocational functioning, and disease or treatment related symptoms  Occurs in 10%-27% of obese indivs  Not all ppl know they are doing it  Important indicator of recovery from or adjustment to o Might sleep-walk to go eat chronic illness o Daily living (ex. sleeping, working, recreational & 5. Pica social activities)  Compulsive craving for eating, chewing, or licking non- o Fn’al aspects of daily living (ex. hygienic routines, dressing, mobility, eating) food items containing no nutrition  Ex. Ability to still play sports, dress self o Ex. chalk, paper, plaster, baking soda, paint chips, ice, glue o Extent to which symptoms and treatment affect a person’s physical, social, cognitive, and emotional  Cannot distinguish btwn food & non-food items fn’ing  Should last for more than 1 mth  Occurs more often in children (10-30%), those w  An important aspect of quality of life is ppl’s perceptions of their own health development disabilities, and it can occur during o So quite subjective pregnancy  Might be due to texture  Illness Intrusiveness: disruptions one is experiencing from their condition or their treatment Chronic Illness (Ch. 11, 12) o Can be measured Chronic Illness o Ex. Taking a pill vs. getting surgery  Results from the disruptions and limitations that disease  At any given time – 58% of population has some chronic and treatment impose on social, family, work, and condition  Accounts for 2/3 of Canada’s health spending recreational life o It is a powerful determinant of quality of life o For most ppl it will lead to their death  High levels of II  lower QoL (ex. Higher levels  More common among: o Women of anxiety & depression) o Can’t do normal activities o Lower-income Canadians o Examples: work, relationships, clothing, eating, etc o Seniors o Can lead to anxiety & depression o Certain ethnic grps such as Aboriginal peoples Evaluating Quality of Life Chronic Health Conditions  An important aspect of quality of life is ppl’s perceptions of  Chronic health conditions: impact day to day physical, emotional, psychological, and social fn’ing, affecting quality oftheir own health  Phenomenologically: according to a person’s own report of life the phenomenon o Can involve a Disease Process (ex. diabetes, heart disease, cancer, arthritis, MS, IBD, COPD) o Self-reports (ex. Would you rate your health?)  Questionnaires  Ex. Can you take long walks or short walk? ,  (-)ve emotions Ability to manage pain  Disbelief, denial, and anger are common immediate o Comparing the quality of life of those living w chronic reactions when first diagnosed disease or conditions to the general populations  An initial sense of shock & disbelief (population norms)  Shatters core beliefs about a “just world” (life is fair & just) o Multidimensional measures: assessment that includes  Difficult to deal w “no end in sight” specific aspects of QoL (physical, emotional, social) o Need to come to acceptance  Ex. Specific questionnaires for symptoms of  Put aside plans & dreams, goals breast cancer for breast cancer patients  (-)ve reactions are more common among younger ppl  Ex. Scale only measuring physical symptoms o Less acceptance, more anger about being unable to o Global measures: a general or overall assessment w pursue goals focusing on aspects  Depression as a result of lack of control  Get an overall global picture on how someone is  Anxiety as a result of uncertainty doing Why Study Quality of Life? The Emotions Experienced Denial  Documents how illness affects vocational, social, and personal A defense mechanism involving the inability to recognize or deal activities of daily living w external threatening events  Basis for interventions designed to improve quality of life  Early reaction to a diagnosis  Help pinpoint which particular problems are likely to  Can have a protective fn in the early stages emerge for patients w particular diseases & treatment side effects  Can have an adverse effect during rehabilitation as denial may interfere w ability to take in important info  Can inform decision-makers about care that will maximize the likelihood of long-term survival w the highest quality of life possible Anxiety  Overwhelmed by changes, lack of info, death  High when waiting for test results, receiving diagnosis, Effects of Patients’ Beliefs Beliefs about… awaiting invasive medical procedures or experience side effects of a treatment, etc…  Nature of the illness  More anxious  more adverse effects o Patients often adopt an inappropriate model for their chronic illness - the acute model of illness Depression  ie. a hypertensive patient believes that because  Common & debilitating he feels alright he no longer has to take his medication o Feel lack of control  May be delayed  need to understand it’s lifelong & needs to be o After denial & anxiety continually treated o can be due to not being educated about what a  Can have a direct impact on symptoms chronic illness is  Patients often show less motivation to undergo rehabilitation  Cause of the illness o Patients develop theories about where their illness came Assessment can be problematic because many of the from physical signs of depression (i.e. fatigue, weight loss) may also be symptoms of disease or treatment side effects  Ex. Stress, physical injury, disease-causing bacteria, G-d’s will o Confusion of symptoms w chronic illness, might not  Ex. Questioning the “Just World” model – see the depression  Factors that predict depression thinking one is too good of a person to get ill  Controllability of the illness o Depression increases w severity of illness o Patients with a perceived sense of control or self- o Extent of pain and disability; experience of other negative life events efficacy fare better than those w/o o Lack of social support The Emotional Responses to Chronic Illness Change of Self-Concept  Immediately after a chronic disease is diagnosed, patients The Mental Self are often in a state of crisis marked by physical, social, and psychological disequilibrium  Self-concept: beliefs about one’s qualities and attributes o Ppl realize their current coping strategies may not  Self-esteem: whether one feels good or bad about their self- concept (personal qualities or attributes) work  Eventually the crisis phase passes, and patients begin to develop a sense of how the chronic illness will alter their The Physical Self
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