Center for Balanced Living Presentation, "What's Up With "ED?"

What’s Up With “ED?”What’s Up With “ED?”
Eating Disorders Q&AEating Disorders Q&A
CLICK ON THIS SLIDE TO BEGINCLICK ON THIS SLIDE TO BEGIN
This is the interactive game that is aThis is the interactive game that is a
part of the Family Eating Disorderpart of the Family Eating Disorder
ManualManual
FED Manual © 2012 The Center for Balanced Living, All rights reservedFED Manual © 2012 The Center for Balanced Living, All rights reserved

Eating Disorder ID 100Eating Disorder ID 100
I am a severely underweight person who:I am a severely underweight person who:
 Restricts food, leading to significant weight loss in theRestricts food, leading to significant weight loss in the
context of age and sexcontext of age and sex
 Delays eating, or eats very littleDelays eating, or eats very little
 Binges or purges at timesBinges or purges at times
 May exercise many hours a dayMay exercise many hours a day
 Sees myself as fat while others see me as thinSees myself as fat while others see me as thin
 Thinks of my body shape continuously and isThinks of my body shape continuously and is
intensely afraid to gain weightintensely afraid to gain weight
What type of eating disorder do I haveWhat type of eating disorder do I have??

AnswerAnswer
Anorexia NervosaAnorexia Nervosa
Restrictor subtype if no binge or purgeRestrictor subtype if no binge or purge
Binge and purge subtypeBinge and purge subtype
Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental Disorders (5th ed.;(5th ed.; DSM-5DSM-5).).
CategoriesCategories

I am a person who is normal or overweight who:I am a person who is normal or overweight who:
 Eats uncontrollably large amounts of food: more thanEats uncontrollably large amounts of food: more than
others eat in a discrete amount of timeothers eat in a discrete amount of time
 Purges at least weekly to prevent weight gain in waysPurges at least weekly to prevent weight gain in ways
such as self-induced vomiting, laxative or diureticsuch as self-induced vomiting, laxative or diuretic
abuse, excessive exercise, or other compensatoryabuse, excessive exercise, or other compensatory
behaviors such as medication abusebehaviors such as medication abuse
 Fasts or severely restricts food intake at timesFasts or severely restricts food intake at times
 Loathes my body and weight and feels fatLoathes my body and weight and feels fat
 Is afraid of gaining weightIs afraid of gaining weight
What type of eating disorder do I have?What type of eating disorder do I have?

AnswerAnswer
Bulimia NervosaBulimia Nervosa
BONUS QUESTIONBONUS QUESTION CategoriesCategories

ED ID 200ED ID 200
BONUS QUESTIONBONUS QUESTION
The Von Trapp family sang about thisThe Von Trapp family sang about this
flower.flower.

ED ID 200ED ID 200
Bonus AnswerBonus Answer
What is EDelweiss?What is EDelweiss?

I am usually an overweight person who:I am usually an overweight person who:
 Eats uncontrollably larger amounts of food thanEats uncontrollably larger amounts of food than
others would eat in a discrete period of timeothers would eat in a discrete period of time
 Binges at least one or more times a weekBinges at least one or more times a week
 Often binges alone and may be angry and upset withOften binges alone and may be angry and upset with
myself afterwardsmyself afterwards
 Often eats alone and/or eats faster than othersOften eats alone and/or eats faster than others
What type of disorder do I have?What type of disorder do I have?

AnswerAnswer
Binge Eating DisorderBinge Eating Disorder

I am a person who:I am a person who:
 Is normal weight but experiences all other symptomsIs normal weight but experiences all other symptoms
of anorexia nervosaof anorexia nervosa
 Has many symptoms of bulimia or binge eatingHas many symptoms of bulimia or binge eating
disorder, but binges and purges less than 1 X weekdisorder, but binges and purges less than 1 X week
 Does not binge, but makes myself purgeDoes not binge, but makes myself purge
 Eats a large amount of my food during the night afterEats a large amount of my food during the night after
awaking from sleepawaking from sleep
What disorder do I have?What disorder do I have?

AnswerAnswer
Eating Disorder: not otherwise specifiedEating Disorder: not otherwise specified
(ED: NOS)(ED: NOS)
Includes sub-threshold AN, BN, BED andIncludes sub-threshold AN, BN, BED and
Night Eating SyndromeNight Eating Syndrome

ED Facts 100ED Facts 100
Eating Disorders are ___________ ___________Eating Disorders are ___________ ___________
____________ mental illnesses.____________ mental illnesses.
A.A.Mortal, ignorant, co-morbidMortal, ignorant, co-morbid
B.B.Serious, intense, thought-basedSerious, intense, thought-based
C.C.Serious, biologically basedSerious, biologically based
D.D.Family and socially causedFamily and socially caused

AnswerAnswer
C: Serious, biologically based mental
illnesses
Determined from studies onDetermined from studies on
HeritabilityHeritability
Neurobiological abnormalitiesNeurobiological abnormalities
Cognitive and emotional deficitsCognitive and emotional deficits
Social and medical disabilitiesSocial and medical disabilities
Kaye, W.H, Frank, G.K, Bailer, U.F., & Henry, S.E. (2005). Neurobiology of anorexia nervosa: Clinical implications of alterations of the function of serotoninKaye, W.H, Frank, G.K, Bailer, U.F., & Henry, S.E. (2005). Neurobiology of anorexia nervosa: Clinical implications of alterations of the function of serotonin
and other neuronal systems.and other neuronal systems. International Journal of Eating DisordersInternational Journal of Eating Disorders,, 37,37, S15–S19. doi: 10.1002/eat.20109S15–S19. doi: 10.1002/eat.20109
Klump, K.L., Bulik, C.M., Kaye, W.H., Treasure, J., & Tyson, E. (2009). Academy for Eating Disorders position paper: Eating disorders are serious mentalKlump, K.L., Bulik, C.M., Kaye, W.H., Treasure, J., & Tyson, E. (2009). Academy for Eating Disorders position paper: Eating disorders are serious mental
illnesses.illnesses. International Journal of Eating Disorders,International Journal of Eating Disorders, 4242, 97–103., 97–103.
Thomas Insel, MD, Director of National Institute of Mental Health (NIMH) statement in letter to National Eating Disorder Asosication. (2006). Retrieved JulyThomas Insel, MD, Director of National Institute of Mental Health (NIMH) statement in letter to National Eating Disorder Asosication. (2006). Retrieved July
2012 http://www.nationaleatingdisorders.org/nedaDir/files/documents/NIMHLetter.pdf2012 http://www.nationaleatingdisorders.org/nedaDir/files/documents/NIMHLetter.pdf

Adam and Eve’s favorite hangout.Adam and Eve’s favorite hangout.

What is EDen.What is EDen.

This mental illness has the highest mortalityThis mental illness has the highest mortality
or death rate of all mental illnesses:or death rate of all mental illnesses:
A. Obsessive Compulsive DisorderA. Obsessive Compulsive Disorder
B.B. Major Depressive DisorderMajor Depressive Disorder
C.C. Eating DisordersEating Disorders
D.D. SchizophreniaSchizophrenia

AnswerAnswer
C: Eating disorders
Eating Disorders have the highest death rate of all psychiatric illnesses.Eating Disorders have the highest death rate of all psychiatric illnesses.
Mortality rates from a longitudinal assessment in 2009 of 1,885 persons:Mortality rates from a longitudinal assessment in 2009 of 1,885 persons:
4.0%4.0% for anorexia nervosa,for anorexia nervosa,
3.9% for bulimia3.9% for bulimia nervosa,nervosa,
5.2% for eating disorder not otherwise specified.5.2% for eating disorder not otherwise specified.
Weighted mortality rates in 2011 study wereWeighted mortality rates in 2011 study were
5.1 for AN, The standardized mortality ratios were 5.86 for AN,5.1 for AN, The standardized mortality ratios were 5.86 for AN,
1.7 for BN, The standardized mortality ratio was 1.93 for BN1.7 for BN, The standardized mortality ratio was 1.93 for BN
3.3 for EDNOS., and standardized was1.92 for EDNOS.3.3 for EDNOS., and standardized was1.92 for EDNOS.
One in 5 individuals with AN who died had committed suicide.One in 5 individuals with AN who died had committed suicide.
The mortality rate of anorexia nervosa is about 12 times higher than the annual death rate from all causes of deathThe mortality rate of anorexia nervosa is about 12 times higher than the annual death rate from all causes of death
among females ages 15-24 in the general population.among females ages 15-24 in the general population.
Sullivan P.F. (1995). Mortality in anorexia nervosa.Sullivan P.F. (1995). Mortality in anorexia nervosa. American Journal of PsychiatryAmerican Journal of Psychiatry,, 152152(7), 1073-4.(7), 1073-4.
Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., & Mitchell, J.E. (2009). Increased mortality in bulimia nervosa and other eating disorders.Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., & Mitchell, J.E. (2009). Increased mortality in bulimia nervosa and other eating disorders.
The American Journal of Psychiatry, 166The American Journal of Psychiatry, 166(12), 1342-6.(12), 1342-6.
Arcelus, J., Mitchell, A.J., Wales, J., Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies.Arcelus, J., Mitchell, A.J., Wales, J., Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Arch GenArch Gen
PsychiatryPsychiatry, 68(7), 724-31., 68(7), 724-31. doi:10.1001/archgenpsychiatry.2011.74doi:10.1001/archgenpsychiatry.2011.74

After doing this action,After doing this action, vasopressinvasopressin (a brain(a brain
chemical and anti-diuretic) surges andchemical and anti-diuretic) surges and
makes the person feel like she/he is on amakes the person feel like she/he is on a
morphine-like high.morphine-like high.

AnswerAnswer
Self-induced vomiting

Her novelHer novel Age of InnocenceAge of Innocence won the 1921won the 1921
Pulitzer Prize for literature, making her thePulitzer Prize for literature, making her the
first woman to win it.first woman to win it.

Who is EDith Wharton?Who is EDith Wharton?

Name three mental illnesses that commonlyName three mental illnesses that commonly
co-occur or co-exist with eating disorders.co-occur or co-exist with eating disorders.

Anxiety disorder
Major depression
Panic disorder
Post-traumatic stress disorder
Obsessive compulsive disorder
Attention deficit-hyperactivity disorder

ED Biology/Genetics 100ED Biology/Genetics 100
Eating disorders are influenced in theirEating disorders are influenced in their
development and maintained by which of thedevelopment and maintained by which of the
following:following:
A.A. GeneticsGenetics
B.B. Neurobiological abnormalitiesNeurobiological abnormalities
C.C. Biological influencesBiological influences
D.D. Social/environmental pressures to be thinSocial/environmental pressures to be thin
E.E. Psychological traitsPsychological traits
F.F. Severe life stressorsSevere life stressors
G.G.Family dynamicsFamily dynamics
H.H. All the aboveAll the above

AnswerAnswer
H: All the above
All are potential inter-related causes of
eating disorders
A.A. GeneticsGenetics
B.B. Neurobiological abnormalitiesNeurobiological abnormalities
C.C. Biological influencesBiological influences
D.D. Social/environmental pressures to be thinSocial/environmental pressures to be thin
E.E. Psychological traitsPsychological traits
F.F. Severe Life StressorsSevere Life Stressors
G.G. Family dynamicsFamily dynamics

ED Biology/Genetic 200ED Biology/Genetic 200
Both environment and genetics influence theBoth environment and genetics influence the
development of weight, shape and eatingdevelopment of weight, shape and eating
disorders, but environment has a strongerdisorders, but environment has a stronger
influence over genes during ______ stage ofinfluence over genes during ______ stage of
development,development,
while genes have a higher influence duringwhile genes have a higher influence during
______ stage of development.______ stage of development.
a)a) ChildhoodChildhood
b)b) AdolescenceAdolescence
c)c) Older adulthoodOlder adulthood

ED Biology/Genetic 200ED Biology/Genetic 200
AnswerAnswer
a) Childhooda) Childhood (environment has stronger influence)(environment has stronger influence)
b) Adolescence and early adulthoodb) Adolescence and early adulthood (genes stronger(genes stronger
influence)influence)
Work by Kelly Klump et.al: Michigan State University found that influence of one's genes on eating disorder symptoms was much greater inWork by Kelly Klump et.al: Michigan State University found that influence of one's genes on eating disorder symptoms was much greater in
pubertal girls with higher levels of estradiol than pubertal girls with lower levels of estradiol. "The reason we see an increase in geneticpubertal girls with higher levels of estradiol than pubertal girls with lower levels of estradiol. "The reason we see an increase in genetic
influences during puberty is that the genes for disordered eating are essentially getting switched on during that time," said Klump. “What'sinfluences during puberty is that the genes for disordered eating are essentially getting switched on during that time," said Klump. “What's
turning on the genes during puberty? And what we found is that increases in estradiol apparently are activating genetic risk for eatingturning on the genes during puberty? And what we found is that increases in estradiol apparently are activating genetic risk for eating
disorders.“disorders.“
EstradiolEstradiol is the most potent estrogen of a group of endogenous estrogen steroids which includes estrone and estriol.is the most potent estrogen of a group of endogenous estrogen steroids which includes estrone and estriol.
Estrogen is a steroid hormone. It codes proteins in the brain. It increases at puberty and then progesterone increases as puberty progresses.Estrogen is a steroid hormone. It codes proteins in the brain. It increases at puberty and then progesterone increases as puberty progresses.
Klump, K.L., Keel, P.K., Sisk, C.,& Burt, S.A. (2010). Preliminary evidence that estradiol moderates genetic influences on disordered eating attitudes and behaviors duringKlump, K.L., Keel, P.K., Sisk, C.,& Burt, S.A. (2010). Preliminary evidence that estradiol moderates genetic influences on disordered eating attitudes and behaviors during
puberty.puberty. Psychological MedicinePsychological Medicine,, 4040(10), 1745-53.(10), 1745-53.
Klump, K.L., McGue, M., & Iacono, W.G. (2000. Age differences in genetic and environmental influences on eating attitudes and behaviors in preadolescent and adolescentKlump, K.L., McGue, M., & Iacono, W.G. (2000. Age differences in genetic and environmental influences on eating attitudes and behaviors in preadolescent and adolescent
female twins.female twins. Journal of Abnormal Psychology, 109Journal of Abnormal Psychology, 109(2), 239-251. doi: 10.1037/0021-843X.109.2.239(2), 239-251. doi: 10.1037/0021-843X.109.2.239
Klump, K. L., Burt, S. A., Spanos, A., McGue, M., Iacono, W.G., & Wade, T. D. (2010). Age differences in genetic and environmental influences on weight and shape concerns.Klump, K. L., Burt, S. A., Spanos, A., McGue, M., Iacono, W.G., & Wade, T. D. (2010). Age differences in genetic and environmental influences on weight and shape concerns.
International Journal of Eating Disorders,International Journal of Eating Disorders, 43,43, 679–688. doi: 10.1002/eat.20772679–688. doi: 10.1002/eat.20772

This action allows a person with anorexiaThis action allows a person with anorexia
nervosa to:nervosa to:
 Think more calmlyThink more calmly
 Experience less mental “noise”Experience less mental “noise”
 Feel a reduction in anxietyFeel a reduction in anxiety
 Feel better and think betterFeel better and think better

AnswerAnswer
NOT eatingNOT eating
Increases in 5 HT and dopamine along a brain pathway result inIncreases in 5 HT and dopamine along a brain pathway result in
increased anxiety, agitation, and psychological delusions.increased anxiety, agitation, and psychological delusions.
When eating, thoughts in AN are more disturbed than in schizophrenia,When eating, thoughts in AN are more disturbed than in schizophrenia,
anxiety increases in AN, BN and BED, and delusions increase.anxiety increases in AN, BN and BED, and delusions increase.
Kaye, W.H., Barbarich, N.C., Putnam, K., Gendall, K.A., Fernstrom, J., Fernstrom, M., …Kishore, A. (2003). Anxiolytic effects of acute tryptophan depletion inKaye, W.H., Barbarich, N.C., Putnam, K., Gendall, K.A., Fernstrom, J., Fernstrom, M., …Kishore, A. (2003). Anxiolytic effects of acute tryptophan depletion in
anorexia nervosa.anorexia nervosa. International Journal of Eating Disorders, 33,International Journal of Eating Disorders, 33, 257–267. doi: 10.1002/eat.10135257–267. doi: 10.1002/eat.10135
Kaye, W.H, Frank, G.K, Bailer, U.F, & Henry, S.E. (2005). Neurobiology of anorexia nervosa: Clinical implications of alterations of the function of serotoninKaye, W.H, Frank, G.K, Bailer, U.F, & Henry, S.E. (2005). Neurobiology of anorexia nervosa: Clinical implications of alterations of the function of serotonin
and other neuronal systems.and other neuronal systems. International Journal of Eating DisordersInternational Journal of Eating Disorders,, 37,37, S15–S19. doi: 10.1002/eat.20109S15–S19. doi: 10.1002/eat.20109
Kaye , W.H. (2008). Neurobiology of anorexia and bulimia nervosa.Kaye , W.H. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology and Behavior, 94Physiology and Behavior, 94, 121-135. doi:10.1016/j.physbeh.2007.11.037, 121-135. doi:10.1016/j.physbeh.2007.11.037
Eddy, K.T, Crosby, R.D., Keel, P.K, Wonderlich, S.A, le Grange, D., Hill, L., Powers, P., & Mitchell, J.E, (2009). Empirical identification and validations ofEddy, K.T, Crosby, R.D., Keel, P.K, Wonderlich, S.A, le Grange, D., Hill, L., Powers, P., & Mitchell, J.E, (2009). Empirical identification and validations of
eating disorder phenotypes in a multi-site clinical sample.eating disorder phenotypes in a multi-site clinical sample. Journal of Nervous and Mental Disease, 197,Journal of Nervous and Mental Disease, 197, 41-49. doi: 10.1097/NMD.0b013e318192738941-49. doi: 10.1097/NMD.0b013e3181927389

People with eating disorders have impairedPeople with eating disorders have impaired
neurocircuits, with the result that they:neurocircuits, with the result that they:
Can’t see the global pictureCan’t see the global picture
Can’t discern positives and negatives whenCan’t discern positives and negatives when
there are too many choicesthere are too many choices
Can’t shift well from one set to anotherCan’t shift well from one set to another
This is why they have severe difficulty in makingThis is why they have severe difficulty in making
and trusting their own __________.and trusting their own __________.

AnswerAnswer
DecisionsDecisions
Frank, G.K.Frank, G.K.,, Kaye, W.H.Kaye, W.H.,, Meltzer, C.C., Price, J.C., Greer, PMeltzer, C.C., Price, J.C., Greer, P.,., McConaha, CMcConaha, C.,., & Skovira, K. (2002).& Skovira, K. (2002). Reduced 5-HT2A receptor binding afterReduced 5-HT2A receptor binding after
recovery from anorexia nervosa.recovery from anorexia nervosa. Biol Psychiatry, 52,Biol Psychiatry, 52, 896896––906906..
Oberndorfer, T.A., Kaye, W.H., Simmons, A.N., Strigo, I.A., & Matthews, S.C. (2011). Demand-specific alteration of medial prefrontal cortexOberndorfer, T.A., Kaye, W.H., Simmons, A.N., Strigo, I.A., & Matthews, S.C. (2011). Demand-specific alteration of medial prefrontal cortex
response during an inhibition task in recovered anorexic women.response during an inhibition task in recovered anorexic women. International Journal of Eating Disorders,International Journal of Eating Disorders, 44,44, 1–8.1–8.
doi: 10.1002/eat.20750doi: 10.1002/eat.20750
Kaye, W.H., Fudge, J., & Paulus, M. (2009, August). New insights into symptoms and neurocircuit function of AN.Kaye, W.H., Fudge, J., & Paulus, M. (2009, August). New insights into symptoms and neurocircuit function of AN. Nature ReviewsNature Reviews
Neuroscience, 10,Neuroscience, 10, 573-584. doi:10.1038/nrn2682573-584. doi:10.1038/nrn2682
Wagner, A., Aizenstein, H., Venkatraman, V.K., Bischoff-Grethe, A., Fudge, J., May, J.C., …Kaye, W.H. (2010). Altered striatal response toWagner, A., Aizenstein, H., Venkatraman, V.K., Bischoff-Grethe, A., Fudge, J., May, J.C., …Kaye, W.H. (2010). Altered striatal response to
reward in bulimia nervosa after recovery.reward in bulimia nervosa after recovery. International Journal of Eating Disorders, 43,International Journal of Eating Disorders, 43, 289–294. doi: 10.1002/eat.20699289–294. doi: 10.1002/eat.20699
Lopez, C., Tchanturia, K., Stahl, D., & Treasure, J. (2008), Central coherence in eating disorders: a systematic review.Lopez, C., Tchanturia, K., Stahl, D., & Treasure, J. (2008), Central coherence in eating disorders: a systematic review. Psychological MedicinePsychological Medicine,,
3838(10), 1393-1404. doi:10.1017/S0033291708003486(10), 1393-1404. doi:10.1017/S0033291708003486
Phillips, M.L, Drevets, W.C., Rauch S.L., & Lane, R. (2003) Neurobiology of emotion perception I: The neural basis of normal emotionPhillips, M.L, Drevets, W.C., Rauch S.L., & Lane, R. (2003) Neurobiology of emotion perception I: The neural basis of normal emotion
perception.perception. Biol. Psych., 54,Biol. Psych., 54, 504–514 . doi:10.1016/S0006-3223(03)00171-9504–514 . doi:10.1016/S0006-3223(03)00171-9

ED Support/Recovery 100ED Support/Recovery 100
My loved one will be in recovery when s/he:My loved one will be in recovery when s/he:
A.A.Stops purgingStops purging
B.B.Stops binge eatingStops binge eating
C.C.Establishes a healthy weight & follows theEstablishes a healthy weight & follows the
meal planmeal plan
D.D.Works to reduce his/her ED behaviorsWorks to reduce his/her ED behaviors
and thoughts one day at a timeand thoughts one day at a time
E.E.All of the aboveAll of the above

AnswerAnswer
E- all of the above

Quothe the raven, never more, never more.Quothe the raven, never more, never more.
(Author)(Author)

Who is EDgar Alan Poe?Who is EDgar Alan Poe?

I can support my loved one when s/heI can support my loved one when s/he
constantly talks about calories and weightconstantly talks about calories and weight
by doing this:by doing this:
A.A.DistractDistract
B.B.InterruptInterrupt
C.C.Stop, Reboot, rerouteStop, Reboot, reroute
D.D.All the aboveAll the above

AnswerAnswer
D: All the aboveD: All the above

When my loved one is binge eating and isWhen my loved one is binge eating and is
alone these are things I can do (include allalone these are things I can do (include all
that apply):that apply):
A.A.Leave him/her aloneLeave him/her alone
B.B.Interrupt and be nearInterrupt and be near
C.C.Call to interruptCall to interrupt
D.D.Not argue with him/herNot argue with him/her
E.E.Stop, Reboot, RerouteStop, Reboot, Reroute

AnswerAnswer
B – E
B. Interrupt and be nearB. Interrupt and be near
C. Call to interruptC. Call to interrupt
D. Not argue with him/herD. Not argue with him/her
E. Stop, Reboot, RerouteE. Stop, Reboot, Reroute

What tools can you offer that could helpWhat tools can you offer that could help
your loved one with his/her eatingyour loved one with his/her eating
disorder:disorder:
(include all that apply)(include all that apply)
A)A)Increase structure and repetitionIncrease structure and repetition
B)B)Limit options for decisions, using multipleLimit options for decisions, using multiple
choicechoice
C)C)Use open ended questionsUse open ended questions
D)D)Follow meal plan, e.g. same daily plan forFollow meal plan, e.g. same daily plan for
ANAN

AnswerAnswer

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