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Chapter 8
Eating Disorders
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Eating Disorders: An Overview
• Two major types of DSM-IV-TR eating disorders– Anorexia nervosa and bulimia nervosa– Severe disruptions in eating behavior– Extreme fear and apprehension about gaining
weight
• Strong sociocultural origins – Westernized views
• Binge eating disorder• Obesity – A growing epidemic
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Bulimia Nervosa: Overview and Defining Features
• Binge eating – hallmark of bulimia– Binge • Eating excess amounts of food
– Eating is perceived as uncontrollable
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Bulimia Nervosa:
• Compensatory behaviors– Purging • Self-induced vomiting, diuretics,
laxatives
– Some exercise excessively, whereas others fast
– Purging subtype – most common subtype
– Nonpurging subtype – about one-third of bulimics
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Associated medical features– Most are within 10% of target
body weight– Purging methods can result in
severe medical problems• Erosion of dental enamel,
electrolyte imbalance• Kidney failure, cardiac arrhythmia,
seizures, intestinal problems, permanent colon damage
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Bulimia Nervosa: Associated Features
• Associated psychological features– Most are overly concerned with body shape– Fear of gaining weight– Most have comorbid psychological disorders
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Anorexia Nervosa: Overview and Defining Features
• Successful weight loss – hallmark of anorexia– Defined as 15% below expected
weight– Intense fear of obesity and
losing control over eating– Anorexics show a relentless
pursuit of thinness– Often begins with dieting– amenorrhea
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• DSM-IV-TR subtypes of anorexia– Restricting subtype – limit caloric intake via diet
and fasting– Binge-eating-purging subtype
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Anorexia Nervosa: Overview and Defining Features
• Associated features– Most show marked
disturbance in body image
– Most are comorbid for other psychological disorders
– Methods of weight loss have life threatening consequences
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Anorexia Nervosa: Overview and Defining Features
– Methods of weight loss have life threatening consequences
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Binge-Eating Disorder: Overview and Defining Features
• Binge-eating disorder – appendix B of DSM-IV-TR– Experimental diagnostic category– Engage in food binges without compensatory
behaviors
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Binge-Eating Disorder:
• Associated features– Many are obese– Concerns about shape and weight– Often older than bulimics and anorexics– More psychopathology vs. non-binging obese
people
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Bulimia and Anorexia: Facts and Statistics
• Bulimia– Majority are female – 90%+– Onset around 16 to 19 years of age– Lifetime prevalence is about 1.1% for females,
0.1% for males– 6-7% of college women suffer from bulimia– Tends to be chronic if left untreated
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Bulimia and Anorexia: Facts and Statistics (continued)
• Anorexia– Majority are female and white– From middle- to upper-middle-class families– Usually develops around age 13 or early
adolescence– More chronic and resistant to treatment than
bulimia
• Cross-cultural considerations• Developmental considerations
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Causes of Bulimia and Anorexia:• Media and cultural considerations– Being thin = success, happiness....really?– Cultural imperative for thinness
• Translates into dieting
– Standards of ideal body size • Change as much as fashion
– Media standards of the ideal • Are difficult to achieve
• Biological considerations– Can lead to neurobiological
abnormalities
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Causes of Bulimia and Anorexia: Toward an Integrative Model
• Psychological and behavioral considerations– Low sense of personal control and self-confidence– Perfectionistic attitudes– Distorted body image– Preoccupation with food– Mood intolerance
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Causes of Bulimia and Anorexia: Toward an Integrative Model
• Dietary restraint• Family influences• Biological dimensions• Psychological dimensions• An integrative model
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Medical and Psychological Treatment of Bulimia Nervosa
• Psychosocial treatments– Cognitive-behavioral therapy (CBT) • Is the treatment of choice• Basic components of CBT
• Medical and drug treatments– Antidepressants • Can help reduce binging and purging behavior• Are not efficacious in the long-term
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Medical and Psychological Treatment of Binge Eating Disorder
• Medical treatment– Sibutramine (Meridia)
• Psychological treatment– CBT• Similar to that used for bulimia• Appears efficacious
– Interpersonal psychotherapy• Equally as effective as CBT
– Self-help techniques• Also appear effective
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Goals of Psychological Treatment of Anorexia Nervosa
• General goals and strategies– Weight restoration• First and easiest goal to achieve
– Psychoeducation– Behavioral and cognitive interventions• Target food, weight, body image, thought and emotion
– Treatment often involves the family– Long-term prognosis for anorexia is poorer than
for bulimia
• Preventing eating disorders
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Obesity: Background and Overview• Not a formal DSM disorder• Statistics– In 2000, 30.5% of adults in the United
States were obese; 33.8% in 2008– Mortality rates
• Are close to those associated with smoking
– Increasing more rapidly • For teens and young children
– Obesity • Is growing rapidly in developing nations
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Obesity and Disordered Eating Patterns
• Obesity and night eating syndrome– Occurs in 7-19% of treatment seekers– Occurs in 42% of individuals seeking bariatric
surgery– Patients are wide awake and do not binge eat
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Obesity and Disordered Eating Patterns
• Causes– Obesity is related to technological advancement– Genetics account for about 30% of obesity cases– Biological and psychosocial factors contribute as
well
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Obesity Treatment
• Treatment– Moderate success with adults– Greater success with children and adolescents
• Treatment progression – from least to most intrusive options
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Obesity Treatment
• First step – Self-directed weight loss programs
• Second step– Commercial self-help programs
• Third step– Behavior modification programs
• Last step– Bariatric surgery