Eating Disorders

Eating Disorders

Anorexia (1%) Bulimia (1-3%) Binge-eating disorder (unknown) 10:1 women to men (varies by age) Onset in adolescence

Highest mortality rate for any disorder

Clinical Picture - Anorexia

Distorted body image Intense fear of weight gain Panic if weight stays same

Up to 20% die Resistant to treatment

15% below expected body weight (DSM) Treatment sought 20-30% below

Clinical Picture - Anorexia

Denial/lack of insight Perfectionistic/OCD features Preoccupation with food

Medical Consequences - Anorexia

Cessation of menstruation Dry skin Brittle hair/nails Sensitivity to cold Cardiovascular problems

Low blood pressure Low heart rate

Clinical Picture - Bulimia

Normal to average weight May consume 30x normal caloric intake

Subjective vs. objective binges A cycle of binging and purging Common on college campuses Depression, shame, guilt

Clinical Picture - Bulimia

Out of control (not like anorexia) Rising prevalence Purging is not effective

Reduces approx 50% of caloric intake Laxatives have little effect

Success in life will be determined by body

Medical Consequences of Bulimia

Enlarged salivary glands Puffy face

Eroded dental enamel Upset sodium/potassium levels

Cardiac arrhythmia Seizures Renal failure

Permanent colon damage from laxatives Calluses on fingers/hands

Clinical Picture – Binge Eating Disorder

Binges, without compensation 20% of obese individuals

50% among those seeking bariatric surgery Same concerns re: weight/shape 33% binge to alleviate distress

Cross Cultural Considerations

Western cultures Recent immigrants increase prevalence after

moving Lower rates among African American & Asian

Americans Associated with higher social class

What Causes Eating Disorders?

Probably multiple sources

1. Social Dimensions

2. Biological Dimensions

3. Psychological Factors

1. Social Dimensions

Body image tied (in middle to upper class) with Happiness Self-worth Success

Desirable body types change, like fashion (but more slowly)

Societal Pressure to be Thin?

60% of Playboy & Miss America meet weight requirements for anorexia

Media portrayal of muscular men Will this have an effect? Overweight men in

media Increase on exercise &

diet

SATISFACTION WITH BODY SIZE

Women rate their body shape as heavier than their ideal and heavier than what they think is attractive

Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985): 102-105

2.0 2.5 3.0 3.5 4.0 4.5 5.0

SATISFACTION WITH BODY SIZE

Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985): 102-105

2.0 2.5 3.0 3.5 4.0 4.5 5.0

male’s attractive

female’s current

female’s attractive

female’s ideal

SATISFACTION WITH BODY SIZE

Men rate their body shape as close to both their ideal and what they think is attractive

Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985): 102-105

2.0 2.5 3.0 3.5 4.0 4.5 5.0

SATISFACTION WITH BODY SIZE

Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, 94 (1985): 102-105

male’s current

male’s ideal

male’s attractive

female’s attractive

2.0 2.5 3.0 3.5 4.0 4.5 5.0

Family Influences

Families of anorexics: Successful Hard-driving Concerned with appearance Eager to maintain harmony (deny conflict or

negative feelings) Mothers want daughters to be thin, likely dieting

2. Biological Dimensions

Genetic component (4-5x more likely)

Inherited personality (impulsivity, emotional instability)

3. Psychological Dimensions

Decreased sense of control and confidence in abilities

Perfectionistic Anxiety

Relief by purging

Treating Eating Disorders

With two types of intervention:

1. Drug Treatments

2. Psychological

Drug Treatments

Not effective for anorexia Some evidence for bulimia

Antidepressants 47-65% reduction binge/purge (Prozac) Probably not effective alone

Psychological Treatments – Bulimia and BED

CBT (Fairburn) Psychoeducation re: medical consequences Eat regular, small meals Dysfunctional thoughts re: shape, weight, food Coping for resisting impulses

Interpersonal Therapy Also effective for binge eating Self-help can be useful for BED

50

40

30

20

IPTCBTBTtreatment

60

70

percent still in remission

10

PSYCHOLOGICAL TREATMENTS

posttreatmentposttreatment1 year1 year6 Months6 Months

Psychological Treatments - Anorexia

Restore weight Often inpatient (below 70% or rapid loss) Poor predictor alone of recovery

Outpatient CBT to address dysfunctional beliefs

Efforts to include family