Transcript Anorexia Nervosa

Eating Disorders
90% of e.d. folks are adolescent/young women.
Anorexia Nervosa—marked by extreme thinness (<85%
healthy weight), obsessional thinking, food phobia, poor selfesteem, exercise, dangerous physical effects. Distorted body
perception.
no treatments are highly successful.
Bulimia Nervosa—marked by binge eating, perceived loss of
control over eating and compensatory behaviors—vomiting,
laxative use, fasting, exercise. More impulsive than A.N.
(obsessive)
better success at treatment
especially meds + cognitive behavioral intervention
• 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
• 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).
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.
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 disorder—symptoms: 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