chapter 11 eating disorders. slide 2 eating disorders although not historically true, current...

Chapter 11

Eating Disorders

Eating Disorders

Although not historically true, current Western beauty standards equate thinness with health and beauty

There has been a rise in eating disorders in the past three decades• The core issue is a morbid fear of weight gain

Two main diagnoses:• Anorexia nervosa

• Bulimia nervosa

Anorexia Nervosa

The main symptoms of anorexia nervosa are:

• A refusal to maintain more than 85% of normal body weight

• Intense fears of becoming overweight

• A distorted view of body weight and shape

• Amenorrhea

Anorexia Nervosa

There are two main subtypes:

• Restricting type• Lose weight by restricting “bad” foods, eventually

restricting nearly all food

• Show almost no variability in diet

• Binge-eating/purging type• Lose weight by vomiting after meals, abusing laxatives

or diuretics, or engaging in excessive exercise• Like those with bulimia nervosa, people with this subtype

may engage in eating binges

Anorexia Nervosa

About 90–95% of cases occur in females

The peak age of onset is between 14 and 18 years

Around 0.5% of females in Western countries develop the disorder

• Many more display some symptoms

Rates of anorexia nervosa are increasing in North America, Japan, and Europe

Anorexia Nervosa

The “typical” case:

• A normal to slightly overweight female has been on a diet

• Escalation to anorexia nervosa may follow a stressful event

• Separation of parents

• Move or life transition

• Experience of personal failure

• Most patients recover

• However, about 2 to 6% become seriously ill and die as a result of medical complications or suicide

Anorexia Nervosa: The Clinical Picture

The key goal for people with anorexia nervosa is thinness

• The driving motivation is FEAR:

• Of becoming obese

• Of losing control of body shape and weight


Despite their dietary restrictions, people with anorexia are extremely preoccupied with food

• This includes thinking and reading about food and planning for meals

• This relationship is not necessarily causal

• It may be the result of food deprivation, as evidenced by the famous 1940s “starvation study” with conscientious objectors


People with anorexia nervosa also demonstrate distorted thinking:

• Often have a low opinion of their body shape

• Tend to overestimate their actual proportions

• Adjustable lens assessment technique – overestimate size by 20%

• Hold maladaptive attitudes and beliefs

• “I must be perfect in every way”

• “I will be a better person if I deprive myself”

• “I can avoid guilt by not eating”


People with anorexia may also display certain psychological problems:• Depression (usually mild)

• Anxiety

• Low self-esteem

• Insomnia or other sleep disturbances

• Substance abuse

• Obsessive-compulsive patterns

• Perfectionism

Anorexia Nervosa: Medical Problems

Caused by starvation:

• Amenorrhea

• Low body temperature

• Low blood pressure

• Body swelling

• Reduced bone density

• Slow heart rate

• Metabolic and electrolyte imbalance

• Dry skin, brittle nails

• Poor circulation

• Lanugo

Bulimia Nervosa

Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges:

• Bouts of uncontrolled overeating during a limited period of time

• Often objectively more than most people would/could eat in a similar period

Bulimia Nervosa

The disorder is also characterized by compensatory behaviors, which mark the subtype of the condition:

• Purging-type bulimia nervosa• Vomiting

• Misusing laxatives, diuretics, or enemas

• Nonpurging-type bulimia nervosa• Fasting

• Exercising excessively

Bulimia Nervosa

Like anorexia nervosa, about 90–95% of bulimia nervosa cases occur in females

The peak age of onset is between 15 and 21 years

Symptoms may last for several years with periodic letup

Bulimia Nervosa

Patients are generally of normal weight

• May be slightly overweight

• Often experience weight fluctuations

“Binge-eating disorder” may be a related diagnosis

• Symptoms include a pattern of binge eating with NO compensatory behaviors (such as vomiting)

• This condition is not yet listed in the DSM

Bulimia Nervosa

Teens and young adults have frequently attempted binge-purge patterns as a means of weight loss, often after hearing accounts of bulimia from friends or the media

In one study:

• 50% of college students reported periodic binges

• 6% tried vomiting

• 8% experimented with laxatives at least once

Bulimia Nervosa: Binges

For people with bulimia nervosa, the number of binges per week can range from 2 to 40

• Average: 10 per week

Binges are often carried out in secret

• Binges involve eating massive amounts of food rapidly with little chewing

• Usually sweet foods with soft texture

• Binge-eaters commonly consume more than 1500 calories (often more than 3000 calories) per binge episode

Bulimia Nervosa: Binges

Binges are usually preceded by feelings of tension and/or powerlessness

Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and “discovery”

Bulimia Nervosa: Compensatory Behaviors

After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects

The most common compensatory behaviors:

• Vomiting

• Affects ability to feel satiated greater hunger and bingeing

• Laxatives and diuretics

• Almost completely fail to reduce the number of calories consumed

Bulimia Nervosa

The “typical” case:

• A normal to slightly overweight female has been on an intense diet

• Research suggests that even among normal subjects, bingeing often occurs after strict dieting

• For example, a study of binge-eating behavior in a low-calorie weight loss program found that 62% of patients reported binge-eating episodes during treatment

Bulimia Nervosa vs. Anorexia Nervosa

Similarities:• Onset after a period of dieting

• Fear of becoming obese

• Drive to become thin

• Preoccupation with food, weight, appearance

• Elevated risk of self-harm or attempts at suicide

• Feelings of anxiety, depression, perfectionism

• Substance abuse

• Disturbed attitudes toward eating


Differences:

• People with bulimia are more worried about pleasing others, being attractive to others, and having intimate relationships

• People with bulimia tend to be more sexually experienced

• People with bulimia display fewer of the obsessive qualities that drive restricting-type anorexia

• People with bulimia are more likely to have histories of mood swings, low frustration tolerance, and poor coping


Differences:

• People with bulimia tend to be controlled by emotion – may change friendships easily

• People with bulimia are more likely to display characteristics of a personality disorder

• Different medical complications:

• Only half of women with bulimia experience amenorrhea vs. almost all women with anorexia

• People with bulimia suffer damage caused by purging, especially from vomiting and laxatives

What Causes Eating Disorders?

Most theorists subscribe to a multidimensional risk perspective:

• Several key factors place individuals at risk

• More factors = greater risk

• Leading factors:

• Sociocultural conditions (societal and family pressures)

• Psychological problems (ego, cognitive, and mood disturbances)

• Biological factors

What Causes Eating Disorders? Societal Pressures

Many theorists argue that current Western standards of female attractiveness have contributed to the rise of eating disorders

• Standards have changed throughout history toward a thinner ideal

• Miss America contestants have declined in weight by 0.28 lbs/yr; winners have declined by 0.37 lbs/yr

• Playboy centerfolds have lower average weight, bust, and hip measurements than in the past

What Causes Eating Disorders? Societal Pressures

Certain groups are at greater risk from these pressures:

• Models, actors, dancers, and certain athletes

• Of college athletes surveyed, 9% met full criteria for an eating disorder while another 50% had symptoms

• 20% of surveyed gymnasts met full criteria for an eating disorder

What Causes Eating Disorders? Ego Deficiencies and Cognitive Disturbances

Bruch argues that eating disorders are the result of disturbed mother–child interactions which lead to serious ego deficiencies in the child and to severe cognitive disturbances

Treatments for Eating Disorders

Eating disorder treatments have two main goals:

• Correct abnormal eating patterns

• Address broader psychological and situational factors that have led to and are maintaining the eating problem

• This often requires the participation of family and friends

Treatments for Anorexia Nervosa

The initial aims of treatment for anorexia nervosa are to:

• Restore proper weight

• Recover from malnourishment

• Restore proper eating

Treatments for Bulimia Nervosa

Treatment programs are relatively new but have risen in popularity

Treatment is frequently offered in specialized eating disorder clinics

Treatments for Bulimia Nervosa

The initial aims of treatment for bulimia nervosa are to:

• Eliminate binge-purge patterns

• Establish good eating habits

• Eliminate the underlying cause of bulimic patterns

Programs emphasize education as much as therapy

chapter 11 eating disorders. slide 2 eating disorders although not historically true, current...

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