Understanding and Treating Eating Disorders

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Understanding and Treating Eating Disorders
Prof. Freedom Leung Department of
Psychology Chinese University of Hong
Kong fykleung_at_psy.cuhk.edu.hk
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Biological mechanisms underlying eating
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(1) Communication between stomach and brain
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a. Weight pressure b. Ghrelin
b
2
a
1
4
3
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(2) Communication between liver and brain
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b
2
a
4
1
3
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(3) Communication between external cues,
pancreas, and brain
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3
b
2
a
4
1
3
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Brain circuits regulating eating
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(4) Communication between fat cells and brain
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b
2
a
4
1
3
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Leptin regulates Neuropeptile-Y (NPY) in PVN
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Leptin genes and obesity
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What would happen if we flood the PVN with NPY?
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NPY and uncontrollable binge eating
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What would happen if we damage the VMH?
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How does the brain process eating stimuli?

• Stimulation from outside (seeing or smelling
  food) and/or from inside (biochemical changes).
• Signals reach different parts of the hypothalamus
  that create eating urge.
• Urge is registered consciously as desire by the
  PFC
• PFC initiates actions to fulfill its desire.
• Food intake leads to change in circulating levels
  of dopamine and other biochemical substances and
  a feeling of satisfaction.

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Brain circuits regulating eating
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Emotional awareness and regulation
1) Orbito-frontal inhibits inappropriate
actions, defer immediate reward in favor of
long-term advantage 2) Ventromedial emotions
are experienced and meaning assigned to our
perceptions 3) Dorsolateral to form plans and
concepts and choose actions 3) 4) Anterior
cingulate focus attention and tune in to own
thoughts
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The pleasure pathway
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How does the brain process eating stimuli?
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5
2
1
4
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Factors affecting weight and shape
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Factors that affect weight and shape

• Genetics that determine
• a. basal metabolism rate
• b. number and distribution of fat cells
• Eating habit (food types and quantity)
• Exercise habit
• Age

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Individual differences in metabolism and body
weight and shape
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Factors that affect weight and shape

• Genetics that determine
• a. basal metabolism rate
• b. number and distribution of fat cells
• Eating habit (food types and quantity)
• Exercise habit
• Age

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Genes, fat distribution, and body shapes
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Facts about fat cells
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Factors that affect weight and shape

• Genetics that determine
• a. basal metabolism rate
• b. number and distribution of fat cells
• Eating habit (food types and quantity)
• Exercise habit
• Age

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Eating in a commercial habitat
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Factors that affect weight and shape

• Genetics that determine
• a. basal metabolism rate
• b. number and distribution of fat cells
• Eating habit (food types and quantity)
• Exercise habit
• Age

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Factors that affect weight and shape

• Genetics that determine
• a. basal metabolism rate
• b. number and distribution of fat cells
• Eating habit (food types and quantity)
• Exercise habit
• Age

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The upper and lower limits of our weight
190 175 160 145 130 115 100 lbs 85
60 - 90
- 15
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Who should lose weight?

• Genetically fat and behaviorally fat very fat
• Genetically fat and behaviorally thin still fat
• Genetically thin but behaviorally fat fat
• Genetically thin and behaviorally thin thin

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Freedoms guidelines in losing weight

• Do you really need to lose weight?
• How much?
• Lose it very gradually
• Stick to food from natural food chains
• Add water to your food
• Exercise regularly
• Keep the changes for life
• Try your best, after, forget the fat!
• ???,???,??????!

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Understanding and treating Eating Disorders
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Important terms

• Non-purging weight loss behaviors (dieting,
  fasting, excessive exercise)
• Bingeing
• Purging behaviors (vomiting, laxative misuses)
• Anorexia without binge/purge symptoms
• Anorexia with b/p symptoms
• Bulimia with previous anorexia
• Bulimia without previous anorexia
• Bulimia - purging vs. non-purging subtypes
• Binge eating disorder

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Natural course of losing weight
dieting-bingeing-compensating

• Dieting to lose 10 - 15 of the healthy weight
• Trigger self-regulatory mechanisms in the
  hypothalamus
• Develop food preoccupation and binge-eating
• Regain weight (increase in body fat ratio)
• Compensatory behaviors (e.g., fasting, excessive
  exercise, self-induced vomiting, or laxatives
  misuse)

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Diagnostic criteria for Anorexia Nervosa

• Self-evaluation is overly influenced by body
  weight and shape
• Body weighs less than 85 of the expected weight
• Have intense fear of gaining weight even
  underweight
• Absence of at least 3 consecutive menses (in men,
  loss of sexual libido)
• Subtypes restricting type vs. binge/purge
  type

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Secondary physical symptoms of Anorexia

• Skin and bone problems
• dry cracking skin
• fine downy hair
• brittle nails
• carotene pigmentation
• Osteoporosis
• Gastro-intestinal problems
• bloating
• abdominal pain
• early satiety
• constipation
• bloody diarrhea (caused by laxative abuse)
• laxative dependency
• bowel obstruction

• Cardiovascular complications
• electrolytes (potassium) imbalances
• muscular weakness
• heart irregularities
• hypotension and associated dizziness
• occasional blackouts

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Diagnostic criteria for Bulimia Nervosa

• Self-worth is overly influenced by body weight
  and shape
• Uncontrollable binge eating
• Engage in compensatory behaviors (e.g., fasting
  or severe dieting, excessive exercise,
  self-induced vomiting or laxative abuse)
• Binge/purge twice a week, for 3 months
• Subtypes purging type vs. non-purging type

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Secondary physical symptoms of Bulimia

• Oral problems
• gum recession and enamel breakdown
• swollen or infected salivary glands
• damaging the esophageal walls
• Gastro-intestinal problems
• bloating
• abdominal pains
• early satiety
• chronic under-hydration
• constipation
• Menstrual irregularities

• Cardiovascular complications
• electrolytes (potassium) imbalances
• muscular weakness
• heart irregularities/sudden death (particularly
  among those also abusing diuretics)

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Russels signs in bulimic patients
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Brain-and-experience model of Anorexia

• Neurobiological predispositions
• Insensitive weight self-regulatory mechanisms in
  the brain
• High obsessive personality trait
• Upbringing experiences
• Parent-child relationships that impair
  self-esteem
• Parental attitudes toward appearance
• Peer pressures and influence
• Socio-cultural beauty standards
• Psychological propensities
• Emotionally feel inadequate and unsure of own
  self-worth
• Cognitively preoccupied with body and shape
  issues
• Diet to gain social approval and acceptance

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Brain-and-experience model of Bulimia

• Neurobiological predispositions
• Sensitive weight self-regulatory mechanisms in
  the brain
• High impulsive personality trait
• Upbringing experiences
• Parent-child relationships that impair
  self-esteem
• Parental attitudes toward appearance
• Peer pressures and influence
• Socio-cultural beauty standards
• Psychological propensities
• Emotionally unstable and feel inadequate
• Cognitively preoccupied with body and shape
  issues
• Diet to gain social approval and acceptance

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Motivations behind self-starvation The principle
of equifinality

• Control eating to achieve self-perfection in the
  eyes of God
• Control eating to gain a sense of self-control
  from intrusive parents
• Control eating/weight to gain social approval

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The 3 big questions for EDs patients

• What are you trying to lose?
• What are you trying to gain?
• What is the real nature of your problem? Eating
  or self-concept ?

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Assessment and treatment of EDs

• Assessment of weight history
• Assessment of eating pattern food diary
• Psychoeducation about weight and shape
• Assessment of problem nature

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References

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