Eating DisordersAnorexia Nervosa

Bulimia Nervosa

Anorexia vs Anorexia Nervosa

Anorexia Nervosa: “nervous loss of appetite”

Anorexia: “loss of appetite”

Anorexia Nervosa

Characterized by:• Intense fear of becoming fat or obese• Distorted body image• Refusal to maintain minimal body weight

• Cessation of menstruation

Pattern of self-starvation

More common among affluent well-educated adolescent girls from affluent countries

AN Cont’d

Highest onset between ages 14-18

Females 8-11 times more likely than Males

Has been stated to be on the increase (usual caveats here)

Can be lethal and certainly causes physical problems

Central Features

• Drive

• Preoccupation

• Cognitive/Perceptual

• Psychological & Mood

• Medical Problems

Physical Problems

Hypothermia (low internal heat)

Low Blood Pressure

Reduced Bone Density

Amennorhea

Electrolyte Imbalances

Cardiac Problems

Death (estimates range between 6 and 50%)

Personality

Obsessional, perfectionistic, heightened need for control

“Prickly” not real warm fuzzy

PDM Eating Disorders

1. Affective: depressive symptoms, anxiety symptoms, emotional concerns (e.g., feelings of being starved for care and affection)

2. Cognitive Patterns: a preoccupation with being inadequate, incompetent, unloved; a focus on being young, “little”, un-grownup, and innocent; desire to remain a child

3. Somatic States: a sense of “numbness”; confusion about bodily sensations; physical emptiness in the stomach associated with the sense of an empty self.

4. Relationship Patterns: issues of control and perfectionism; keep their problem secret, relate to others superficially; handle fears of feelings unloved by compliance

Bulimia Nervosa: Characteristics

Also known as Binge Purge Syndrome

Binges and Compensatory Behaviours

Weight usually stays in normal range (might fluctuate)

Some become significantly underweight

Bulimia Nervosa

Two Subtypes (Based on the

compensatory behaviours):• Purging (use of laxatives, diuretics, vomiting

• Nonpurging (fasting and exercise)

Bulimia Nervosa cont’d

Again, well educated, from affluent families, terrified of becoming fat

More prevalent (1 or 2/100) than AN and especially common among specific groups• College women

• Private women’s colleges (10 – 25%)

Bulimia Nervosa (Binge-Purge Syndrome)

Binge: Uncontrollable eating (binges)• Occurs over discrete period of time

• Consumes considerably more food than most would eat (> 3000 calories in some cases) during the time:Gobbles, with minimal chewing, sweet taste, high caloric content, soft texture

Food hardly tasted or thought about

Binges

Aware that binges are not normal • Have fears that unable to stop binges

• Shame, guilt, self-blame and depressed after episodes

• The frequency of binges can range (reports of 2 – 40 / week, although 10/week is average)

Compensatory Behaviour

Compensatory Behaviour: Done to get rid of calories from the binges

- Purging: Vomiting, laxatives,

diuretics, enemas,

- Other: Fasting, excessive exercise

- smoking, chewing gum

Physical Problems

Dental Erosion

Electrolyte imbalances

Cardiac problems

Anorexia Nervosa & Bulimia Nervosa

Loss of Control in BN opposite to AN

BN more concerned about pleasing others and more sexually experienced than those with AN

AN & BN: dieting is major risk factor and often disorder starts with episode of dieting

AN & BN: Usually chronic and intermittent

Anorexia Nervosa & Bulimia Nervosa

Lack of insight in AN (i.e., don’t see behaviour or body as necessarily abnormal)

Insight in BN (i.e., know binges and compensatory behavior not normal, hence the secretiveness)

Distinction between AN and BN

Not so clear as once thought

Can have both at different times

Anorexia Nervosa:• Restricting Type

• Binge/Eating Purging Type

Jessica AN & BN

Eating Disorders in General

Anorexia Deaths

What do we know about Anorexia Nervosa?

Anorexia Deaths

What do we know about Anorexia Nervosa?

1. Life Threatening

Anorexia Deaths

What do we know about Anorexia Nervosa?

1. Life Threatening

2. Predominantly in Women

Anorexia Deaths

What do we know about Anorexia Nervosa?

1. Life Threatening

2. Predominantly in Women

3. Predominantly in Young Women

Method

Data from National Center for Health Statistics (US Database)

“Multiple Cause of Death Records”

For all death certificates registered between 1986 and 1990

N = 10,600,000 (that’s right 10 million 6 hundred thousand subjects)

Death Record

Consisted of:• Demographic information

• Cause of death (i.e., underlying cause of death)

• Up to 20 death related conditions (disorders or diseases) present just prior to or at the time of death

• Primary Cause and Contributing Cause

Selected Ss with AN as primary or contributing cause of death

Results

724 individuals with AN listed as primary or contributing cause (149/year)

Predominantly female (79%)

Replications

BC Data from Stats Canada Replication:• Median age of death: 80 years

Norway (Reas et al., 2006) Replication:• Mean age of death from AN: 61 years

• Thirty one percent of deaths from AN were men