2.  Two Main Types  Anorexia Nervosa  Bulimia Nervosa  Share Strong Drive to be Thin  Largely a Westernized, Female Problem  Largely an Upper SES Problem  Two Main Types  Anorexia Nervosa  Bulimia Nervosa  Share Strong Drive to be Thin  Largely a Westernized, Female Problem  Largely an Upper SES Problem

3.  Interview  Observation  Reports from family/friends  Objective Psychological Tests  (e.g., Eating Disorder Inventory)  Interview  Observation  Reports from family/friends  Objective Psychological Tests  (e.g., Eating Disorder Inventory) Assessment of Eating Disorders

4.  Bingeing – Eat Large Amounts of Food – Eating is Out of Control  Bingeing – Eat Large Amounts of Food – Eating is Out of Control  Compensatory Behaviors –Purging via –Self-Induced Vomiting, Enemas –Laxatives, Diuretics, Exercise, Fasting  Binge-Purge occur, on average, at least 2 X wk for 3 months  Self-evaluation is unduly influenced by body shape and weight  Compensatory Behaviors –Purging via –Self-Induced Vomiting, Enemas –Laxatives, Diuretics, Exercise, Fasting  Binge-Purge occur, on average, at least 2 X wk for 3 months  Self-evaluation is unduly influenced by body shape and weight Bulimia Nervosa

5.  Medical Consequences  Salivary Gland Enlargement  Eroded Dental Enamel  Electrolyte Imbalance  Intestinal Problems  Calluses on Fingers and Hands  Salivary Gland Enlargement  Eroded Dental Enamel  Electrolyte Imbalance  Intestinal Problems  Calluses on Fingers and Hands

6.  Facts and Statistics  90-95% are Women  Onset 16-19 Years of Age  6-8% of college women  About 2.8% Population Overall  Chronic if Left Untreated  90-95% are Women  Onset 16-19 Years of Age  6-8% of college women  About 2.8% Population Overall  Chronic if Left Untreated

7.  Clinical Description  Intense fear of – Gaining weight – Becoming fat  Intense fear of – Gaining weight – Becoming fat  Refusal to maintain body weight – 15% Below Expected Normal  Distorted body image  Amenorrhea (in females)  Refusal to maintain body weight – 15% Below Expected Normal  Distorted body image  Amenorrhea (in females)

8.  Two Subtypes  Restricting Type – Excessive Dieting  Restricting Type – Excessive Dieting  Binge-Eating / Purging Type – Rely on Purging – About Half of All Cases  Binge-Eating / Purging Type – Rely on Purging – About Half of All Cases

9.  Medical Consequences  Dry Skin, Brittle Hair or Nails  Sensitivity to Cold (Lanugo)  Risk of death (suicide, starvation, electrolyte imbalance, heart problems)  Dry Skin, Brittle Hair or Nails  Sensitivity to Cold (Lanugo)  Risk of death (suicide, starvation, electrolyte imbalance, heart problems)

10.  Associated Features and Facts  Begins in adolescence (onset often associated with a stressful life event)  Perfectionistic High-Achievers  All-or-None Thinking  Obsessive and Orderly  Comorbid DSM Disorders – Obsessive-Compulsive Disorder – Substance Abuse  Begins in adolescence (onset often associated with a stressful life event)  Perfectionistic High-Achievers  All-or-None Thinking  Obsessive and Orderly  Comorbid DSM Disorders – Obsessive-Compulsive Disorder – Substance Abuse

11.  Causes  Social and Cultural Factors –- examples? – Media – Sets Impossible Idealized Images  Social and Cultural Factors –- examples? – Media – Sets Impossible Idealized Images

12.  Causes  Biological Influences  Runs in Families  Unclear What is Inherited  The Serotonin-Hypothesis: BN represents an underlying hyposerotonergic condition  Biological Influences  Runs in Families  Unclear What is Inherited  The Serotonin-Hypothesis: BN represents an underlying hyposerotonergic condition

13.  Causes  Dieting: When food is restricted, we become preoccupied with it! (The PsychoBiological Impasse)  Family Influences (esp. in AN) – Successful and Driven – Concerned About Appearances – Eager to Maintain Harmony – Deny or Ignore Conflicts – Lack of Open Communication  Dieting: When food is restricted, we become preoccupied with it! (The PsychoBiological Impasse)  Family Influences (esp. in AN) – Successful and Driven – Concerned About Appearances – Eager to Maintain Harmony – Deny or Ignore Conflicts – Lack of Open Communication

14.  Psychosocial Treatments for BN  Cognitive-behavioral treatments – Education about eating behavior – Scheduled eating – Exposure / Response prevention  Cognitive-behavioral treatments – Education about eating behavior – Scheduled eating – Exposure / Response prevention

15.  Psychosocial Treatments  Anorexia Nervosa – First restore normal weight! – many will gain weight; keeping the weight on is harder – residential treatment – control issues? IPT  Anorexia Nervosa – First restore normal weight! – many will gain weight; keeping the weight on is harder – residential treatment – control issues? IPT

16.  Biological treatments  Bulimia Nervosa – Because serotonin is thought to play an important role in mediating satiety, SSRIs have been tried – e.g., fluoxetine (Prozac) has demonstrated effectiveness  Anorexia (not effective)  Bulimia Nervosa – Because serotonin is thought to play an important role in mediating satiety, SSRIs have been tried – e.g., fluoxetine (Prozac) has demonstrated effectiveness  Anorexia (not effective)