Chapter 9 Eating Disorders

Anorexia Nervosa

Diagnostic criteria
Refusal to maintain normal body weight
Less than 85%

Intense fear of gaining weight and being fat

Fear not reduced by weight loss

Distorted body image

Feel fat even when emaciated

Amenorrhea
Loss of menstrual period

Two types:
Restricting Binge-eating-purging
2

Table 9.1 Sample Items from Eating Disorders Inventory (EDI)

Figure 9.1Assessment of Body Image

Anorexia Nervosa
Onset early to middle teen years Usually triggered by dieting and stress Women 10x as likely to develop disorder as men Often comorbid with depression, OCD, phobias, panic, alcoholism & PDs

Physical Changes in Anorexia

Low blood pressure, heart rate decrease, kidney & gastrointestinal problems Loss of bone mass Brittle nails, dry skin, hair loss Lanugo
Soft, downy body hair

Depletion of potassium & sodium

Can cause tiredness, weakness, and death
6

Prognosis

70% recover
May take several years Relapse common

Bulimia Nervosa

Uncontrollable eating binges followed by compensatory behavior to prevent weight gain

Occur at least 2x per week for 3 months

Two types:
Purging (vomiting, laxatives) Non-purging (fasting, excessive exercise)

Bulimia vs. Anorexia, binge-eating-purging type

Extreme weight loss in anorexia At or above normal weight in bulimia
8

Bulimia Nervosa

Binges often triggered by stress and negative emotions Typical food choices:
Cakes, cookies, ice cream, other easily consumed, high calorie foods

Avoiding a craved food can increase likelihood of binge Loss of control during binge
Shame and remorse often follow
9

Bulimia Nervosa
Onset late adolescence or early adulthood Prevalence 1 2% 90% women Comorbid with depression, PDs, anxiety, substance abuse, conduct disorder Suicide attempts & completions higher than in general population

10

Physical Changes in Bulimia

Menstrual irregularities Potassium depletion Laxative use depletes electrolytes which can cause cardiac irregularities Loss of dental enamel from vomiting

Teeth appear jagged

11

Prognosis
70% recover 10% remain fully symptomatic Early intervention linked with improved outcomes Poorer prognosis when depression and substance abuse are comorbid

12

Binge Eating Disorder

Diagnosis in need of further study Involves:

Recurrent binges
2x per week for at least 6 months

Loss of control during binge Binge causes distress

No loss of weight or purging Often accompanied by obesity

Body mass index (BMI) > 30
13

Etiology of Eating Disorders: Genetics

Family and twin studies support genetic link

Higher MZ concordance rates for both anorexia and bulimia

Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable Adoption studies needed Linkage on chromosome 1 (Grice et al., 2002)
Need for replication
14

Etiology of Eating Disorders: Neurobiological Factors

Hypothalamus not directly involved Low levels of endogenous opioids

Substances that reduce pain, enhance mood, & suppress appetite Released during starvation
May reinforce restricted eating of anorexia

Low levels of opioids in bulimia promote craving

Reinforce binging

Serotonin & dopamine may also play a role

15

Table 9.2 The Restraint Scale

16

Etiology of Eating Disorders: Sociocultural Factors

Societal emphasis on thinness Dieting, especially among women, has become more prevalent
Often precedes onset

Body dissatisfaction and preoccupation with thinness also predict eating disorders Societal objectification of women leads to selfobjectification Unrealistic media portrayals fuel body dissatisfaction
17

Etiology of Eating Disorders: Cross Cultural Factors

Anorexia found in many cultures Bulimia most common in industrialized, western countries

As countries become more industrialized, bulimia rates increase

Preoccupation with thinness also culturally influenced

18

Etiology of Eating Disorders: Ethnic Factors

White teens as compared to African American teens

More body dissatisfaction
BMI increases linked to greater body dissatisfaction

More dieting

White and Hispanic college students exhibit more body dissatisfaction than African American students Socio-economic status
Eating Disorders less linked to SES than in previous years
19

Etiology of Eating Disorders: Psychodynamic View

Disturbed parent-child relationship

Over-controlling parent
Dieting a means to gain control and identity (Baruch, 1980)

Conflicted mother-daughter relationship

Bulimia creates a sense of self (Goodsitt, 1997)

Personality characteristics
Body dissatisfaction, lack of interoceptive awareness, and negative emotions (Leon et al., 1999) Perfectionism (Tyrka et al., 2002)
20

Etiology of Eating Disorders: Family Characteristics

Disturbed family relationships

High levels of family conflict Low levels of support

Family characteristics
May result from, not be a cause of, eating disorder Not specific to eating disorders
Also found in families of individuals with other types of psychopathology

Minuchins proposed family characteristics

Enmeshment, overprotectiveness, rigidity, lack of conflict resolution
21

Etiology of Eating Disorders: Child Abuse

High rates of childhood sexual and physical abuse Reports of abuse not specific to eating disorders

Also found in other diagnostic categories

22

Etiology of Eating Disorders: Cognitive Behavioral View

Anorexia
Focus on body dissatisfaction and fear of fatness Certain behaviors (e.g., restrictive eating, excessive exercise) negatively reinforcing
Reduce anxiety about weight gain

Feelings of self control brought about by weight loss are positively reinforcing Criticism from family & peers regarding weight can also play a role
23

Etiology of Eating Disorders: Cognitive Behavioral View

Bulimia
Self-worth strongly influenced by weight Low self-esteem Rigid restrictive eating triggers lapses which can become binges
Many off-limit foods Restraint Scale measures dieting and overeating

Disgust with oneself and fear of gaining weight lead to compensatory behavior
e.g., vomiting, laxative use

Stress, negative affect trigger binges

24

Figure 9.2 Schematic of Cognitive Behavior Theory of Bulimia Nervosa

25

Treatment of Eating Disorders

Most individuals dont receive treatment

Often deny problem

Antidepressants
Effective for bulimia but not anorexia Drop out and relapse rates high

Family therapy CBT for bulimia

Challenge societal ideals of thinness Challenge beliefs about weight and dieting CBT more effective than medication
26

Prevention of Eating Disorders

Psychoeducational approaches De-emphasize sociocultural influences Risk Factor Approach

Identify those most at risk and intervene early

27