Chapter 9 Eating Disorders

Ch 9

Two Main Types Anorexia Nervosa Bulimia Nervosa

Share Strong Drive to be Thin Largely a Female Problem Largely a Westernized Problem Largely an Upper SES Problem Many Die as a Result!

Two Main Types Anorexia Nervosa Bulimia Nervosa

Share Strong Drive to be Thin Largely a Female Problem Largely a Westernized Problem Largely an Upper SES Problem Many Die as a Result!

Anorexia Nervosa• Anorexia nervosa is an eating disorder

characterized by self-starvation– Person’s weight is 85% or less of normal weight– Person has an intense fear of gaining weight– Person has a distorted sense of their body shape– In females, anorexia nervosa leads to a loss of

the menstrual period

Ch 9.1

Assessment of Body Image

• Top figure– Body image ratings of

women who score high on measure of distorted eating behaviors

• Bottom Figure– Body image ratings of

women who score low on measure of distorted eating behaviors

Pathways to Eating Disorders

Ch 9.2

• Two types of anorexia nervosa:– Restricting type loses weight by severely limiting the

amount of food consumed– Binge-eating-purging type engages in binges (large

amount of food consumed) following by purging (vomiting or use of laxatives)

• Lifetime prevalence of anorexia nervosa is less than 1% and is 10 times more frequent in women than in men

Anorexia Nervosa

Ch 9.3

• Anorexia nervosa is linked to depression• Anorexia nervosa can have severe physical

effects including– Altered electrolyte levels (potassium and sodium)

lead to changes in nerve and muscle function

• Prognosis: 70% of anorexia nervosa patients recover

Anorexia Nervosa

Ch 9.4

Associated Features and Facts Associated Features and Facts Begins Early in Adolescence Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders

– Depression– Obsessive-Compulsive Disorder– Substance Abuse

Begins Early in Adolescence Perfectionistic High-Achievers All-or-None Thinking Obsessive and Orderly Comorbid DSM Disorders

– Depression– Obsessive-Compulsive Disorder– Substance Abuse

Causes Causes Social and Cultural Factors

– Thinness Equals Success – Has Increased Over Time

Media– Sets Impossible Idealized Images

Social and Cultural Factors– Thinness Equals Success – Has Increased Over Time

Media– Sets Impossible Idealized Images

Causes Causes When Food is Restricted

– We Become Preoccupied With It! Media

– Sets Impossible Idealized Images

When Food is Restricted– We Become Preoccupied With It!

Media– Sets Impossible Idealized Images

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

• Bulimia Nervosa involves episodes of rapid overeating followed by purging – A binge is defined as eating an excessive amount of

food within two hours– Purging refers to vomiting, laxative abuse, fasting or

excessive exercise

• Bulimia involves a fear of gaining weight• Prevalence of bulimia nervosa is 1-2% of the

female population; only .1% of male population

Bulimia Nervosa

Ch 9.5

Facts and Statistics Facts and Statistics 90-95% are Women White; Middle-to-Upper Middle Class Onset 16-19 Years of Age 6-8% College Women About 1% of Female Population Overall Chronic if Left UntreatedCo-morbidity with Substance Abuse

90-95% are Women White; Middle-to-Upper Middle Class Onset 16-19 Years of Age 6-8% College Women About 1% of Female Population Overall Chronic if Left UntreatedCo-morbidity with Substance Abuse

• Binge Eating Disorder involves– Recurrent binges (twice a week for at least 6

months)– Lack of control during the binge episode

• Binge Eating Disorder does not involve– Loss of weight– Compensatory behaviors of purging

Binge Eating Disorder

Ch 9.6

Etiology of Eating Disorders• Biological accounts of eating disorders:

– Genetic • Anorexia and bulimia run in families• Twin studies show genetic contribution to anorexia and bulimia• With anorexia, evidence for linkage on chromosome 1.

– Endogenous opioids may play role in bulimia– Serotonin may be deficient in bulimia:

• Bulimics have less serotonin metabolites• Bulimics are less responsive to serotonin agonists• Serotonergic drugs are often effective for bulimia

Ch 9.7

Sociocultural Influences on Eating Disorders

• While cultural standards of the ideal woman have moved toward thinness, the reality is that both men and women are becoming more obese– Prevalence of obesity has doubled since 1900– As social views of obesity become more

negative, the incidence of eating disorders increases

Ch 9.8

Eating Disorders and Cross-Cultural Influences

• Eating disorders more prevalent in industrialized societies which emphasize thinness. – US, Canada, Japan, Europe

• As countries become more “westernized”, eating disorders increase.

• When women from countries with low prevalence rates more to countries with higher prevalence rates, prevalence increases.

• Variations in assessment methods and diagnostic criteria make it difficult to be certain about differences in prevalence rates from country to country.

Psychological Views of Eating Disorders

• Personality studies indicate that– Starvation can alter personality – Personality variables such as perfectionism, low self-

esteem, propensity to experience negative emotions and an inability to distinguish bodily states are predictors for the development of eating disorders

• Self-reports of childhood sexual/physical abuse are higher in eating disorder subjects

Ch 9.9

Treatment of Eating Disorders

• Most eating disorder subjects (> 90 %) are NOT in treatment

• Treatment of severe anorexia often takes place in a hospital

• Bulimia can be treated with antidepressant drugs (involving the serotonin system)

• No drugs are currently available for the treatment of anorexia nervosa

Ch 9.10

Psychological Therapy for Eating Disorders

• Psychological treatment of anorexia:– Short-term increases in body weight

• Operant conditioning of eating can lead to short-term weight gains

– Long-term maintenance of body weight gain• Not yet achieved by any treatment modality

• Bulimia treatment involves cognitive behavior therapy: change thought processes that result in overeating; interpersonal therapy also effective.

Ch 9.11

Psychosocial Treatments Psychosocial Treatments Bulimia Nervosa

– Education About Eating Behavior– Scheduled Eating– Alter Thinking About Shape, Eating, and Weight

Treatment Works!

Bulimia Nervosa– Education About Eating Behavior– Scheduled Eating– Alter Thinking About Shape, Eating, and Weight

Treatment Works!

Psychosocial Treatments Psychosocial Treatments Anorexia Nervosa

– Must Restore Normal Weight!– Most Will Gain Weight (Easy)– Keeping the Weight On (Hard)– Treatment Similar to Bulimia

Treatment Can Work!

Anorexia Nervosa– Must Restore Normal Weight!– Most Will Gain Weight (Easy)– Keeping the Weight On (Hard)– Treatment Similar to Bulimia

Treatment Can Work!

Rumination Disorder Rumination Disorder Regurgitating and Reswallowing Food Disorder of Infancy--Adolescence Can Occur With Bulimia High Mortality Rate (25%)

Regurgitating and Reswallowing Food Disorder of Infancy--Adolescence Can Occur With Bulimia High Mortality Rate (25%)

Rumination Disorder Rumination Disorder

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

Rumination Disorder Rumination Disorder

Infants and Very Young “Failure to Thrive Syndrome”

Infants and Very Young “Failure to Thrive Syndrome”

Pica Pica

Feeding Disorder Feeding Disorder

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 Co-morbidity with substance abuse

Severe Craving Loss of Control Used to Cope With Negative Feelings Preoccupied with Substance Unsuccessful Attempts to Quit Denial Adverse Psychosocial Consequences Co-morbidity with substance abuse