Eating Disorders

1
Eating Disorders

• An eating disorder is a complex compulsion to
  eat, or not eat, in a way which disturbs physical
  and mental health.
• The eating may be excessive (compulsive
  over-eating)
• too limited (restricting)
• may include normal eating punctuated with
  episodes of purging
• may include cycles of binging and purging

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Eating disorders

• The most commonly known eating disorders are
  Anorexia nervosa and Bulimia nervosa.
• The most widely and rapidly spreading eating
  disorder is compulsive overeating or Binge eating
  disorder. These are also the three most common
  eating disorders.
• All three can cause severe, immediate and
  long-term health issues and can cause death.

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Anorexia Nervosa

• The American Psychiatric Association defines
  anorexia nervosa as the presence of an abnormally
  low body weight (15 below normal body weight for
  age and height),
• the intense fear of gaining weight or becoming
  fat,
• disturbance and preoccupation with body weight
  and shape,
• and amenorrhea (the absence of three consecutive
  menstrual cycles).
• Anorexia can be life-threatening as victims
  commonly refuse to eat and drastically lose
  weight in which causes the lack of nutrients
  within the their body.

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Anorexia nervosa

• Anorexics are commonly perfectionists, driven to
  succeed yet they set unattainable standards of
  performance for themselves.
• When they fail to meet these standards, they look
  for a part of their lives they can control food
  and weight become that control for them.
• Low self-esteem and constant self-criticism cause
  anorexics to constantly fear losing control, and
  even consuming a small amount of food could be
  considered a loss of control.
• One thousand women die of anorexia nervosa each
  year, and millions more suffer from the
  destructive physical complications.

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Characteristics of Anorexia Nervosa

• It is primarily suffered by females. Females
  outnumber males by a factor of 20-1 although some
  psychologists say 10-1.
• It usually starts in adolescence but can occur in
  adults or children.
• Leminson et al (1993) reported that 4 in 1000
  females experience the disorder in America. In
  Britain, the figure is higher 2 separate
  figures have been published 10 in 1000 and 40
  in 1000. 70,000 people suffer from anorexia
  (Brooke 1996).
• The disease is characterized by a refusal to eat
  and deliberate weight loss.
• Most anorectics stop having periods.

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Characteristics of anorexia nervosa

• There is a deterioration in general health which
  includes low blood pressure, low body
  temperature, constipation and dehydration. In 5
  - 15 anorexia is fatal.
• They always avoid calorie-rich foods.
• They are almost always hungry and often look at
  things to do with food, like recipes, books etc.

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Characteristics of anorexia nervosa

• They report that they do not get any pleasure
  from eating and do not enjoy taste sensations.
  Fat tastes revolting.
• They have a fear of being overweight. There are
  2 main types of anorectics fasters and bingers
  (a person who occasionally eats a lot and then
  throws it up). Binge eating creates guilt which
  is why they vomit it up.
• Anorectics do not recognize how thin they are,
  even when they are looking in the mirror.

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Bulimia Nervosa

• Bulimia nervosa is characterized by the recurrent
  episodes of bingeing (eating large quantities of
  food over short periods of time)
• followed by attempts to compensate for the
  excessive caloric intake by such purging
  behaviours as self-induced vomiting, laxative
  abuse, severe restrictive dieting or fasting, or
  excessive exercise.
• Bulimics often have "binge food," which is the
  food they typically consume during binges.
• Some have described their binge episodes as a
  physical high they feel, numbing out, going into
  auto-pilot, losing all control, immediate
  comfort, etc.

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Bulimia nervosa

• The reasoning or triggers behind a binge may
  serve different purposes for different people.
• This binge episode leads the individual to feel
  guilt, shame, embarrassment, and complete
  failure.
• Bulimics try to regain control of themselves and
  the situation by purging the food making up for
  their mistake.

10
Bulimia nervosa

• This leads to feeling famished and empty again,
  and therefore, another uncontrollable binge,
  followed by feeling powerless, and the vicious
  binge/purge cycle continues.
• Bulimics have extreme eating and exercising
  habits, instead of demonstrating moderation.
• This compulsive behaviour is often echoed in
  similar destructive behaviour such as sexual
  promiscuity, pathological lying, and shoplifting.
  

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There are 2 types of bulimics

• The purging type who expels the food as soon as
  it is consumed.
• The non-purging type who, between binges, goes
  on strict diets and vigorous exercise schedules.
  The binges are between 2 and 30 times a week,
  depending upon the individual.

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Characteristics of bulimia nervosa

• Cooper (1995) says that most bulimics are women.
  Only 5 are male.
• It usually begins in adolescence but appears
  later than anorexia nervosa.
• There are more bulimics than anorectics. 5 of
  the population is said to be bulimic.

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Characteristics of bulimia nervosa

• Bulimia is also fear of fatness, although
  bulimics have a normal body weight.
• There is a tendency for weight to fluctuate.
• Bulimics tend to feel guilty and therefore binge
  eat in private.
• They can have a puffy facial appearance because
  vomiting swells the parotid gland.

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Bulimia nervosa

• The digestive tract is damaged and bulimics are
  often dehydrated.
• The tooth enamel is also damaged by the acids
  that come up with the vomit.
• They also suffer from anxiety, sleep disturbances
  and depression.

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Bulimia nervosa

• Some bulimics indulge in self-mulitative
  behaviour.
• Parkin and Eagles (1993) reported cases of
  blood-letting. Blood-letting is inserting some
  sort of implement into the vein to let the blood,
  and it appears to give as much satisfaction as
  binge eating.
• Vomiting usually relieves feelings of anxiety.

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Binge-Eating Disorder

• This is often referred to as Compulsive
  Overeating. Binge-eating disorder is similar to
  bulimia in the recurrent episodes of bingeing
• however, binge-eaters do not engage in any
  purging behaviour or attempt to rid themselves of
  the food in any way.
• Binges often take place in secret, when the
  person is alone, since feelings of shame and
  disgust often accompany the binge.

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Binge-Eating Disorder

• Binge eaters typically eat very rapidly, hide
  food, and stuff themselves to the point of
  feeling sick.
• Some binge eaters may eat to fill an emotional
  void or spiritual emptiness they feel, in a
  desperate effort to be satisfied.
• This is called emotional eating, which is a
  coping mechanism for stress, depression, anxiety,
  anger, and many other negative emotions.

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Causes environmental factors

• Environmental factors
• The media may be a significant influence on
  eating disorders through its impact on values,
  norms, and image standards accepted by modern
  society.
• Both societys exposure to media and eating
  disorders have grown immensely over the past
  decade.
• Researchers and clinicians are concerned about
  the relationship between these two phenomena and
  finding ways to reduce the negative influence
  thin-ideal media has on womens body perception
  and susceptibility to eating disorders.

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Environmental factors

• The dieting industry makes billions of dollars
  each year by consumers continually buying
  products in an effort to be the ideal weight.
• Hollywood displays an unrealistic standard of
  beauty that makes the public feel incredibly
  inadequate and dissatisfied and forces people to
  strive for an unattainable appearance.
• This takes an enormous toll on one's self-esteem
  and can easily lead to dieting behaviours,
  disordered eating, body shame, and ultimately an
  eating disorder.

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The Behavioural Model

• The behavioural model states that anorexia is a
  phobia a weight phobia.
• There is an idealization in society of thin women
  which may be creating a weight problem/phobia in
  certain people.
• There is some support that there are pressures to
  be slim in western societies.
• Lee et al (1992) argue that non-western cultures
  have a much lower incidence of anorexia nervosa.
  
• Sui Wah (1989) suggests that in many non-western
  cultures importance is attached to food and
  families tend to eat together, so if someone is
  not eating properly, it will not go unnoticed.

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Family Relationships

• Many studies have found that women lack control
  over their bodies.
• Especially in conditions of criticism and
  coercive parental control during childhood, girls
  use food refusal to gain autonomy and control
  over their environment.
• Many studies have showed that many women who
  experienced physical or sexual abuse as a child
  end up with eating disorders as a method of
  punishing oneself due to the feeling of being
  worthless, or to strive to be good enough so
  they can finally receive the love and acceptance
  they lacked during childhood.

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Family relationships

• Women may have developed low self-esteem and poor
  body image, but they can find achievement in
  abiding by food rules
• they gain a sense of control and independence in
  being disciplined and avoiding "bad" food.
• These distorted thoughts are correlated with
  perfectionism and obsessive behaviour, giving
  women a false sense of control when, in reality,
  the eating disorder has totally consumed them.

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Developmental etiology

• Research from a family systems perspective
  indicates that eating disorders stem from both
  the adolescent's difficulty in separating from
  over-controlling parents, and disturbed patterns
  of communication.
• When parents are critical and unaffectionate,
  their children are more prone to becoming
  self-destructive and self-critical, and have
  difficulty developing the skills to engage in
  self-care giving behaviours.
• When coping strategies have not been developed in
  the family system, food and drugs serve as a
  substitute.

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The psychodynamic model

• The psychodynamic model has proposed many
  possible reasons
• A girl is afraid of reaching puberty and sexual
  maturity, and so does not eat in order to look
  pre-pubescent. They argue if the girl becomes
  sexually mature, she fears having to become more
  independent. Menstruation usually stops, which
  is another reason preventing a girl from growing
  up.
• If a girl doesnt eat, she can continue to look
  like a boy. In addition to this, if her period
  stops, it considerably reduces the issue of her
  sexuality.
• The parents of anorectics often tend towards
  domineering behaviour, and not eating is one way
  that a girl can assert her individuality.

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Biological/Genetic factors

• Research has shown that many people who suffer
  from an eating disorder are highly correlated
  with having depression and obsessive compulsive
  disorder.
• Depressed, obsessive compulsive and bulimic
  patients were found to have lower than normal
  serotonin levels.
• Neurotransmitters, such as serotonin, dopamine,
  and noradrenaline, are released as you eat.

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Biological factors

• Cortisol is a hormone released by the adrenal
  cortex which promotes blood sugar and increases
  metabolism.
• High levels of cortisol were found in people with
  eating disorders.
• This imbalance may be caused by a problem in or
  around the hypothalamus.
• A study in London at Maudsley Hospital found that
  anorexics were found to have a large variation of
  serotonin receptors and a high level of
  serotonin.
• Many of these chemicals and hormones are
  associated with the hypothalamus in the brain.

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Biological factors

• Damage to the hypothalamus can result in
  abnormalities in temperature regulation, eating,
  drinking, sexual behaviour, fighting, and
  activity level.
• Uher Treasure (2005) performed a study
  researching brain lesions effects on eating
  disorders.
• They evaluated 54 formally published cases of
  eating disorders and brain damage.

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Biological factors

• They found many correlations between eating
  disorders and damage to the hypothalamus.
• People with brain lesions in the hypothalamus had
  abnormal eating behaviours unprovoked and self
  induced vomiting, over concern with becoming fat,
  cheating with eating, frequent sleepiness,
  depression, obsessive compulsive behaviour and
  diabetes.

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Statistics on Eating Disorders

• Eating Disorders

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Gender and eating disorders

• Gender imbalance

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Using behaviour therapy and positive
reinforcements

• In the first stage of therapy, the therapist
  establishes a reinforcer to be given every time
  the patient eats.
• After a while, eating gradually increases.
• The parents are then instructed in ways to
  continue the reinforcements for appropriate
  eating behaviours.
• Although it is accepted that therapies based on
  the behavioural model can alter behaviour,
  critics argue that such therapies fail to
  identify a disorders underlying causes.
• Hence, removing one symptom of a disorder may
  simply result in another occurring in some form.

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Worldwide statistics on eating disorders

• STATISTICS
• Prevalence
• 1 in 5 women struggle with an eating disorder or
  disordered eating.
• Up to 24 million people suffer from an eating
  disorder in the United States
• Up to 70 million people world wide struggle with
  an eating disorder.

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Statistics

• Almost 50 of people with eating disorders meet
  the criteria for depression.
• Nearly half of all Americans personally know
  someone with an eating disorder. Eating disorders
  have the highest mortality rate of any mental
  illness.
• The mortality rate associated with anorexia
  nervosa is 12 times higher than the death rate of
  ALL causes of death for females 15-24 years old.
• 20 of people suffering from anorexia will
  prematurely die from complications related to
  their eating disorder, including suicide and
  heart problems.

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Treatments

• Eating disorder treatment depends on your
  specific type of eating disorder. But in general,
  it typically includes psychotherapy, nutrition
  education and medication.
• If your life is at risk, you may need immediate
  hospitalization to stabilize your health.
• You may have a treatment team of medical doctors,
  mental health providers and dieticians.

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Psychotherapy

• Individual psychotherapy can help you learn how
  to exchange unhealthy habits for healthy ones.
• You learn how to monitor your eating and your
  moods, develop problem-solving skills, and
  explore healthy ways to cope with stressful
  situations.
• Psychotherapy can also help improve your
  relationships and your mood.
• A type of psychotherapy called cognitive
  behavioural therapy is commonly used in eating
  disorder treatment.
• Family therapy and group therapy also may be
  helpful for some people.

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Nutritional information

• Dieticians and other health care providers can
  offer information about a healthy diet and help
  design an eating plan to achieve a healthy weight
  and healthy-eating habits.
• If you have binge-eating disorder, you may
  benefit from medically supervised weight-loss
  programs.

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Medications

• MedicationsMedication can't cure an eating
  disorder.
• However, medications may help you control urges
  to binge or purge or to manage excessive
  preoccupations with food and diet.
• Medications such as antidepressants and
  anti-anxiety medications may also help with
  symptoms of depression or anxiety, which are
  frequently associated with eating disorders.