Chapter 9 Eating Disorders Ch 9

 Two Main Types  Anorexia Nervosa  Bulimia Nervosa  Share Strong Drive to be Thin  Largely a Female Problem  Largely a Westernized Problem  Largely an Upper SES Problem  Many Die as a Result!  Two Main Types  Anorexia Nervosa  Bulimia Nervosa  Share Strong Drive to be Thin  Largely a Female Problem  Largely a Westernized Problem  Largely an Upper SES Problem  Many Die as a Result!

Anorexia Nervosa Anorexia nervosa is an eating disorder characterized by self-starvation –Person’s weight is 85% or less of normal weight –Person has an intense fear of gaining weight –Person has a distorted sense of their body shape –In females, anorexia nervosa leads to a loss of the menstrual period Ch 9.1

Assessment of Body Image Top figure –Body image ratings of women who score high on measure of distorted eating behaviors Bottom Figure –Body image ratings of women who score low on measure of distorted eating behaviors

Pathways to Eating Disorders Ch 9.2

Two types of anorexia nervosa: –Restricting type loses weight by severely limiting the amount of food consumed –Binge-eating-purging type engages in binges (large amount of food consumed) following by purging (vomiting or use of laxatives) Lifetime prevalence of anorexia nervosa is less than 1% and is 10 times more frequent in women than in men Anorexia Nervosa Ch 9.3

Anorexia nervosa is linked to depression Anorexia nervosa can have severe physical effects including –Altered electrolyte levels (potassium and sodium) lead to changes in nerve and muscle function Prognosis: 70% of anorexia nervosa patients recover Anorexia Nervosa Ch 9.4

 Associated Features and Facts  Begins Early in Adolescence  Perfectionistic High-Achievers  All-or-None Thinking  Obsessive and Orderly  Comorbid DSM Disorders – Depression – Obsessive-Compulsive Disorder – Substance Abuse  Begins Early in Adolescence  Perfectionistic High-Achievers  All-or-None Thinking  Obsessive and Orderly  Comorbid DSM Disorders – Depression – Obsessive-Compulsive Disorder – Substance Abuse

 Causes  Social and Cultural Factors – Thinness Equals Success – Has Increased Over Time  Media – Sets Impossible Idealized Images  Social and Cultural Factors – Thinness Equals Success – Has Increased Over Time  Media – Sets Impossible Idealized Images

 Causes  When Food is Restricted – We Become Preoccupied With It!  Media – Sets Impossible Idealized Images  When Food is Restricted – We Become Preoccupied With It!  Media – Sets Impossible Idealized Images

 Causes  Family Influences – Successful and Driven – Concerned About Appearances – Eager to Maintain Harmony – Deny or Ignore Conflicts – Lack of Open Communication  Family Influences – Successful and Driven – Concerned About Appearances – Eager to Maintain Harmony – Deny or Ignore Conflicts – Lack of Open Communication

Bulimia Nervosa involves episodes of rapid overeating followed by purging –A binge is defined as eating an excessive amount of food within two hours –Purging refers to vomiting, laxative abuse, fasting or excessive exercise Bulimia involves a fear of gaining weight Prevalence of bulimia nervosa is 1-2% of the female population; only.1% of male population Bulimia Nervosa Ch 9.5

 Facts and Statistics  90-95% are Women  White; Middle-to-Upper Middle Class  Onset Years of Age  6-8% College Women  About 1% of Female Population Overall  Chronic if Left Untreated  Co-morbidity with Substance Abuse  90-95% are Women  White; Middle-to-Upper Middle Class  Onset Years of Age  6-8% College Women  About 1% of Female Population Overall  Chronic if Left Untreated  Co-morbidity with Substance Abuse

Binge Eating Disorder involves –Recurrent binges (twice a week for at least 6 months) –Lack of control during the binge episode Binge Eating Disorder does not involve –Loss of weight –Compensatory behaviors of purging Binge Eating Disorder Ch 9.6

Etiology of Eating Disorders Biological accounts of eating disorders: –Genetic Anorexia and bulimia run in families Twin studies show genetic contribution to anorexia and bulimia With anorexia, evidence for linkage on chromosome 1. –Endogenous opioids may play role in bulimia –Serotonin may be deficient in bulimia: Bulimics have less serotonin metabolites Bulimics are less responsive to serotonin agonists Serotonergic drugs are often effective for bulimia Ch 9.7

Sociocultural Influences on Eating Disorders While cultural standards of the ideal woman have moved toward thinness, the reality is that both men and women are becoming more obese –Prevalence of obesity has doubled since 1900 –As social views of obesity become more negative, the incidence of eating disorders increases Ch 9.8

Eating Disorders and Cross- Cultural Influences Eating disorders more prevalent in industrialized societies which emphasize thinness. –US, Canada, Japan, Europe As countries become more “westernized”, eating disorders increase. When women from countries with low prevalence rates more to countries with higher prevalence rates, prevalence increases. Variations in assessment methods and diagnostic criteria make it difficult to be certain about differences in prevalence rates from country to country.

Psychological Views of Eating Disorders Personality studies indicate that –Starvation can alter personality –Personality variables such as perfectionism, low self- esteem, propensity to experience negative emotions and an inability to distinguish bodily states are predictors for the development of eating disorders Self-reports of childhood sexual/physical abuse are higher in eating disorder subjects Ch 9.9

Treatment of Eating Disorders Most eating disorder subjects (> 90 %) are NOT in treatment Treatment of severe anorexia often takes place in a hospital Bulimia can be treated with antidepressant drugs (involving the serotonin system) No drugs are currently available for the treatment of anorexia nervosa Ch 9.10

Psychological Therapy for Eating Disorders Psychological treatment of anorexia: –Short-term increases in body weight Operant conditioning of eating can lead to short-term weight gains –Long-term maintenance of body weight gain Not yet achieved by any treatment modality Bulimia treatment involves cognitive behavior therapy: change thought processes that result in overeating; interpersonal therapy also effective. Ch 9.11

 Psychosocial Treatments  Bulimia Nervosa – Education About Eating Behavior – Scheduled Eating – Alter Thinking About Shape, Eating, and Weight  Treatment Works!  Bulimia Nervosa – Education About Eating Behavior – Scheduled Eating – Alter Thinking About Shape, Eating, and Weight  Treatment Works!

 Psychosocial Treatments  Anorexia Nervosa – Must Restore Normal Weight! – Most Will Gain Weight (Easy) – Keeping the Weight On (Hard) – Treatment Similar to Bulimia  Treatment Can Work!  Anorexia Nervosa – Must Restore Normal Weight! – Most Will Gain Weight (Easy) – Keeping the Weight On (Hard) – Treatment Similar to Bulimia  Treatment Can Work!

 Rumination Disorder  Regurgitating and Reswallowing Food  Disorder of Infancy--Adolescence  Can Occur With Bulimia  High Mortality Rate (25%)  Regurgitating and Reswallowing Food  Disorder of Infancy--Adolescence  Can Occur With Bulimia  High Mortality Rate (25%)

 Rumination Disorder  Infants and MR Populations  Eating Non-Nutritive Substances – paint, string, hair, feces,  Infants and MR Populations  Eating Non-Nutritive Substances – paint, string, hair, feces,  Pica

 Rumination Disorder  Infants and Very Young  “Failure to Thrive Syndrome”  Infants and Very Young  “Failure to Thrive Syndrome”  Pica  Feeding Disorder

Are Eating Disorders Are Eating Disorders a Form of Addiction? a Form of Addiction?

v Severe Craving v Loss of Control v Used to Cope With Negative Feelings v Preoccupied with Substance v Unsuccessful Attempts to Quit v Denial v Adverse Psychosocial Consequences v Co-morbidity with substance abuse v Severe Craving v Loss of Control v Used to Cope With Negative Feelings v Preoccupied with Substance v Unsuccessful Attempts to Quit v Denial v Adverse Psychosocial Consequences v Co-morbidity with substance abuse