Ch 11-Eating disorders Flashcards
Anorexia
In control
Restrictive type anorexia
Restricts eating and/or over-exercise
Binging/purging type anorexia
-Person still significantly underweight
<85% of recommended healthy body weight
Previous DSM-4 specifiers
-Missed 3 consecutive menstrual cycles
–>”manorexia”
“Manorexia”
10-15% anorexics are male
Higher mortality rates
Characteristics of anorexia
- perfectionism
- depression
- obsessed with food
- lower self-esteem
- distorted body image
Background of individuals with anorexia
- enmeshed families (intrusive/invasive)
- high expectations
- middle or upper class
Ages of anorexia & prevalence
Peak ages: 14 & 18 years (bimodal)
Peak range: 15-19 yrs
*on increase in Japan, Europe, China
Treatment of anorexia
Main focus: weight gain!
CBT
Operant
Family Therapy
CBT for anorexia
frequently used
Operant techniques for anorexia
Positive & negative reinforcement to modify maladaptive behaviors
Maudsely Approach family therapy
engages entire family
- encourages anorexic to re-feed
- adjust family dynamics
Irony of recovery from anorexia
- can increase health risks
- heart tissue becomes lost/weakened
Restrictive type comorbid disorders/characteristics
Introversion
Conformity
perfectionism
rigidity
Binging/Purging type comorbid disorders/characteristics
Extraversion
Histrionic PD
impulse control
substance use/abuse
Bulimia
Out of control
*may be normal or overweight
2000-5000 calories/binge
Compensatory behaviors for bulimia
Any behavior that compensates for food intake
ex. vomiting, laxatives, exercise
“Exercise bulimia/addiction”
Strong relationship with eating disorders
~70% also meet criteria for eating disorder
DSM-5 criteria for bulimia
at least 1 episode/week for at least 3 months
Evidence for impulse control problems
More evidence for problems with substance abuse, gambling, etc.
Comorbid mental disorders for bulimia
Mood disorders GAD Panic Disorder Social Phobias Substance use disorders Borderline PD
Central issue for ALL eating disorders
CONTROL
Binge eating disorder
*New to DSM
- Binges in eating without purging
- NO compensatory behaviors
Diagnostic criteria for Binge Eating Disorder
- eat more rapidly
- eat large amounts
- secretive
- may eat when not hungry
- lack of control over eating
severity rating of BED
Mild: 1-3 episodes/wk
Moderate: 4-7 episodes/wk
Severe: 8-13 episodes/wk
Extreme: 14+ episodes/wk
Prevalence rates of BED
Females: 1.5x more likely than males
Clinical samples: majority white females
Community samples: Black & white females = equal rates
Cultural differences in african american women for BED
less likely to be treated for eating disorder
more likely to be obese
express less concern about eating/body shape/weight
report less distress over body weight
Comorbid Mental Disorders for BED
Major depression
OCD
Avoidant PD
Emotional eating
eating in response to negative affect
*typically eat foods high in fat, sugar, calories (comfort foods)
Schneider et al. study on emotional eating
Subjects induced into anxiety states showed higher preference for high calorie foods
Obesity/Overweight changes over time in US
1975: 47%
2000: 61%
2003: 67%
2012: 69% (35% of which are obese)
BMI
based on height & weight
<18 underweight
>25 overweight
>30 obese
>40 Morbid obesity
U shaped curve for mortality rates
*limitation distinguishing fat from muscle weight
Irony in actual weight vs ideal body size
Body ideals in weight–>decreased over time
Actual body weights–>increased over time
sociocultural factors in eating disorders
Social roles & cultural ideals push expectations on us –>discrepancies
Cited reasons for body image concerns/dieting in adolescent girls
- mass media
- peer influences
- criticism from family members
Causes of eating disorders
MULTIFACTORIAL & MULTIDEMENSIONAL
Biological causes of eating disorders
Subcallousal cingulate: affects moods & emotion regulation
Resistant anorexia w/ nothing else that works: Treatment w/ deep brain stimulation
Genetic causes of eating disorders
- Tend to run in families
- families with comorbid disorders (OCD, other anxiety disorders)
Mutations in genes: increase likelihood of developing eating disorder by 90%
Perseverative behaviors
behaviors that persist/continue even when reinforcement has stopped
-more likely to develop eating disorder
Waller study eating disordered attitudes
Those scoring higher on disordered eating attitudes:
- lower levels persistence (stopping once reaching goal)
- higher levels perseveration (continuing even though they will never be satisfied/succeed)
psychological causes of eating disorders
- depression
- impulse control
- parenting received: emphasis on weight, appearance, enmeshed, lack of expression of negative affect
- self-esteem issues
Social causes of eating disorders
- peer/family influences
- sociocultural values
- media influences
Anne Becker fiji study
1995: intro to TV, NO disordered eating
1998: 11.3% began purging
2007: 45% reported purging
