Transcript Chapter 11

Chapter 11
Eating Disorders
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 90–95% 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
• Slow heart rate
• Low body temperature
• Metabolic and
electrolyte imbalance
• Low blood pressure
• Body swelling
• Reduced bone density
• 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 90–95% 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 mother–child 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
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