two main types until recently anorexia nervosa bulimia nervosa share strong drive to be thin ...
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Two Main Types Until Recently Anorexia Nervosa Bulimia Nervosa
Share Strong Drive to be Thin Largely a Female Problem Largely a Westernized Problem Largely an Upper SES Problem Mortality may resultBinge-eating disorder
Two Main Types Until Recently Anorexia Nervosa Bulimia Nervosa
Share Strong Drive to be Thin Largely a Female Problem Largely a Westernized Problem Largely an Upper SES Problem Mortality may resultBinge-eating disorder
Clinical Description Clinical Description Binging
– Eat Large Amounts of Food– Eating is Out of Control
Binging– Eat Large Amounts of Food– Eating is Out of Control
Belief that popularity and self-esteem are determined by weight and body shape Compensatory Behaviors
– Purging via Self-Induced Vomitting Laxatives, Diuretics, Exercise, Fasting
Belief that popularity and self-esteem are determined by weight and body shape Compensatory Behaviors
– Purging via Self-Induced Vomitting Laxatives, Diuretics, Exercise, Fasting
Subtypes
Purging (most common) Vomiting, laxatives, or diuretics
Nonpurging Exercise and/or fasting 6-8% of Bulimics not in DSM-5 due to low rate
Most are within 10% of normal weight
Subtypes
Purging (most common) Vomiting, laxatives, or diuretics
Nonpurging Exercise and/or fasting 6-8% of Bulimics not in DSM-5 due to low rate
Most are within 10% of normal weight
Medical Consequences Medical Consequences Salivary Gland EnlargementSalivary Gland Enlargement Eroded Dental EnamelEroded Dental Enamel Electrolyte ImbalanceElectrolyte Imbalance Intestinal ProblemsIntestinal Problems Calluses on Fingers and HandsCalluses on Fingers and Hands Kidney failure Kidney failure Cardiac arrhythmia Cardiac arrhythmia Seizures Seizures Permanent colon damagePermanent colon damage
Salivary Gland EnlargementSalivary Gland Enlargement Eroded Dental EnamelEroded Dental Enamel Electrolyte ImbalanceElectrolyte Imbalance Intestinal ProblemsIntestinal Problems Calluses on Fingers and HandsCalluses on Fingers and Hands Kidney failure Kidney failure Cardiac arrhythmia Cardiac arrhythmia Seizures Seizures Permanent colon damagePermanent colon damage
90-95% are Women, 6-8% College Women90-95% are Women, 6-8% College Women White; Middle-to-Upper Middle ClassWhite; Middle-to-Upper Middle Class Onset 10-21 Years of AgeOnset 10-21 Years of Age About 2.8% Population OverallAbout 2.8% Population Overall Chronic if Left UntreatedChronic if Left Untreated
Bulimia in men, 5-10% maleBulimia in men, 5-10% male Caucasian, middle to upper classCaucasian, middle to upper classTypically gay or bisexualTypically gay or bisexual Athletes with weight regulationsAthletes with weight regulationsOnset = older age rangeOnset = older age range
90-95% are Women, 6-8% College Women90-95% are Women, 6-8% College Women White; Middle-to-Upper Middle ClassWhite; Middle-to-Upper Middle Class Onset 10-21 Years of AgeOnset 10-21 Years of Age About 2.8% Population OverallAbout 2.8% Population Overall Chronic if Left UntreatedChronic if Left Untreated
Bulimia in men, 5-10% maleBulimia in men, 5-10% male Caucasian, middle to upper classCaucasian, middle to upper classTypically gay or bisexualTypically gay or bisexual Athletes with weight regulationsAthletes with weight regulationsOnset = older age rangeOnset = older age range
Associated Features Associated Features More Severe Form: Purging Type Most Have Other DSM Disorders Paradoxically:
– Purging is an Inefficient Means to Reduce Weight
A Closely Related Disorder– Binge-Eating Disorder (new to DSM)
More Severe Form: Purging Type Most Have Other DSM Disorders Paradoxically:
– Purging is an Inefficient Means to Reduce Weight
A Closely Related Disorder– Binge-Eating Disorder (new to DSM)
Marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia
Marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia
Often found in weight-control programs 20% 50% among candidates for bariatric surgery Better response to treatment
Often found in weight-control programs 20% 50% among candidates for bariatric surgery Better response to treatment
Associated Features Associated Features
Many medically obese
Older, and have more psych distress / disorders than non-binging obese
Concerned about shape and weight
Many medically obese
Older, and have more psych distress / disorders than non-binging obese
Concerned about shape and weight
Lifetime prevalence: 2.8%12-month prevalence: 1.2%
Lifetime prevalence: 2.8%12-month prevalence: 1.2%
Clinical Description Clinical Description
Relentless pursuit of thinness Often begins with dieting Morbid Fear of
– –
Relentless pursuit of thinness Often begins with dieting Morbid Fear of
– –
Deliberate Weight Loss Life-Threatening Consequences
Deliberate Weight Loss Life-Threatening Consequences
Two Subtypes Two Subtypes
Restricting Type – Excessive Dieting
Restricting Type – Excessive Dieting
Binge-Eating-Purging Type • Rely on Purging; Eat less during Binges, &
purge more consistently than Bulimics• About Half of All Cases• More Impulsive Behavior
Binge-Eating-Purging Type • Rely on Purging; Eat less during Binges, &
purge more consistently than Bulimics• About Half of All Cases• More Impulsive Behavior
Medical Consequences Medical Consequences Amenorrhea Dry Skin Brittle Hair or Nails Sensitivity to Cold Lanugo Heart Problems Electrolyte Imbalance
Amenorrhea Dry Skin Brittle Hair or Nails Sensitivity to Cold Lanugo Heart Problems Electrolyte Imbalance
Associated Features and Facts Associated Features and Facts Begins Early in Adolescence Body image disturbance Pride in diet and control Rarely seek treatment Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders
– Obsessive-Compulsive Disorder– Substance Abuse– Suicide– Anxiety– Mood disorders (71%)
Begins Early in Adolescence Body image disturbance Pride in diet and control Rarely seek treatment Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders
– Obsessive-Compulsive Disorder– Substance Abuse– Suicide– Anxiety– Mood disorders (71%)
More female than malesCaucasian, middle to upper classOnset = age 13 to 18ChronicResistant to treatmentLifetime prevalence: .6%
More female than malesCaucasian, middle to upper classOnset = age 13 to 18ChronicResistant to treatmentLifetime prevalence: .6%
Causes Causes Social and Cultural Factors
– Thinness Equals Success – Has Increased Over Time
North American minority populations Immigrants to western cultures
Increase in eating disorders Increase in obesity
Cultural values Standards for body image Media
– Sets Impossible Idealized Images– Promotes body image and weight as frequent issues
Social and Cultural Factors– Thinness Equals Success – Has Increased Over Time
North American minority populations Immigrants to western cultures
Increase in eating disorders Increase in obesity
Cultural values Standards for body image Media
– Sets Impossible Idealized Images– Promotes body image and weight as frequent issues
Causes Causes Family Influences
– Successful and Driven– Concerned About Appearances– Eager to Maintain Harmony – Deny or Ignore Conflicts– Lack of Open Communication
Family Influences– Successful and Driven– Concerned About Appearances– Eager to Maintain Harmony – Deny or Ignore Conflicts– Lack of Open Communication
Causes Causes Biological InfluencesBiological Influences
– Runs in FamiliesRuns in Families– Unclear What is InheritedUnclear What is Inherited– Modeling Mommies??Modeling Mommies??
Psychological InfluencesPsychological Influences– Diminished Sense of ControlDiminished Sense of Control–Family, interpersonal issues of controlFamily, interpersonal issues of control– Low Self-Esteem Low Self-Esteem
Biological InfluencesBiological Influences– Runs in FamiliesRuns in Families– Unclear What is InheritedUnclear What is Inherited– Modeling Mommies??Modeling Mommies??
Psychological InfluencesPsychological Influences– Diminished Sense of ControlDiminished Sense of Control–Family, interpersonal issues of controlFamily, interpersonal issues of control– Low Self-Esteem Low Self-Esteem
Anorexia
No demonstrated efficacy
Bulimia
Antidepressants May enhance psychological treatment No long-term efficacy
Anorexia
No demonstrated efficacy
Bulimia
Antidepressants May enhance psychological treatment No long-term efficacy
Cognitive-behavior therapy (CBT) Treatment of choice Target problem eating behaviors Target dysfunctional thoughts
Interpersonal psychotherapy Improve interpersonal functioning Similarly effective, long-term
Cognitive-behavior therapy (CBT) Treatment of choice Target problem eating behaviors Target dysfunctional thoughts
Interpersonal psychotherapy Improve interpersonal functioning Similarly effective, long-term
Cognitive-behavior therapy (CBT)Interpersonal psychotherapy
As effective as CBTMedications
Prozac No benefit
Meridia Possible benefits
Cognitive-behavior therapy (CBT)Interpersonal psychotherapy
As effective as CBTMedications
Prozac No benefit
Meridia Possible benefits
Family involvement Communication about eating/food Attitudes about body shape
Long-term prognosis Poorer than bulimia
Weight restoration May require hospitalization
Target dysfunctional attitudes Body shape Control Thinness = worth
Family involvement Communication about eating/food Attitudes about body shape
Long-term prognosis Poorer than bulimia
Weight restoration May require hospitalization
Target dysfunctional attitudes Body shape Control Thinness = worth
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• Rapid increases in prevalence– U.S. adults
• 1991 = 12%• 2000 = 30.5% • 2002 = 30.6% • 2004 = 32.2%• 2008 = 33.8%• 2010 = 35.7%
– Developing nations– Health Risks– 70% of U.S. adults overweight– BMI versus weight
Obesity—Statistics
Spread of modernizationInactive, sedentary lifestyle + high fat foods
Genetics 30% of the cause
Biological factors Initiation and maintenance of eating
Psychosocial factorsImpulse control, affect regulation, attitudes
Causes of Obesity
Disordered Eating Patterns in Cases of Obesity
Night eating syndromeAssociated with
obesity1/3 of daily calories
consumedPatients are awakeNo binge eating
Progression from least to most intrusiveSelf-directed weight loss programsCommercial self-help programsBehavior modification programsBariatric surgery
15% of patients who have bariatric surgery fail to lose significant weight
EfficacyModerate for adultsHigher for children and adolescents
Family involvement
Obesity Treatment
Severe Craving Loss of Control Used to Cope With Negative Feelings Preoccupied with Substance Unsuccessful Attempts to Quit Denial Adverse Psychosocial Consequences
Severe Craving Loss of Control Used to Cope With Negative Feelings Preoccupied with Substance Unsuccessful Attempts to Quit Denial Adverse Psychosocial Consequences
Rumination Disorder Rumination Disorder Regurgitating and Reswallowing Food Disorder of Infancy--Adolescence Can Occur With Bulimia “Failure to Thrive Syndrome”
Regurgitating and Reswallowing Food Disorder of Infancy--Adolescence Can Occur With Bulimia “Failure to Thrive Syndrome”