Chapter 20 Eating Disorders

Question 1

Anorexia nervosa

Answer 1

A life-threatening eating disorder characterized by:
- The client’s restriction of nutritional intake necessary to maintain a minimally normal body weight
- Intense fear of gaining weight or becoming fat,
- Significantly disturbed perception of the shape or size of the body
- Steadfast inability or refusal to acknowledge the seriousness of the problem or even its very existence

Question 2

Risk Factors for Anorexia Nervosa

Answer 2

Biologic Risk Factors: Obesity; dieting at an early age

Developmental Risk Factors: Issues of developing autonomy and having control over self and environment
- Developing a unique identity
- Dissatisfaction with body image

Family Risk Factors: Family lacks emotional support parental maltreatment
- Cannot deal with conflict

Sociocultural Risk Factors: Cultural ideal of being thin
- Media focus on beauty, thinness, fitness
- Preoccupation with achieving the ideal body

Question 3

Onset & Clinical Course of Anorexia Nervosa

Answer 3

Typically begins between the ages of 14–18 years.

In the early stages, clients often deny having a negative body image or anxiety regarding their appearance.
- They are pleased w/ their ability to control their weight and may express this.
- When they initially come for treatment, they may be unable to identify or to explain their emotions about life events such as school or relationships with family or friends.
- A profound sense of emptiness is common

As the illness progresses, depression and lability in mood become more apparent.

As dieting and compulsive behaviors increase, clients isolate themselves.
- This social isolation can lead to a basic mistrust of others and even paranoia.
- Clients may believe their peers are jealous of their weight loss & may believe that family and health care professionals are trying to make them “fat and ugly.

Question 4

What are the two subtypes of anorexia nervosa?

Answer 4

1) Restricting
2) Binge-eating & purging

Question 5

How do clients with the restricting subtype of anorexia nervosa lose weight?

Answer 5

Dieting, fasting, or excessive exercising

Question 6

How do clients with the binge-eating & purging subtype of anorexia nervosa lose weight?

Answer 6

Engage regularly in binge-eating followed by purging

Question 7

Binge-eating

Answer 7

Consuming a large amount of food (far greater than most people eat at one time) in a discrete period of usually 2 hours or less

Question 8

Purging

Answer 8

Involves compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics

Question 9

Physical Problems of Anorexia Nervosa

Answer 9

Amenorrhea

Constipation

Overly sensitive to cold, lanugo hair on body

Loss of body fat

Muscle atrophy

Hair loss

Dry skin

Dental caries

Pedal edema

Bradycardia, arrhythmias

Orthostasis

Enlarged parotid glands and hypothermia

Electrolyte imbalance (i.e., hyponatremia, hypokalemia)

Question 10

Behavior & Thought Process Associated w/ Patients Battling Anorexia Nervosa

Answer 10

Clients with anorexia become totally absorbed in their quest for weight loss and thinness

They still experience hunger but ignore it and also ignore the signs of physical weakness and fatigue
- They often believe that if they eat anything, they will not be able to stop eating and will become fat.

Clients with anorexia are often preoccupied with food-related activities, such as grocery shopping, collecting recipes or cookbooks, counting calories, creating fat-free meals, and cooking family meals. T

They may also engage in unusual or ritualistic food behaviors such as refusing to eat around others, cutting food into minute pieces, or not allowing the food they eat to touch their lips.
- These behaviors increase their sense of control.
- Excessive exercise is common; it may occupy several hours a da

Question 11

Bulimia Nervosa

Answer 11

An eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising

BMI: Usually w/in normal range, but some clients are overweight or underweight

The amount of food consumed during a binge episode is much larger than a person would normally eat.
- Often engages in binge eating secretly. Between binges, the client may eat low-calorie foods or fast.

Binging or purging episodes are often precipitated by strong emotions and followed by guilt, remorse, shame, or self-contempt.

Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these clients.
- Dentists are often the first healthcare professionals to identify clients with bulimia

Question 12

Risk Factors for Bulimia Nervosa

Answer 12

Biologic Risk Factors: Obesity
- Early dieting
- Possible serotonin and norepinephrine disturbances
- Chromosome 1 susceptibility

Developmental Risk Factors: Self-perceptions of being overweight, fat, unattractive, and undesirable
- Dissatisfaction w/ body image

Family Risk Factors: Chaotic family w/ loose boundaries
- Parental maltreatment including possible physical or sexual abuse

Sociocultural Risk Factors: Cultural ideal of being thin
- Media focus on beauty, thinness, fitness
- Preoccupation with achieving the ideal body
- Weight-related teasing

Question 13

Binge Eating Disorder

Answer 13

Characterized by recurrent episodes of binge eating;
- No regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives
- Guilt, shame, and disgust about eating behaviors
- Marked psychological distress

Frequently affects people over age 35 years, and it occurs more often in men than does any other eating disorder

Individuals are more likely to be overweight or obese, overweight as children, and teased about their weight at an early age

Question 14

Night Eating Syndrome

Answer 14

Characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks

It is associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss

Most people with night eating syndrome are obese.

Treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants has shown positive effects

Question 15

Pica

Answer 15

Persistent ingestion of nonfood substances

Question 16

Rumination

Answer 16

Repeated regurgitation of food that is then rechewed, reswallowed, or spat out

Question 17

Which population is pica and rumination more common in?

Answer 17

These 2 disorders are more common in persons w/ intellectual developmental disability

Question 18

Orthorexia nervosa

Answer 18

An obsession with proper or healthful eating

It is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, but some believe it is on the rise and may constitute a separate diagnosis

Others believe it is a type of anorexia or a form of OCD.

Behaviors include:
- Compulsive checking of ingredients
- Cutting out increasing number of food groups
- Inability to eat only “healthy” or “pure” foods
- Unusual interest in what others eat
- Hours spent thinking about food, what will be served at an event
- Obsessive involvement in food blogs

Question 19

What are the characteristics of both anorexia & bulimia nervosa?

Answer 19

Perfectionism
Obsessive–compulsiveness
Neuroticism
Negative emotionality
Harm avoidance
Low self-directedness
Low cooperativeness
Traits associated w/ avoidant personality disorder

Question 20

Etiology of Eating Disorders

Answer 20

Biological factors
- Strong genetic link: Heritability is 60%

Neurobiological: Altered brain serotonin contributes to appetite dysregulation
- Disruptions in the nuclei of the hypothalamus relating to hunger and satiety

Psychological factors: Cognitive behavioral/Dialectical behavioral therapies indicate learned behaviors and distorted thinking

Developmental factors: Struggle for autonomy, identity
- Overprotective or enmeshed families

Body image disturbance: Self-perceptions of the body

Family influences (family dysfunction, childhood adversity)

Sociocultural factors (media, pressure from others)

Question 21

Enmeshment

Answer 21

Lack of clear boundaries

Question 22

Body Image

Answer 22

How a person perceives their body, that is, a mental self-image.

Question 23

Body Image Disturbance

Answer 23

Occurs when there is an extreme discrepancy between one’s body image & the perceptions of others and extreme dissatisfaction w/ one’s body image

Question 24

Cultural Considerations of Eating Disorders

Answer 24

Both anorexia nervosa and bulimia nervosa have been more prevalent in industrialized societies, where food is abundant, and beauty is linked with thinness.

Westernization has been associated with increasing disordered eating issues.
Ex) On the island of Fiji, when there was little television prior to the 1990s, eating disorders were almost nonexistent, and being “plump” was considered the ideal shape for girls and women.
- In the 5 years following the widespread introduction of television, the number of eating disorders in Fiji increased significantly

Eating disorders are most common in: The United States, Canada, Europe, Australia, Japan, New Zealand, South Africa, and other developed industrialized countries.

As a society becomes more prosperous with increased availability of foods high in fat and carbohydrates and increased emphasis on the thinness equals beauty concept, the incidence of eating disorders increases.

In addition, immigrants from cultures in which eating disorders are rare may develop eating disorders as they assimilate the thin-body ideal