1. Eating Disorders Anorexia Nervosa Bulimia Nervosa

7. DSM-IV-TR v Anorexia Nervosa: “nervous loss of appetite” v Anorexia: “loss of appetite”

8. Anorexia Nervosa v Characterized by: –Intense fear of becoming fat or obese –Distorted body image –Refusal to maintain minimal body weight –Cessation of menstruation v Pattern of self-starvation v More common among affluent well-educated adolescent girls from affluent countries

9. AN Cont’d v Highest onset between ages 14-18 v Females 8-11 times more likely than Males v Has been stated to be on the increase (usual caveats here) Can be lethal and certainly causes physical problems

10. Central Features v Drive v Preoccupation v Cognitive/Perceptual v Psychological & Mood v Medical Problems

11. Physical Problems v Hypothermia (low internal heat) v Low Blood Pressure v Reduced Bone Density v Amennorhea v Electrolyte Imbalances v Cardiac Problems v Death (estimates range between 6 and 50%)

12. Personality v Obsessional, perfectionistic, heightened need for control v “Prickly” not real warm fuzzy

13. Video v Video Anorexia

15. Bulimia Nervosa: Characteristics v Also known as Binge Purge Syndrome v Binges and Compensatory Behaviours v Weight usually stays in normal range (might fluctuate) v Some become significantly underweight

16. Bulimia Nervosa v Two Subtypes (Based on the compensatory behaviours): compensatory behaviours): –Purging (use of laxatives, diuretics, vomiting –Nonpurging (fasting and exercise)

17. Bulimia Nervosa cont’d v Again, well educated, from affluent families, terrified of becoming fat v More prevalent (1 or 2/100) than AN and especially common among specific groups –College women –Private women’s colleges (10 – 25%)

18. Bulimia Nervosa (Binge-Purge Syndrome) Binge : Uncontrollable eating (binges) –Occurs over discrete period of time –Consumes considerably more food than most would eat (> 3000 calories in some cases) during the time: u Gobbles, with minimal chewing, sweet taste, high caloric content, soft texture u Food hardly tasted or thought about

19. Binges v Aware that binges are not normal –Have fears that unable to stop binges –Shame, guilt, self-blame and depressed after episodes –The frequency of binges can range (reports of 2 – 40 / week, although 10/week is average)

20. Compensatory Behaviour Compensatory Behaviour: Done to get rid of calories from the binges - Purging: Vomiting, laxatives, diuretics, enemas, diuretics, enemas, - Other: Fasting, excessive exercise - smoking, chewing gum - smoking, chewing gum

21. Physical Problems v Dental Erosion v Electrolyte imbalances v Cardiac problems

22. BulimiaVideo Clips v Comer Video Bulimia 1

23. Anorexia Nervosa & Bulimia Nervosa v Loss of Control in BN opposite to AN v BN more concerned about pleasing others and more sexually experienced than those with AN v AN & BN: dieting is major risk factor and often disorder starts with episode of dieting v AN & BN: Usually chronic and intermittent

24. Anorexia Nervosa & Bulimia Nervosa v Lack of insight in AN (i.e., don’t see behaviour or body as necessarily abnormal) v Insight in BN (i.e., know binges and compensatory behavior not normal, hence the secretiveness)

25. Distinction between AN and BN v Not so clear as once thought v Can have both at different times v Anorexia Nervosa: –Restricting Type –Binge/Eating Purging Type Jessica AN & BN

26. Eating Disorders in General

30. Anorexia Deaths v What do we know about Anorexia Nervosa?

31. Anorexia Deaths v What do we know about Anorexia Nervosa? 1. Life Threatening

32. Anorexia Deaths v What do we know about Anorexia Nervosa? 1. Life Threatening 2. Predominantly in Women

33. Anorexia Deaths v What do we know about Anorexia Nervosa? 1. Life Threatening 2. Predominantly in Women 3. Predominantly in Young Women

34. Method v Data from National Center for Health Statistics (US Database) v “Multiple Cause of Death Records” v For all death certificates registered between 1986 and 1990 v N = 10,600,000 (that’s right 10 million 6 hundred thousand subjects)

35. Death Record v Consisted of: –Demographic information –Cause of death (i.e., underlying cause of death) –Up to 20 death related conditions (disorders or diseases) present just prior to or at the time of death –Primary Cause and Contributing Cause

36. v Selected Ss with AN as primary or contributing cause of death

37. Results v 724 individuals with AN listed as primary or contributing cause (149/year) v Predominantly female (79%)

41. Replications v BC Data from Stats Canada Replication: –Median age of death: 80 years v Norway (Reas et al., 2006) Replication: –Mean age of death from AN: 61 years –Thirty one percent of deaths from AN were men