eating disorders and body image over the life-cycle 2005-2006 kathryn j. zerbe, m.d. professor and...

Eating Disorders and Eating Disorders and Body Image over the Life-Body Image over the Life-

cycle 2005-2006cycle 2005-2006

KATHRYN J. ZERBE, M.D.KATHRYN J. ZERBE, M.D.

Professor and Vice ChairProfessor and Vice ChairDirector of Outpatient ServicesDirector of Outpatient Services

Department of PsychiatryDepartment of PsychiatryDirector of Behavioral MedicineDirector of Behavioral Medicine

Center for Women’s Health, OHSUCenter for Women’s Health, OHSU

Diseases of the soul are Diseases of the soul are more dangerous, and more dangerous, and more numerous, than more numerous, than those of the body.those of the body.

Cicero, Tusculanarum Disputationum

The Hunger Artists: Ariel & HelenThe Hunger Artists: Ariel & Helen

Maternal neglect / paternal disinterestMaternal neglect / paternal disinterest Longing to be lovedLonging to be loved Constant flight from feelingsConstant flight from feelings Restless, disorganized activityRestless, disorganized activity Parents Parents nevernever expressed affection, expressed affection,

humor, pride, or sympathyhumor, pride, or sympathy Parents unable to recognize child as a Parents unable to recognize child as a

person in her own rightperson in her own right

Hunger ArtistsHunger Artists (cont.) (cont.)

Impaired social/intellectual skillsImpaired social/intellectual skills Loss of spontaneity, dejectionLoss of spontaneity, dejection Self-rocking, self-rolling, head waggingSelf-rocking, self-rolling, head wagging Distortions in body image as early as Distortions in body image as early as

age 4 on “Draw-a-Person” testage 4 on “Draw-a-Person” test

Sylvia Brody, Sylvia Brody, The Development of The Development of Anorexia Anorexia

Nervosa: the Hunger ArtistsNervosa: the Hunger Artists, (2002)., (2002).

Cultural EtiologyCultural Etiology

Societal attitudes -- Furnham & Alibhai Societal attitudes -- Furnham & Alibhai (1983)(1983)

Narcissistic pursuit of perfection/idealNarcissistic pursuit of perfection/ideal

Discrimination of obese persons Discrimination of obese persons pervasivepervasive

Becker (1993/1995): Study of FijiBecker (1993/1995): Study of Fiji

Experience of Hunger among Experience of Hunger among Conscientious ObjectorsConscientious Objectors

Pervasiveness of thoughts about food.Pervasiveness of thoughts about food. Changes in emotionalityChanges in emotionality Lack of interest in activities (except those Lack of interest in activities (except those

related to food getting activities)related to food getting activities) Change in motivationChange in motivation Toying with foodToying with food Hunger! Hunger! Hunger!Hunger! Hunger! Hunger!

Men and HungerMen and Hunger, 1946, 1946

Effects of Starvation among Effects of Starvation among Conscientious ObjectorsConscientious Objectors (cont.)(cont.)

Humor--jokes fell flatHumor--jokes fell flat Discussions of food. Those who Discussions of food. Those who

succeeded in substituting other interests succeeded in substituting other interests for food were rare. Constant for food were rare. Constant preoccupation with food; discussion of preoccupation with food; discussion of favorite recipes.favorite recipes.

Moodiness--experiences of depression, Moodiness--experiences of depression, irritability. “Psychotherapy cannot cure irritability. “Psychotherapy cannot cure psychological complaints due to psychological complaints due to physiological causes.”physiological causes.”

Effects of Starvation among Effects of Starvation among Conscientious ObjectorsConscientious Objectors (cont.)(cont.)

Physical activity -- inertia, apathy, Physical activity -- inertia, apathy, physical weakness.physical weakness.

Group solidarity. “The starving live Group solidarity. “The starving live in their own little world with little in their own little world with little interest in the larger areas of life.”interest in the larger areas of life.”

Changes in intellectual capacity. Changes in intellectual capacity. Decisions become harder.Decisions become harder.

Biological Bedrocks of AgingBiological Bedrocks of Aging

Until age 60, women tend to gain 5-10 lbs Until age 60, women tend to gain 5-10 lbs per decadeper decade

Fat deposits tend to increase with Fat deposits tend to increase with developmental milestones: puberty, developmental milestones: puberty, pregnancy, menopausepregnancy, menopause

Women are also:Women are also:1)1) Born with more fat cells than menBorn with more fat cells than men

2)2) Have slower metabolic rates than menHave slower metabolic rates than men

3)3) Hormonal influences (estrogen, progesterone) Hormonal influences (estrogen, progesterone) increase likelihood of weight gain over life cycleincrease likelihood of weight gain over life cycle

Symptoms of Eating Disorder Symptoms of Eating Disorder of Middle and Late Lifeof Middle and Late Life

Preoccupation with body imagePreoccupation with body image Use of over-the-counter, prescribed, or Use of over-the-counter, prescribed, or

illicit substances to lose weightillicit substances to lose weight ““Exercise addiction”Exercise addiction” Inability to make life transitions or to Inability to make life transitions or to

mourn significant lossesmourn significant losses Fear of aging; competition with younger Fear of aging; competition with younger

generationsgenerations Unrealistic goalsUnrealistic goals

Similarities and Differences between Similarities and Differences between Depression and Eating Disorders in Later Depression and Eating Disorders in Later

LifeLifeSymptomsSymptoms DepressionDepression Eating D/OEating D/O

Weight lossWeight loss ++ + + (if (if anorexia)anorexia)

Memory impairmentMemory impairment ++ ++

Concentration problemConcentration problem ++ ++

InsomniaInsomnia ++ __

Delusion about bodyDelusion about body ++ __

Body image Body image preoccupationpreoccupation

RareRare ++

You should always know when You should always know when you’re shifting gears in life. you’re shifting gears in life. You should leave your era. It You should leave your era. It should never leave you.should never leave you.

Leontyne PriceLeontyne Price

Development/Resiliency Development/Resiliency in Middle Lifein Middle Life

Neugarten (1968) – Peak period for Neugarten (1968) – Peak period for competence, ability to handle stress, sense competence, ability to handle stress, sense of control, productivity.of control, productivity.

Perspective on time changes: focus on years Perspective on time changes: focus on years left to live rather than time since birth.left to live rather than time since birth.

No longer the socialized; now the No longer the socialized; now the socializers.socializers.

Empathy for people both younger and older.Empathy for people both younger and older.

Body ImageBody Image

70% of women, 70% of women, ages 30-74, are ages 30-74, are dissatisfied with dissatisfied with their weighttheir weight

Allaz, AF, et al (1998), Int J Eating Disorders, 287.

Body ImageBody Image

3,400 women / 500 men, 13-90 years old3,400 women / 500 men, 13-90 years old 2/3 women, 1/3 men: weight gains greatest 2/3 women, 1/3 men: weight gains greatest

detriment to self-imagedetriment to self-image 62% females, 13-16 y/o, dissatisfied with 62% females, 13-16 y/o, dissatisfied with

weightweight 67% females > 30, dissatisfied with weight67% females > 30, dissatisfied with weight

1997 Poll, 1997 Poll, Psychology TodayPsychology Today

Body ImageBody Image

89% of women want to lose 89% of women want to lose weightweight

15% would sacrifice up to 5 15% would sacrifice up to 5 years to achieve desired weightyears to achieve desired weight

24% would sacrifice 3 years of 24% would sacrifice 3 years of lifelife

1997 Poll, 1997 Poll, Psychology TodayPsychology Today

Body Image - WOMENBody Image - WOMEN

78% dissatisfied with weight78% dissatisfied with weight 48% conceal signs of aging48% conceal signs of aging 37% want to change teeth37% want to change teeth 34% want better legs34% want better legs 32% want to change bust32% want to change bust 18% want smaller feet18% want smaller feet

Louis Harris Poll, 1987, Louis Harris Poll, 1987, Inside AmericaInside America

Body Image - MENBody Image - MEN

56% dissatisfied with weight56% dissatisfied with weight 36% want more hair36% want more hair 34% want to change weight34% want to change weight 27% want to conceal signs of aging27% want to conceal signs of aging 19% want a different nose19% want a different nose

Louis Harris Poll, 1987, Louis Harris Poll, 1987, Inside AmericaInside America