psychological and physical factors

1

• Eating Disorders
• 90 of e.d. folks are adolescent/young women.
• Anorexia Nervosamarked by extreme thinness (lt85
  healthy weight), obsessional thinking, food
  phobia, poor self-esteem, exercise, dangerous
  physical effects. Distorted body perception.
• no treatments are highly successful.
• Bulimia Nervosamarked by binge eating, perceived
  loss of control over eating and compensatory
  behaviorsvomiting, laxative use, fasting,
  exercise. More impulsive than A.N. (obsessive)
• better success at treatment
• especially meds cognitive behavioral
  intervention

2

• History
• 1694 first case of anorexia nervosa mentioned
  ("phtisis nervosa"), with the female patient
  showing food avoidance, emaciation, cessation of
  menstrual periods
• 1874 term "anorexia nervosa" introduced
  psychological component of the illness recognized
• There are more data available on AN. Estimates of
  prevalence (total number in the population) are
  difficult to obtain (underreporting) but are in
  the 1-2 range. Incidence (number of newly
  diagnosed cases per year) has shown a 3-fold
  increase in the 70s and 80s and is still on the
  rise. The most common onset is age 14-16.
• There are three clear risk groups
• Female teenagers - only 5 of all anorexic
  patients are male.
• Students in private schools (as opposed to public
  schools), especially in upper socioeconomic
  strata.
• Dancers and models

3

• Anorexia Nervosa ritualized food intake weight
  phobia distorted body perception depression
  starvation
• Bulimia Nervosa normal weight extreme weight
  control binge episodes distorted body percep.
  physical complications (due to vomiting, abuse of
  laxatives, etc.)
• Causes
• Anorexia Nervosa Deep lack of control flight
  from maturation runs in families (genetics or
  modeling?) cognitive biases regarding weight and
  body shape.
• Bulimia Nervosa Little theory as of now.
  Restraint hypothesis "catastrophic shifts" occur
  if restrained behavior (which creates an
  approach-avoidance conflict) is violated slightly
  (e.g., eating one piece of chocolate leads to
  eating a whole cake).

4
more on eating disorders

• approximately 50 of eating disordered patients
  have had a depressive episode or anxiety attack
  prior to the onset of their eating problems. We
  know that these disorders have a strong
  biological basis and that they can be treated
  with medications.
• We have also learned that semi-starvation, binge
  eating (particularly complex carbohydrates),
  excessive exercise, and even self-induced
  vomiting alters neurochemistry in ways that may
  actually help individuals feel less depressed and
  calmer.

5

• somatoform disorders-
• diagnoses somatization disorder, conversion
  disorder, hypochondriasis, body dysmorphic
  disorder, pain disorder.
• frequent complaints e.g., headaches, fatigue,
  heart palpitations, fainting spells, nausea,
  vomiting, abdominal pain, bowel trouble,
  allergies, menstrual and sexual problems.
• immature, overexcitable, superficial social
  relations, self-centered.
• somatization disordersymptoms pain,
  gastrointestinal, sexual/reproductive,
  pseudoneurological (conversion). unnecessary
  surgeries common
• conversion- lost function, la belle indifference
  (hysteria)
• hypochondriasis- preoccupation with
  illness/health status
• Body dysmorphic disorder- imaged body defect