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Chapter 9
Eating Disorders
Ch 9
 Two Main Types
 Anorexia Nervosa
 Bulimia Nervosa
 Share Strong Drive to be Thin
 Largely a Female Problem
 Largely a Westernized Problem
 Largely an Upper SES Problem
 Many Die as a Result!
Anorexia Nervosa
• Anorexia nervosa is an eating disorder
characterized by self-starvation
– Person’s weight is 85% or less of normal
weight
– Person has an intense fear of gaining weight
– Person has a distorted sense of their body
shape
– In females, anorexia nervosa leads to a loss of
the menstrual period
Ch 9.1
Assessment of Body Image
• Top figure
– Body image ratings of
women who score high on
measure of distorted eating
behaviors
• Bottom Figure
– Body image ratings of
women who score low on
measure of distorted eating
behaviors
Pathways to Eating Disorders
Ch 9.2
Anorexia Nervosa
• Two types of anorexia nervosa:
– Restricting type loses weight by severely
limiting the amount of food consumed
– Binge-eating-purging type engages in binges
(large amount of food consumed) following by
purging (vomiting or use of laxatives)
• Lifetime prevalence of anorexia nervosa is
less than 1% and is 10 times more frequent
in women than in men
Ch 9.3
Anorexia Nervosa
• Anorexia nervosa is linked to depression
• Anorexia nervosa can have severe physical
effects including
– Altered electrolyte levels (potassium and
sodium) lead to changes in nerve and muscle
function
• Prognosis: 70% of anorexia nervosa
patients recover
Ch 9.4
 Associated Features and Facts
 Begins Early in Adolescence
 Perfectionistic High-Achievers
 All-or-None Thinking
 Obsessive and Orderly
 Comorbid DSM Disorders
– Depression
– Obsessive-Compulsive Disorder
– Substance Abuse
 Causes
 Social and Cultural Factors
– Thinness Equals Success
– Has Increased Over Time
 Media
– Sets Impossible Idealized Images
 Causes
 When Food is Restricted
– We Become Preoccupied With It!
 Media
– Sets Impossible Idealized Images
 Causes
 Family Influences
– Successful and Driven
– Concerned About Appearances
– Eager to Maintain Harmony
– Deny or Ignore Conflicts
– Lack of Open Communication
Bulimia Nervosa
• Bulimia Nervosa involves episodes of rapid
overeating followed by purging
– A binge is defined as eating an excessive amount of
food within two hours
– Purging refers to vomiting, laxative abuse, fasting or
excessive exercise
• Bulimia involves a fear of gaining weight
• Prevalence of bulimia nervosa is 1-2% of the
female population; only .1% of male population
Ch 9.5
 Facts and Statistics
 90-95% are Women
 White; Middle-to-Upper Middle Class
 Onset 16-19 Years of Age
 6-8% College Women
 About 1% of Female Population Overall
 Chronic if Left Untreated
Co-morbidity with Substance Abuse
Binge Eating Disorder
• Binge Eating Disorder involves
– Recurrent binges (twice a week for at least 6
months)
– Lack of control during the binge episode
• Binge Eating Disorder does not involve
– Loss of weight
– Compensatory behaviors of purging
Ch 9.6
Etiology of Eating Disorders
• Biological accounts of eating disorders:
– Genetic
• Anorexia and bulimia run in families
• Twin studies show genetic contribution to anorexia and bulimia
• With anorexia, evidence for linkage on chromosome 1.
– Endogenous opioids may play role in bulimia
– Serotonin may be deficient in bulimia:
• Bulimics have less serotonin metabolites
• Bulimics are less responsive to serotonin agonists
• Serotonergic drugs are often effective for bulimia
Ch 9.7
Sociocultural Influences on
Eating Disorders
• While cultural standards of the ideal woman
have moved toward thinness, the reality is
that both men and women are becoming
more obese
– Prevalence of obesity has doubled since 1900
– As social views of obesity become more
negative, the incidence of eating disorders
increases
Ch 9.8
Eating Disorders and CrossCultural Influences
• Eating disorders more prevalent in industrialized
societies which emphasize thinness.
– US, Canada, Japan, Europe
• As countries become more “westernized”, eating
disorders increase.
• When women from countries with low prevalence
rates more to countries with higher prevalence
rates, prevalence increases.
• Variations in assessment methods and diagnostic
criteria make it difficult to be certain about
differences in prevalence rates from country to
country.
Psychological Views of Eating
Disorders
• Personality studies indicate that
– Starvation can alter personality
– Personality variables such as perfectionism, low selfesteem, propensity to experience negative emotions
and an inability to distinguish bodily states are
predictors for the development of eating disorders
• Self-reports of childhood sexual/physical abuse
are higher in eating disorder subjects
Ch 9.9
Treatment of Eating Disorders
• Most eating disorder subjects (> 90 %) are
NOT in treatment
• Treatment of severe anorexia often takes
place in a hospital
• Bulimia can be treated with antidepressant
drugs (involving the serotonin system)
• No drugs are currently available for the
treatment of anorexia nervosa
Ch 9.10
Psychological Therapy for
Eating Disorders
• Psychological treatment of anorexia:
– Short-term increases in body weight
• Operant conditioning of eating can lead to short-term weight
gains
– Long-term maintenance of body weight gain
• Not yet achieved by any treatment modality
• Bulimia treatment involves cognitive behavior
therapy: change thought processes that result in
overeating; interpersonal therapy also effective.
Ch 9.11
 Psychosocial Treatments
 Bulimia Nervosa
– Education About Eating
Behavior
– Scheduled Eating
– Alter Thinking About Shape,
Eating, and Weight
 Treatment Works!
 Psychosocial Treatments
 Anorexia Nervosa
– Must Restore Normal Weight!
– Most Will Gain Weight (Easy)
– Keeping the Weight On (Hard)
– Treatment Similar to Bulimia
 Treatment Can Work!
 Rumination Disorder
 Regurgitating and Reswallowing
Food
 Disorder of Infancy--Adolescence
 Can Occur With Bulimia
 High Mortality Rate (25%)
 Rumination Disorder
 Pica
 Infants and MR Populations
 Eating Non-Nutritive Substances
– paint, string, hair, feces,
 Rumination Disorder
 Pica
 Feeding Disorder
 Infants and Very Young
 “Failure to Thrive Syndrome”
Are
Eating
Disorders
a Form
of
Addiction?








Severe Craving
Loss of Control
Used to Cope With Negative Feelings
Preoccupied with Substance
Unsuccessful Attempts to Quit
Denial
Adverse Psychosocial Consequences
Co-morbidity with substance abuse