Eating Disorders: Class Notes Flashcards
Eating Disorders, General
Most common: anorexia nervosa, bulimia nervosa, and binge-eating disorder
BMI is the most common way to judge/evaluate the presence of these disorders
Similarities between anorexia nervosa and bulimia nervosa
o An intense fear of gaining weight and a pursuit to be thin despite the consequences
• Often leading to illness, organ failure, or even death
o Grappling with perfection and control despite actual weight
3 general body types
o From skin to heavy: ectomorphic, mesomorphic, endormorphic
Anorexia Nervosa
Below expected BMI for height and age
“significantly low weight”
Disturbance in one’s shape or size–experience of weight
Intense fear of gaining weight
Some remain obsessed about food despite fear of ingesting it
Restrictive type
• Attempt to control via exercise or ingesting small quantities
Binge-eating/purging type
• Attempt to control via purging
Versus body dysmorphic disorder
• Where most energy is spend obsessing over specific bodily features
Bulimia Nervosa
Frequent episodes of excessive eating with a subjective sense of lack of control
A binge episode can be described as a quasi-dissociative state
Inappropriate compensatory behavior to negate the effects of the binge
**The anorexia exclusion
• Bulimia is only diagnosable in those who have average to above-average weight
Bulimia: 2 subtypes
Purging
• Via vomiting, laxatives, diuretics
Nonpurging
• Via fasting, exercise
Bulimia vs Anorexia: Insight
Bulimia: lack of insight, but increased interest in the perceptions of others
Anorexia: Increased insight and less interested in the perceptions of others
Bulimia vs Anorexia: Sexual Activity
Bulimia: Increased chance of being sexually active
Anorexia: Decreased chance of being sexually active
Bulimia vs Anorexia: Weight
Bulimia: focus on maintaining weight
Anorexia: focus on losing weight
Bulimia vs Anorexia: Obsessive Personality
Bulimia:less obsessive personality traits
Anorexia: more obsessive personality traits
Bulimia vs Anorexia: Mood Swings
Bulimia: increased mood swings
Anorexia: decreased chance of mood swings
Bulimia vs Anorexia: Impulse Control
Bulimia: lack of impulse control
Anorexia: overdeveloped impulse control
Bulimia vs Anorexia: Substance Abuse
Bulimia: more likely to abuse drugs/alcohol
*typically starts with an addiction to diet pills
Anorexia: less likely to abuse drugs/alcohol
Binge-Eating Disorder
Subjective loss of control during an episode of increased food intake
No inappropriate attempt to limit or reduce the subsequent weight gain
Medical Consequences of Eating Disorders
Amenorrhea – the body needs fat in order to sustain menstrual cycle
Mouth – breakdown of teeth and gums
Hair – thins and becomes brittle
Hypokalemia – a potassium deficiency that causes irregular heart rate
Blood stream – anemia and change in blood pressure
Muscles – weaken and become swollen
Kidneys – stone development and potential failure
Bodily fluids – decreased potassium, magnesium, and sodium
Eating Disorders Onset
Anorexia typically develops between ages 15 and 19
Bulimia typically develops later, 20-24 years old
Females:males = 3:1
Eating Disorders: Prevalence
Binge-eating disorder most common: 3.5% of females, 2% of males
Anorexia is rarer, and bulimia is rarer than anorexia
• Fluidity present between eating disorder diagnoses
People tend to switch between the two anorexia subtypes
• Restrictive ↔ binge-purge
Not uncommon for those with binge-purge anorexia to become bulimic
• Binge purge anorexia → bulimia
Some with binge eating disorder may later develop bulimia
• Binge eating disorder → bulimia
No evidence that those with binge disorder develop anorexia
Eating Disorders: Comorbidity
With clinical depression, 21-91% of all eating disorder cases
Symptoms of starvation resemble those of depression, so these percentages may be inflated
Secondary symptoms of eating disorders also resemble depression
Mood disorders, in general, may predispose someone to eating disorders
High comorbidity with mood disorders
High rate of mood disorders in family members of those who have been diagnosed with eating disorders
Decreased serotonin (aka 5-HT) in those with eating disorders and mood disorders • SSRIs help depression and those with eating disorders
Obsessive-compulsive disorder
o Particularly with anorexia
Substance abuse disorders
Various personality disorders
o Impulsivity, affectability (borderline-like)
Eating Disorders across Cultures
Originally, eating disorders were a “western-disorder”
o Specifically with Caucasian females
More recently, they have become a world-wide problem
o Still more common though in Caucasian and Asian populations
Fallon-Rozin study
Women think men find a lower BMI to be more attractive, and they currently are too heavy
Men rate the optimal body weight for women to be higher than women expect
Men tend to think the optimal body weight is their current body weight
Women prefer men that are lower than this however
• May explain why men tend to be less likely diagnosed with an eating disorder – this thinking is a defense
Eating Disorders Among Female college athletes
9% have eating disorders
~50% engage in behaviors that are affiliated with eating disorders
Family Influences
~50% of those with eating disorders come from families that emphasize thinness or control
Adolescents with anorexia come from families with strict, non-abstract, covert, conflict resolution behaviors
Some argue the eating disorder may be a defense of the adolescent to reduce the conflict between the parents – redirect their attention
Individual Factors
Internalized ideals of thinness or perfectionism
Consistent negative mood images and/or negative emotionality
History of childhood sexual abuse
Regular dieting
Dieting
Dieting is the biggest predictor of binging
Adolescents who diet are 8x more likely to develop an eating disorder
As dieting becomes more regular, serotonin decreases
• Explains the feelings of being depleted while dieting
Abstinence Violation Effect
Phenomenon that occurs if one is dieting and lapses, there is a belief that one might as well continue to lapse
An all-or-nothing mentality
“I already ate a slice, I might as well eat the rest of the pie”
This behavior is also popular with those combating drug/alcohol abuse
Biological Explanations
Hypothalamus
o Controls eating, drinking, and menstrual cycle
Weight set-point theory
o Lateral hypothalamus – produces hunger when activated
• Destruction = refusal to eat
Ventromedial hypothalamus –produces satisfaction (satiety center)
• Destruction = over-eating
The hypothalamus acts like a thermometer and attempts to keep balance
May explain when one is anorexic, they experience an increase in thoughts related to food
The hypothalamus is attempting to encourage hunger to maintain the weight set-point
Eating disorders are conflicts between desire and one’s weight set-point
There is no way to discover one’s weight set-point
This is why some argue dieting is pointless
The set-point prevents one from gaining or losing weight
Hypothalamus and GLP
Glucagon-like peptide (GLP) may interact with these subsections
Activates distinct areas of the hypothalamus in order to ensure the body weight remains centered around the weight set-point
If one gains weight, GLP activates the ventromedial
If one loses weight, GLP activates the lateral
Treating Anorexia
2 paths of treatment
- Correct eating patterns – the priority
- Correct cognitive patterns
Currently:
Supportive-nursing care
Antidepressants
• Limited success
Family therapy
• Identify sources of stress or support
• Identify areas of familial improvement
In the past
• Hospitalization and forced feeding
o No cooperation
Treating Anorexia: Supportive-nursing care
In outpatient centers, nurses educate, encourage, and take time to confirm obesity will not occur
Then cooperatively work with patient to ensure up to 4,000 calories are ingested each day
Normal weight returns after 8-12 weeks
After normal weight returns, nurses attempt to correct faulty cognitions, including teaching to
- Recognize/trust internal hunger cues
- Address misconceptions and faulty core beliefs
- Recognize distortions
Treating Bulimia
Combination of medication and therapy
In-session meals
Groups eat meals together and then identify and express emotions and physical sensations of being full
CBT orientation is successful
• Therapists guide individuals to alter faulty thinking
• Food diaries
• Include mood, and moments of hunger
• Goal = to recognize triggers for binges
Antidepressants
• Starting in 1996, with the approval of Prozac
Treating Binge-eating Disorder
Similar to bulimia
Teach to recognize triggers of binge episodes
Commonly include subjective moments of loss of control, and increased anxiety
Treatment Outcomes: Anorexia
Weight typically restored quickly, but psychological pathology can take years to correct
After 21 years • 51% - fully recovered • 21% - partially recovered • 10% - not recovered • 16% - have died
**Mortality rate of anorexia is high
All eating disorders are relatively high
Recovery process is not smooth
Pregnancy may help combat anorexic-inducing thoughts since they are expected to gain weight at this time
However, those with severe anorexia will not get pregnant out of fear of gaining weight
Treatment Outcomes: Bulimia + Binge-Eating Disorder
70% recover
Antidepressants help reduce behaviors by 25-30%
