Ch.9

Question 1

Anorexia Nervosa and naming problem

Answer 1

“lack of appetite induced by nervousness.” This definition is something of a misnomer, however, as a lack of appetite is neither the core difficulty nor necessarily even true.
t the heart of anorexia nervosa is a pursuit of thinness that is relentless and that involves behaviors that result in a significantly low body weight.

Question 2

DSM-IV to DSM-5 classification of anorexia

Answer 2

An important change from DSM-IV to DSM-5 is that in DSM-5 amenorrhea (cessation of menstruation) is no longer required for a person to be given the diagnosis
Studies have suggested that women who continue to menstruate but meet all the other ­diagnostic criteria for anorexia nervosa are very similar psychologically to women who have amenorrhea and have ceased menstruating (Attia & Roberto, 2009). Amenorrhea is also not a criterion that can be used for males, nor can it be assessed in prepubescent girls or in women who use hormonal contraceptives.

Question 3

The first known medical account of anorexia nervosa,

Answer 3

was published in 1689 by Richard Morton (see ­Silverman, 1997, for a good general historical overview). Morton described two patients, an 18-year-old girl and a 16-year-old boy, who suffered from a “nervous consumption” that resulted in wasting of body tissue. The female patient eventually died because she refused treatment.

Question 4

two types of anorexia nervosa:

Answer 4

the restricting type and the binge-eating/purging type. The central difference between these two subtypes concerns the way in which patients maintain their very low weight. In the restricting type, every effort is made to limit the quantity of food consumed. Caloric intake is tightly controlled. Patients often try to avoid eating in the presence of other people.
When they are at the table, they may eat ­excessively slowly, cut their food into very small pieces, or ­dispose of food secretly

Question 5

Restriction of food intake in anorexia

Answer 5

The relentless restriction of food intake is not present in all patients with anorexia nervosa. Patients with the binge-eating/purging type of anorexia nervosa differ from patients with restricting anorexia nervosa because in addition to restrictive eating, they also either binge eat, purge, or binge eat and purge.

Question 6

Binge vs purge

Answer 6

Binge eating involves an out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances. These binge-eating episodes may be followed by efforts to purge, or remove the food they have eaten from their bodies, as the following case example shows. Methods of purging commonly include self-induced vomiting or misuse of laxatives, diuretics, and enemas

Question 7

Are excercise and fasting a method of purging?

Answer 7

Other compensatory behaviors that do not involve purging are excessive exercise or fasting.

Question 8

Bulimia nervosa and its naming origin

Answer 8

characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by using inappropriate behaviors such as self-induced vomiting and excessive exercise
The word bulimia comes from the Greek bous (which means “ox”), and limos (“hunger”). It is meant to denote a hunger of such proportions that the person “could eat an ox.”

Question 9

DSM 4 VS DSM 5 diagnostic criteria of bulimia

Answer 9

Compared to DSM-IV, the diagnostic ­criteria for bulimia nervosa have been relaxed. Binge eating and purging now have to occur on average once a week (instead of twice a week) over a 3-month period

Question 10

Differences between bulimia and anorexia

Answer 10

The clinical picture of the binge-eating/purging type of anorexia nervosa has much in common with bulimia nervosa. Indeed, some researchers have argued that the bulimic type of anorexia nervosa should really be considered another form of bulimia nervosa. The difference between a person with bulimia nervosa and a person with the binge-eating/purging type of anorexia nervosa is weight. By definition, the person with anorexia nervosa is severely underweight. This is not true of the person with bulimia nervosa. Consequently, if the person who binges or purges also meets criteria for anorexia nervosa, the diagnosis is anorexia nervosa (binge-eating/purging type) and not bulimia nervosa. In other words, the anorexia nervosa diagnosis “trumps” the bulimia nervosa diagnosis.

Question 11

Why does an anorexia diagnosis take diagnostic precedence?

Answer 11

This is because there is a far greater mortality rate associated with anorexia nervosa than with bulimia nervosa. Recognizing this, the DSM requires that the more severe form of eating pathology take precedence diagnostically.

Question 12

Diference between anorexia and bulimia from a self perspective/ concealing patterns

Answer 12

Whereas people with anorexia nervosa often deny the seriousness of their disorder and are surprised by the shock and concern with which others view their emaciated conditions, those with bulimia nervosa are often preoccupied with shame, guilt, and self-deprecation. They make efforts to conceal their behavior as they struggle (often unsuccessfully) to master their urges to binge. The case described next depicts a typical pattern.

Question 13

binge-eating disorder (BED).

Answer 13

BED has some clinical features in common with bulimia nervosa (see the DSM-5 criteria box). However, there is an important difference. After a binge, the person with BED does not engage in any form of inappropriate “compensatory” behavior such as purging, using laxatives, or even exercising to limit weight gain

Question 14

memorize chart pg 295

Question 15

Difference between BED than anorexia and bulimia in diet

Answer 15

There is also much less dietary restraint in BED than is typical of either bulimia nervosa or anorexia nervosa (­Wilfley et al., 2000). A typical binge averages around 1,900 calories

Question 16

Galen bulimos

Answer 16

Moreover, as far back as the second century, the Greek physician Galen referred to a syndrome characterized by overeating, vomiting, and fainting, which he termed bulimos

Question 17

Anorexia and bulimia age onset

Answer 17

Anorexia nervosa and bulimia nervosa do not occur in appreciable numbers before adolescence. Children as young as age 7, though, have been known to develop eating disorders, especially anorexia nervosa
Anorexia nervosa is most likely to develop in 16- to 20-year-olds. For bulimia nervosa, the age group at highest risk is young women the age range of 21 to 24

Question 18

Gender ratios in eating disorder/ diagnostic differences in men vs women/ undereports

Answer 18

Although in the past it was thought that the gender ratio was as high as 10:1, more recent estimates suggest that there are three females for every male with an eating disorder (Jones & Morgan, 2010). This downward revision of the gender ratio reflects the fact that eating disorders in men may have been underdiagnosed in the past because of the stereotype that they are female disorders. Another reason for the underdiagnosis of eating disorders in men is the gender bias in the DSM criteria. These emphasize the type of weight and shape concerns (e.g., desire to be thin) and methods of weight control (dieting) that are more typical of women. For men, body dissatisfaction often involves a wish to be more muscular. Overexercising as a means of weight control is also more common in men.

Question 19

Risk factor for eating disorders for men

Answer 19

One established risk factor for eating disorders in men is homosexuality. Gay and bisexual men have higher rates of eating disorders than heterosexual men do (Feldman & Meyer, 2007). Gay men (like heterosexual men) value attractiveness and youth in their romantic partners. Because gay men (like women) are seeking to be sexually attractive to men, body dissatisfaction may therefore be more of an issue for gay men than it is for heterosexual men. In support of this idea, Smith and colleagues (2011) found that gay men were more dissatisfied with their bodies and had higher levels of disordered eating than heterosexual men did. Moreover, gay men tended to believe that a potential mate would want them to be leaner than they themselves wanted to be.

Question 20

categories of eating disorders in DSM 4 VS 5

Answer 20

The old DSM-IV category of eating disorders was renamed in DSM-5 and is now called feeding and eating disorders. This reflects the fact that, in addition to the major diagnoses of anorexia nervosa, bulimia nervosa, and binge-eating disorder, the DSM-5 also recognizes several other types of eating and feeding problems.

Question 21

Purging disorder

Answer 21

. Purging disorder, as its name suggests, involves purging in normal weight people who have not eaten large amounts of food.

Question 22

Avoidant restrictive food intake disorder

Answer 22

This is characterized by a failure to eat an appropriate diet, leading to weight loss and nutritional deficiencies. There is no focus on weight or shape, as is the case with anorexia or bulimia nervosa. Rather, the food avoidance or restriction may be motivated by dislike of food smells or other sensory aspects of food

Question 23

eating disorder not eitherwise specifiedn DSM 4

Answer 23

This was designed to be a catch-all category. However, it ended up being used for a majority of patients—around 60 percent of adolescents and adults who sought treatment in outpatient settings (Eddy, Doyle, et al., 2008; Fairburn & Bohn, 2005). This was hardly a desirable situation. To address the problem, changes were made to the diagnostic criteria for anorexia nervosa and bulimia nervosa, and BED was also included as a formal diagnosis. This is expected to reduce the need for the use of an additional catch-all diagnostic category. That said, new to DSM-5 is another category called Other Specified Feeding and Eating Disorders. This can be used for problems that still do not fit well in any other categories.

Question 24

most common form of eating disorder

Answer 24

s binge eating disorder. Worldwide, and based on the most recent data, the lifetime prevalence of binge-eating disorder is around 2 percent

Question 25

lifetime prevalence of bulimia nervosa in us for women vs men

Answer 25

lifetime prevalence of bulimia nervosa in the United States is around 1.5 percent for women and 0.5 percent for men

Question 26

Pattern of bulimia during past few decades

Answer 26

has decreased over time

Question 27

m,ortality rate of anorexic girls vs normal

Answer 27

The mortality rate for people with anorexia nervosa (most of whom are females) is more than five times higher than the mortality rate for young females ages 15 to 34 in the general U.S. population

Question 28

Physiological symptoms anorexia

Answer 28

Because they are so undernourished, people with this disorder have a difficult time coping with cold temperatures. Their hands and feet are often cold to the touch and have a purplish-blue tinge due to problems with temperature regulation and lack of oxygen to the extremities. As a consequence of chronically low blood pressure, patients often feel tired, weak, dizzy, and faint. Thiamin (vitamin B1) deficiency may also be present; this could account for some of the depression and cognitive changes documented in low-weight anorexia patient

Question 29

Anorexia and risks later in life

Answer 29

may result in increased risk for osteoporosis in later life. This is because peak bone density is normally attained during the years of early adulthood. The failure to eat healthily during this time may result in more brittle and fragile bones forever
-People with anorexia nervosa can die from heart arrhythmias (irregular heartbeats). Sometimes this is caused by major imbalances in key electrolytes such as potassium (Mitchell & Crow, 2010). Chronically low levels of potassium (hypokalemia) can also result in kidney damage and renal failure severe enough to require dialysis.

Question 30

Bulimia nervosa mortality rate compared to normal

Answer 30

twice people without

Question 31

Long term risks of bulimia

Answer 31

Purging can cause electrolyte imbalances and low potassium, which, as we have already mentioned, puts the patient at risk for heart abnormalities. Another complication is damage to the heart muscle, which may be due to the use of ipecac syrup, a poison that causes vomiting. More typically, however, patients develop calluses on their hands from sticking their fingers down their throats to make themselves sick. In extreme cases, where objects such as a toothbrush are used to induce vomiting, tears to the throat can occur.
-the contents of the stomach are acidic, patients damage their teeth when they throw up repeatedly. Brushing the teeth immediately after vomiting damages them even more. Mouth ulcers and dental cavities are a common consequence of repeated purging, as are small red dots around the eyes that are caused by the pressure of throwing up. Finally, patients with bulimia very often have swollen parotid (salivary) glands caused by repeatedly vomiting. These are known as “puffy cheeks” or “chipmunk cheeks” by many people with bulimia.

Question 32

e second most common cause of death in those who suffer from anorexia nervosa

Answer 32

suicide. The most recent estimate from a meta-analysis suggests that individuals with anorexia nervosa are 18 times more likely to die by suicide than comparably aged women in the general population
- It has been suggested that patients who have lost their ability to maintain an “emotionally protective” low body weight are at particularly high risk of suicide

Question 33

Prognosis for bulimia and anorexia

Answer 33

th regard to bulimia nervosa, in the long term, prognosis tends to be quite good
worse for anorexia but recovery still possible
recovery is relative: even if they don’t meet the criteria, still might struggle with it

Question 34

Binge eating disorder and clinical remission

Answer 34

Finally, like patients with bulimia nervosa, patients with binge eating disorder also have high rates of clinical remission. Following a period of intensive treatment, two-thirds of a sample of 60 patients no longer had any form of eating disorder

Question 35

Diagnostic crossover problems and eating disorders

Answer 35

quite common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder. This may reflect the fact that current diagnostic systems are not doing a good job categorizing these disorders and that dimensionally based approaches might be more appropriate.
-however, there were no cases of direct transition from the restricting type of anorexia nervosa directly into bulimia nervosa
-Finally, we note that binge-eating disorder and anorexia nervosa appear to be quite distinct disorders.

Question 36

Diagnostic overlap between anorexia nervosa and bulimia nervosa

Answer 36

So if someone with anorexia nervosa (binge-eating/purging subtype) gains weight, the diagnosis will change to bulimia nervosa to reflect this fact, even though there may not be a big clinical change in the illness itself. Moreover, even after they have crossed over into bulimia nervosa, these women remain vulnerable to relapsing back into anorexia nervosa. This suggests that clinicians should pay attention to a past history of anorexia nervosa even when patients no longer meet the low-weight criterion necessary for its diagnosis.

Question 37

comorbidity and eating disorders

Answer 37

-Eating disorder diagnoses are commonly associated with other diagnosable psychiatric conditions. In fact, comorbidity is the rule rather than the except
on
- For instance, approximately 68 percent of patients with anorexia nervosa, 63 percent of patients with bulimia nervosa, and almost 50 percent of people with binge-eating disorder are also diagnosed with depression
- In addition, there is frequent co-occurrence of substance abuse disorders in the binge-eating/purging subtype of anorexia nervosa as well as in bulimia nervosa. The restrictive type of anorexia nervosa, however, tends not to be associated with higher rates of substance abuse

Question 38

personality disorders and eating disorders

Answer 38

Comorbid personality disorders are frequently diagnosed in people with eating disorders (Cassin & von Ranson, 2005; Rø et al., 2005). Indeed, about 58 percent of women with eating disorders may have a personality disorder (Rosenvinge et al., 2000). Personality disorders in the anxious-avoidant cluster (Cluster C) are found in those with anorexia nervosa as well as those with bulimia nervosa. However, dramatic, emotional, or erratic (Cluster B) problems, including borderline personality disorder, are more typically associated with bulimia nervosa
- Consistent with this, more than a third of patients with eating disorders have engaged in the kinds of self-harming behaviors (cutting or burning themselves, for example) that are symptomatic of borderline personality disorder

Question 39

personality disorders and BED

Answer 39

Personality disorders are similarly reported in around 30 percent of patients with BED, with avoidant, obsessive-compulsive, and borderline personality disorders being the most common (Friborg et al., 2014). People with BED also have high rates of anxiety disorders (65 percent), mood disorders (46 percent), and substance use disorders

Question 40

problem with diagnosing personality disoirders and eating disorders

Answer 40

One problem with simple examinations of personality disorders in patients with eating disorders is that some of the disturbances found in these patients could reflect the consequences of malnourishment. Starvation is known to increase both irritability and obsessionality (Keys et al., 1950). We must therefore be cautious in our conclusions.
- Research suggests that some personality traits in patients with eating disorders might both predate the onset of the disorder and remain even when the eating disorder remits and the patient has recovered
-Researchers are now investigating whether classifying eating disordered patients based on personality subtypes might have some value with regard to predicting response to treatment

Question 41

Iranian eating disorder rates

Answer 41

comparable to US

Question 42

Caucasian and eating disorders

Answer 42

Being Caucasian, however, does appear to be associated with subclinical problems that may place individuals at higher risk for developing eating disorders. Examples of such problems include body dissatisfaction, dietary restraint, and a drive for thinness.

Question 43

African americans and eating disorders

Answer 43

Although Asian women exhibit levels of pathological eating similar to those of white women (Wildes et al., 2001), it has long been held that African Americans are less susceptible to subclinical types of eating problems and body image concerns than Caucasians are
However, as minorities become more and more integrated and internalize white, middle-class societal values about the desirability of thinness, we should expect to see increases in the rates of eating disorders in minorities. As an example of this, Alegria and colleagues (2007) have demonstrated that rates of eating disorders were higher in Latinos who were born in the United States compared with those who were not.

Question 44

African american women and eating disorder factors

Answer 44

In contrast to young white, Asian American, and Hispanic girls, black adolescent girls seem less inclined to use weight and appearance to fuel their sense of identity and self-worth (Grabe & Hyde, 2006; Polivy et al., 2005). This may provide them with some protection from the development of eating disorders. However, any protection afforded to black women seems to be linked to how strongly they identify with their ethnic group and how much they receive culturally consistent messages that value what their bodies naturally look like and support who they are.

Question 45

Bulimia vs anorexia and culture

Answer 45

In contrast, bulimia nervosa does seem to be a culture-bound syndrome. More specifically, it seems to occur in people who have had some exposure to Western ideals about thinness, who have access to large amounts of food, and who, because of modern plumbing, can purge in private
- The more important point, however, is that anorexia nervosa is not a disorder that occurs simply because of exposure to Western ideals and the modern emphasis on thinness.

Question 46

Biological causal factors in eating disorders

Answer 46

-This is because the tendency to develop an eating disorder has been shown to run in families (Wade, 2010). The biological relatives of people with anorexia nervosa or bulimia nervosa have elevated rates of anorexia nervosa and bulimia nervosa themselves.
-twin studies: suggest that both anorexia nervosa and bulimia nervosa are heritable disorders
-it has been suggested that the contribution of genetic factors to the development of eating disorders may be about as strong as the contribution of genetic factors to bipolar disorder and schizophrenia

Question 47

candidate genes

Answer 47

Several candidate genes studies have been conducted (candidate genes are genes that are thought to affect risk for eating disorders), but no convincing findings have so far emerged.

Question 48

chromsome 12 and anorexia nervosa

Answer 48

his study identified a locus (a specific position or location of a gene) for anorexia nervosa on chromosome 12, in a region that has previously shown associations with Type 1 diabetes and autoimmune disorders. Supporting the notion that anorexia nervosa is a psychiatric illness, however, strong genetic correlations were found between anorexia nervosa, schizophrenia, and neuroticism. More surprisingly, significant genetic correlations were also found with metabolic factors including body mass index, high-density lipoprotein cholesterol, insulin, and glucose. These exciting findings indicate that anorexia nervosa has both psychiatric and metabolic underpinnings

Question 49

Hypothjalamus and eating disorders/ ventromedial hypothalamus/ animal studies

Answer 49

-Animal studies have demonstrated that lesions in a part of the hypothalamus called the ventromedial hypothalamus (VMH) cause the animal to behave as if starved. Such animals eat voraciously and rapidly become obese (Ravussin et al., 2014). In contrast, when the VMH is stimulated electrically, food intake is inhibited and the animal loses weight. Stimulating another area of the hypothalamus (the lateral hypothalamus) triggers eating.
HUMANS= There is no good evidence that obvious abnormalities in the hypothalamus play a central role in eating disorders, however. Uher and Treasure (2005) reviewed a series of case reports of patients with tumors in the hypothalamus. Although these were sometimes associated with an increase or loss of appetite, there was no evidence that they resulted in specific eating disorders

Question 50

damage to frontal and temporal cortex and anorexia nervosa

Answer 50

damage to the frontal and the temporal cortex did seem to be linked to the development of anorexia nervosa in some cases and bulimia nervosa in others. This is interesting because the temporal cortex is known to be involved in body image perception. Parts of the frontal cortex (particularly an area called the orbitofrontal cortex) also play a role in monitoring the pleasantness of stimuli such as smell and taste

Question 51

lateral hypothalamus

Answer 51

Although still speculative at this time, it is reasonable to suggest that the hypothalamus “senses” weight in some way and keeps things in balance with the ventromedial hypothalamus acting as a “satiety center” and the lateral hypothalamus serving as an “appetite center.” It is also reasonable to think that the lateral hypothalamus acts as a site that integrates other information relevant for regulating food intake. The lateral hypothalamus receives information from many parts of the brain, including the frontal cortex and the amygdala (which is a part of the brain involved in emotion and fear learning). Animal research suggests that a network involving these (and other) brain areas may be important not only for overeating in response to environmental cues but for suppressing eating in response to fear

Question 52

set point and weight

Answer 52

-There is a well-established tendency for our bodies to resist marked variation from some sort of biologically determined set point or weight that our individual bodies try to “defend”
-One important kind of physiological opposition designed to prevent us from moving far from our set point is hunger. As we lose more and more weight, hunger may rise to extreme levels, encouraging eating, weight gain, and a return to a state of equilibrium.

Question 53

Serotonin and eating disorders

Answer 53

Serotonin is a neurotransmitter that has been implicated in obsessionality, mood disorders, and impulsivity. It also modulates appetite and feeding behavior. Because many patients with eating disorders respond well to treatment with antidepressants (which target serotonin), some researchers have concluded that eating disorders involve a disruption in the serotonergic system

Question 54

Serotonin synthesis and eating disorders

Answer 54

Serotonin is made from an essential amino acid called tryptophan. This can only be obtained from food. After tryptophan is consumed, it is converted to serotonin via a series of chemical reactions. People with anorexia nervosa have low levels of 5-HIAA, which is a major metabolite of serotonin. This may be because they are eating so little food. In contrast, levels of 5-HIAA are normal in people with bulimia nervosa. What is interesting is that, after recovery, both of these patient groups have higher levels of 5-HIAA than control women do; they also have higher levels of 5-HIAA than they had when they were in the ill state
=Although the finding of higher levels of 5-HIAA in recovered patients compared to controls seems counterintuitive, it has been suggested that resuming normal eating makes it possible to detect abnormalities in the serotonin system (such as higher levels of serotonin in several different brain areas) that might be involved in risk for eating disorders.

Question 55

reward sensitivity and eating disorders

Answer 55

-A new direction in eating disorders research centers on the brain pathways and neurotransmitters (such as dopamine) that are involved in reward processing. This makes a lot of sense because individuals who binge eat tend to consume high-fat and high-sugar foods that most of us tend to think of as rewarding. In contrast, being less sensitive to food reward may make it easier for some people to restrict their food intake, thereby increasing risk for the development of anorexia nervosa

Question 56

Changes in reward sensitivty and what is rewarding for those with disorders

Answer 56

There is also evidence that patients with anorexia nervosa show more activity in brain reward areas when they view pictures of thin rather than healthy models. For controls, the opposite pattern is found with more reward area activity occurring when viewing normal weight models. One theory is that a reluctance to gain weight and subsequent food restriction changes reward sensitivity, rendering food cues more aversive and increasing reward responsiveness to anorectic cues (such as images of thin models) and behaviors (such as not eating). In other words, reward and punishment systems get contaminated; normally rewarding stimuli such as food become aversive, and stimuli associated with self-starvation become valued

Question 57

Media and pressures to be thin fiji

Answer 57

Within Fijian culture, being fat was associated with qualities that were highly valued such as being strong, able to work, and kind and generous. Being thin, in contrast, was regarded negatively because it was thought to reflect being sickly, incompetent, or having somehow received poor treatment. Culturally, fatness was preferred over thinness, and dieting was viewed as offensive. What was also striking was the total absence of any condition that could be considered an eating disorder.

After television came to Fiji, however, the cultural climate changed. Not only were Fijians able to see programs such as Beverly Hills 90210 and Melrose Place that were popular at that time, but many young women also began to express concerns about their weight and dislike of their bodies. For the first time, women in Fiji started to diet in earnest. The young Fijian women studied by Becker also made comments that suggested that their body dissatisfaction and wish to lose weight were motivated by a desire to emulate the actors they had seen on television.

Question 58

family influences and eating disorders

Answer 58

-Echoing this sentiment, more than one-third of patients with anorexia nervosa reported that family dysfunction was a factor that contributed to the development of their eating disorder (Tozzi et al., 2003). Patients with anorexia nervosa perceive their families as more rigid, less cohesive, and as having poorer communication than healthy control participants do
-In addition, many of the parents of patients with eating disorders have long-standing preoccupations regarding the desirability of thinness, dieting, and good physical appearance (Garner & Garfinkel, 1997). Like their children, they have perfectionistic tendencies
-have also noted that women with bulimia nervosa could be differentiated from both a general psychiatric control group and a healthy control group on such risk factors as high parental expectations, other family members’ dieting, and degree of critical comments from other family members about shape, weight, or eating. In a large sample of college-age women, the strongest predictor of bulimic symptoms was the extent to which family members made disparaging comments about the woman’s appearance and focused on her need to diet

Question 59

gender and eating disorder development

Answer 59

eating disorders are much more frequently found in women than in men. Being female is a strong risk factor for developing eating disorders, particularly anorexia nervosa and bulimia nervosa (Jacobi et al., 2004). Moreover, the greatest period of risk for these disorders occurs in adolescence. Binge-eating disorder does not follow this pattern, however. The onset of binge-eating disorder is typically well after adolescence. Binge-eating disorder is also much more likely to be found in males as well as in females.

Question 60

Perfectionism and eating disorders

Answer 60

(defined as the pursuit of unattainably high standards combined with an intolerance of mistakes) has long been regarded as an important risk factor for eating disorders (Bruch, 1973). This is because people who are perfectionistic may be much more likely to subscribe to the thin ideal and relentlessly pursue the “perfect body.” It has also been suggested that perfectionism helps maintain bulimic pathology through the rigid adherence to dieting that then drives the binge/purge cycle

Question 61

anorexia and perfectionism

Answer 61

Research supports the association of perfectionism and eating disorders (Bardone-Cone et al., 2007). This is especially true for anorexia nervosa. In a study of 322 women, Halmi and colleagues (2000) found that women with anorexia nervosa scored higher on a measure of perfectionism than did a sample of controls without an eating disorder. The women with anorexia nervosa scored higher on perfectionism regardless of whether they had the restricting subtype of anorexia nervosa or subtypes that involved either purging or binge eating and purging.

Question 62

Dieting and eating disorders

Answer 62

is a risk factor for the development or worsening of eating disorders (Jacobi et al., 2004; Striegel-Moore & Bulik, 2007). In a large sample of adolescent girls, body dissatisfaction and dieting predicted symptoms of bulimia nervosa at a 1-year follow-up

Question 63

why has dieting been linked to eating disorders?

Answer 63

Results indicated that going on a diet was indeed predictive of future binge eating. However, the results also highlighted the importance of other factors. More specifically, it was the people who dieted and also reported more symptoms of depression or had low self-esteem that were most likely to develop problems with binge eating later. In other words, although dieting itself was a risk factor for future binge eating, low self-esteem and symptoms of depression created additional risk.

Question 64

Negative affect and eating disorders

Answer 64

causal risk factor for body dissatisfaction (Stice, 2002). When we feel bad, we tend to become very self-critical. We may focus on our limitations and shortcomings while magnifying our flaws and defects. This seems to be especially true of individuals with eating disorders, who, like people with depression, tend to show distorted ways of thinking and of processing information received from the environment

Question 65

treatment of anorexia

Answer 65

Individuals with anorexia nervosa view the disorder as a chronic condition and are generally pessimistic about their potential for recovery
-have a high dropout rate from therapy, and patients with the binge-eating/purging subtype of anorexia nervosa are especially likely to terminate inpatient treatment prematurely
-The most immediate concern with patients who have anorexia nervosa is to restore their weight to a level that is no longer life threatening. In severe cases, this requires hospitalization and extreme measures such as intravenous feeding. This is followed by rigorous control of the patient’s caloric intake so as to progress toward a targeted range of weight gain. Normally, this short-term effort is successful. However, without treatment designed to address the psychological issues that fuel the anorexic behavior, any weight gain will be temporary and the patient will soon need medical attention again.

Question 66

medications and anorexia

Answer 66

Antidepressants are sometimes used in the treatment of anorexia nervosa, although there is no evidence that they are especially effective (Brown & Keel, 2012b). In contrast, research suggests that treatment with an antipsychotic medication called olanzapine may be beneficial. Antipsychotic medications (which help with disturbed thinking) are routinely used in the treatment of schizophrenia

Question 67

family therapy and anorexia adolescents

Answer 67

he best-studied approach, which (very importantly) blames neither the parents nor the child for the anorexia nervosa, is known as the Maudsley model (le Grange & Lock, 2005). A typical treatment program involves 10 to 20 sessions spaced over 6 to 12 months. The treatment has three phases. In the refeeding phase, the therapist works with the parents and supports their efforts to help their child (typically a daughter) to eat healthily once more. Family meals are observed by the therapist, and efforts are made to guide the parents as a functioning support team for their daughter’s recovery. After the patient starts to gain weight, the negotiations for a new pattern of relationships phase begins, and family issues and problems begin to be addressed. Later, in the termination phase of treatment, the focus is on the development of more healthy relationships between the patient and her parents

Question 68

CBT and anorexia vs bulimia

Answer 68

involves changing behavior and maladaptive styles of thinking, has proved to be very effective in treating bulimia nervosa. Because anorexia nervosa shares many features with bulimia nervosa, CBT is often used with patients with anorexia nervosa as well (Vitousek, 2002). The recommended length of treatment is 1 to 2 years. A major focus of the treatment involves modifying distorted beliefs concerning weight and food, as well as distorted beliefs about the self that may have contributed to the disorder
-The limited success of CBT for patients with anorexia nervosa may be due to the extreme cognitive rigidity that is characteristic of those with this disorder (Brown & Keel, 2012a). There is clearly a need for new treatment developments, particularly for older patients with more long-standing problems.

Question 69

medications and bulimia

Answer 69

A positive response is usually apparent within the first 3 weeks. People who do not show early improvement are unlikely to benefit from further treatment with the same medication (Sysko et al., 2010). Perhaps surprisingly, antidepressants seem to decrease the frequency of binges as well as improve patients’ mood and preoccupation with shape and weight

Question 70

cbt for bulimia

Answer 70

he “behavioral” component of CBT for bulimia nervosa focuses on normalizing eating patterns. This includes meal planning, nutritional education, and ending binging and purging cycles by teaching the person to eat small amounts of food more regularly. The “cognitive” element of the treatment is aimed at changing the cognitions and behaviors that initiate or perpetuate a binge cycle. This is accomplished by challenging the dysfunctional thought patterns typically present in bulimia nervosa, such as the “all-or-nothing” or dichotomous thinking described earlier.

Question 71

transdiagnostic approach to treatment. CBTE

Answer 71

s we have already mentioned, the majority of patients with eating disorders have a mixed clinical picture. What this means is that they show some symptoms of anorexia and some symptoms of bulimia, combined in a variety of ways. Fairburn and colleagues (2009) have now reformulated cognitive behavior therapy for bulimia nervosa in an effort to increase its potency and also to make it a relevant treatment for pathological eating, no matter what the diagnosis is. The new treatment is called enhanced cognitive-behavior therapy, or CBT-E. One form of the treatment (the default treatment) is quite focused, targeting eating issues as well as concerns about shape and weight, extreme dieting, purging, and binge eating. The other form of the treatment is broader and also addresses such things as perfectionism, low self-esteem, and relationship problems.

Question 72

Interpersonal psychotherapy (IPT)

Answer 72

IPT, which seeks to improve interpersonal functioning, is often used in the treatment of mood disorders (see Chapter 7) and is also the leading alternative treatment for eating disorders

Question 73

Treatment of Binge-Eating Disorder

Answer 73

antidepressant medications are sometimes used to treat this disorder. Other categories of medications, such as appetite suppressants and anticonvulsant medications, have also been a focus of interest
-people who had received either IPT or guided CBT were doing better than those in the behavioral weight loss group. What is also noteworthy is that the dropout rate was much lower for people in the IPT group (7 percent dropped out) than it was in the guided CBT (30 percent) or behavioral weight loss groups (28 percent).

Question 74

Evolutionarily advantages of storing fat

Answer 74

It serves as a hedge against periods of food shortage and makes survival more likely during times of famine. But in our modern world, access to food is no longer a problem for millions of people. The food supply is stable, and large amounts of energy-dense foods are readily available. Not surprisingly, most of us are getting heavier. For some people, the problem becomes even more extreme and results in obesity. Considered in this way, obesity can be regarded as a state of excessive, chronic fat storage

Question 75

obesity

Answer 75

Obesity is defined on the basis of a statistic called the body mass index (BMI). This is a measure of a person’s weight relative to height and is calculated using the formula
Generally speaking, people with a BMI below 18.5 are considered underweight; 18.5 to 24.9 is considered normal; 25.0 to 29.9 is overweight; and obesity is defined as having a BMI above 30.

Question 76

morbid obesity

Answer 76

Having a BMI above 40 or being more than 100 pounds overweight is called morbid obesity.

Question 77

obesity longterm risks

Answer 77

Obesity brings with it increased risk for many health problems. These include high cholesterol, hypertension, heart disease, arthritis, diabetes, and cancer
US: , less than a third of the population is at a normal or healthy weight.

Question 78

ethnic minorities and obesity

Answer 78

With the exception of Asians, obesity is more prevalent in ethnic minorities. In general, rates of obesity are also somewhat higher in men than they are in women. The notable exception involves African Americans. One in every two black women is obese. This is the highest rate of obesity found for any group

Question 79

weight stigma

Answer 79

People who are obese are often judged harshly by others. They are routinely ridiculed, discriminated against, and stigmatized (Carr & Friedman, 2005). Weight discrimination is also increasing
-Weight bias is even found in health care professionals who may blame patients who are obese for being overweight and having weight-related health problems

Question 80

obesity and diagnosis

Answer 80

obesity is not an eating disorder, and it is not included in DSM-5. However, Volkow and O’Brien (2007) suggest that some forms of obesity are driven by an excessive motivational desire for food. They liken such symptoms as the compulsive consumption of food and the inability to restrain eating despite the wish to do so to symptoms of substance abuse and drug dependence. This parallels the view, offered by some, that obesity is a “food addiction” (see Cota et al., 2006). It has also been suggested that obesity and addiction may both concern problems in key brain regions involved in motivation, reward, and inhibitory control.

Question 81

genes and obesity

Answer 81

Some of the genes that may, in our ancestral past, have been advantageous and helped us survive in times of famine may predispose those who carry them to readily gain weight when food is plentiful. Interestingly, population groups that were most susceptible to starvation throughout history are those that are most inclined to become obese when they have a sedentary lifestyle and a Western diet
- Genes associated with thinness and leanness have been found in certain animals, and a special type of rat has now been bred that does not become obese even when fed a high-fat diet. Twin studies further suggest that genes play a role both in the development of obesity and in the tendency to binge
POLYGENIC

Question 82

hormones and weight regulation/ leptin and ghrelin

Answer 82

. Remarkably, we are able to regulate our energy balance with a precision of more than 99.5 percent.
-Leptin (the name comes from the Greek word leptos, meaning “thin”) is produced by fat cells. It provides a key metabolic signal that informs the central nervous system about the state of the body’s fat reserves. When body fat levels decrease, leptin production decreases and food intake is stimulated: Rare genetic mutations that result in an inability to produce leptin cause people to have an insatiable appetite and result in morbid obesity
Ghrelin (the name comes from a Hindu word meaning “growth”) is a hormone that is produced by the stomach. It is a powerful appetite stimulator. Under normal circumstances, ghrelin levels rise before a meal and fall after we have eaten.

Question 83

leptin as a treatment

Answer 83

when leptin is given to individuals who are overweight, in the majority of cases it has little effect. People who are overweight generally have high levels of leptin in their bloodstream. The problem is that they are resistant to its effects. In fact, it has been suggested that obesity may result from a person’s being resistant to leptin (Friedman, 2004). However, this is not an adequate explanation because even lean individuals show resistance to high concentrations of leptin

Question 84

prader wili syndrome

Answer 84

People with a rare condition called Prader–Willi syndrome have chromosomal abnormalities that create many problems, one of which is very high levels of ghrelin. Sufferers are extremely obese and often die before age 30 from obesity-related causes. The food cravings experienced by people with Prader–Willi syndrome can be so extreme that food has to be kept locked away so that they cannot binge

Question 85

naturally occuring foods fat and sugars

Answer 85

Most naturally occurring foods tend to be high in sugar (e.g., fruits) or fat (e.g., nuts) but not both.
-Foods with low nutritional value (high fat, high sugar) are less expensive and also much easier to find than foods with high nutritional value

Question 86

food advertising and eating

Answer 86

Food advertising seems to trigger the kind of automatic and unconscious eating that is not related to being hungry. In one study, children ate 45 percent more after watching a TV cartoon that contained food advertisements than they did if the cartoon contained advertising for other products

Question 87

families and obesity

Answer 87

It is possible that overfeeding infants and young children causes them to develop more adipose cells and may thus predispose them to weight problems in adult hood
-Finally, there is some evidence that obesity might be “socially contagious.” Provocative research findings have shown that if someone close to us (e.g., a spouse, sibling, or friend) becomes obese, the chance that we ourselves will later become obese can increase by as much as 57 percent.

Question 88

adipose cells and obesity

Answer 88

Obesity is related to the number and size of fat (adipose) cells in the body (Heymsfield et al., 1995). People who are obese have markedly more adipose cells than people of normal weight (Peeke & Chrousos, 1995). When people with obesity lose weight, the size of the cells is reduced but not their number. Some evidence suggests that the total number of adipose cells stays the same from childhood onward

Question 89

stress and comfort food

Answer 89

Foods that are high in fat or carbohydrates are the foods that console most of us when we are feeling troubled

Question 90

treatment of obesity

Answer 90

A first step in the treatment of obesity is a clinical approach that, ideally, involves a low-calorie diet, exercise, and some form of behavioral intervention.

Question 91

medications and obesityu

Answer 91

Orlistat (Xenical) works by reducing the amount of fat in the diet that can be absorbed once it enters the gut. Other drugs such as lorcaserin (Belviq) work in different ways and target serotonin or other neurotransmitters. The newest medication to receive FDA approval is Contrave. This is a combination of naltrexone (used to treat drug and alcohol addiction) and bupropion (used to treat depression and to help smokers quit).