Post on 17-Dec-2015
Eating Disorders
It has not always done so, but Western society today equates thinness with health and beauty Thinness has become a national obsession
There has been a rise in eating disorders in the past three decades The core issue is a morbid fear of weight gain
Two main diagnoses:
Anorexia Nervosa
The main symptoms of anorexia nervosa are: A refusal to maintain more
than 85% of normal body weight
Intense fears of becoming overweight
Distorted view of weight and shape
Amenorrhea
Anorexia Nervosa
There are two main subtypes: Restricting type
Lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food
Show almost no variability in diet Binge-eating/purging type
Lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics
Like those with bulimia nervosa, people with this subtype may engage in eating binges
Anorexia Nervosa
The “typical” case: A normal to slightly overweight female has been on a
diet Escalation toward anorexia nervosa may follow a
stressful event Separation of parents Move away from home Experience of personal failure
Most patients recover However, about 2% to 6% become seriously ill and die as a
result of medical complications or suicide
Anorexia Nervosa: The Clinical Picture
The key goal for people with anorexia nervosa is becoming thin The driving motivation is fear:
Of becoming obese Of giving in to the desire to eat Of losing control of body size and shape
Anorexia Nervosa: The Clinical Picture
Despite their dietary restrictions, people with anorexia nervosa are preoccupied with food This includes thinking and reading about food and
planning for meals This relationship is not necessarily causal
It may be the result of food deprivation, as evidenced by the famous 1940s “starvation study” with conscientious objectors
Anorexia Nervosa: The Clinical Picture
Persons with anorexia nervosa also think in distorted ways: Usually have a low opinion of their body shape Tend to overestimate their actual proportions
Adjustable lens assessment technique Hold maladaptive attitudes and misperceptions
“I must be perfect in every way” “I will be a better person if I deprive myself” “I can avoid guilt by not eating”
Anorexia Nervosa: The Clinical Picture
People with anorexia nervosa also display certain psychological problems:
Anorexia Nervosa: Medical Problems
Caused by starvation:
Bulimia Nervosa
Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges: Bouts of uncontrolled overeating during a limited period
of time Eat objectively more than most people would/could eat in a
similar period
Bulimia Nervosa
The “typical” case: A normal to slightly overweight female has been on an
intense diet Research suggests that even among normal
participants, bingeing often occurs after strict dieting Like anorexia nervosa, about 90%–95% of
bulimia nervosa cases occur in females The peak age of onset is between 15 and 21
years Symptoms may last for several years with
periodic letup
Bulimia Nervosa
The disorder is also characterized by inappropriate compensatory behaviors, which mark the subtype of the condition: Purging-type bulimia nervosa
Forced vomiting Misusing laxatives, diuretics, or
enemas Nonpurging-type bulimia
nervosa Fasting Exercising frantically
Bulimia Nervosa
Patients are generally of normal weight Often experience marked weight fluctuations Some may also qualify for a diagnosis of anorexia
“Binge-eating disorder” is a related diagnosis Symptoms include a pattern of binge eating with NO
compensatory behaviors (such as vomiting)
Bulimia Nervosa: Binges
People with bulimia nervosa may have between 1 and 30 binge episodes per week
Binges are often carried out in secret Binges involve eating massive amounts of food very
rapidly with little chewing Usually sweet, high-calorie foods with soft texture
Binge-eaters commonly consume between 1,000 and 10,000 calories per binge episode
Overlapping Patterns Of Anorexia Nervosa, Bulimia Nervosa, And Obesity
Bulimia Nervosa: Binges
Binges are usually preceded by feelings of great tension and/or powerlessness
Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and being discovered
Bulimia Nervosa: Compensatory Behaviors
After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects
The most common compensatory behaviors: Vomiting
Fails to prevent the absorption of half the calories consumed during a binge
Repeated vomiting affects the ability to feel satiated greater hunger and bingeing
Laxatives and diuretics Also largely fails to reduce the number of calories consumed
Bulimia Nervosa: Compensatory Behaviors
Compensatory behaviors may temporarily relieve the negative feelings attached to binge eating Over time, however, a cycle develops in which purging
bingeing purging…
Bulimia Nervosa vs. Anorexia Nervosa
Bulimia Nervosa vs. Anorexia Nervosa
Bulimia Nervosa vs. Anorexia Nervosa
Binge Eating Disorder
Repeated eating binges during which they feel no control over their eating
These individuals do not perform inappropriate compensatory behavior
As a result of their frequent binges, around two-thirds of people with binge eating disorder become overweight or even obese
What Causes Eating Disorders?
Most theorists and researchers use a multidimensional risk perspective to explain eating disorders: Several key factors place individuals at risk More factors = greater likelihood of developing a
disorder Leading factors:
Psychological problems (ego, cognitive, and mood disturbances) Biological factors Sociocultural conditions (societal, family, and multicultural
pressures)
Psychodynamic Factors: Ego Deficiencies
Hilde Bruch developed a largely psychodynamic theory of eating disorders Argued that eating disorders are the result of disturbed
mother–child interactions, which lead to serious ego deficiencies in the child and to severe perceptual disturbances
Psychodynamic Factors: Ego Deficiencies
Bruch argues that parents may respond to their children either effectively or ineffectively Effective parents accurately attend to a child's biological
and emotional needs Ineffective parents fail to attend to child's needs; they
feed when the child is anxious, comfort when the child is tired, etc. Such children may grow up confused and unaware of their own
internal needs and turn, instead, to external guides
Clinical reports and research have provided some empirical support for this theory
Cognitive Factors
Bruch's theory also contains several cognitive factors, like improper labeling of internal sensations and needs According to cognitive theorists, these deficiencies
contribute to a broad cognitive distortion that lies at the center of disordered eating (e.g., negative self-judgment based on body shape and weight)
Mood Disorders
Many people with eating disorders, particularly those with bulimia nervosa, experience symptoms of depression Theorists believe mood disorders may “set the stage”
for eating disorders
Mood Disorders
There is empirical support for the claim that mood disorders set the stage for eating disorders: Many more people with an eating disorder qualify for a
clinical diagnosis of major depressive disorder than do people in the general population
Close relatives of those with eating disorders seem to have higher rates of mood disorders
People with eating disorders, especially those with bulimia nervosa, have serotonin abnormalities
Symptoms of eating disorders are helped by antidepressant medications
Biological Factors
Biological theorists suspect certain genes may leave some people particularly susceptible to eating disorders Consistent with this idea:
Relatives of people with eating disorders are up to 6 times more likely to develop the disorder themselves
Identical (MZ) twins with anorexia: 70% Fraternal (DZ) twins with anorexia: 20% Identical (MZ) twins with bulimia: 23% Fraternal (DZ) twins with bulimia: 9%
These findings may be related to low serotonin
Biological Factors
Other theorists believe that eating disorders may be related to dysfunction of the hypothalamus Researchers have identified two separate areas that
control eating: Lateral hypothalamus (LH) Ventromedial hypothalamus (VMH)
Biological Factors
Some theorists believe that the hypothalamus, related brain areas, and chemicals together are responsible for weight set point – a “weight thermostat” of sorts Set by genetic inheritance and early eating practices,
this mechanism is responsible for keeping an individual at a particular weight level If weight falls below set point: hunger, metabolic rate
binges If weight rises above set point: hunger, metabolic rate
Dieters end up in a battle against themselves to lose weight
Societal Pressures
Many theorists believe that current Western standards of female attractiveness are partly responsible for the emergence of eating disorders Western standards have changed throughout history
toward a thinner ideal Miss America contestants have declined in weight by 0.28 lbs/yr;
winners have declined by 0.37 lbs/yr Playboy centerfolds have lower average weight, bust, and hip
measurements than in the past
Societal Pressures
Members of certain subcultures are at greater risk from these pressures: Models, actors, dancers, and certain athletes
Of college athletes surveyed, 9% met full criteria for an eating disorder while another 50% had symptoms
20% of surveyed gymnasts appear to have an eating disorder
Societal Pressures
Societal attitudes may explain economic and racial differences seen in prevalence rates Historically, women of higher SES expressed more
concern about thinness and dieting These women had higher rates of eating disorders than women
of the lower socioeconomic classes Recently, dieting and preoccupation with thinness,
along with rates of eating disorders, are increasing in all groups
Societal Pressures
The socially accepted prejudice against overweight people may also add to the “fear” and preoccupation about weight About 50% of elementary and 61% of middle school
girls are currently dieting A recent survey of adolescent girls tied eating disorders
and body dissatisfaction to social networking, Internet activities, and television browsing
Family Environment
Families may play an important role in the development of eating disorders As many as half of the families of those with eating
disorders have a long history of emphasizing thinness, appearance, and dieting
Mothers of those with eating disorders are more likely to be dieters and perfectionistic themselves
Family Environment
Abnormal interactions and forms of communication within a family may also set the stage for an eating disorder Influential family theorist Salvador Minuchin cites
“enmeshed family patterns” as causal factors of eating disorders These patterns include overinvolvement in, and overconcern
about, family member's lives
Multicultural Factors: Racial and Ethnic Differences
A widely publicized 1995 study found that eating behaviors and attitudes of young African American women were more positive than those of young white American women Specifically, nearly 90% of the white American
respondents were dissatisfied with their weight and body shape, compared to around 70% of the African American teens
The study also suggested that the groups had different ideals of beauty
Multicultural Factors: Racial and Ethnic Differences
Eating disorders among Hispanic American female adolescents are about equal to those of white American women
Eating disorders also appear to be on the increase among Asian American women and young women in several Asian countries
Multicultural Factors: Racial and Ethnic Differences
Males account for only 5% to 10% of all cases of eating disorders
The reasons for this striking difference are not entirely clear, but Western society's double standard for attractiveness is, at the very least, one reason
A second reason may be the different methods of weight loss favored: Men are more likely to exercise Women more often diet
Multicultural Factors: Racial and Ethnic Differences
It seems that some men develop eating disorders as linked to the requirements and pressures of a job or sport The highest rates of male eating disorders have been
found among: Jockeys Wrestlers Distance runners Body builders Swimmers
Multicultural Factors: Racial and Ethnic Differences
For other men, body image appears to be a key factor
Last, some men seem to be caught up in a new kind of eating disorder – reverse anorexia nervosa or muscle dysmorphobia
How Are Eating Disorders Treated?
Eating disorder treatments have two main goals: Correct dangerous eating patterns Address broader psychological and situational factors
that have led to, and are maintaining, the eating problem This often requires the participation of family and friends
Treatments for Anorexia Nervosa
The immediate aims of treatment for anorexia nervosa are to: Regain lost weight Recover from malnourishment Eat normally again
Treatments for Anorexia Nervosa
In the past, treatment took place in a hospital setting; it is now often offered in day hospitals or outpatient settings
In life-threatening cases, clinicians may need to force tube and intravenous feedings on the patient This may breed distrust in the patient and create a
power struggle In contrast, behavioral weight-restoration approaches
have clinicians use rewards whenever patients eat properly or gain weight
Treatments for Anorexia Nervosa
The most popular weight-restoration technique has been the combination of supportive nursing care, nutritional counseling, and high-calorie diets Necessary weight gain is often achieved in 8 to 12
weeks Researchers have found that people with
anorexia nervosa must overcome their underlying psychological problems to achieve lasting improvement
Treatments for Anorexia Nervosa
In most treatment programs, a combination of behavioral and cognitive interventions are included On the behavioral side, clients are required to monitor
feelings, hunger levels, and food intake and the ties among those variables
On the cognitive sides, they are taught to identify their “core pathology”
Treatments for Anorexia Nervosa
Therapists help patients recognize their need for independence and control
Therapists help patients recognize and trust their internal feelings
A final focus of treatment is helping clients change their attitudes about eating and weight Using cognitive approaches, therapists correct
disturbed cognitions and educate about body distortions Family therapy is important for anorexia nervosa
treatment The main issues are often separation and boundaries
Treatments for Anorexia Nervosa
The use of combined treatment approaches has greatly improved the outlook for people with anorexia nervosa But even with combined treatment, recovery is difficult
The course and outcome of the disorder vary from person to person
Treatments for Anorexia Nervosa
Treatments for Bulimia Nervosa
Treatment is frequently offered in eating disorder clinics
The immediate aims of treatment for bulimia nervosa are to: Eliminate binge-purge patterns Establish good eating habits Eliminate the underlying cause of bulimic patterns
Programs emphasize education as much as therapy
Treatments for Bulimia Nervosa
Cognitive-behavioral therapy is particularly helpful: Behavioral techniques
Diaries are often a useful component of treatment Exposure and response prevention (ERP) is used to break the
binge-purge cycle Cognitive techniques
Help clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape
Typically teach individuals to identify and challenge the negative thoughts that precede the urge to binge
Treatments for Bulimia Nervosa
Other forms of psychotherapy If clients do not respond to cognitive-behavioral therapy,
other approaches may be tried A common alternative is interpersonal therapy (IPT); a
treatment that seeks to improve interpersonal functioning may be tried
Psychodynamic therapy has also been used
Treatments for Bulimia Nervosa
Other forms of psychotherapy Various forms of psychotherapy are often
supplemented by family therapy and may be offered in either individual or group therapy format Group formats provide an opportunity for patients to express
their thoughts, concerns, and experiences with one another Group therapy is helpful in as many as 75% of cases
Treatments for Bulimia Nervosa
Antidepressant medications During the past 15 years, all groups of antidepressant
drugs have been used in bulimia nervosa treatment Drugs help as many as 40% of patients
Medications are best when used in combination with other forms of therapy
Treatments for Bulimia Nervosa
Left untreated, bulimia nervosa can last for years Treatment provides immediate, significant
improvement in about 40% of cases An additional 40% show moderate response
Follow-up studies suggest that 10 years after treatment about 75% of patients have fully or partially recovered
Treatments for Bulimia Nervosa
Relapse can be a significant problem, even among those who respond successfully to treatment Relapses are usually triggered by stress Relapses are more likely among persons who:
Had a longer history of symptoms Vomited frequently Had histories of substance use Have lingering interpersonal problems