Eating Disorders

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Chapter 11

• Eating Disorders

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Eating Disorders

• Although not historically true, current Western
  beauty standards equate thinness with health and
  beauty
• There has been a rise in eating disorders in the
  past three decades
• The core issue is a morbid fear of weight gain
• Two main diagnoses
• Anorexia nervosa
• Bulimia nervosa

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Anorexia Nervosa

• The main symptoms of anorexia nervosa are
• A refusal to maintain more than 85 of normal
  body weight
• Intense fears of becoming overweight
• A distorted view of body weight and shape
• Amenorrhea

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Anorexia Nervosa

• There are two main subtypes
• Restricting type
• Lose weight by restricting bad foods,
  eventually restricting nearly all food
• Show almost no variability in diet
• Binge-eating/purging type
• Lose weight by vomiting after meals, abusing
  laxatives or diuretics, or engaging in excessive
  exercise
• Like those with bulimia nervosa, people with this
  subtype may engage in eating binges

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Anorexia Nervosa

• About 9095 of cases occur in females
• The peak age of onset is between 14 and 18 years
• Around 0.5 of females in Western countries
  develop the disorder
• Many more display some symptoms
• Rates of anorexia nervosa are increasing in North
  America, Japan, and Europe

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Anorexia Nervosa

• The typical case
• A normal to slightly overweight female has been
  on a diet
• Escalation to anorexia nervosa may follow a
  stressful event
• Separation of parents
• Move or life transition
• Experience of personal failure
• Most patients recover
• However, about 2 to 6 become seriously ill and
  die as a result of medical complications or
  suicide

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Anorexia Nervosa The Clinical Picture

• The key goal for people with anorexia nervosa is
  thinness
• The driving motivation is FEAR
• Of becoming obese
• Of losing control of body shape and weight

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Anorexia Nervosa The Clinical Picture

• Despite their dietary restrictions, people with
  anorexia are extremely preoccupied with food
• This includes thinking and reading about food and
  planning for meals
• This relationship is not necessarily causal
• It may be the result of food deprivation, as
  evidenced by the famous 1940s starvation study
  with conscientious objectors

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Anorexia Nervosa The Clinical Picture

• People with anorexia nervosa also demonstrate
  distorted thinking
• Often have a low opinion of their body shape
• Tend to overestimate their actual proportions
• Adjustable lens assessment technique
  overestimate size by 20
• Hold maladaptive attitudes and beliefs
• I must be perfect in every way
• I will be a better person if I deprive myself
• I can avoid guilt by not eating

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Anorexia Nervosa The Clinical Picture

• People with anorexia may also display certain
  psychological problems
• Depression (usually mild)
• Anxiety
• Low self-esteem
• Insomnia or other sleep disturbances
• Substance abuse
• Obsessive-compulsive patterns
• Perfectionism

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Anorexia Nervosa Medical Problems

• Caused by starvation
• Amenorrhea
• Low body temperature
• Low blood pressure
• Body swelling
• Reduced bone density

• Slow heart rate
• Metabolic and electrolyte imbalance
• Dry skin, brittle nails
• Poor circulation
• Lanugo

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Bulimia Nervosa

• Bulimia nervosa, also known as binge-purge
  syndrome, is characterized by binges
• Bouts of uncontrolled overeating during a limited
  period of time
• Often objectively more than most people
  would/could eat in a similar period

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Bulimia Nervosa

• The disorder is also characterized by
  compensatory behaviors, which mark the subtype of
  the condition
• Purging-type bulimia nervosa
• Vomiting
• Misusing laxatives, diuretics, or enemas
• Nonpurging-type bulimia nervosa
• Fasting
• Exercising excessively

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Bulimia Nervosa

• Like anorexia nervosa, about 9095 of bulimia
  nervosa cases occur in females
• The peak age of onset is between 15 and 21 years
• Symptoms may last for several years with periodic
  letup

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Bulimia Nervosa

• Patients are generally of normal weight
• May be slightly overweight
• Often experience weight fluctuations
• Binge-eating disorder may be a related
  diagnosis
• Symptoms include a pattern of binge eating with
  NO compensatory behaviors (such as vomiting)
• This condition is not yet listed in the DSM

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Bulimia Nervosa

• Teens and young adults have frequently attempted
  binge-purge patterns as a means of weight loss,
  often after hearing accounts of bulimia from
  friends or the media
• In one study
• 50 of college students reported periodic binges
• 6 tried vomiting
• 8 experimented with laxatives at least once

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Bulimia Nervosa Binges

• For people with bulimia nervosa, the number of
  binges per week can range from 2 to 40
• Average 10 per week
• Binges are often carried out in secret
• Binges involve eating massive amounts of food
  rapidly with little chewing
• Usually sweet foods with soft texture
• Binge-eaters commonly consume more than 1500
  calories (often more than 3000 calories) per
  binge episode

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Bulimia Nervosa Binges

• Binges are usually preceded by feelings of
  tension and/or powerlessness
• Although the binge itself may be pleasurable, it
  is usually followed by feelings of extreme
  self-blame, guilt, depression, and fears of
  weight gain and discovery

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Bulimia Nervosa Compensatory Behaviors

• After a binge, people with bulimia nervosa try to
  compensate for and undo the caloric effects
• The most common compensatory behaviors
• Vomiting
• Affects ability to feel satiated ? greater hunger
  and bingeing
• Laxatives and diuretics
• Almost completely fail to reduce the number of
  calories consumed

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Bulimia Nervosa

• The typical case
• A normal to slightly overweight female has been
  on an intense diet
• Research suggests that even among normal
  subjects, bingeing often occurs after strict
  dieting
• For example, a study of binge-eating behavior in
  a low-calorie weight loss program found that 62
  of patients reported binge-eating episodes during
  treatment

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Bulimia Nervosa vs. Anorexia Nervosa

• Similarities
• Onset after a period of dieting
• Fear of becoming obese
• Drive to become thin
• Preoccupation with food, weight, appearance
• Elevated risk of self-harm or attempts at suicide
• Feelings of anxiety, depression, perfectionism
• Substance abuse
• Disturbed attitudes toward eating

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Bulimia Nervosa vs. Anorexia Nervosa

• Differences
• People with bulimia are more worried about
  pleasing others, being attractive to others, and
  having intimate relationships
• People with bulimia tend to be more sexually
  experienced
• People with bulimia display fewer of the
  obsessive qualities that drive restricting-type
  anorexia
• People with bulimia are more likely to have
  histories of mood swings, low frustration
  tolerance, and poor coping

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Bulimia Nervosa vs. Anorexia Nervosa

• Differences
• People with bulimia tend to be controlled by
  emotion may change friendships easily
• People with bulimia are more likely to display
  characteristics of a personality disorder
• Different medical complications
• Only half of women with bulimia experience
  amenorrhea vs. almost all women with anorexia
• People with bulimia suffer damage caused by
  purging, especially from vomiting and laxatives

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What Causes Eating Disorders?

• Most theorists subscribe to a multidimensional
  risk perspective
• Several key factors place individuals at risk
• More factors greater risk
• Leading factors
• Sociocultural conditions (societal and family
  pressures)
• Psychological problems (ego, cognitive, and mood
  disturbances)
• Biological factors

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What Causes Eating Disorders? Societal Pressures

• Many theorists argue that current Western
  standards of female attractiveness have
  contributed to the rise of eating disorders
• Standards have changed throughout history toward
  a thinner ideal
• Miss America contestants have declined in weight
  by 0.28 lbs/yr winners have declined by 0.37
  lbs/yr
• Playboy centerfolds have lower average weight,
  bust, and hip measurements than in the past

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What Causes Eating Disorders? Societal Pressures

• Certain groups are at greater risk from these
  pressures
• Models, actors, dancers, and certain athletes
• Of college athletes surveyed, 9 met full
  criteria for an eating disorder while another 50
  had symptoms
• 20 of surveyed gymnasts met full criteria for an
  eating disorder

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What Causes Eating Disorders? Ego Deficiencies
and Cognitive Disturbances

• Bruch argues that eating disorders are the result
  of disturbed motherchild interactions which lead
  to serious ego deficiencies in the child and to
  severe cognitive disturbances

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Treatments for Eating Disorders

• Eating disorder treatments have two main goals
• Correct abnormal eating patterns
• Address broader psychological and situational
  factors that have led to and are maintaining the
  eating problem
• This often requires the participation of family
  and friends

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Treatments for Anorexia Nervosa

• The initial aims of treatment for anorexia
  nervosa are to
• Restore proper weight
• Recover from malnourishment
• Restore proper eating

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Treatments for Bulimia Nervosa

• Treatment programs are relatively new but have
  risen in popularity
• Treatment is frequently offered in specialized
  eating disorder clinics

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Treatments for Bulimia Nervosa

• The initial aims of treatment for bulimia nervosa
  are to
• Eliminate binge-purge patterns
• Establish good eating habits
• Eliminate the underlying cause of bulimic
  patterns
• Programs emphasize education as much as therapy