 Eating Disorders  90% of e.d. folks are adolescent/young women.  Anorexia Nervosa—marked by extreme thinness (<85% healthy weight), obsessional thinking, food phobia, poor self- esteem, exercise, dangerous physical effects. Distorted body perception.  no treatments are highly successful.  Bulimia Nervosa—marked by binge eating, perceived loss of control over eating and compensatory behaviors—vomiting, laxative use, fasting, exercise. More impulsive than A.N. (obsessive)  better success at treatment  especially meds + cognitive behavioral intervention

History –1694: first case of anorexia nervosa mentioned ("phtisis nervosa"), with the female patient showing food avoidance, emaciation, cessation of menstrual periods –1874: term "anorexia nervosa" introduced; psychological component of the illness recognized There are more data available on AN. Estimates of prevalence (total number in the population) are difficult to obtain (underreporting) but are in the 1-2% range. Incidence (number of newly diagnosed cases per year) has shown a 3-fold increase in the 70s and 80s and is still on the rise. The most common onset is age There are three clear risk groups: –Female teenagers - only 5% of all anorexic patients are male. –Students in private schools (as opposed to public schools), especially in upper socioeconomic strata. –Dancers and models

Anorexia Nervosa: ritualized food intake; weight phobia; distorted body perception; depression; starvation Bulimia Nervosa: normal weight; extreme weight control; binge episodes; distorted body percep.; physical complications (due to vomiting, abuse of laxatives, etc.) Causes Anorexia Nervosa: Deep lack of control; flight from maturation; runs in families (genetics or modeling?); cognitive biases regarding weight and body shape. Bulimia Nervosa: Little theory as of now. Restraint hypothesis: "catastrophic shifts" occur if restrained behavior (which creates an approach-avoidance conflict) is violated slightly (e.g., eating one piece of chocolate leads to eating a whole cake).

more on eating disorders approximately 50% of eating disordered patients have had a depressive episode or anxiety attack prior to the onset of their eating problems. We know that these disorders have a strong biological basis and that they can be treated with medications. We have also learned that semi-starvation, binge eating (particularly complex carbohydrates), excessive exercise, and even self-induced vomiting alters neurochemistry in ways that may actually help individuals feel less depressed and calmer.

 somatoform disorders -  diagnoses: somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, pain disorder.  frequent complaints: e.g., headaches, fatigue, heart palpitations, fainting spells, nausea, vomiting, abdominal pain, bowel trouble, allergies, menstrual and sexual problems.  immature, overexcitable, superficial social relations, self- centered.  somatization disorder—symptoms: pain, gastrointestinal, sexual/reproductive, pseudoneurological (conversion). unnecessary surgeries common  conversion- lost function, la belle indifference (hysteria)  hypochondriasis- preoccupation with illness/health status  Body dysmorphic disorder- imaged body defect