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 When Food is Restricted…

When Food is Restricted…–

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

Are

Eating

Disorders

Are

Eating

Disorders

a Form

of

Addiction?

a Form

of

Addiction?

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”

Infants and MR Populations Eating Non-Nutritive Substances

– paint, string, hair, feces,

Infants and MR Populations Eating Non-Nutritive Substances

– paint, string, hair, feces,

Pica Pica