Ch. 9 Eating Disorders

Question 1

Anorexia Nervosa

Answer 1

Anorexia nervosa – purposely maintains significantly low body weight, intensely fears becoming overweight, has a distorted view of her weight and shape, and is excessively influenced by her weight and shape in her self-evaluations.

• Restricting-type anorexia nervosa – restricting their intake of food
• Binge-eating/purging-type anorexia nervosa – Almost no variability in diet. Others, however, lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics, and they may even engage in eating binges.
• 90% female
• peak age of onset is between 14 and 20 years.
• Between 0.6 and 4.0% of all females in Western countries develop the disorder in their lifetime
• Increasing in North America, Europe, and Japan.
• Typically the disorder begins after a person who is slightly overweight or of normal weight has been on a diet.
  
  • The escalation toward anorexia nervosa may follow a stressful event.
• Although most people with the disorder recover, as many as 6% of them become so seriously ill that they die.
• The suicide rate among people with anorexia nervosa is five times the rate found in the general population.
• Fear provides their motivation – fear of becoming obese
• Anorexics think in distorted ways, have a low opinion of their body shape, are likely to overestimate their actual proportions, and are preoccupied with food.
• In a famous “starvation study” conducted in the late 1940s, 36 normal-weight conscientious objectors were put on a semi-starvation diet for six months. They began to show all the same symptoms of Anorexics.
• Anorexics suffer from depression, anxiety, low self-esteem, and insomnia, or other sleep disturbances, and many with substance abuse.
  
  • Many display obsessive-compulsive patterns. People with anorexia nervosa and others with obsessive-compulsive disorder score equally high for obsessiveness and compulsiveness.
• PERFECTIONISTIC – a characteristic that typically precedes the onset of Anorexia
• MEDICAL PROBLEMS – The starvation habits of anorexia nervosa cause medical problems.
  
  • Amenorrhea – The absence of menstrual cycles

Question 2

Bulimia Nervosa

Answer 2

Bulimia nervosa – A disorder marked by frequent eating binges followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight. Also known as Binge-purge syndrome.

• Binge – An episode of uncontrollable eating during which a person ingests a very large quantity of food.
  
  • Binges come in 1-30 binges per week
  • They binge in secret so they are aware that what they’re doing is wrong.
• 90% Women
• Begins between 15 and 20 years old
• Lasts for years with Periodic letup
• Weight remains within normal range, but with great fluctuation
• While Anorexia is motivated by fear of being obese, Bulimia is motivated by a desire to be attractive to others.
• Most Bulimics realize they have an eating disorder.
  
  • Studies show that both animals and humans binge when placed on very strict diets. The binging relieves the tension caused by restrictive diets but causes other problems.
  • Although the binge itself may be experienced as pleasurable in the sense that it relieves the unbearable tension the individual has been experiencing, it is followed by feelings of extreme self-blame, shame, guilt, and depression, as well as fears of gaining weight and being discovered.
• COMPENSATORY BEHAVIORS – people with bulimia nervosa try to compensate for and undo its effects, Vomiting (which only prevents the absorption of about 50% of the calories), and use of laxatives or diuretics, which have little effect on calorie absorption.

Question 3

Bulimia Nervosa Versus Anorexia Nervosa

Answer 3

Both begin after a period of dieting and are preoccupied with all the same things – weight, appearance, obsessiveness, and perfectionism. Often struggling with depression. Substance abuse may accompany either disorder, perhaps beginning with the excessive use of diet pills.

Differences include: Those with bulimia nervosa tend to be more concerned about pleasing others, being attractive to others, and having intimate relationships than anorexics

• More than one-third of those with bulimia nervosa display the characteristics of a personality disorder, particularly borderline or avoidant personality disorder,
• Only half of women with bulimia nervosa are amenorrheic or have very irregular menstrual periods, compared with almost all of those with anorexia nervosa.
• Repeated vomiting bathes teeth and gums in hydrochloric acid, leading some women with bulimia nervosa to have serious dental problems.
• Frequent vomiting or chronic diarrhea (from the use of laxatives) can cause a host of serious medical problems.
• BODY DISSATISFACTION – People who evaluate their weight and shape negatively – 73% of all girls and women are dissatisfied with their bodies, compared with 56% of all boys and men.
• Factors most closely tied to body dissatisfaction are perfectionism and unrealistic expectations. Body dissatisfaction is the single most powerful contributor to dieting and to the development of eating disorders.

Question 4

Binge-Eating Disorder

Answer 4

Binge-eating disorder – engage in repeated eating binges during which they feel no control over their eating. However, they do not perform inappropriate compensatory behavior.

• As a result of their frequent binges, around half of people with binge-eating disorder become overweight or even obese.
• Important to recognize, however, that most overweight people do not engage in repeated binges; their weight results from frequent overeating and/or a combination of biological, psychological, and sociocultural factors.
• Between 2 and 7% of the population have binge-eating disorder.
• 64% of sufferers are female
• There is a sense of loss of control experienced by individuals during the binge.
• Like other eating disorders, those with Binge-eating disorder typically are preoccupied with food, weight, and appearance; tend to base their evaluation of themselves largely on their weight and shape; often misperceive their body size and are extremely dissatisfied with their body; often struggle with feelings of depression, anxiety, and perfectionism; and may abuse substances.
  
  • Unlike the other eating disorders, binge-eating disorder does not necessarily begin with efforts at extreme dieting. And people with this disorder typically first develop it later than those with the other eating disorders.

Question 5

What Causes Eating Disorders?

Answer 5

Multidimensional risk perspective – to explain eating disorders, researchers identify several key risk factors that place a person at risk for these disorders. The more of these factors present, the more likely it is that a person will develop an eating disorder.

• Agrees with the (developmental psychopathology perspective) that risk factors for eating disorders unfold over the course of development, that interactions between these factors are key, and that different risk factors and combinations of factors may lead to the same eating disorders.
• PSYCHOLOGICAL FACTORS – Hilde Bruch, a pioneer in the study and treatment of eating disorders, developed a largely psychodynamic theory of the disorders, arguing that disturbed mother-child interactions lead to serious ego deficiencies in the child (including a poor sense of independence and control) and to severe perceptual disturbances that jointly help produce disordered eating.
  
  • According to Bruch, parents may respond to their children either effectively or ineffectively. Effective parents accurately attend to their children’s biological and emotional needs, giving them food when they are crying from hunger and comfort when they are crying out of fear. Ineffective parents, by contrast, fail to attend to their children’s needs, deciding that their children are hungry, cold, or tired without correctly interpreting the children’s actual condition. They may feed their children when their children are anxious rather than hungry, or comfort them when they are tired rather than anxious.
    
    • Children who receive such parenting may grow up confused and unaware of their own internal needs, not knowing for themselves when they are hungry or full, and unable to identify their own emotions “experience themselves as not being in control of their behavior, needs, and impulses, as not owning their own bodies”
    • Adolescence increases their basic desire to establish independence, yet they feel unable to do so.
    • To overcome their sense of helplessness, they seek excessive control over their body size and shape and over their eating habits.
    • Studies have shown that parents of teenagers with eating disorders do tend to define their children’s needs rather than allow the children to define their own needs.
    • People with eating disorders perceive internal cues, including emotional cues, inaccurately.
    • When research participants with an eating disorder are anxious or upset, for example, many of them mistakenly think they are also hungry, and they respond as they might respond to hunger—by eating.
      
      • Studies support Bruch’s argument that people with eating disorders rely excessively on the opinions, wishes, and views of others.
• COGNITIVE-BEHAVIORAL FACTORS – as a result of ineffective parenting, people with eating disorders improperly label their internal sensations and needs, generally feel little control over their lives, and in turn, want to have excessive levels of control over their body size.
  
  • This contributes to a broad cognitive distortion that lies at the center of disordered eating. people with anorexia nervosa and bulimia nervosa judge themselves—often exclusively—based on their shape and weight and their ability to control them.
• DEPRESSION – depressive disorders help set the stage for eating disorders. Their claim is supported by four kinds of evidence:

1. First, many more people with an eating disorder qualify for a clinical diagnosis of major depressive disorder.
2. Second, the close relatives of people with eating disorders seem to have a higher rate of depressive disorders
3. Third, the depression-related brain circuit of many people with eating disorders shows abnormalities that are similar to those of people with depression.
4. Fourth, people with eating disorders are sometimes helped by the same antidepressant drugs that reduce depression.

• HOWEVER, it could be true that eating disorders cause depression.
• BIOLOGICAL FACTORS – Biological theorists suspect that certain genes may leave some people particularly susceptible to eating disorders.
  
  • Consistent with this idea, relatives of people with eating disorders are up to six times more likely than other people to develop the disorders themselves.
    
    • If one identical twin has anorexia nervosa, the other twin also develops the disorder in as many as 70 percent of cases.
  • Brain Circuits could play a role – each of the circuits linked to generalized anxiety, obsessive-compulsive, and depressive disorders also acts dysfunctionally to some degree in people with eating disorders
  • Similarly, the activity levels of serotonin, dopamine, and glutamate (key neurotransmitters in the anxiety-related, obsessive-compulsive-related, and depression-related circuits) are abnormal in people with eating disorders.
  • HOWEVER, it is just as possible that the dysfunctions in those circuits are actually the RESULT of eating disorders.
  • ALTERNATIVELY, the observed circuit dysfunctions may simply reflect the fact that many people with eating disorders also suffer from anxiety, obsessive-compulsive, and/or depressive disorders.
  • This shows that although there is a correlation, there is not evidence of causation.
  • Many biological theorists focus their explanation of eating disorders on one part of the brain in particular, the hypothalamus:
    
    • HYPOTHALAMUS – A brain structure that helps regulate various bodily functions, including eating and hunger.
    • Lateral hypothalamus (LH) – A brain region that produces hunger when activated.
    • Ventromedial hypothalamus (VMH) – A brain region that depresses hunger when activated.
    • These areas of the hypothalamus and related brain structures are apparently activated by chemicals from the brain and body, depending on whether the person is eating or fasting.
    • One such brain chemical is the natural appetite suppressant glucagon-like peptide-1 (GLP-1)
    • The hypothalamus, related brain structures, and chemicals such as GLP-1, working together, comprise a “weight thermostat” in the body, which is responsible for keeping an individual at a particular weight level called the WEIGHT SETPOINT.
      
      • According to the Weight set point theory, when people diet and fall to a weight below their weight set point, their brain starts trying to restore the lost weight.
      • Hypothalamic and related brain activity produces a preoccupation with food and a desire to binge. They also trigger bodily changes that make it harder to lose weight and easier to gain weight, however little is eaten. Once the brain and body begin conspiring to raise weight in this way, dieters actually enter into a battle against themselves.
      • Some people apparently manage to shut down the inner “thermostat” and control their eating almost completely. these people move toward restricting-type anorexia nervosa.
• SOCIETAL FACTORS – one survey of 248 adolescent girls directly tied eating disorders and body dissatisfaction to social networking.
• FAMILY ENVIRONMENT – Enmeshed family pattern – A family system in which members are overinvolved with each other’s affairs and overly concerned about each other’s welfare. – often leads to eating disorders, but NOT a consistent indicator.
• MULTICULTURAL FACTORS – found that the eating behaviors and attitudes of young African American women were more positive than those of young white American women.
  
  • African American respondents emphasized personality traits over physical characteristics. They defined the “perfect” African American girl as smart, fun, easy to talk to, not conceited, and funny; she did not necessarily need to be “pretty,” as long as she was well-groomed.
  • Those who consider themselves more oriented to white American culture have particularly high rates of anorexia nervosa and bulimia nervosa.
  • These eating disorders also appear to be on the increase among young Asian American women and young women.
• GENDER DIFFERENCES – society’s emphasis on a thin appearance is clearly aimed at women much more than men, and some theorists believe that this difference has made.
  
  • Men are more likely to use exercise to lose weight
  • Women use dieting, and it is dieting that most often leads to eating disorders.
  • Men with eating disorders tend to get them due to jobs or sports which weight control was important,
  • but body image is certainly a key factor in the others.
  • MUSCLE DYSMORPHIA – Men with this disorder are very muscular but still see themselves as scrawny and small and therefore continue to strive for a “perfect” body through extreme measures such as excessive weight lifting or the abuse of steroids.

Question 6

How Are Eating Disorders Treated?

Answer 6

Treatments for eating disorders have two goals.

1. to correct the dangerous eating pattern as quickly as possible.
2. to address the broader psychological and situational factors.

TREATMENT for ANOREXIA – The immediate aims of treatment for anorexia nervosa are to help people regain their lost weight, recover from malnourishment, and eat normally again. Therapists must then help them to make psychological and perhaps family changes to lock in those gains.

• Nutritional Rehabilitation – a phase of treatment where patients gain weight quickly and return to health within weeks.
  
  • The most popular nutritional rehabilitation approach is a combination of supportive nursing care, nutritional counseling, and a relatively high-calorie diet.
• Behavioral Weight Restoration – offer rewards whenever patients eat properly or gain weight and offer no rewards when they eat improperly or fail to gain weight.
• Life-threatening cases might require feeding intravenously.
• Motivational interviewing – A treatment that uses empathy and inquiring review to help motivate clients to recognize they have a serious psychological problem and commit to making constructive choices and behavior changes.
• LONG-LASTING CHANGE – People with anorexia nervosa must overcome their underlying psychological problems in order to create lasting improvement.
  
  • Therapists typically use a combination of education, psychotherapy, and family therapy to help reach this broader goal.
  • COGNITIVE BEHAVIORAL THERAPY
    
    • On the behavioral side, clients are typically required to monitor (perhaps by keeping a diary) their feelings, hunger levels, and food intake and the ties between these variables.
    • On the cognitive side, they are taught to identify their “core pathology” – the deep-seated incorrect belief that they should be judged by their shape and weight and by their ability to control these physical characteristics.
    • They are helped to recognize their need for independence and teach them more appropriate ways to exercise control.
    • They are guided to change their attitudes about eating and weight.
    • The therapists may guide the clients to identify, challenge, and change maladaptive assumptions, such as “I must always be perfect” or “My weight and shape determine my value.”
    • They may also educate the clients about the body distortions typical of anorexia nervosa and help them see that their own assessments of their size are incorrect.
    • Cognitive-behavioral techniques are often very effective in cases of anorexia nervosa, more effective than psychodynamic therapies, psychoeducation, or supportive therapy alone
    • Family therapy can be an invaluable part of treatment for anorexia nervosa, particularly for children and adolescents with the disorder
• Outlook for anorexia – with treatment, weight is quickly restored, females usually begin to once again menstruate, and the death rate seems to be falling.
  
  • However, 25% never really recover, about 33% have recurring anorexic behavior, and most have continuing psychological problems.
  • The direr the patient’s condition prior to treatment, the poorer the recovery rate.

TREATMENT for BULEMIA – Treatment focuses on:

1. Nutritional rehabilitation, which, for bulimia nervosa, means helping clients to eliminate their binge-purge patterns and establish good eating habits.
2. a combination of therapies aimed at eliminating the underlying causes of bulimic patterns.

• The programs emphasize education as much as therapy.
• Cognitive-behavioral therapy is more helpful with Bulimia than Anorexia
• Antidepressants are also more helpful with bulimia than anorexia.
• COGNITIVE-BEHAVIORAL THERAPY – focused on stopping the Binge-Purge cycle. Keep diaries of eating behavior, feelings to help observe eating patterns more objectively and recognize the emotions and situations that trigger their desire to binge.
  
  • Smartphone apps are useful in such tracking. Cognitive-behavioral therapists may also use the behavioral technique of exposure and response prevention to help break the binge-purge cycle.
    
    • This approach consists of exposing people to situations that would ordinarily raise anxiety and then preventing them from performing their usual compulsive responses until they learn that the situations are actually harmless and their compulsive acts unnecessary
  • Therapists typically teach the clients to identify and challenge the negative thoughts that regularly precede their urge to binge, change their perfectionist standards
  • Helps 75% of patients stop the binge-purge cycle.
    
    • Also supplemented by family therapy
  • In the event that the Cognitive-behavioral approach fails, they could try INTERPERSONAL THERAPY which improves interpersonal functioning.
• BODY SHAMING – can cause great distress
• Bulimia can last for years but treatment produces immediate, significant improvement in 40% of clients with another 40% showing a moderate response.
• Relapses can be triggered by new life stresses.

TREATMENT for BINGE EATING – Treatment focuses on cognitive-behavioral therapy and sometimes antidepressants (same as Bulimia).

• 60% of clients are helped out of the binge purging by the end of treatment, though remain fat, which requires a different set of therapies to address.
• And their weight problems are often resistant to long-term improvement even after ceasing binge eating.
• THE BODY PROJECT – is a prevention program that includes weekly group sessions for women and has had good results.