Chapter 9 Eating Disorders and Obesity ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 9 Eating Disorders and Obesity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Eating Disorders Clinical Aspects of Eating Disorders Risk and Causal Factors in Eating Disorders Treatment of Eating Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Aspects of Eating Disorders Most common forms Anorexia nervosa Bulimia nervosa © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Aspects of Eating Disorders Central to both disorders Intense and pathological fear of becoming overweight and fat Pursuit of thinness that is relentless and sometimes deadly © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Refusal to maintain normal weight Types Anorexia Nervosa Characteristics Fear of gaining weight Refusal to maintain normal weight Types Restricting type Binge-eating/ purging type Anorexia nervosa is characterized by A fear of gaining weight A refusal to maintain a normal weight There are two types of anorexia nervosa: Restricting type Binge-eating/purging type Distorted thoughts and values are typical Members of some groups or professions, such as ballet dancers and models, are at greater risk © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Characteristics Bulimia Nervosa Frequent episodes of binge eating Lack of control over eating Recurrent inappropriate behavior Unlike patients with anorexia nervosa, bulimic patients are typically of normal weight Recurrent inappropriate behavior to prevent weight gain © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Purging type Vomiting Laxatives Diuretics Nonpurging type Fasting Bulimia Nervosa Purging type Vomiting Laxatives Diuretics Nonpurging type Fasting Exercise © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Characteristics Binge Eating Disorder Frequent episodes of binge eating Typically overweight or obese No compensatory weight loss behaviors New disorder in DSM-5 No compensation for binging behavior Less dietary restrictions than with bulimia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Age of Onset and Gender Differences Anorexia nervosa is most likely to develop in 15- to 19-year-olds Bulimia nervosa is most likely to develop in women ages 20-24 Three females for every male with an eating disorder Pathological patterns of eating date back several centuries but did not attract much attention until the 1970s and 1980s Underreporting of eating disorders in men and misdiagnosis makes gender comparison difficult © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Prevalence of Eating Disorders U.S. lifetime prevalence of binge eating disorder is around 3.5% in women and 2% in men U.S. lifetime prevalence of anorexia nervosa is around .9% in women and .3% in men U.S. lifetime prevalence of bulimia is around 1.5% in women and .5% in men Prevalence of binge eating disorder higher in obese people Risk has increased in 1900s © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Medical Complications of Eating Disorders Anorexia can lead to Death from heart arrhythmias Kidney damage Renal failure Bulimia can lead to Electrolyte imbalances Hypokalemia (low potassium) Damage to hands, throat, and teeth © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 9.2: Medical Effects of Anorexia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Course and Outcome Suicide risk is high among anorexics Long-term prognosis for bulimia is relatively good compared to anorexia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Course and Outcome Binge eating Bulimia Anorexia After 21 years: 51% fully recovered 21% partially recovered 10% not recovered 16% no longer alive Bulimia 70% in remission after 11 to 12 years Binge eating 60% in remission after 6 years Löwe and colleagues (2001) looked at the clinical outcomes of patients with anorexia nervosa 21 years after they had first sought treatment Many who recover will still have food issues © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Long-Term Stability of Eating Disorders People with eating disorders often later develop other eating disorders “Diagnostic crossover” common among subtypes of anorexia Uncommon between binge-eating disorder and anorexia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 9.3: Diagnostic Crossover in Eating Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Association of Eating Disorders with Other Forms of Psychopathology Eating disorders associated with following disorders: Clinical depression Obsessive-compulsive disorder Substance abuse disorders Various personality disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Eating Disorders across Cultures Attitudes that lead to eating disorders are more common in whites and Asians than African Americans Eating disorders are becoming a problem worldwide Eating disorders are becoming a problem worldwide The attitudes that lead to eating disorders are more common in whites and Asians than African Americans © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Risk and Causal Factors in Eating Disorders Biological factors Sociocultural factors Family influences Individual risk factors Eating disorders multidetermined © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Biological Factors Serotonin Brain abnormalities Set-point theory Hereditary tendency Set-point theory Brain abnormalities Serotonin The tendency to develop an eating disorder runs in families Whether this is due to genetic influence has yet to be determined Set-point theory (the idea that our bodies resist marked variation) may play a role Damage to the frontal and temporal cortex linked with anorexia and sometimes bulimia Serotonin levels may play a role © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Sociocultural Factors Media-related idealized extreme thinness Female internalized ideal Western values toward thinness Sociocultural influences such as fashion magazines idealize extreme thinness Women often internalize the thin ideal Western values toward thinness (e.g., as reflected in American TV) may have influenced non-Western cultures toward disordered attitudes toward eating © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

In what ways do you think families influence anorexia nervosa? Family Influences In what ways do you think families influence anorexia nervosa? Families of anorexics characteristics: Limited tolerance of disharmonious affect or psychological tension Emphasis on propriety and rule-mindedness Parental over-direction of child or subtle discouragement of autonomous strivings Poor skills in conflict resolution Preoccupations regarding desirability of thinness, dieting, and good physical appearance © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Individual Risk Factors Gender Age Internalization of thin ideal Perfectionism Negative body image Dieting Negative emotionality Childhood sexual abuse Gender (female) Age (adolescence) Binge-eating disorder onsets after adolescence and more common in men than women Internalization of thin ideal Perfectionism Negative body image Dieting Negative emotionality Childhood sexual abuse (debatable) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Eating Disorders Challenging Hospital commitment Treatment can be challenging because patients are often conflicted about getting well Approximately 17% of patients with severe eating disorders have to be committed to hospitals against their will Hospitalization can lead to competitive pressure to be more anorexic than fellow patients © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Anorexia Nervosa Common treatments Emergency procedures to restore weight Antidepressants or other medications Family therapy Cognitive-behavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Bulimia Nervosa Common treatments Antidepressants or other medications Cognitive-behavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Binge-Eating Disorder Antidepressants and other medication Cognitive-behavioral and interpersonal therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Defined by body mass index Obesity Obesity Defined by body mass index In the U.S., 1/3 of adults are obese Increased significantly in last 30 years Linked with many health problems © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Demographic factors Obesity Sex Race or ethnicity Socioeconomic status Demographic and behavioral factors Sex (male except for African American women) Race or ethnicity (minorities) Socioeconomic status (low) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Obesity True or false? From a diagnostic perspective, obesity is an eating disorder. False. From a diagnostic perspective, obesity is not an eating disorder Many clinicians regard the central problem as compulsive food consumption or a “food addiction” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Risk and Causal Factors in Obesity Risk factors Genetic inheritance Hormones Sociocultural influences Family influences Stress and “comfort food” Hormones involved in appetite and weight regulation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Evolutionary genetics The Role of Genes Evolutionary genetics Genetic mutation Genes that may have helped our ancestors survive famine may now contribute to obesity A genetic mutation has been specifically linked to binge eating © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Hormones Involved in Appetite and Weight Regulation Leptin Grehlin Leptin—a hormone produced by fat cells that acts to reduce food intake An inability to produce leptin can lead to obesity Grehlin—a hormone produced by the stomach that stimulates appetite High levels of grehlin can lead to obesity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Sociocultural Influences Time pressure Restaurant portions Immigrants to U.S. Time pressure can cause poor eating and exercise habits Restaurant portions are relatively large in the U.S. Immigrants to the U.S. have lower rates of obesity for first 10 years but increase in BMI later © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Family behavior patterns Family Influences Family behavior patterns High-fat, high-calorie diet Eating to alleviate distress or show love Overfeeding “Socially contagious” obesity Family behavior patterns High-fat, high-calorie diet Eating to alleviate distress or show love Overfeeding infants and young children can predispose them to obesity Obesity can be “socially contagious” among those in close relationships © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Stress and “Comfort Food” Comfort foods Foods high in fat and carbohydrates © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Stress and “Comfort Food” Stimuli or conditions and cues Watching TV Watching movies Attending parties Becoming anxious, angry, or bored Certain stimuli or conditions can serve as cues to eat, especially for obese people © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Pathways to binge eating Pathways to Obesity Pathways to binge eating Social pressure to conform to the thin ideal Depression Low self-esteem Binge eating is predictor of later obesity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 9.6: Pathways to Obesity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Lifestyle modifications Treatment of Obesity Lifestyle modifications Medications Bariatric surgery Lifestyle modifications Low-calorie diet, exercise, and behavioral intervention Medications Meridia, Xenical Bariatric Surgery Reduces capacity of stomach or shortens intestine © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Importance of Prevention Eat three fewer bites of food at meals Walk or take stairs more often Sleep more Three simple steps Once people become obese, it is difficult for them to lose weight and maintain their new low weight Therefore, prevention is important © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

What is the role of public policy on fighting obesity? Unresolved Issues What is the role of public policy on fighting obesity? Should unhealthy foods be taxed or banned? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.