Eating Disorders

Abnormal Psychology

Chapter 10

Kate Moss vs. Marilyn Monroe

• Cultural Obsessions with thinness• Increased incidence of diagnosis• Statistics of dieting and body perception

Eating Disorder Subtypes

• Anorexia Nervosa- the refusal to maintain a minimally normal body weight. Anorexia literally means “loss of appetite” when in actuality people suffering from anorexia are hungry but they starve themselves, sometimes to death.

• Bulimia Nervosa- characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors suchas self-induced vomiting, misuse of laxatives or excessive exercise. Bulimia literally means “hungry enough to eat an ox”. The person suffering from bulimia usually has a normal appetite and maintain a normal weight.

Symptoms associated with Anorexia

1. Refusal to Maintain a Normal Weigh

2. Disturbance in evaluation weight or shape

3. Fear of Gaining Weight

4. Cessation of Menstruation (Amenorrhea)

Medical Complications– Electrolyte imbalance that can lead to cardiac

arrest or kidney failure.– Inability to maintain normal blood pressure and

temperature.– Lanugo-development of a fine downy hair on the

face or trunk of the patient.– Abnormally dry and cracked skin– Infertility– Dental erosion– Bone loss– Lethargy– Anemia

Co-morbid Diagnosis

• Obsessive Compulsive Disorder• Depression• Obsessive Compulsive Personality

Disorder• Bi-directionality with OCD and Depression

Bulimia

• Many people with bulimia have a history of anorexia.

• (Def). Eating an amount of food in a fixed period of time that is clearly larger than most people would eat under a similar circimstance.

• Societal Confounds to Def.

Binge Eating

• Spontaneous or planned

• Inappropriate Compensatory Behaviors

Excessive Emphasis on Weight or Shape

• Body perception and obsession shared with anorexics.

• Exhilarated by positive comments or interest in their appearance.

• Self –esteem falls with any negative comments about their appearance

Co-morbid Psychological Disorders

• Depression• Anxiety Disorders• Personality Disorders• Substance Abuse

Medical Complications

• Dental erosion• Sensitized Gag reflex• Enlargement of the salivary glands• Electrolyte imbalance• Ruptured esophagus or stomach

Classification of Eating Disorders

• Anorexia Nervosa- Defined by the four symptoms previously discussed:– Refusal to maintain normal body weight– Intense fear of weight gain– Disturbance in perception of body shape including

denial of the seriousness of low body weight– Amenorrhea

Two subtypes:• Restricting-people who rarely engage in binge eating or purging• Binge eating/purge eating-defined by regular binge eating and

purging during the course of the disorders.

Epidemiology of Eating Disorders

• Gender differences and Standards of Beauty– 10 times more common among women than men. – Cultural ideal of beauty changes over time, with the

ideal becoming more and more thin. – Research on Beauty Pageant Contestants and

Playboy Centerfolds from 1959-1988.– Barbie Doll

• Age of Onset– - typically begin in late adolescence or early

adulthood.– there is a significant rise in cases of anorexia during

early adolescence as girls approach puberty.

Etiology

• Social Factors– Internalization of the ideal of thinness– Troubled Family Relationships: Different in

Bulimia and Anorexia• Bulimics-considerable conflict and rejection in

families.• Anorexics - enmeshment hypothesis anorexics

Psychological Factors

• Psychologists have not yet identified unambiguous contributing psychology factors to eating disorders.

• Four most prominent theories– Control Issues– Depression/Dysphoria– Body Image dissatisfaction– Reaction to dietary restraint.

Struggle for Control Theory (Bruch)

• Cluster of psychological symptoms that appear to contribute to the development of eating disorders.– Excessive External Control (Good Girls &

People Pleasers)– Perfectionism– Lack of Introceptive Awareness

Depression, Low Self Esteem, Dysphoria

• Depression, dysphoria (negative mood states), and low self esteem have been shown to contribute to the onset, or maintain cases of eating disorders.

• Anti-depressant medication has been shown to reduce symptoms of bulimia.

• Family incidence• Low self esteem and pre-occupation with social

self.• Dysphoria triggers binge eating.

Negative Body Image

• Highly critical evaluation of one’s weight and shape.

• Includes both a distorted perception and a dissatisfaction with one’s body evidenced by a large distance between a person’s actual and ideal.

• Thought to be problematic when combined with other risk factors such as perfectionism and low self esteem.

Dietary Restraint

• Some symptoms of eating disorders are thought to be direct consequences of restricted eating.

• Overly strict diet increases hunger, frustration and lack of attention to internal cues, all of which make binge eating more likely.

• Obsessive thoughts and compulsive eating rituals have been found to be direct consequences of semistarvation.

• Food restriction itself may trigger other behavior patterns seen in eating disorders such as obsessions about food, and rituals such as compensatory behaviors.

Biological Factors

• Homeostatic Mechanisms• Weight set points• Hyperlipogenesis• Genetics

Anorexia:Treatment and Outcome

• Weight Gain• Address Difficulties that lead to disorder in therapy

– Structured Family therapy– Interoceptive awareness– Cognitive Behavioral Therapy

• Outcome– Current treatments not very effective– Life long struggle with preoccupation with diet, weight and

body shape.

Bulimia:Treatment and Outcome

• Anti-depressant Medication• Cognitive Behavioral Therapy• Interpersonal Psychotherapy• Outcome

The Case of Florence

History:Florence was a 30 year old single white female with a

Bachelors Degree in English.Parents: Both livingOne Brother: 34 married with children worked as a lawyer.Medical Problems: None---except for previous in patient

treatment for Anorexia Employment: She worked at as a regional manager for a

grocery store chain, and was forced to go to therapy by her boss due to her increasing weight loss.

Symptoms

• Weight at 91 lbs at 5’9’’• Shivering—extremely cold at 73 degrees• Lanugo• Stringy hair• Poor eye contact• Flat affect• Admitted to feeling pressure from job and family• Forced into therapy by boss due to severe weight loss• Denial that anything was wrong, thought co-workers might

be jealous of how thin she was-claimed “she looked like a fox”, was very proud of her 91 pounds, but her ideal was 87.

Background• Normal childhood• At age 13, she was made fun of for being fat, even though she

weighed 125 at 5’8”, she began exercising daily and dieting.• Admired thin actresses and wanted to look like them.• By 14 she was exercising 3 hours a day and her grades had

dropped. She had a boyfriend for a year, and was convinced her liked her because she was thin, and broke up with her because she gained weight.

• Eating rituals developed, she would only eat on certain days and at certain times to maintain her 93 pounds in high school.

• Menstruation stopped—she decided this was a good thing as she would not have to worry about getting pregnant when she did have sex.

• At 15, she fainted at school and was diagnosed with Anorexia and entered in patient therapy.

Therapeutic Insights as a teen-ager

• Florence realized she had a problem during her first in patient treatment where she underwent intensive therapy.

• Claimed to hate herself, not know who she was. She also felt inferior to her family and like she would not amount to much.

• She claimed the treatment helped, she was released and went to college.

Relapse• Florence did not continue treatment when she went to college as

she felt things were under control. However, upon gaining 20 pounds her freshman year. She was horrified at the weight gain, and although she did not restrict, she exercises until she took the 20 pounds off.

• Florence anorexia stayed under control until crisis occurred in her life, usually centering around work or men.

• Florence was hired by a supermarket chain just out of college where she was very successful. Her symptoms returned when she started graduate school part time and felt pressure to maintain good grades and perform well at work. She was upset by gaining weight, and turning 30.

• All symptoms returned at this time, as she weighted 93 pounds, developed amennorhea and thought she looked fabulous.

• Concern of co-workers and boss forced her into treatment or she would lose her job.

Assessment

• Unstructured Interview• Thematic Apperception Test• Becks Depression Inventory-mild• Physical Examination-family physician

hospitalized her immediately and she claimed he scared her for the first time in her life by telling her she was dangerously underweight and some of the medical complications that could happen due to her extreme weight loss.

Treatment Plan• Slowly restore weight an normalize eating patterns. Weight gain needs to be

gradual at about 2-3 pounds per week, during which she had to remain in the hospital (30 days after which she weighed 116).

• Group Therapy-first involved with group therapy and then discontinued. Anorexics often compare themselves to others and are jealous or upset by women who are thinner and often want to drop out. Group therapy has mixed results with all anorexics.

• Family therapy-very helpful as communication between Florence and her parents were poor. They admitted they had wanted her to be a doctor or lawyer, and she felt their disappointment. They were able to communicate being proud of her accomplishments.

• Individual Therapy-Florence liked the one on one most and found it most helpful.

• Upon discharge, she agreed to go to some support groups for Anorexics and found them very helpful. She also agreed to participate in family therapy at a later time.

• Continued in treatment for one year, at which time she was discharged. She was effectively communicating with her family, doing well at work, and maintaining her weight as well as a good body image.

Prognosis

• Fair• Eating disorders are not thought to be

cured, but can definitely go into remission, the patient must be aware of this and look for any signs that the disorder is recurring.