Eating disorders

Question 1

Major types of DSM-IV eating disorders

Answer 1

 Anorexia nervosa and bulimia nervosa
 Both involve severe disruptions in eating behavior
 Both can involve extreme fear and apprehension about gaining weight
 Both have strong sociocultural origins

Question 2

Other Sub types of DSM-IV Eating Disorders

Answer 2

 Binge-eating disorder

 Rumination disorder, pica, feeding disorder

Question 3

Gender Differences?

Answer 3

 More frequently diagnosed with women  Lifetime prevalence rate
 Anorexia
 0.5% - 1%
 More women diagnosed than men  Bulimia
 1-3%
 90% of all cases are women

Question 4

Characteristics

Answer 4

 See eating disorders increasing with men
 Sports where man must “make weight”
 Increased advertising aimed at ideal image
 Men are catching up (ideal muscle)
 Common in young adolescents and the college population
 Issues related to body image are culturally defined
 Current “ideal” weight in U.S.
 15-20% below our average weight
 Not case in all cultures
 Not case across all times in U.S.

Question 5

Anorexia Nervosa

Answer 5

 Diagnostically
 Refusal to maintain a minimally normal body
weight
 15% below expected weight
 Intense fear of gaining weight
 Image problems
 Significant disturbance in perception of shape or size of one’s body
 Undue influence of body weight or shape on self- evaluation
 Denial of the seriousness of current low body weight  Amenorrhea
 Absence of at least three consecutive menstrual cycles
 Most be postmenarchael female

Question 6

Anorexia Nervosa

Answer 6

 DSM-IVSubtypesofAnorexia  Restricting subtype
 Limit caloric intake via diet and fasting  Binge-eating-purging subtype
 Induced vomiting or the misuse of laxatives, diuretics, or enemas
 About 50% of those diagnosed  AssociatedFeatures
 Most are co-morbid for other psychological disorders
 Methods of weight loss can have severe life threatening medical consequences

Question 7

Anorexia Nervosa

Answer 7

 Over-controlofeatingbehavior
 Relentless pursuit of thinness
 Person becomes “phobic” about gaining weight
 Weight is below what would be considered “ideal” by many
 Many begin with normal diet
 Then become extreme
 e.g., Limit caloric intake to 600 calories/day
 Starveselvestothinnessanddeath
 Death from malnutrition is main concern here


Question 8

Anorexia Nervosa

Answer 8

  Personispreoccupiedwiththinness
  May become obsessed with food and food related
issues
  May become gourmet cook
  Cook for others though
  Oftentimespersonwilleatalone
  Maywearbulkyclothes(bigsweaters)asget thinner
  Camouflage thinness, and/or
  Because they are cold
  Loss of body fat (insulator)

Question 9

Anorexia Nervosa

Answer 9

  Appearance will change
  Develop brittle hair and nails
  Eyes become sunken
  Bodychanges
  Lower body temperature
  Pulse drops
  Develop constipation
  Cease menstruating (amenorrhea)
  Body will feed off own tissue to survive
  Initially fat stores then organs

Question 10

Anorexia Nervosa

Answer 10

 Psychologicalchanges
 Low self-esteem
 Clinical depression or chronically low mood
 Moodiness
 Poor school performance
 Person may report difficulty thinking clearly
 Withdrawal from previous friendships and other
peer-relationships
 Deterioration in relationships with the family
 Hospitalization is necessary at extreme ends to keep person alive
 Intravenous feedings


Question 11

Anorexia Research Data

Answer 11

  Majorityare   Female
  Caucasian
  From middle-to-upper middle class families
  Usuallydevelopsaroundage13orearly
  Tendstobemorechronicandresistantto treatment than bulimia
  LifetimeprevalenceratesforAnorexia
  Females = 0.5%
  Males = 0.1%
adolescence

Question 12

Anorexia Research Data

Answer 12

 People suffering from eating disorders have the highest mortality rate of any mental illness
 National Association of Anorexia Nervosa and Associated Disorders
 5-10% of anorexics die within 10 years after contracting the disease
 18-20% of anorexics will be dead after 20 years
 only 30-40% ever fully recover

Question 13

Anorexia Research Data

Answer 13

 Death from anorexia nervosa
 12 times higher than ALL of combined
causes of death for females 15-24 years of age
 20% will prematurely die from complications related to their eating disorder
 Including suicide and heart problems
 30-50% of these deaths are from suicide


Question 14

Anorexia Treatment

Answer 14

 Medicaltreatment
 There are none with demonstrated efficacy
 Psychologicaltreatment  Weight restoration
 First and easiest goal to meet
 Treatment involves education, behavioral, and
cognitive interventions
 Treatment often involves the family
 Long-term prognosis for anorexia is poorer than
for bulimia

Question 15

Bulimia Nervosa

Answer 15

 Diagnostically
 Recurrent episodes of binge eating
 Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
 Sense of lack of control over eating during the episode
 e.g., Feeling that one cannot stop eating or control what or how
much one is eating
 Recurrent inappropriate compensatory behavior to prevent
weight gain
 e.g., Self-induced vomiting; misuse of laxatives, diuretics,
enemas; fasting; or excessive exercise
 Occurs, on average, at least twice a week for 3 months
 Self-evaluation is unduly influenced by body shape and
weight
 Cannot occur exclusively during Anorexia Nervosa

Question 16

Bulimia Nervosa

Answer 16

 Characterized by binge eating and inappropriate compensatory methods to prevent weight gain
 Compensatory behaviors
 Purging
 Self-induced vomiting, diuretics, laxatives
 Some exercise excessively, others fast

Question 17

Bulimia Nervosa

Answer 17

 Binge cycling
 Rapid consumption of large amounts of food followed by some kind of purging
 Binge has been defined as 1200 calories at once
 Average binge is 4000-5000 calories  Problem
 People can define binge as very small caloric intake (1 candy bar) and must immediately purge this
 Probably still talking about Bulimia here

Question 18

Subtypes of bulimia

Answer 18

 DSM-IV Subtypes of bulimia  Purging subtype
 Most common subtype
 e.g., Vomiting, laxatives, enemas  Nonpurging subtype
 About6-8%ofcases
 e.g., Excess exercise, fasting

Question 19

Bulimia Nervosa

Answer 19

 Associated behaviors
 Person tends to be very secretive in both eating and purging
 Person often feels very depressed afterwards
 Most are over concerned with body shape, fear gaining weight
 Most are within 10% of target body weight
 Can be very painful to ingest massive amounts of calories

Question 20

Bulimia Nervosa

Answer 20

  Purgingmethodsleadtoseveremedical problems
  Very negative outcomes are possible with bulimia
  Damage the electrolyte system
  Damage to stomach
  Death is a possibility with bulimia
  Psychologicalfeatures
  Become more and more withdrawn
  Mood disorders
  Anxiety disorders
  Substance Abuse
  e.g., diet pills

Question 21

Bulimia Research Data

Answer 21

 Lifetime prevalence  1-3% for females
 90% are female
 6-10% of college women suffer from bulimia  0.1% for males
 Onset around 16 to 19 years of age  Tends to be chronic if left untreated

Question 22

Bulimia Research Data

Answer 22

 10% of individuals suffering from bulimia will die from either
 Starvation
 Cardiac arrest
 Other medical complications  Suicide

Question 23

Bulimia treatment

Answer 23

 MedicalTreatment
 Antidepressants can help reduce binging and
purging behavior
 Antidepressants are not efficacious in the long-
term
 PsychologicalTreatment
 Cognitive-behavior therapy (CBT) is the treatment of choice
 Interpersonal psychotherapy results in long-term gains similar to CBT
 Somedifficultieswithreplication

Question 24

College Populations

Answer 24

 Eating Problems  Research Data
 61% of college women have some kind of eating disturbance
 Chronic dieting, restrained eaters
 Not all diagnosable Eating Disorders
 About .1 to 1% of college women meet criteria for anorexia
 Bulimia is more common
 1-5% of freshman women are bulimic
 College athletes show high number of higher risk
eating/dieting behaviors  Making weight, etc.

Question 25

Characteristics of Women with Eating Disorders

Answer 25

 As children tend to be  High achieving
 Perfectionistic
 Often overly compliant
 Come from family that places great emphasis on physical beauty
 70% of these women on diets as early as elementary school

Question 26

IF A FRIEND HAS THIS

Answer 26

  Bedirect
  Tell person you’re concerned
  Don'tcommentrepeatedlyonthethinness   May take this as compliment or as you being
jealous
  May be reinforcing
  Instead,emphasizecaringaboutthisperson   Commenton
  What you have observed
  What your concerns are specifically

Question 27

IF A FRIEND HAS THIS

Answer 27

 Ifpersonopensup
 May be great relief in getting this secret out in the open
 Person may be angry at you for bringing this up
 Be compassionate with the person
 Want to be there with how they feel
 Be comforting
 Encourage person that people get better
 Hang in there and support them

Question 28

Eating disorders and body image

Answer 28

 Socialization
 Woman is told she can never be too thin
 Thinness in advertising is linked to success in
other areas
 Overall, an incredible pressure in society to stay
thin
 Pressures are changing for ideal male image
 Considertheseimagesfromthemedia

Question 29

Body Image Disturbance

Answer 29

  Emergingareaofresearch   Continuum
  Body image satisfaction
  Body image dissatisfaction
  Body image disturbance
  Body Dysmorphic Disorder

Question 30

Body Dysmorphic Disorder

Answer 30

 Defined(DSM-IV-TR;APA,2000)
 Preoccupation with perceived defect in appearance  If slight physical anomaly is present, concern is markedly
excessive
 Preoccupation causes clinically significant distress
or impairment in social, occupational, or other important areas of functioning
 Not better accounted for by another mental disorder (e.g., Anorexia Nervosa)
 Prevalence: 4 - 40% US population
 College: 4 - 18%

Question 31

Problems with BI disturbance

Answer 31

 Relationship to over all psychological distress
 Relationship to seeking elective cosmetic surgery
 As increase BID, more likely to seek surgery
 Literature suggests may assist with distress  May become worse
 Note that seeking surgery does not equal BID

Question 32

Body Dysmorphic Disorder

Answer 32

 Conceptualizations
 Somatoform Disorder
 Body-based problem (pain, hypochondriasis)  Eating disorder
 BDD present, subsumed by Anorexia Nervosa  Obsessive compulsive spectrum disorder
 Cyclic pattern of checking, symptom alleviation
 Psychotic disorder
 Delusional quality of perceptions and beliefs

Question 33

Body Dysmorphic Disorder

Answer 33

 Challenge of multiple conceptualizations
 Etiology unclear
 Treatment (theoretically) depends on formulation
 Multiple formulations – where to start?
 Each has very different implications (drugs,
therapy, etc.)
 Convoluted clinical science

Question 34

Body Dysmorphic Disorder

Answer 34

 Intrapersonalfactors
 Seek to remove or eliminate experience of emotional or cognitive distress (experiential avoidance)
 Negatively reinforced escape and avoidance repertoire
 Avoidance of thoughts related to perceived deficit
 Efforts to escape or neutralize those thoughts
 Checking, camouflaging, surgeries  Unworkable strategy
 Increased problems
 Acceptance Commitment Therapy (ACT)
 Hayes, Strosahl, & Wilson (2000)

Question 35

Conclusion

Answer 35

  BehavioralfactorsareimportantinBDD
  Experientialavoidance
  Predicts BDD case
  Does not predict BDD severity
  Interpersonalproblemswithexpressionof
emotional experiences
  Do not predict BDD case
  Predict BDD severity
  Currentlybuildingspecificassessments
  Empirically-basedtreatmentbuilding
  Principally based intervention given these data