1. Eating Disorders Chapter 7 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

2. Anorexia Nervosa (AN) A serious condition marked by an inability to maintain a normal healthy body weight -Measured by body mass index (BMI) Restricting vs. binge eating/purging type Copyright © 2012 by Pearson Education, Inc. All rights reserved.

3. According to the DSM-IV-TR… Anorexia Nervosa Restricting or binge eating/purging subtypes Use weight and shape as a measure of self-evaluation Denial of illness Intense fear of gaining weight or “feeling fat” Perception of body size and weight is distorted Absence of menstruation, amenorrhea Also remember being considered “underweight” by one’s BMI Copyright © 2012 by Pearson Education, Inc. All rights reserved.

4. So what does AN really look like? Copyright © 2012 by Pearson Education, Inc. All rights reserved.

5. Anorexia Nervosa and the Facts… Affects 1% of the general population (1 out of 100) Females are 9x more likely to develop the disorder Low BMIs & Osteoporosis Begins in adolescence (usually after puberty) Highest mortality rate of any psychiatric disorder (10.5x more likely) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

6. Who’s Considered at Risk? Segments of the population where emphasis is placed on body shape and weight -Actors, dancers, models, athletes, etc. Personality traits -Perfectionism -Obsessionality -Neuroticism -Low self-esteem -Developmental tasks (leaving home for college) -Worriers Can you think of any other populations that would be considered “at risk” for Anorexia Nervosa? Copyright © 2012 by Pearson Education, Inc. All rights reserved.

7. Comorbidity and AN 80% will suffer from major depression Up to 75% will suffer from anxiety disorders Anxiety as a risk factor in the development of AN Copyright © 2012 by Pearson Education, Inc. All rights reserved.

8. Bulimia Nervosa (BN) A disorder characterized by recurrent episodes of binge eating in combination with some form of compensatory behavior aimed at undoing the effects of the binge or preventing weight gain Compensatory behaviors -purging subtype vs. non-purging subtype It’s important to note that consuming 1,000 calories is the minimum to qualify for a binge session, but some consume up to 20,000 calories in one binge episode. Often referred to as the “invisible eating disorder” because people tend to be of normal weight or overweight. Copyright © 2012 by Pearson Education, Inc. All rights reserved.

9. What one needs to be diagnosed with BN… Recurrent episodes of binge eating Experience a lack of control over eating Engage in recurrent compensatory behaviors -self-induced vomiting -misuse of laxatives, diuretics, enemas, or other medications -fasting or excessive exercise Copyright © 2012 by Pearson Education, Inc. All rights reserved.

10. So what does BN really look like? Nine times more likely in females. Mortality is rare for those with BN compared to those with AN. Copyright © 2012 by Pearson Education, Inc. All rights reserved.

11. Some causes of BN… Westernized societal emphasis on the “thin ideals,” culture-bound syndrome Environmental exposure Social learning Information sharing (i.e., hearing about it from friends or reading material on the disorder) Personality (i.e., low self-esteem, perfectionism, more impulsive, and have higher rates of novelty seeking behaviors) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

12. Comorbidity and BN 80% of people with BN have another psychiatric disorder Most common disorders seen in conjunction with BN: anxiety disorders, major depression, substance use, and personality disorders Examples: Elton John and Princess Diana Copyright © 2012 by Pearson Education, Inc. All rights reserved.

13. Eating Disorders Not Otherwise Specified (EDNOS) A residual diagnostic category for people who have eating disorders that do not match the classic profile of anorexia nervosa or bulimia nervosa DSM-IV-TR criteria Binge eating disorder (BED) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

14. Binge Eating Disorder (BED) A disorder characterized by regular binge eating behaviors, but without the compensatory behaviors that are part of bulimia nervosa Still under investigation Common in people who are overweight and obese (found in 3.5% of women and 2% of men in the general population meet criteria) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

15. What one needs to be diagnosed with BED… Recurrent episodes of binge eating Report of distress over binge eating Associated with three or more of the following: -eating rapidly -eating past the point of “feeling full” -eating large amounts of food when not physically hungry -eating alone due to embarrassment -feeling disgusted with oneself, depressed, or guilty Copyright © 2012 by Pearson Education, Inc. All rights reserved.

16. Impact of Gender and Ethnicity Gender Female prevalence rates 9 to 1 Reasons -“Thin ideal” -Objectification of the female body -Influence of female hormones Male athletes Ethnicity Stereotypes Lack of clear data Need for research with more diverse populations Factors to consider (i.e., SES, education level, familial influence) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

17. Developmental issues to consider… Weight problems Prevalence rates in childhood vs. adolescence Social -Leads to social isolation from peers and family Emotional -Associated with symptoms of depression and anxiety Physical -Onset of menstruation, percentage of body fat, and more mature “womanly” figures Copyright © 2012 by Pearson Education, Inc. All rights reserved.

18. And the brain says… Role of the hypothalamus Activity-based anorexia Neuroendocrine and neurohormonal factors Brain structure and brain functioning Family “genetics” Biological factors to consider in the development of eating disorders Copyright © 2012 by Pearson Education, Inc. All rights reserved.

19. But my thoughts tell me... Patterns of family dysfunction (Salvador Minuchin) -Enmeshment Distorted cognitions -Related to body shape, weight, eating and personal control Society and Culture -Western “thin ideals” -Culture value on beauty Psychological factors to consider in the development of eating disorders Copyright © 2012 by Pearson Education, Inc. All rights reserved.

20. The Treatment of Eating Disorders Copyright © 2012 by Pearson Education, Inc. All rights reserved.

21. Basic Treatment Goals Anorexia nervosa -Normalization of eating behavior and weight -Increase caloric intake and weight gain Bulimia nervosa -Normalization of eating -Elimination of binge eating and purging Binge eating disorder -Normalization of eating -Elimination of binge eating -Weight stabilization or weight loss -Improve psychological factors (i.e., depression, self-esteem, and self-efficacy) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

22. Once hospitalized, then what? Inpatient treatment -Multidisciplinary team approach -Maintenance of healthy weight -Consideration of other factors (i.e., social supports, other medical conditions, work, school, suicidal ideation, etc.) -Psychotherapy (i.e., individual, group, and family) -Privileges given as result of compliance with treatment -Treatment (comprehensive plan, including “food”) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

23. Medication: Quick fix or long-term results? Biological treatment -Commonly prescribed -Need for medication specific to symptoms of Anorexia Nervosa -Fluoxetine (Prozac) is an anti-depressant or Selective Serotonin Reuptake Inhibitor (SSRIs) used to treat Bulimia Nervosa -No medications have been FDA approved for Binge Eating Disorder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

24. Nutritional Counseling Nutritional rehabilitation -Dieticians and nutritionists specializing in the treatment of eating disorders -Nutritional needs for someone with anorexia nervosa -Nutritional needs after assessment of someone with bulimia nervosa -Nutritional needs upon evaluation of someone with binge eating disorder -Best utilized in conjunction with other treatments Copyright © 2012 by Pearson Education, Inc. All rights reserved.

25. Changing faulty beliefs one step at a time… Cognitive-behavioral therapy -Focuses on changing one’s perception about body shape, weight, eating, and sense of control -Addresses both automatic thoughts and core beliefs -Replaces negative thoughts and problematic behaviors -Use of self-monitoring Copyright © 2012 by Pearson Education, Inc. All rights reserved.

26. Interpersonal Psychotherapy (IPT) IPT -A brief, time-limited therapy approach that focuses on decreasing eating disorder symptoms by enhancing social skills in relationships -Addresses four problem areas (i.e., interpersonal disputes, role transitions, abnormal grief, and interpersonal deficits) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

27. Eating Disorders and the Family Unit Family-based interventions -Minuchin’s and Palazzoli’s views of dysfunctional family system -Modern approaches to family therapy -The Maudsley Method -Effective with adolescents with eating disorders Copyright © 2012 by Pearson Education, Inc. All rights reserved.