1. 6-1 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd CHAPTER 6 EATING DISORDERS

2. 6-2 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd AIMS AND OBJECTIVES Provide overview of historical approaches to eating disorders Describe current classification system for anorexia nervosa, bulimia nervosa, and binge eating disorder Review information regarding prevalence, age of onset, course, associated problems, and aetiology of these conditions Outline main treatment approaches Discuss key challenges and controversies

3. 6-3 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Historical and current approaches Anorexia nervosa First recognized in the 1870s and conceptualised as a loss of appetite due to mental causes In 1970, Gerald Russell proposed formal diagnostic criteria DSM-IV-TR characterizes anorexia as a relentless pursuit of thinness DSM-IV-TR criteria 1. Maintaining a body weight at a subnormal level (<85%) 2. Intense fear of becoming fat 3. A distorted body image 4. Amenorrhea Two types: restricting and binge eating / purging

4. 6-4 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Historical and current approaches Bulimia Nervosa Although there are references from ancient Greece / Rome to binge eating, contemporary descriptions appeared in the 19 th century In 1979, Gerald Russell distinguished bulimia from anorexia Bulimia nervosa patients had strong urges to overeat and were not underweight DSM-IV-TR criteria 1. Recurrent episodes of binge eating with a sense of loss of control over food intake 2. Inappropriate compensatory behaviour to prevent weight gain 3. Both (1) and (2) occur on average at least 2x per week for 3 months 4. Self-evaluation unduly influenced by body shape and weight 5. Absence of anorexia nervosa Two types: purging and non-purging

5. 6-5 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Historical and current approaches Eating disorder not otherwise specified: binge eating disorder DSM-IV- TR provides the category of eating disorder not otherwise specified (EDNOS) for those who do not meet for anorexia or bulimia People with EDNOS may have subjective binges that do not meet criteria for bulimia nervosa Binge eating disorder is a subgroup of EDNOS defined by the occurrence of binge eating episodes without the weight control behaviours characteristic of those with bulimia nervosa

6. 6-6 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Anorexia nervosa Epidemiology Affects mainly adolescent girls and young women 0.9% lifetime prevalence, 10x more common in females Age of onset and course of the disorder Age of onset is usually in early to late adolescence Mortality rate (5-10%) is the highest of all psychiatric disorders Substantial portion of patients will fail to make a full recovery Associated Features and medical problems Psychological comorbidities include mood and anxiety disorders, substance use disorders, and personality disorders Medical problems include irregular heart beats, heart failure, and severe metabolic disturbance

7. 6-7 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Anorexia nervosa Aetiology Biological factors Moderate heritability Higher concordance for monozygotic versus dizygotic twins Interaction between genetic factors and environment Environment has been found to influence attitudinal factors, such as body dissatisfaction Some research suggesting abnormally high levels of serotonin activity Neuroendocrine (hormonal systems) are irregular, but this may be a consequence of the disorder rather than a cause Possible abnormalities in the structure and function of the brain

8. 6-8 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Anorexia nervosa Aetiology Psychological factors Low self-esteem Individuals seek to overcome through attainment of extreme thinness Negative affect Individuals try to avoid emotional distress by focusing on eating, shape,and weight Dysfunctional thinking Individuals judge their worth in terms of their eating habits, body shape, and weight Perfectionism Unrealistically high standards pursued in the domain of eating and weight

9. 6-9 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Anorexia nervosa Aetiology Social factors Family factors Individuals with anorexia report higher levels of criticism and lower levels of care and affection from parents, but is a retrospective report and subject to bias Parents influence their children through direct comments and through modelling Peer factors Girls in peer groups that emphasize thinness are at increased risk Cultural values Anorexia more likely to occur in historical periods/cultures that place a high value on the control of eating, shape, and weight

10. 6-10 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Anorexia nervosa Aetiology Psychological factors Low self-esteem Individuals seek to overcome through attainment of extreme thinness Negative affect Individuals try to avoid emotional distress by focusing on eating, shape, and weight Dysfunctional thinking Individuals judge their worth in terms of their eating habits, body shape, and weight Perfectionism Unrealistically high standards pursued in the domain of eating and weight

11. 6-11 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Anorexia Nervosa Treatment Motivational enhancement therapy (MET) Unlike most disorders, people with anorexia are attached to their disorder MET aims to help patients increase their motivation to change Cognitive behaviour therapy Conducted in 3 stages: 1. Establish supportive and collaborative relationship and meal plan 2. Target dysfunctional beliefs about weight and food 3. Prepare for the end of treatment and prevent relapse Family therapy Maudsley Model – promotes re-feeding and weight gain by encouraging parents to take responsibility for health eating in the home Family therapy may be preferable to individual treatment for younger patients

12. 6-12 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Bulimia nervosa Epidemiology Prevalence Primarily affects females 1-3% lifetime prevalence Age of onset and course of the disorder Age of onset is later than anorexia nervosa, late adolescence and young adulthood Can become chronic for some Associated medical and psychological problems Depletion of electrolytes from purging behaviours in 50% Depression, anxiety, and substance use disorders are common

13. 6-13 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Bulimia nervosa Aetiology Biological factors Moderate heritability Family predisposition to obesity and family histories of substance use and mood disorders Reduced serotonergic function Social factors Individuals with bulimia report: more critical comments and teasing about shape, weight, or eating poorer family functioning more negative interpersonal interactions before binge eating episodes

14. 6-14 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Bulimia nervosa Aetiology Psychological factors Dual Pathway Model – binge eating episodes are triggered by dietary restriction, negative affect, or both

15. 6-15 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Bulimia nervosa Treatment Motivational enhancement therapy (MET) Like anorexia, some individuals with bulimia are not motivated to recover MET has been shown to increase recovery and treatment response Self-help approaches Little support for pure self-help approaches, but guided self-help may be effective Cognitive behaviour therapy 1. Educate patient about bulimia and self-perpetuating cycle of dieting 2. Eliminate all dieting and target dysfunctional cognitions 3. Focus on relapse prevention Interpersonal psychotherapy Help individuals identify and change interpersonal problems Pharmacological approaches Antidepressant medication is more effective than placebo

16. 6-16 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Binge eating disorder Epidemiology Prevalence 2/3 female 3-5% lifetime prevalence Age of onset and course of the disorder Age of onset is unknown, estimated to be late adolescence and young adulthood Course is controversial, some suggest it is a short-term condition while others argue it is more chronic Associated medical and psychological problems The most prominent physical problem is overweight or obesity Mood disorders, anxiety disorders, substance use and personality disorders are common

17. 6-17 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Binge eating disorder Aetiology Biological factors Preliminary support for moderate heritability May entail dysfunction in serotonin system Hormonal disturbances may also play a role Psychological factors Strong support for the role of negative affect Emotional eating is associated with binge eating disorder Social factors Poorer family functioning Obesity stigma

18. 6-18 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Binge eating disorder Treatment Self-help approaches Pure self-help and guided self-help approaches both may be efficacious Cognitive behaviour therapy (CBT) Targets of treatment are develop a moderate eating plan increase physical activity, and achieve greater acceptance of body shape/weight Interpersonal psychotherapy Highly effective in reducing binge eating and as effective as CBT Behavioural weight loss Emphasis is on weight loss by restricting caloric intake and increasing activity Pharmacological approaches Antidepressant medications have been supported, although not as effective as CBT

19. 6-19 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd EATING DISORDERS Current challenges and controversies Limitations of current treatment approaches More large controlled trials of psychotherapy are needed While CBT is effective for bulimia, much room for improvement Approaches to eating disorders and obesity need to be integrated Large gap between presence of eating disorder and diagnosis and treatment Involuntary treatment Many clinical and ethical dilemmas related to imposing treatment on patients who are at risk of death (e.g, in serious cases of anorexia) Prevention of eating disorders Can focus on general or specific risk factors depending on whether individuals are beginning to display symptoms

20. 6-20 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd SUMMARY Historical and Current Approaches to Eating Disorders Anorexia Nervosa Epidemiology, Onset, Course, and Associated Problems Aetiology Treatment Bulimia Nervosa Epidemiology, Onset, Course, and Associated Problems Aetiology Treatment Binge Eating Disorder Epidemiology, Onset, Course, and Associated Problems Aetiology Treatment Current Challenges and Controversies