Eating disorders

 2-3% women  men  Binge eating the most common disorder  Similar prevalence rates in Japan (5.8%) and Norway  Symptoms reported in up to 40% of college women in USA  Iran, Tehran, reports rates of 3.2%

 Repeated episodes of binge eating with compensatory behaviours ◦ Preoccupation with eating ◦ Idealization of thinness ◦ Fear of becoming fat ◦ Onset- late teens, early twenties ◦ BUT will usually have a normal BMI

 Vomiting  Misusing laxative  Fasting  Excessive exercise  Use of drugs (legal and illegal) for weight control

 Self-esteem depends on maintaining a certain weight ◦ Highly dissatisfied with their weight (cognitive) ◦ Distorted sense of their own body (cognitive) ◦ Negative self-image (cognitive) ◦ Feel guilt and shame about wasting food (affective)

◦ May lead to depression (affective) ◦ Use of vomiting, laxatives, exercise or dieting (behavioural) ◦ Swollen salivary glands, erosion of teeth, stomach or intestinal problems (somatic) ◦ Eating in private (behavioural) ◦ Self-harm, substance abuse or suicide (behavioural)

 Eat large amounts in short time (2 hrs) ◦ Feeling a sense of loss of control while eating (can’t stop) ◦ Feeling of guilt and disgust (ego-dystonic)

 Twin studies (Kendler et al,1991) ◦ 2000 female twins  Concordance of 23% in MZ twins and 9% in DZ twins  Other study rates vary from 23% to 83%- what could cause this difference in results? ◦ Strobber (2000) found first degree relatives 10% more likely to develop disorder ◦ Serotonin levels. Increase levels decrease food intake  Carraso (2000) found lower levels in bulimics  Smith et al (1990) lowered levels in recovered bulimics and they reported cognitive symptoms “feeling fat”

 Body Image Distortion Theory (Bruch, 1962) ◦ Delusion that they are fat ◦ Overestimate their body size  Patients uncertain about size and shape and report a judgment that is higher than the truth  Gender Difference (Fallon and Rozin, 1985 ◦ women chose thinner body shapes for “ideal, attractive, and current” compared to men (p.163)

 Cognitive disinhibition ◦ Dichotomous thinking  All-or-nothing approach to judging body-image ◦ Strict regimes  Bulimics following strict diets to reach their “ideal weight”- when they break the rules then binge and purge to regain control ◦ Thoughts about eating (cognitive) act to release all dietary restrictions (disinhibition)

 Polivy and Herman (1985) ◦ Compared dieters and non-dieters  When given a choice to eat ice cream dieters ate more than non-dieters  3 out of 4 women diet at some point in their lives but only 1 in 33 suffer from bulimia ????  There is no cause and effect  “Distorted eating is the result of distorted thinking”  “Distorted thinking results in distorted eating”

 We compare ourselves to others  Media role in “beautiful people”  “Perfect body” figure for women has changed over last 50 years in the West  Current medial ideal is only achievable by 5% of women

 Body size is culturally- incidences of eating disorders is cultural  Rise in incidence of eating disorders in USA, Japan and Europe ◦ Attributed to media images and messages that we need to be thin ◦ Girls- dolls distort female figure ◦ Boys- beginning to come under pressure to “bulk up” and body build

 Biomedical, individual and group  Biopsychosocial approach (eclectic) ◦ Drugs may be used to correct brain chemical imbalances that could the cause or be caused by disorder (very individual) ◦ Cognitive therapy -individual  Therapist role is more authoritarian  Confidential meetings

◦ Group therapy-  support network is established-  role playing  increase social skills  “you are not alone”  Therapist role diminished  Issues with confidentiality  Issues with groups in general  “not being heard”  Issues with culture (strict gender roles, deference to members due to age or tribal status)

 Indigenous healing practices ◦ Traditional, spiritual and religious beliefs  Chinese Taoist cognitive psychotherapy  Community psychologists ◦ Analysis psychology health as community level  Ecological model (Miller 2000)- connects the relationship between people and the settings they live in  Resources within the community affect its health

 What criteria do we use for measuring improvement ◦ Length of time of decreased symptoms ◦ Total absence of symptoms ◦ Observable behavioural changes ◦ Quantitative data? Qualitative data? ◦ Who decides, the patient, their family, the doctor, the community?

◦ Subjective ◦ Disorders symptoms are individualistic ◦ Therapy is individualised and personalised ◦ Most therapeutic approaches produce improvement but non-specific factors may play a role ◦ The placebo effect can be useful ◦ Some treatments work better than others for specific problems ◦ Best indicator of success was how well the clients rated their therapist during the initial session

 For symptoms of depressant ◦ Tricyclic antidepressants ◦ SSRI (selective serotonin reuptake inhibitors) (prozac, zoloft)  Cognitive-Behavioural Therapy (CBT) ◦ Most widely used treatment ◦ Focuses on obsession with body image and negative thinking ◦ Focuses on behavioural components (vomiting and binge eating)

 Record what they eat- how they feel  Feedback therapy- identify triggers  Cognitive techniques to improve self image and avoid damaging thought patterns  Not 100%- only 50% stop binging and purging

 Highly used, relatively effective  Long term  Looking at the family (Minuchin) ◦ Restructure the family-family group therapy ◦ Just as successful as CBT but CBT was slightly faster

 May get negative ideas from group  Group might switch to being pessimistic  Could reinforce negative behaviours  Competition  Group members may be co-therapists  Feeling of judgement or pressure

 If psychologists were able to show that Barbie produces a distorted body image for young girls, should society ban the production of the doll?  How could social learning theory be used to explain the etiology of bulimia?  Read Jaeger et al. (2002) on p. 165 ◦ Identify the aim ◦ Describe the method ◦ Evaluate the research