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Eating Disorders: Etiology and Treatment (Aetiology - AN and BN…
Eating Disorders: Etiology and Treatment
Aetiology - AN and BN
Neurobiological factors: endogenous opioids (starvation can impact mood positively, reinforcing state), anorexics may have less serotonin metabolites, binges may be due to serotonin deficits
Genetic factors: anorexic patients - 1st degree relative 10 times likely to have same disorder, bulimic patients - 4 times, increased rate in identical twins compared with fraternal
Environmental factors: early menarche (menstrual cycle), stress in mothers during pregnancy, premature birth/complications
Psychodynamic factors: disturbed parent-child relationship, smothering of parents, (id, ego, superego = child, patient, parent) - in anorexia, there is an underdeveloped ego and over reliance on parents, young person trying to resist puberty
Cognitive behavioural factors: media, bullying, family history of depression, physical/sexual abuse, troubled family/personal relationships, fear of fatness
Aetiology and Treatment of BED
Only introduced when DSM 5 was published so little is known
Potential causes: childhood obesity, negative weight comments, depression, childhood abuse
Treatment: cognitive behavioural therapy and interpersonal therapy
Treatment - AN and BN
AN - hospitalisation to gain immediate weight --> operant conditioning to achieve healthy weight; family therapy, lunch meetings
BN - CBT most valid, interpersonal therapy and family therapy
Anti-depressants: reduce binge eating and vomiting and depression, AN does not respond well to this
Understanding emotions and cognitions > media literacy and changing fat talk > challenging attitudes > engage with body through movement/self care > cognitive restructuring, exposure, response prevention
Body Dysmorphic Disorder
Criteria: obsessive compulsive spectrum (not eating disorder), preoccupation with flaws, repetitive mental acts (mirror checking, excessive grooming) related to appearance, not restricted to concerns about weight/fat
Prevalence about 2% of population, most common comorbidity is OCD (41% in BDD sample)
Treatment: CBT and selective serotonin re-uptake inhibitor (SSRI), fluoxetine