Eating Disorders

Types

• Anorexia Nervosa
• Bulimia Nervosa
• Binge-Eating Disorder

Anorexia Nervosa

• Restriction of energy intake relative to requirements, leading to significantly low body weight.
• Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though at a significantly low weight).
• Disturbance in the way in which one’s body weight or shape is experienced.
• tend to present as extreme thin
• Primary in adolescent girls and young women
• tend to starve self

Subtypes

• Restricting
  • Not taking in calories
  • Can also be exercise, eat a little, but counter with a lot of exercise
  • tend to be introverted
• Binge-eating/Purging
  • laxitives, diaretics
  • extraverted, impulsive
  • more guilt, depression, anxiety

Weight Assessment

Body Mass Index (BMI)

• assess body weight for height, weight in KG/Square(height in Meters)
  • moderately correlated with body fat

Example (Height: 5'9")

Physical Complications

• Irregular heart rate
• Low blood pressure
• Heart damage when body is forced to use muscle as an energy source
• Kidney disease
• Bone loss
• Purging often results in enlarged salivary glands

Course/Outcome

• Highly variable
  • some recover after one episode
  • others fluctuate after gaining weight, relapse
  • chronic and deteriorating course
• Onset in adolescence associated with more positive outcomes
• High mortality rate

Bulimia Nervosa

• Recurrent episodes of binge eating.
  • eating in a discrete period of time, 2 hr period, an amount of food, definitely larger than what normal individuals would eat in a similar amount of time in similar circumstances.
  • vast majority would not engage in behavior
• Recurrent inappropriate compensatory behaviors in order to prevent weight gain.
  • fasting or excessive exercise
• Binge eating and compensatory behaviors both occur, on average, at least once a week for 3 months.
• Self-evaluation is unduly influenced by body shape and weight.
  • does not occur exclusively when anorexic
  • spurred by emotional, engage in purging behavior from binging behavior
  • circular
• often eating to cope
• hist. of substance use

Physical Complications

• Erosion of tooth enamel
• Dehydration
• Swollen salivary glands
• Lowered potassium (can weaken heart and cause arrhythmia and cardiac arrest)
• Inflammation of esophagus, stomach, and rectal area

Course/Outcome

• Begins in late adolescence or early adulthood.
• Mortality rates elevated, especially among those who exercise excessively.
• Prognosis more positive than anorexia.
• Individuals with greater emotional stability and positive social support have better outcomes.
  • 68% of participants in study did not have symptoms after 22 years

Binge-Eating Disorder (BED)

• Recurrent episodes of binge-eating, at least once a week for three months.
• Associated with three (or more) of the following:
  - Eating much more rapidly than normal.
  - Eating until feeling uncomfortably full.
  - Eating large amounts of food when not feeling physically hungry.
  - Eating alone because of feeling embarrassed by how much one is eating.
  - Feeling disgusted with oneself, depressed, or very guilty afterward.
• usually gain a lot of weight

Physical Complications and Associated Characteristics

• 20-40% of those in weight-control programs have BED.
• Likely to be overweight.
• Increased risk of Type 2 diabetes, high blood pressure, and high cholesterol levels.
• difficulty controlling impulse and regulating neg. emotions

Course/Outcome

• Begins in late adolescence or early adulthood.
• Remission rates higher than anorexia or bulimia.
• Most individuals with BED make a full recovery over a 5-year period.
• Weight may remain high.

Etiology of Eating Disorders

Psychological Factors

• Body dissatisfaction
• Passivity, low self-esteem, dependence, and lack of assertiveness are associated with dysfunctional eating patterns.
• Perfectionism
• Impulsivity
• Depression
• Lack of self-confidence
• Use of control over eating to deal with stress

Social Dimension

• Negative family relationships may produce a self-critical style.
• Family members can unintentionally produce pressure to be thin.
• Peers can also produce pressure to lose weight.
• Friends extremely focused on dieting.
• "Fat talk" can increase body dissatisfaction and lower self-esteem.
• Appearance standards are influenced by social media and a desire to look attractive to an online audience.

Sociocultural Dimension

• In Western cultures, physical appearance is considered a very important attribute.
• Women are socialized to be conscious of body shape and weight.
• Social comparison appears to be a strong risk factor for eating disorders.
• Mass media portrayals of lean, muscular male bodies are increasing.

Biological Dimension

• Disordered eating tends to run in families.
• Eight areas in the human genome are associated with metabolism and weight.
• Dopamine levels control appetite.
• Other neurotransmitters and hormones involved (serotonin, ghrelin).
• Altered functioning of the appetitive neural circuitry.

Treatment

Treatment of Anorexia Nervosa

• Family therapy is an important and effective component in treatment.
• Psychological interventions:
  • Help client understand and cooperate with rehabilitation.
  • Help client understand dysfunctional attitudes.
  • Improve interpersonal and social reinforcement.
  • Address other psychological conflicts.
• Treatment is provided in either an outpatient or a hospital setting.

Treatment of Bulimia Nervosa

• Treat physical conditions.
• Normalize eating patterns.

Treatment Goals

• Encouraging the consumption of three balanced meals a day.

• Reducing rigid food rules and body image concerns.

• Identifying triggers for bingeing.

• Developing strategies for coping with emotional distress.

• Cognitive-behavioral treatment

• Antidepressant medications (e.g., SSRIs) are sometimes helpful.

Treatment of Binge-Eating Disorder

• Fewer physical complications presented.
• Includes healthy approaches to weight loss.
• Similar to treatments for bulimia:
  • Determine factors that trigger overeating.
  • Learn strategies to reduce binges.

Two Phases

• Antidepressant medications are sometimes effective:
  • Has less effect on weight reduction.
  • Incorporates strategies for addressing interpersonal difficulties and regulating negative emotions.
• Cognitive-behavioral therapy (CBT) can produce significant reductions in binge eating.

Obesity

• Defined as body mass index (BMI) greater than 30.
• 42% of U.S. adults are obese.
• Growing recognition that obesity is a disease.
• Childhood obesity has a significant health impact, especially for girls.
• DSM-5 does not recognize obesity as a specific disorder.