Eating disorders Flashcards
Major types of DSM-IV eating disorders
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
Other Sub types of DSM-IV Eating Disorders
Binge-eating disorder
Rumination disorder, pica, feeding disorder
Gender Differences?
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
Characteristics
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.
Anorexia Nervosa
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
Anorexia Nervosa
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
Anorexia Nervosa
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

Anorexia Nervosa
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)
Anorexia Nervosa
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
Anorexia Nervosa
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

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

Anorexia Treatment
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
Bulimia Nervosa
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
Bulimia Nervosa
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
Bulimia Nervosa
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
Subtypes of bulimia
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
Bulimia Nervosa
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
Bulimia Nervosa
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
Bulimia Research Data
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
Bulimia Research Data
10% of individuals suffering from bulimia will die from either
Starvation
Cardiac arrest
Other medical complications Suicide
Bulimia treatment
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
College Populations
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.
Characteristics of Women with Eating Disorders
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
IF A FRIEND HAS THIS
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
IF A FRIEND HAS THIS
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
Eating disorders and body image
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
Body Image Disturbance
Emergingareaofresearch Continuum Body image satisfaction Body image dissatisfaction Body image disturbance Body Dysmorphic Disorder
Body Dysmorphic Disorder
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%
Problems with BI disturbance
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
Body Dysmorphic Disorder
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
Body Dysmorphic Disorder
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
Body Dysmorphic Disorder
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)
Conclusion
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
