Disordered Eating

Disordered Eating vs. Eating Disorder

• Eating disorders are psychiatric conditions– Extreme, continuous body dissatisfaction

coupled with long-term eating patterns that negatively affect body functioning

– Typical behaviors = food restriction, obsessive exercise, self-induced vomiting

– Anorexia & bulimia nervosa

Disordered Eating vs. Eating Disorder

• Disordered Eating general application of atypical eating behavior to maintain low weight– Going on & off diets; refusing to ingest fats– Usually not chronic behaviors: rarely cause

illness– Many people do seek psychiatric care for it

Intimately tied to body image

• Body image: the way you feel about your body

Factors contributing to Eating Disorders

• Family environment• Unrealistic media images• Sociocultural values• Personality traits• Genetic & Biological factors

Factors contributing to Eating Disorders

• Family environment– You’re more likely to develop an eating disorder

if a sibling has one– Families with anorexic member are more

“uptight”• Rigid structure; avoidance of controversial topics; fuzzy

interpersonal boundaries– Families with bulimic member are more

“chaotic”• Less stable organization; less nurturing; more angry &

disruptive

Factors contributing to Eating Disorders

• Unrealistic media images– Adolescents are less capable of understanding

that these are uncommon, unrealistic, and often unnatural body types.

– Consequently less able to distance themselves from a need to acquire that body

Factors contributing to Eating Disorders

• Sociocultural values– “Western values” contribute to eating disorders

• Significantly more common in white Western women than others (worldwide)

– Everyday interactions with family and peers influence how we feel about our bodies

Factors contributing to Eating Disorders

• Personality Traits– People with anorexia nervosa tend toward social

inhibition, compliance, emotional restraint• Do these traits predispose one to the disease, or are

they side-effects of starvation?– People with bulimia nervosa tend to be impulsive,

extroverted, have low self-esteem• seek external validation• Prone to mood swings that result in binging• Prone to self-criticism• Prone to anxiety disorders and substance abuse

Factors contributing to Eating Disorders

• Genetic & Biological factors– Both bulimia & anorexia are much more

common among related individuals• Could be due to genetic or cultural transmission

– Twin studies of bulimia nervosa found that relatedness (heritability) & key environmental factors EACH accounted for ~50% of the variability in who was diagnosed

– Imbalances in hormones involved with feelings of hunger may also be involved

Anorexia nervosa• Suite of unhealthful practices

employed to reduce weight below 85% of normal (for height & weight)

• 90-95% are young women• 0.5-1% of US females develop AN

– 5 - 20 % of those diagnosed will die from complications within 10 years.

• Leading cause of death in females aged 15-24

Anorexia nervosa• Symptoms:

– Self-starvation; refusal to maintain minimal body weight

– Intense fear of weight gain, despite being underweight by all measures

– Undue influence of body weight on self-image or denial of problem

– Amenorrhea in women past puberty• Absence of at least three menstrual cycles

Anorexia nervosa• Health risks:

– Loss of body fat– Loss of proteins from skeletal muscle and organs.

Reduction of non-vital functions• Periods cease; growth stops

– Electrolyte imbalance - leads to irregular heart beat & heart failure (cramping is least of your worries)

– Cardiovascular problems - tachycardia, low bp, dizziness

– GI problems - general weakness & loss of function– Osteoporosis…why?

Bulimia nervosa• Binging

– High rate & quantity of food consumption: more than usual (in relation of time, place, social context)

– Loss of self control; inability to stop; sense of euphoria

– Occur ~ twice or more per week• Purging

– Usually, but not always, after each binge– Vomiting, laxatives, obsessive exercise

Bulimia nervosa• Prevalence

– Affects 1-4% of women (estimate)– Mortality rates much lower than for AN

(1% dying within 10 years)– Occurs mostly in women, but also in men

competing in sports requiring a thin build

Bulimia nervosa• Symptoms

– Recurrent episodes of binging– Recurrent inappropriate compensatory

behavior (laxatives, vomiting, diuretics)– Binge-purge cycle continues for more

than three months– Body shape & weight unduly influence

self-image

Bulimia nervosa• Health risks

– Electrolyte imbalance leads to irregular heart beat & heart failure

• Caused by dehydration & loss of Na+ and K+ through vomiting

– GI problems: inflammation, ulceration, possible rupture of esophagus

• Caused by HCl + mechanical trauma from frequent vomiting– Dental problem: tooth decay, staining & mouth sores

• HCl in vomit– Calluses on hands, swelling in cheek & jaw area

Disordered Eating patterns• Binge eating• Chronic dieting• Chronic overeating

Binge Eating Disorder• Symptoms:

– Often overweight– Lack of control during binging– Chaotic eating behaviors (eating too fast,

too much, in private)– Negative self-esteem, poor body image– Often associated with depression,

substance abuse, anxiety disorders

Binge Eating Disorder• Health Risks:

– Increased risk of overweight or obesity– Foods eaten during binge are often high

in fat and sugar– Increased stress (caused be negative

self-talk) leads to psychological distress

Chronic Dieting• Symptoms:

– Preoccupation with food, weight, calories• Classify food as “good” or “bad”

– Strict dieting– Excessive exercise

• Chronic fatigue– Loss of concentration; mood swings– Increased criticism of body shape

Chronic dieting• Health Risks:

– Insuffiecient nutrient intake– Insufficient caloric intake

• low vitamin and mineral intake– Decreased energy expenditure due to a

reduced BMR– Decreased ability to exercise– Increased risk of eating disorder

Reduced BMR with dieting

Female Athlete Triad• Female athlete triad: serious medical syndrome

frequently seen in female athletes; consists of– Disordered eating– Menstrual dysfunction– Osteoporosis

• Seen especially in sports that emphasize lean bodies or use subjective scoring– Examples?