Transcript COMPLEXITIES OF EATING DISORDERS

COMPLEXITIES OF EATING
DISORDERS
By
Patti Higgins
Prevalence
 Approximately 5-10 million women and 1
million men struggle with eating disorders,
such as anorexia, bulimia and binge-eating
disorder.
 Eating disorders (ED) are complex,
physiologically and psychologically
devastating diseases that require professional
treatment (www.nationaleatingdisorders.org).
Anorexia Nervosa
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Refusal to maintain a minimum body weight
(85% of the expected weight).
Intense fear becoming fat, despite being severely
underweight (Hall & Ostroff, 1999).
Abnormal self-perception of body image, denial
of low weight, and preoccupation with losing
weight .
Female patients often develop amenorrhea.
90% of anorexic cases are female; 10 % are
males.
Bulimia
 Repeated cycles of bingeing (extreme overeating)
and purging (fasting, vomiting, exercising)
behaviors.
 After bingeing, the patient attempts to control
weight gain by inappropriate means such as fasting,
self-induced vomiting, excessive exercise, abuse of
laxatives, diuretics, or other drugs.
 90% females; 10 % males.
ED Assessments
 Eating Disorder
Examination
Questionnaire (EDEQ) accurately assess
and identify females
with anorexia and
bulimia.
 Eating Attitudes Test
(EAT-12) can identify
pre-eating disorder
cases.
 Eating Disorder
Inventory (EDI) can
identify pre-eating
disorder symptoms.
Etiology of ED
 Wells and Sadowski (2001) view the etiology
of bulimia nervosa as highly complex,
involving various biological, psychological,
social and family factors.
 Polivy & Herman (2002) noted family
factors such as dysfunctional
communication, enmeshment and criticism,
family attitudes about food, weight, and body
image were related to development of eating
disorders.
Mothers & daughters
 Pike and Rodin (1991) “examined features of 77
mothers' attitudes and behavior that relate to
disordered eating among their adolescent
daughters” (p. 198). Maternal criticism and view of
daughter’s unattractiveness were related to ED.
 Mother / daughter relationship is a risk factor for
eating disorders. Study indicated that both
anorexics’ and bulimics’ descriptions of their
mothers were generally negative (Johnsson, Smith
& Amner, 2001).
Family relationships
 Wonderlich, Klein and Council (1996) found bulimic females
perceived both parents as hostilely disengaged. Additionally,
bulimics related their negative self-concepts with perceptions
of paternal attack/friendliness.
 Humphrey (1989) compared videotapes of 74 family triads
with anorexic, bulimic-anorexic, bulimic and normal
daughters. The taped were coded using Benjamin's structural
analysis of social behavior (SASB).
 Bulimics and their parents were hostilely enmeshed; parents
undermined daughter's separation and self-assertion.
 Anorexics’ parents gave double messages of nurturant
affection combined with neglect of their daughter's needs
Parental relationships
 Wade, Bulik & Kendler (2001) found that
poorer quality of the marital relationship
predicted the presence of subclinical bulimia
nervosa (SBN), generalized anxiety disorder
(GAD) and alcohol dependence in offspring.
Mood factors
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ED may represent a way of coping with
problems of identity and personal control
(Polivy & Herman, 2002, p. 187).
Tachi, Murakami, Murotsu and Washizuka
(2001) reported binge and purge behaviors may
be related to attempts to regulate negative
moods.
Beebe’s (1994) reported that bulimic behaviors
are related to both escapism and feelings of
hopelessness.
Moods…
 Fassino, Daga, Piero, Leombruni &
Rovera (2001) used State-Trait
Anger Expression Inventory
(STAXI), Temperament and
Character Inventory (TCI) and
Eating Disorder Inventory II (EDIII) to discover high impulsivity
among ED clients. Extreme anger
was found in bulimic anorexics.
American culture
 80% of American women are dissatisfied with their
appearance and body image.
 42% of 1-3 graders want to be thinner (Collins,
1991).
 81% of 10 year olds are afraid of getting fat
(Mellin et al., 1991).
 The average American woman is 5'4" tall and
weighs 140 pounds. The average American model is
5'11" tall and weighs 117 pounds.
 Most fashion models are thinner than 98% of
American women (Smolak, 1996).
Americans obsess on thinness
 51% of 9 and 10 year old girls feel better about
themselves if they are on a diet (Mellin et al.,
1991).
 46% of 9-11 year olds are sometimes or very
often on diets, and 82% of their families are
sometimes or very often on diets (GustafsonLarson & Terry, 1992).
 91% of women surveyed on a college campus
had attempted control their weight by dieting.
Media factors
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Guerro-Prado, Barjau-Romero, Chinchilla, &
Moreno (2001) found an “undeniable influence of
mass media in the genesis and maintenance” (p.
403) of eating disorders.
Researchers also speculate that more males may
develop the disorder as the media continues to
pressure men and boys to strive for ideal body
image (Polivy & Herman, 2002).
Polivy and Herman (2002) propose that
sociocultural factors including the media contribute
to the increase of eating disorders among young
women.
Ethnicity and cultural factors
 Kuba and Harris (2001) studied 115 Mexican
American women and found that contextual
variables such as level of acculturation,
socioeconomic status (SES), peer
socialization, family structure, and
immigration status influence the occurrence
of eating disorders in women of color.
Males
 Eliot & Baker (2001) collected
comprehensive descriptions of 40 eating
disordered males and surveyed others.
Indications are that many males do have
extreme concerns about body image and
weight.
Treatments
 Wells & Sadowski (2001) suggest comprehensive,
individualized and multifaceted therapy, including
both pharmacological and behavioral treatment
components.
 Little (2002) suggests hospitalization to stabilize
the patient, behavior modification, family
counseling, group counseling, drug therapy and
individual psychotherapy.
Family Therapy
 Minuchin and Fishman (1981) emphasized that
the anorexic or bulimic patient exhibits these
symptoms as a response to the dysfunctional
family system. Suggest reestablishing parental
heirarchy through structural family therapy.
 Enhancing parenting skills and communication
processes have been helpful with anorexic
families (DeAngelis, 2002; Cierpka, Reich &
Kraul, 1998).
More family therapy…
 Milan trained therapists may view eating disorders
such as anorexia and bulimia as “family
games”(Goldenberg & Goldenberg, 2000).
 Narrative therapists engage in externalizing
conversations to demonstrate that the family or client
is not the problem: “the problem is the problem”
(Goldenberg & Goldenberg, 2000, p. 316).
 McDaniel, Hepworth and Doherty (1992) proposed
medical family therapy, which refers to “the
biopsychosocial treatment of individuals and families
who are dealing with medical problems” (p. 2).
Multi-modal options
 Goals of therapy include promoting understanding,
improving intrapersonal and interpersonal
functioning, restoring normal exercise patterns, and
addressing comorbid psychopathology and
psychological conflicts (Muscari, 2002, p. 22).
 Bean and Weltzin (2001) suggest multidimensional
residential treatment that has cognitive-behavioral,
interpersonal, experiential and family therapies.
 Riess (2002) recommends cognitive-behavioral
therapy (CBT), psychoeducation, interpersonal
therapy (IPT), and relational therapy (RT).
Physical Exercise
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Sundgot-Borgen, Rosenvinge, Bahr and Schneider
(2002) examined the effect of physical exercise as an
experimental treatment condition against the welldocumented effect of cognitive-behavioral therapy
(CBT). Exercise helped reduce drive for thinness,
improved change in body composition, enhanced
aerobic fitness, and reduced frequency of bingeing,
purging and laxative abuse.
Pharmacological options
 Research demonstrated the efficacy of fluoxetine
treatment as statistically superior to the placebo
treatment. Bulimic patients who received fluoxetine
exhibited reduction in frequency of vomiting
episodes and frequency of binge eating episodes
(Romano, Halmi, Sarkar, Koke & Lee, 2002, p.
671).
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“Continued treatment with fluoxetine in patients with
bulimia nervosa who responded to acute treatment with
fluoxetine improved outcome and decreased the
likelihood of relapse” (Romano et al., 2002, p. 671).
Conclusion
 ED are complex disorders requiring thorough review
of diagnoses, etiologies, family issues, assessment
methods, family therapy treatment models and other
treatment approaches of eating disorders.
 The prevalence and seriousness of eating disorders,
such as anorexia, bulimia, binge eating disorder
warrant improvements in public awareness,
psychoeducational techniques and media
responsibility.
 Furthermore, family prevention and intervention have
been indicated as highly beneficial.