eating disorders ch9

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Chapter 9

Eating Disorders


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Anorexia Nervosa

Diagnostic criteria Refusal to maintain normal body weight

Less than 85%

Intense fear of gaining weight and being fat

Fear not reduced by weight loss Distorted body image

Feel fat even when emaciated

Amenorrhea

Loss of menstrual period

Two types:

Restricting

Binge-eating-purging


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Table 9.1 Sample Items from Eating

Disorders Inventory (EDI)


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Figure 9.1Assessment

of Body Image


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Anorexia Nervosa

Onset early to middle teen years

Usually triggered by dieting and stress

Women 10x as likely to develop disorderas men

Often comorbid with depression, OCD,

phobias, panic, alcoholism & PDs


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Physical Changes in Anorexia

Low blood pressure, heart rate decrease,

kidney & gastrointestinal problems

Loss of bone mass

Brittle nails, dry skin, hair loss

Lanugo

Soft, downy body hair

Depletion of potassium & sodium

Can cause tiredness, weakness, and death


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Prognosis

70% recover

May take several years

Relapse common


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Bulimia Nervosa

Uncontrollable eating binges followed bycompensatory behavior to prevent weight gain Occur at least 2x per week for 3 months

Two types:

Purging (vomiting, laxatives) Non-purging (fasting, excessive exercise)

Bulimia vs. Anorexia, binge-eating-purgingtype Extreme weight loss in anorexia

At or above normal weight in bulimia


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Bulimia Nervosa

Binges often triggered by stress and negativeemotions

Typical food choices:

Cakes, cookies, ice cream, other easily consumed,high calorie foods

Avoiding a craved food can increaselikelihood of binge

Loss of control during binge

Shame and remorse often follow


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Bulimia Nervosa

Onset late adolescence or earlyadulthood

Prevalence 1 2%

90% women Comorbid with depression, PDs, anxiety,

substance abuse, conduct disorder

Suicide attempts & completions higherthan in general population


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Physical Changes in Bulimia

Menstrual irregularities

Potassium depletion

Laxative use depletes electrolytes whichcan cause cardiac irregularities

Loss of dental enamel from vomiting

Teeth appear jagged


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Prognosis

70% recover

10% remain fully symptomatic

Early intervention linked with improvedoutcomes

Poorer prognosis when depression and

substance abuse are comorbid


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Binge Eating Disorder

Diagnosis in need of further study

Involves: Recurrent binges

2x per week for at least 6 months

Loss of control during binge

Binge causes distress

No loss of weight or purging

Often accompanied by obesity Body mass index (BMI) > 30


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Etiology of Eating Disorders:

Genetics

Family and twin studies support genetic link

Higher MZ concordance rates for both anorexia

and bulimia

Body dissatisfaction, desire for thinness,binge eating, and weight preoccupation all

heritable

Adoption studies needed

Linkage on chromosome 1 (Grice et al., 2002) Need for replication


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Neurobiological Factors

Hypothalamus not directly involved

Low levels ofendogenous opioids

Substances that reduce pain, enhance mood, &

suppress appetite Released during starvation

May reinforce restricted eating of anorexia

Low levels of opioids in bulimia promote craving

Reinforce binging

Serotonin & dopamine may also play a role


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Eti l f E ti Di d


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Sociocultural Factors

Societal emphasis on thinness

Dieting, especially among women, hasbecome more prevalent Often precedes onset

Body dissatisfaction and preoccupation withthinness also predict eating disorders

Societal objectification of women leads to self-objectification

Unrealistic media portrayals fuel bodydissatisfaction

Eti l f E ti Di d


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Cross Cultural Factors

Anorexia found in many cultures

Bulimia most common in industrialized,

western countries

As countries become more industrialized,

bulimia rates increase

Preoccupation with thinness also

culturally influenced

Eti l f E ti Di d


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Ethnic Factors

White teens as compared to African Americanteens More body dissatisfaction

BMI increases linked to greater body dissatisfaction

More dieting White and Hispanic college students exhibit

more body dissatisfaction than AfricanAmerican students

Socio-economic status

Eating Disorders less linked to SES than inprevious years

Eti l f E ti Di d


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Psychodynamic View

Disturbed parent-child relationship Over-controlling parent

Dieting a means to gain control and identity (Baruch,1980)

Conflicted mother-daughter relationship Bulimia creates a sense of self (Goodsitt, 1997)

Personality characteristics Body dissatisfaction, lack of interoceptive

awareness, and negative emotions (Leon et al.,1999)

Perfectionism (Tyrka et al., 2002)

Eti l f E ti Di d


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Family Characteristics

Disturbed family relationships High levels of family conflict

Low levels of support

Family characteristics

May result from, not be a cause of, eating disorder Not specific to eating disorders

Also found in families of individuals with other types ofpsychopathology

Minuchins proposed family characteristics

Enmeshment, overprotectiveness, rigidity, lack ofconflict resolution



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Child Abuse

High rates of childhood sexual and

physical abuse

Reports of abuse not specific to eating

disorders

Also found in other diagnostic categories



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Cognitive Behavioral View

Anorexia

Focus on body dissatisfaction and fear of fatness

Certain behaviors (e.g., restrictive eating,

excessive exercise) negatively reinforcing

Reduce anxiety about weight gain

Feelings of self control brought about by weight

loss are positively reinforcing

Criticism from family & peers regarding weight can

also play a role



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Cognitive Behavioral View

Bulimia Self-worth strongly influenced by weight

Low self-esteem

Rigid restrictive eating triggers lapses which can

become binges Many off-limit foods Restraint Scale measures dieting and overeating

Disgust with oneself and fear of gaining weightlead to compensatory behavior e.g., vomiting, laxative use

Stress, negative affect trigger binges


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Figure 9.2 Schematic of Cognitive

Behavior Theory of Bulimia Nervosa


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Treatment of Eating Disorders

Most individuals dont receive treatment Often deny problem

Antidepressants Effective for bulimia but not anorexia

Drop out and relapse rates high Family therapy

CBT for bulimia Challenge societal ideals of thinness

Challenge beliefs about weight and dieting

CBT more effective than medication


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Prevention of Eating Disorders

Psychoeducational approaches

De-emphasize sociocultural influences

Risk Factor Approach

Identify those most at risk and intervene

early

eating disorders ch9

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