Tentamen samenvatting 3.5C
Week 1 – Eating Disorders
Eating disorders in adolescent and young adult males: prevalence, diagnosis, and
treatment strategies Limbers
Prevalence of EDs in men
Existing prevalence rates likely underestimate the number of males affected by EDs, as the social
stigma associated with ED pathology in males often causes them to minimize or deny the presence of
symptoms.
Male ED symptom presentation
Adolescent and young adult males who present for ED treatment, especially for binge ED, generally
report
less shape and weight concern,
less drive for thinness, and
less body dissatisfaction than their female counterparts.
Whereas body dissatisfaction in white females is usually associated with a desire to be thinner,
adolescent and young adult male concerns typically center around being “bigger” and more
muscular.
!An exception! to this is males with anorexia nervosa who may be more likely to have
concerns about thinness and not muscularity.
Muscle dysmorphic disorder = describes individuals who have a preoccupation with their
appearance and are concerned that they are not sufficiently large and muscular.
Given that adolescent and young adult males with EDs often present with concerns about
being insufficiently large and muscular, it has been suggested that muscle dysmorphic
disorder would be better classified in the DSM as a type of ED.
Other sex differences in ED pathology have been reported in the peer-reviewed literature.
Adolescent and young adult males who present with bulimic symptoms are less likely to
engage in dieting, laxative use, and self-induced vomiting than females.
Compared to females, adolescent and young adult males are less likely to report eating in
response to negative emotion, experiencing a sense of loss of control when binge eating,
and restricting their food intake in response to body dissatisfaction.
Sexuality has also been identified as a male-specific risk factor for the development of EDs,
in that adolescent and young adult males who are gay or bisexual exhibit higher rates of
ED pathology.
Assessment of EDs in men
,Since contemporary ED measures were created and normed predominantly for female populations, a
major criticism of these measures has been their overreliance on items that capture stereotypically
feminine indicators of ED pathology.
While the early validation work of the EDAM (Eating Disorder Assessment for Men) has yielded
promising findings, further research is needed to establish the psychometric properties of the EDAM
and other male-specific measures including the Male Body Image Concerns Scale and the Male Body
Checking Questionnaire, particularly for male adolescent populations.
Treatment strategies for men with EDs
Several explanations have been proposed for why males seek treatment for disordered eating later
and at lower rates than their female counterparts:
For example, adolescent and young adult males may not be as readily aware that their
eating and weight control behaviors are pathological due to a perception that EDs mostly
affect females.
Further, physicians and other health care providers may be less likely to recognize
disordered eating symptoms in adolescent and young adult males due to their lower rates
of incidence and differences in symptom presentation.
Most notably, adolescent and young adult males may be less likely to seek treatment than
females due to an overall higher degree of shame and stigma related to their Eds.
Improving interpersonal interactions has been identified as an important target in ED treatments for
adolescent and young adult males.
Factors that influence the therapy
therapist characteristics and quality of therapeutic relationships
Adolescent and young adult males with EDs appear to be particularly at-risk for comorbid
substance abuse, which may negatively impact their treatment course and outcomes
participation in competitive sports.
o Adolescent and young adult male athletes have a higher incidence of EDs and general
eating pathology than non-athlete males young adult males who participate in
sports that value leanness or require athletes to fall into certain weight categories may
experience pressure from teammates and/or coaches to engage in unhealthy weight
control practices
, EATING DISORDERS IN CHILDREN AND ADOLESCENTS: STATE OF THE
ART REVIEW CAMPBELL
Epidemiology of EDs in children and adolescents
The lifetime prevalence of AN is between 0.5% to 2%, with a peak age of onset of 13 to 18
years.
AN has a mortality rate of at least 5% to 6%, the highest mortality rate of any
psychiatric illness.
The lifetime prevalence of BN is higher at between 0.9% and 3%, with an older age of onset
of 16 to 17 years.
Although mortality rates in BN are estimated to be ∼2%,12 the risk of lifetime suicidality
and suicide attempts in BN are much higher.
Furthermore, younger patients diagnosed with EDs are more likely to be boys, with a female to
male ratio of 6 to 1, compared with a 10 to 1 ratio in adults. However, EDs in younger patients are
thus still more prevalent among girls.
Clinical presentation of EDs in children and adolescents
The explosive physical and cognitive development that occurs during this period lends itself to
substantial differences in the presentation of EDs in children and adolescents.
Younger patients are likely to have atypical presentations; instead of rapid weightloss, they
may present with failure to make expected gains in weight or height and may not endorse
body image concerns or engage in binge eating or purging behaviors.
Boys and children and adolescents who are overweight or obese are at risk for delayed
diagnoses and significant complications.
Adolescents with chronic illnesses, especially insulin-dependent diabetes mellitus, are also at
higher risk of developing ED behaviors and should be screened regularly.
Providers should evaluate all patients for high-risk behaviors, such as dieting or excessive exercise,
and follow their growth trajectories and BMI to assess for weight loss or failure to make appropriate
gains. If an ED is suspected, it is important to obtain a comprehensive medical, family, and social
history and a complete review of systems and to perform a thorough physical examination to
evaluate for physical stigmata and medical complications of EDs.
Obtaining the history from both the patient and caregiver(s) is important; although time alone
with the adolescent is recommended, history from caregiver(s) can be crucial in
elucidating behaviors or cognitions that the adolescent may not report.
Diagnosis of EDs in children and adolescents
The DSM-5 broadens the inclusion criteria for both AN and BN, BED is now a formal diagnosis,
and other EDs have been further clarified. Adolescents with AN often present with dramatic
weight loss or poor growth and may be preoccupied with food and weight. Restriction of entire
food groups (ie, new-onset vegetarianism) or calories, and the development of food rituals are
commonplace.
, They commonly refuse to eat foods they once enjoyed, avoid meals with family and friends,
and overexercise in a rigid manner. Pubertal milestones such as linear growth or menstrual
cycles are often affected.
In addition, behavioral criteria are considered equivalent to cognitive criteria, equating fear of weight
gain to failure to gain weight in the face of low body weight or growth stunting.
Treatment modalities for children and adolescents with EDs
The treatment threshold for ED adolescents should be low because of potentially irreversible
effects of EDs on growth and development, their mortality risk, and evidence that early treatment
improves outcomes. Treating patients in a home setting is preferred.
Primary treatment modalities in pediatric AN are individual therapy, CBT, and FBT.
FBT has the largest evidence base of any treatment.
CBT has been studied in adolescents with BN and shows promise, but there is growing
evidence that FBT is also effective.
CBT has also demonstrated efficacy in BED.
Family-based Treatment (FBT)
Caregivers are not blamed but instead empowered to refeed their child back to health. Siblings
are also supported in this treatment because they frequently have numerous concerns about their sick
brother or sister. Additionally, the disorder is externalized from the child to release blame toward
the child for their disorder.
FBT progresses through 3 phases that target the goals of treatment in children and adolescents with
EDs: physical, behavioral and psychological recovery.
Phase I of FBT focuses on coaching the caregivers to refeed their child to recovery
through specific therapeutic interventions. Food exposures are commonly used to target
anxieties and aversions to certain foods or food groups; caregivers are encouraged to
incorporate foods their children used to enjoy before the ED rather than to practice avoidance.
Once the child is weightrestored, FBT progresses to Phase II
Phase II focuses on gradually transferring developmentally appropriate control of eating
back to the child or adolescent
Phase III works on relapse prevention and any other remaining developmental
considerations, and then treatment termination
Pharmacotherapy
Week 1 – Eating Disorders
Eating disorders in adolescent and young adult males: prevalence, diagnosis, and
treatment strategies Limbers
Prevalence of EDs in men
Existing prevalence rates likely underestimate the number of males affected by EDs, as the social
stigma associated with ED pathology in males often causes them to minimize or deny the presence of
symptoms.
Male ED symptom presentation
Adolescent and young adult males who present for ED treatment, especially for binge ED, generally
report
less shape and weight concern,
less drive for thinness, and
less body dissatisfaction than their female counterparts.
Whereas body dissatisfaction in white females is usually associated with a desire to be thinner,
adolescent and young adult male concerns typically center around being “bigger” and more
muscular.
!An exception! to this is males with anorexia nervosa who may be more likely to have
concerns about thinness and not muscularity.
Muscle dysmorphic disorder = describes individuals who have a preoccupation with their
appearance and are concerned that they are not sufficiently large and muscular.
Given that adolescent and young adult males with EDs often present with concerns about
being insufficiently large and muscular, it has been suggested that muscle dysmorphic
disorder would be better classified in the DSM as a type of ED.
Other sex differences in ED pathology have been reported in the peer-reviewed literature.
Adolescent and young adult males who present with bulimic symptoms are less likely to
engage in dieting, laxative use, and self-induced vomiting than females.
Compared to females, adolescent and young adult males are less likely to report eating in
response to negative emotion, experiencing a sense of loss of control when binge eating,
and restricting their food intake in response to body dissatisfaction.
Sexuality has also been identified as a male-specific risk factor for the development of EDs,
in that adolescent and young adult males who are gay or bisexual exhibit higher rates of
ED pathology.
Assessment of EDs in men
,Since contemporary ED measures were created and normed predominantly for female populations, a
major criticism of these measures has been their overreliance on items that capture stereotypically
feminine indicators of ED pathology.
While the early validation work of the EDAM (Eating Disorder Assessment for Men) has yielded
promising findings, further research is needed to establish the psychometric properties of the EDAM
and other male-specific measures including the Male Body Image Concerns Scale and the Male Body
Checking Questionnaire, particularly for male adolescent populations.
Treatment strategies for men with EDs
Several explanations have been proposed for why males seek treatment for disordered eating later
and at lower rates than their female counterparts:
For example, adolescent and young adult males may not be as readily aware that their
eating and weight control behaviors are pathological due to a perception that EDs mostly
affect females.
Further, physicians and other health care providers may be less likely to recognize
disordered eating symptoms in adolescent and young adult males due to their lower rates
of incidence and differences in symptom presentation.
Most notably, adolescent and young adult males may be less likely to seek treatment than
females due to an overall higher degree of shame and stigma related to their Eds.
Improving interpersonal interactions has been identified as an important target in ED treatments for
adolescent and young adult males.
Factors that influence the therapy
therapist characteristics and quality of therapeutic relationships
Adolescent and young adult males with EDs appear to be particularly at-risk for comorbid
substance abuse, which may negatively impact their treatment course and outcomes
participation in competitive sports.
o Adolescent and young adult male athletes have a higher incidence of EDs and general
eating pathology than non-athlete males young adult males who participate in
sports that value leanness or require athletes to fall into certain weight categories may
experience pressure from teammates and/or coaches to engage in unhealthy weight
control practices
, EATING DISORDERS IN CHILDREN AND ADOLESCENTS: STATE OF THE
ART REVIEW CAMPBELL
Epidemiology of EDs in children and adolescents
The lifetime prevalence of AN is between 0.5% to 2%, with a peak age of onset of 13 to 18
years.
AN has a mortality rate of at least 5% to 6%, the highest mortality rate of any
psychiatric illness.
The lifetime prevalence of BN is higher at between 0.9% and 3%, with an older age of onset
of 16 to 17 years.
Although mortality rates in BN are estimated to be ∼2%,12 the risk of lifetime suicidality
and suicide attempts in BN are much higher.
Furthermore, younger patients diagnosed with EDs are more likely to be boys, with a female to
male ratio of 6 to 1, compared with a 10 to 1 ratio in adults. However, EDs in younger patients are
thus still more prevalent among girls.
Clinical presentation of EDs in children and adolescents
The explosive physical and cognitive development that occurs during this period lends itself to
substantial differences in the presentation of EDs in children and adolescents.
Younger patients are likely to have atypical presentations; instead of rapid weightloss, they
may present with failure to make expected gains in weight or height and may not endorse
body image concerns or engage in binge eating or purging behaviors.
Boys and children and adolescents who are overweight or obese are at risk for delayed
diagnoses and significant complications.
Adolescents with chronic illnesses, especially insulin-dependent diabetes mellitus, are also at
higher risk of developing ED behaviors and should be screened regularly.
Providers should evaluate all patients for high-risk behaviors, such as dieting or excessive exercise,
and follow their growth trajectories and BMI to assess for weight loss or failure to make appropriate
gains. If an ED is suspected, it is important to obtain a comprehensive medical, family, and social
history and a complete review of systems and to perform a thorough physical examination to
evaluate for physical stigmata and medical complications of EDs.
Obtaining the history from both the patient and caregiver(s) is important; although time alone
with the adolescent is recommended, history from caregiver(s) can be crucial in
elucidating behaviors or cognitions that the adolescent may not report.
Diagnosis of EDs in children and adolescents
The DSM-5 broadens the inclusion criteria for both AN and BN, BED is now a formal diagnosis,
and other EDs have been further clarified. Adolescents with AN often present with dramatic
weight loss or poor growth and may be preoccupied with food and weight. Restriction of entire
food groups (ie, new-onset vegetarianism) or calories, and the development of food rituals are
commonplace.
, They commonly refuse to eat foods they once enjoyed, avoid meals with family and friends,
and overexercise in a rigid manner. Pubertal milestones such as linear growth or menstrual
cycles are often affected.
In addition, behavioral criteria are considered equivalent to cognitive criteria, equating fear of weight
gain to failure to gain weight in the face of low body weight or growth stunting.
Treatment modalities for children and adolescents with EDs
The treatment threshold for ED adolescents should be low because of potentially irreversible
effects of EDs on growth and development, their mortality risk, and evidence that early treatment
improves outcomes. Treating patients in a home setting is preferred.
Primary treatment modalities in pediatric AN are individual therapy, CBT, and FBT.
FBT has the largest evidence base of any treatment.
CBT has been studied in adolescents with BN and shows promise, but there is growing
evidence that FBT is also effective.
CBT has also demonstrated efficacy in BED.
Family-based Treatment (FBT)
Caregivers are not blamed but instead empowered to refeed their child back to health. Siblings
are also supported in this treatment because they frequently have numerous concerns about their sick
brother or sister. Additionally, the disorder is externalized from the child to release blame toward
the child for their disorder.
FBT progresses through 3 phases that target the goals of treatment in children and adolescents with
EDs: physical, behavioral and psychological recovery.
Phase I of FBT focuses on coaching the caregivers to refeed their child to recovery
through specific therapeutic interventions. Food exposures are commonly used to target
anxieties and aversions to certain foods or food groups; caregivers are encouraged to
incorporate foods their children used to enjoy before the ED rather than to practice avoidance.
Once the child is weightrestored, FBT progresses to Phase II
Phase II focuses on gradually transferring developmentally appropriate control of eating
back to the child or adolescent
Phase III works on relapse prevention and any other remaining developmental
considerations, and then treatment termination
Pharmacotherapy
