Chapter 34 — Self-Check Quiz

⚠️ CONTENT NOTE. This quiz is about the illnesses, the myths and the language — not about criteria, thresholds or numbers. ⚠️ There are none here, deliberately. ⚠️ §34.14 has the help information.

20 questions. Answers with explanations at the end. Aim for 16+.

Questions

1. The difference between Chapter 33's cycle and an eating disorder is that:

• a) One is more severe than the other
• b) Chapter 33's cycle is maintained by the environment; an eating disorder is maintained by itself
• c) One involves food and the other doesn't
• d) There is no meaningful difference

2. Eating disorders are best described as:

• a) Diets that went too far
• b) Psychiatric illnesses with genetic, neurobiological, psychological and social contributions
• c) A lifestyle choice
• d) A form of vanity

3. This chapter deliberately omits diagnostic thresholds because:

• a) They are secret
• b) Reproduced in a textbook they get read as entry requirements, and people conclude they are not ill enough
• c) They are unimportant
• d) They change too often

4. Which is the most common eating disorder?

• a) Anorexia nervosa
• b) Binge eating disorder
• c) Bulimia nervosa
• d) ARFID

5. ARFID differs from the other restrictive disorders in that:

• a) It is milder
• b) It has no body-image component — restriction is driven by sensory factors, fear of aversive consequences, or low interest in eating
• c) It only affects children
• d) It is not a real diagnosis

6. OSFED is:

• a) A mild category for people who are nearly ill
• b) A category for clinically serious presentations that don't match the others' pattern, with comparable outcomes
• c) Obsolete
• d) Only used in research

7. Most people with eating disorders are:

• a) Underweight
• b) Not underweight
• c) Adolescent girls
• d) Unable to work

8. People in larger bodies with restrictive eating disorders are:

• a) Diagnosed faster
• b) Routinely praised for their symptoms, referred less often, and sometimes advised to lose weight while unwell
• c) Not at medical risk
• d) Rare

9. Medical complications of restriction follow from:

• a) A person's position on a weight chart
• b) The behaviour, and the rate and degree of change
• c) Genetics alone
• d) Duration only

10. Refeeding syndrome means that:

• a) Nutrition should be withheld
• b) Reintroducing nutrition to a substantially undernourished person causes shifts that can be fatal — so restoration is a monitored medical procedure
• c) Recovery is impossible
• d) Only hospital food is safe

11. Some of what looks like personality in a person who is significantly undernourished is:

• a) Fixed and permanent
• b) Physiology — the Minnesota findings, and it improves with nutrition
• c) Entirely psychological
• d) Evidence of a personality disorder

12. RED-S:

• a) Only affects female athletes
• b) Affects all sexes at every level and does not require a low body weight — the deficit is relative to expenditure
• c) Requires an eating disorder to be present
• d) Is the same thing as anorexia nervosa

13. In athletes, detection is harder because:

• a) They are healthier
• b) The behaviours are praised as dedication, and performance can improve before it collapses
• c) They see doctors less
• d) The symptoms are different

14. Amenorrhoea in an athlete is:

• a) Normal, and a sign of training hard enough
• b) A symptom
• c) Only relevant to elite athletes
• d) Untreatable

15. "They have to want to recover before treatment can work" is:

• a) ✅ Well supported
• b) ❌ Not supported — ambivalence is a characteristic feature, early intervention improves outcomes, and this belief is used to justify waiting
• c) 🟡 Unclear
• d) True for adolescents only

16. "Dieting causes eating disorders" is:

• a) ✅ Well supported
• b) 🟡 Unclear — dieting is a real risk factor and not a cause; both "dieting is harmless" and "dieting causes eating disorders" are wrong
• c) ❌ Not supported at all
• d) ⚗️ Untested

17. The historical belief that families cause eating disorders:

• a) Has been confirmed
• b) Has not held up — and family-based treatment, which enlists parents as a resource, has the best evidence base for adolescents
• c) Applies only to mothers
• d) Is still the mainstream view

18. Orthorexia is:

• a) A formal diagnosis in DSM-5-TR
• b) Not a formal diagnosis; it names something real that frequently meets criteria for OSFED or ARFID, and is ⚗️ under-tested as a distinct entity
• c) Not a real phenomenon
• d) A synonym for healthy eating

19. The rule §34.11 gives about commenting on bodies is:

• a) Only comment favourably
• b) Do not comment on anyone's body, ever, including favourably — you do not know who you are talking to
• c) Comment only on health, not appearance
• d) Comment only if asked

20. The strongest modifiable predictor of outcome is:

• a) Age at onset
• b) Duration of untreated illness
• c) Body weight at presentation
• d) Family history

Answers

1. b) Maintained by the environment vs maintained by itself. ⚠️ Remove the cue and the behaviour finds another route, because what drives it is a self-sustaining system involving beliefs about food, weight, control and self-worth. Which is why several of Chapter 33's tools make things worse here. §34.2.

2. b) Psychiatric illnesses. ⚠️ Heritability is substantial, neurobiological contributions are increasingly well characterized, and mortality is among the highest of any psychiatric category. ⚠️ Dieting is a real risk factor and not the same thing. §34.0, §34.8.

3. b) They get read as entry requirements. ⚠️ Thresholds exist to make clinical research comparable and to allocate treatment. Reproduced in a textbook they do something else — people conclude they are not ill enough to deserve help. §34.1.

4. b) Binge eating disorder. ⚠️ It was not formally recognized until 2013 and is still widely mistaken for a lack of self-control rather than a psychiatric condition. §34.1.

5. b) No body-image component. ⚠️ Which means every screening question built around weight and shape returns nothing — Ren, in Case Study 2, was called fussy for about eleven years. §34.1, §34.3.

6. b) Clinically serious, comparable outcomes. ⚠️ The name misleads badly. "Not fitting the criteria" is a statement about the criteria, not about how ill someone is. §34.1.

7. b) Not underweight. ⚠️ Binge eating disorder, bulimia nervosa, OSFED and atypical anorexia nervosa together account for the great majority of presentations. This is the most consequential misconception in the chapter. §34.4.

8. b) Praised, under-referred, and sometimes advised to lose weight. ⚠️ The weight loss produced by an illness is received as an achievement, sometimes by clinicians — which is why guidance in several countries now states that weight and BMI should not be the sole determinant of access to treatment. §34.4, and Rukhsana in Case Study 2.

9. b) The behaviour, and the rate and degree of change. ⚠️ Cardiac, electrolyte, endocrine, bone and gastrointestinal complications do not require a low weight. §34.4, §34.5.

10. b) A monitored medical procedure. ⚠️ Phosphate, potassium, magnesium and fluid shift rapidly and it can be fatal (Ch 29 §29.7). ⚠️ This is one of the two places in this whole textbook where following general nutrition advice could kill someone. §34.5.

11. b) Physiology, and it improves with nutrition. ⚠️ The rigidity, preoccupation, low mood and social withdrawal are the Minnesota findings in one person (Ch 33 §33.6) — which is why nutritional restoration comes early even when the psychological work has barely begun. §34.2, §34.12.

12. b) All sexes, every level, no low weight required. ⚠️ The deficit is relative to expenditure, which is why an athlete can develop it while eating what would be entirely adequate for a non-athlete. §34.6.

13. b) Praised as dedication, and performance improves first. ⚠️ Weighing food and training through fatigue are called commitment in a context where they would be flags anywhere else, and short-term performance gains function as confirmation. §34.6, and Marcus in Case Study 2.

14. b) A symptom. ⚠️ It is not normal and is not a sign of training hard enough. Saying so is one of the more useful things a coach can do, and the belief that it is normal remains widespread. §34.6.

15. b) ❌ Not supported. ⚠️ Ambivalence is a characteristic feature rather than an obstacle; early intervention improves outcomes; and family-based treatment for adolescents does not require the young person to be motivated at the outset. ⚠️ It is one of the more dangerous things a person can be told, because it justifies waiting. §34.8.

16. b) 🟡 Unclear / it depends. ⚠️ A real risk factor, particularly in adolescence, and most people who diet do not develop an eating disorder. Both halves matter. §34.8.

17. b) Has not held up. ⚠️ Family-based treatment explicitly enlists parents as a resource rather than treating them as the problem, and has the best evidence base of any treatment for adolescents. ⚠️ The old belief actively harmed families for decades. §34.8, §34.12.

18. b) Not formal; names something real; ⚗️ under-tested. ⚠️ And it is the one presentation the culture actively supplies — every other eating disorder has to work around social approval; this one is congruent with it. ⚠️ The distinguishing questions are about what the rules DO, not what they contain. §34.9.

19. b) Never, including favourably. ⚠️ A person losing weight because they are unwell will be complimented on it repeatedly by people who mean well, and each compliment is reinforcement from someone whose opinion they value. ⚠️ It costs nothing to follow, and you do not know who you are talking to. §34.11.

20. b) Duration of untreated illness. ⚠️ Which is why "it's a phase," "they have to want it first," and "you're not sick enough" are not merely wrong — they are costly, and the cost is measured in the one variable the evidence says is modifiable. §34.12, 🧾 §34.13.

Scoring

Three items worth checking regardless of score.

Question 7. ⚠️ If one fact from this chapter travels with you, make it this one.

Question 15. ⚠️ This belief is used to justify waiting, and waiting is the thing that costs.

Question 19. ⚠️ The single easiest change anyone reading this can make today.

⚠️ §34.14 has the help information. There is no threshold you have to reach.