Two Main Types Anorexia Nervosa Bulimia Nervosa

Share Strong Drive to be Thin Largely a Westernized, Female Problem Largely an Upper SES Problem

Two Main Types Anorexia Nervosa Bulimia Nervosa

Share Strong Drive to be Thin Largely a Westernized, Female Problem Largely an Upper SES Problem

InterviewObservationReports from family/friendsObjective Psychological Tests

(e.g., Eating Disorder Inventory)

InterviewObservationReports from family/friendsObjective Psychological Tests

(e.g., Eating Disorder Inventory)

Assessment of Eating Assessment of Eating DisordersDisorders

Bingeing– Eat Large Amounts of Food– Eating is Out of Control

Bingeing– Eat Large Amounts of Food– Eating is Out of Control

Compensatory Behaviors–Purging via

–Self-Induced Vomiting, Enemas–Laxatives, Diuretics, Exercise, Fasting

Binge-Purge occur, on average, at least 2 X wk for 3 monthsSelf-evaluation is unduly influenced by body shape and weight

Compensatory Behaviors–Purging via

–Self-Induced Vomiting, Enemas–Laxatives, Diuretics, Exercise, Fasting

Binge-Purge occur, on average, at least 2 X wk for 3 monthsSelf-evaluation is unduly influenced by body shape and weight

Bulimia NervosaBulimia Nervosa

Medical Consequences Medical Consequences

Salivary Gland Enlargement Eroded Dental Enamel Electrolyte Imbalance Intestinal Problems Calluses on Fingers and Hands

Salivary Gland Enlargement Eroded Dental Enamel Electrolyte Imbalance Intestinal Problems Calluses on Fingers and Hands

Facts and Statistics Facts and Statistics

90-95% are Women Onset 16-19 Years of Age 6-8% of college women About 2.8% Population Overall Chronic if Left Untreated

90-95% are Women Onset 16-19 Years of Age 6-8% of college women About 2.8% Population Overall Chronic if Left Untreated

Clinical Description Clinical Description Intense fear of

– Gaining weight– Becoming fat

Intense fear of – Gaining weight– Becoming fat

Refusal to maintain body weight– 15% Below Expected Normal

Distorted body imageAmenorrhea (in females)

Refusal to maintain body weight– 15% Below Expected Normal

Distorted body imageAmenorrhea (in females)

Two Subtypes Two Subtypes

Restricting Type – Excessive Dieting

Restricting Type – Excessive Dieting

Binge-Eating / Purging Type – Rely on Purging– About Half of All Cases

Binge-Eating / Purging Type – Rely on Purging– About Half of All Cases

Medical Consequences Medical Consequences

Dry Skin, Brittle Hair or Nails Sensitivity to Cold (Lanugo) Risk of death (suicide, starvation, electrolyte imbalance, heart problems)

Dry Skin, Brittle Hair or Nails Sensitivity to Cold (Lanugo) Risk of death (suicide, starvation, electrolyte imbalance, heart problems)

Associated Features and Facts Associated Features and Facts Begins in adolescence (onset often associated with a stressful life event) Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders

– Obsessive-Compulsive Disorder– Substance Abuse

Begins in adolescence (onset often associated with a stressful life event) Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders

– Obsessive-Compulsive Disorder– Substance Abuse

Causes Causes

Social and Cultural Factors–- examples?– Media

– Sets Impossible Idealized Images

Social and Cultural Factors–- examples?– Media

– Sets Impossible Idealized Images

Causes Causes

Biological InfluencesRuns in FamiliesUnclear What is Inherited The Serotonin-Hypothesis: BN represents an underlying hyposerotonergic condition

Biological InfluencesRuns in FamiliesUnclear What is Inherited The Serotonin-Hypothesis: BN represents an underlying hyposerotonergic condition

Causes Causes Dieting: When food is restricted, we become preoccupied with it! (The PsychoBiological Impasse)Family Influences (esp. in AN)

– Successful and Driven– Concerned About Appearances– Eager to Maintain Harmony – Deny or Ignore Conflicts– Lack of Open Communication

Dieting: When food is restricted, we become preoccupied with it! (The PsychoBiological Impasse)Family Influences (esp. in AN)

– Successful and Driven– Concerned About Appearances– Eager to Maintain Harmony – Deny or Ignore Conflicts– Lack of Open Communication

Psychosocial Treatments for BN Psychosocial Treatments for BN Cognitive-behavioral treatments

– Education about eating behavior– Scheduled eating– Exposure / Response prevention

Cognitive-behavioral treatments– Education about eating behavior– Scheduled eating– Exposure / Response prevention

Psychosocial Treatments Psychosocial Treatments Anorexia Nervosa

– First restore normal weight!– many will gain weight; keeping the weight on is harder– residential treatment– control issues? IPT

Anorexia Nervosa– First restore normal weight!– many will gain weight; keeping the weight on is harder– residential treatment– control issues? IPT

Biological treatments Biological treatments Bulimia Nervosa

– Because serotonin is thought to play an important role in mediating satiety, SSRIs have been tried– e.g., fluoxetine (Prozac) has demonstrated effectiveness

Anorexia (not effective)

Bulimia Nervosa– Because serotonin is thought to play an important role in mediating satiety, SSRIs have been tried– e.g., fluoxetine (Prozac) has demonstrated effectiveness

Anorexia (not effective)