Chapter 10: Eating Disorders

Question 1

What are the types of eating disorders?

Answer 1

Anorexia nervosa (restricting or binge-eating/purging)
Bulimia nervosa
Binge-eating disorder

Question 2

What is anorexia nervosa?

Answer 2

Characterized by extreme thinness
Occurs primarily in adolescent girls and young women
Individuals starve themselves, detesting any weight gain
Most people with the disorder continue to insist they are overweight even when clearly emaciated

Question 3

What are the subtypes of anorexia nervosa?

Answer 3

Restricting:
Weight loss through severe dieting or exercising
Individuals with this type tend to be more introverted

Binge-eating/purging:
Self-induced vomiting, laxatives, or diuretics
Individuals are more extroverted and impulsive
Report more anxiety, depression, or guilt

Question 4

What are the physical complications of anorexia nervosa?

Answer 4

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

Question 5

What is the course and outcome of anorexia nervosa?

Answer 5

Course is highly variable:
Some recover after one episode
Others fluctuate between weight gain and relapse
Others have chronic and deteriorating course

Onset in adolescence is associated with more positive outcomes
High mortality rate

Question 6

What is bulimia nervosa?

Answer 6

Recurrent episodes of binge eating (rapid consumption of large quantities of food) at least once a week for three months
Loss of control over eating during the binge episode
Self-evaluation strongly influenced by weight or body shape
Those with bulimia are aware that their eating habits are not normal
Distressed and ashamed, individuals hide behavior from others
More prevalent than anorexia

Question 7

What are the physical complications associated with bulimia nervosa?

Answer 7

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
Use eating as a way of coping with distressing thoughts or external stressors
Impulsive, engage in risky behaviors, and abuse drugs (7 times more likely to commit suicide)

Question 8

What is the course and outcome of bulimia nervosa?

Answer 8

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
Psychosocial stress and low social status increase the likelihood of continued difficulties

Question 9

What is binge-eating disorder?

Answer 9

Involves binging, feeling of loss of control, and marked distress over binge eating episodes
BED does not involve use of compensatory behaviors, such as vomiting, fasting, or excessive exercise
Binges often preceded by distressing emotions such as guilt, depression, or disgust

Question 10

How is binge-eating disorder diagnosed?

Answer 10

History of binge-eating episodes at least once a week for 3 months and at least 3 of the following with binge-eating episodes:
Eating more rapidly than normal
Uncomfortable feeling of fullness
Eating large amounts of food even when not hungry
Eating alone due to embarrassment about the quantity eaten
Feeling depressed or guilty after bingeing

Question 11

What are the physical complications associated with binge-eating disorder?

Answer 11

Likely to be overweight
Type 2 diabetes, high blood pressure, and high cholesterol levels
Individuals with BED who become obese tend to have difficulty regulating negative emotions and controlling impulsive behavior

Question 12

What is the course and outcome of binge eating disorder?

Answer 12

Begins in late adolescence or early adulthood
Remission rates higher than anorexia or bulimia
Weight may remain high

Question 13

What is meant by Other Specified Feeding or Eating Disorders?

Answer 13

Disturbed eating patterns not meeting criteria for anorexia or bulimia nervosa, like:
Individuals of normal weight who meet other criteria for anorexia
Individuals who meet criteria for bulimia but binge less than once a week
Night-eating syndrome
Individuals who do not binge but frequently purge to control weight

Many individuals who receive this diagnosis will eventually meet the diagnostic criteria for bulimia nervosa or binge-eating disorder

Question 14

What are the psychological causes of eating disorders?

Answer 14

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

Question 14

What are the social causes of eating disorders?

Answer 14

Negative family relationships -> 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 (appearance-related social media consciousness, or ASMC, increases the risk of developing or continuing disordered eating)

Question 15

What are the sociocultural causes of eating disorders?

Answer 15

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 (high body dissatisfaction, increased feelings of guilt and depression, thoughts of “solutions” such as dieting, purging, and extreme exercise)
Mass media portrayals of lean, muscular male bodies are increasing (gay men tend to place greater emphasis on physical attractiveness and have more body dissatisfaction and eating disorder symptoms)

Question 16

What are the biological causes of eating disorders?

Answer 16

Disordered eating tends to run in families
Eight areas in the human genome are associated with metabolism and weight
Dopamine levels control appetite (lower levels desire food more)
Other neurotransmitters and hormones involved (Serotonin, Ghrelin)
Altered functioning of the appetitive neural circuitry
Reduced activity in the part of the brain that motivates reward-seeking
Increased activation of the cognitive “self-control” circuitry

Question 17

How is anorexia nervosa treated?

Answer 17

Treatment is provided in either an outpatient or a hospital setting (severe physiological reactions can occur during re-feeding, new foods are introduced to supplement food low in calories, phobic reactions can occur from eating new foods previously thought “forbidden”)

Psychological interventions:
Understand and cooperate with rehabilitation
Understand dysfunctional attitudes
Improve interpersonal and social reinforcing
Other psychological conflicts
Family therapy

Question 18

How is bulimia nervosa treated?

Answer 18

Treatment goals are to treat physical conditions and normalize eating patterns

Cognitive-behavioral treatment:
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

Antidepressant medications such as SSRIs sometimes helpful

Question 19

How is binge-eating disorder treated?

Answer 19

Similar to treatments for bulimia, fewer physical complications, healthy approaches to weight loss

Two phases:
Determine factors that trigger overeating
Learn strategies to reduce binges

Antidepressant medications are sometimes effective
CBT can produce significant reductions in binge eating, less effect on weight reduction
Incorporates strategies for addressing interpersonal difficulties and regulating negative emotions