Adolescence and Emotional & Behavioral Problems

Eating Disorders Anorexia Nervosa (AN) Bulimia Nervosa (BN)

Does this look familiar? Salvador Dali, “Swans Reflecting Elephants”

Swans Reflecting Elephants Dali captured the way that so many of us perceive our bodies… …we are all amazing in our own unique ways, yet when we look in the mirror we are so consumed with each little flaw that we become unable to appreciate our own beauty.

BODY IMAGE Perception Evaluation Importance

THE CHANGING FEMALE BEAUTY IDEAL Body Image In a recent U.S. study, almost half of the surveyed women had negative evaluations of their own overall appearance. THE CHANGING FEMALE BEAUTY IDEAL

BUT IT’S NOT JUST ADULTS… By middle school, 20% to 50% of girls in the US say that they feel too fat. One study found that 40% of adolescent girls believed that they were overweight, despite their normal weight range.

It’s NOT just a female issue…

It’s NOT just a female issue… Typical growth for boys: characterized by quick gains in height but not necessarily by quick gains in muscle or weight.

It’s NOT just a female issue… This is in striking contrast to the ideal body image for men, which has become increasingly muscular. MALE BEAUTY IDEAL

Cosmetic Surgery In 2003, there were 8.3 million procedures (surgical and nonsurgical) done: 322,975 liposuctions on women 61,646 liposuctions on men 280,401 breast enlargement procedures From 2002 to 2003, the number of girls who were 18 years of age and younger who got breast implants increased almost 400%.

BODY IMAGE AND EATING DISORDERS Perception Evaluation Importance distortion Evaluation dissatisfaction Importance undue influence on sense of self-worth

Refusal to maintain minimum weight for height Body image disturbance EATING DISORDERS IN THE DSM IV ANOREXIA NERVOSA Refusal to maintain minimum weight for height Body image disturbance Amenorrhea (in females) Recurrent episodes of binge eating Over valuation of weight/shape Recurrent extreme compensatory behaviors BULIMIA NERVOSA

ANOREXIA NERVOSA (AN)

Anorexia Nervosa Onset: Early to mid-adolescent period INTENSE FEAR OF GAINING WEIGHT DENIAL OF THE SERIOUSNESS of the CURRENT LOW WEIGHT PRESENCE of AMENORRHEA in post-menarchal females for at least 3 consecutive periods

Anorexia Nervosa (AN) Refusal to maintain minimally normal body weight (weight <85% of expected for age and height) Self-evaluation is unduly influenced by body shape & weight, or Weight: underweight

AN types 1. Restricting Restrictive eating patterns and significant weight loss May change to binge/purge subtype 2. Binge eating/purging Does regularly engage in binging & purging Those with binge/purging type more likely to: Have impulse control problems Abuse alcohol or drugs Attempt suicide

Anorexia Nervosa: Clinical Aspects WEIGHT: very decreased FEMALE to MALE ratio = 10 : 1 MENSTRUATION : absent BINGE-EATING: 25 to 50% of patients MORTALITY : 5% per decade

AN Features Diet greatly restricted - limited to a few foods, total food intake greatly reduced Some feel globally overweight, others feel thin but parts of body are “too fat”

PHYSICAL SIGNS

AN Features Obsessive weighing, measuring body parts, mirror inspection likely Insight low – typically AN recognized by family

In the name of the Pursuit of thinness Insufficient energy intake Delusion of being fat Obsession to be thinner Does not diminish with weight loss Denial Can be fatal

BULIMIA NERVOSA (BN)

Bulimia Nervosa (BN) Recurrent episodes of binge eating Lack of control – can’t stop or control amount Recurrent compensatory behavior Self-evaluation is unduly influenced by body shape & weight

BULIMIA NERVOSA (Avoidance of obesity) Awareness that eating pattern is abnormal Depressed moods and self-deprecating thoughts

BN Types 1. Purging – regularly purges 2. Nonpurging – uses other compensatory behaviors Temporary relief via avoidance of weight gain by ??? Weight: normal

BN Features Onset: late adolescence, early adulthood Abnormality is in amount of food consumed Binges often secret (easier to hide than AN) May develop strict rules (diet) regarding eating that are inevitably broken & lead to a binge Feelings associated with binges? ???

PHYSICAL SIGNS

Prevalence of Eating Disorders Prevalence has increased over the last 50 years. AN 0.5% to 1% BN 1% to 3% of adolescent and young adult girls/women. Female : Male = 10:1

Prevalence of Eating Disorders More common among…

Comorbidity AN: Depression, anxiety Severe medical problems and can lead to death in extreme cases Depression, anxiety Dependent on other people’s approval, extreme need for control Substance abuse and dependence (BN)

Etiology SOCIETAL PRESSURE FOR THINNESS COGNITIVE INTERNALIZIATION OF UNREALISTIC IMAGES FAMILIAL FACTORS RELATED TO APPEARANCE AND ACHIEVEMENT

The Role of Media and Culture

DOCUMENTARY IS IT BARBIE'S FAULT?

As you watch… What are the most common words in fashion magazines? What did you learn about the diet-eating disorder Link? What are the stereotypes for young teenagers? How do you see the role of the media in Turkey in terms of promoting an ideal body image?