Abnormal Psychology Chapter 11

Anorexia Nervosa Clinical Description: 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 Statistics:

- About 90% - 95% of cases occur in females - The peak age of onset is between 14 and 18 years - Between 0.5% and 3.5% of females in Western countries develop the disorder. Many more display at least some symptoms.

Eating Disorders Drug Treatment

- Anorexia * No demonstrated efficacy - Bulimia * Antidepressants * May enhance psychological treatment * No long-term efficacy

Binge Eating Disorder Continues

- Between 2 and 7% of the population display binge eating disorder - The binges and many other symptoms that characterize this pattern are similar to those seen in bulimia - On the other hand, those with binge eating disorder are not driven to thinness, the disorder doesn't start following a diet, and there are not large gender differences in the prevalence of this disorder.

Eating Disorder Etiology "Biological genes"

- Biological theorists suspect certain genes may leave some people particularly susceptible to eating disorders. *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% - 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)

Clinical Description of Bulimia Nervosa

- Bulimia nervosa, also known as "binge-purge syndrome," is characterized by binges: Repeated bouts of uncontrolled overeating during a limited period of time. Eat objectively more than most people would/ could eat in a similar period. - The disorder is also characterized by inappropriate compensatory behaviors, including: * Forced vomiting * Misusing laxatives, diuretics, or enemas * Fasting * Exercising excessively - Patients are generally of normal weight.

Eating Disorders Etiology "Cognitive factors"

- 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). - There is empirical support for the claim that mood disorders set the state for eating disorders: * Many more people with an eating disorder qualify for a clinical diagnosis of major than do people in the general population. * Close relatives of those with eating disorders seem to have higher rates of depressive disorders. * People with eating disorders, especially those with bulimia nervosa, have serotonin abnormalities. * Symptoms of eating disorders are helped by antidepressant medications.

Binge Eating Disorder Treatment

- Cognitive-behavior therapy *Similar format to bulimia -Interpersonal psychotherapy * As effective as CBT - Medications *Prozac-no benefit * Meridia - possible benefits

Eating Disorders Treatment

- 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.

Eating Disorders Etiology Continues

- 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. - 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 over-involvement in, and over-concern about, family member's lives.

Binge Eating Disorder, Comparison to Bulimia Disorder

- Like those with bulimia, individuals with binge eating disorder engage in repeated eating binges during which they feel no control. These individuals do not perform inappropriate compensatory behaviors. - As a result of their binges, two-thirds of people with this disorder become overweight or obese. * It is important to recognize, however, that most overweight people do not engage in repeated binges.

Eating Disorders Gender 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; - 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 - Some men seem to be caught up in a new kind of eating disorder- reverse anorexia nervosa or "muscle dysmorphobia."

Eating Disorders Etiology: Societal Pressure

- Many theorists believe that current Western standards of female attractiveness are partly responsible for the emergence of eating disorders. -Media standards - Social and gender standards * Internal and perceived -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.

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 as many as 10,000 calories per binge episode. - Binges are usually preceded by feelings of great tension - Although the binge itself maybe pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and being discovered. - After a binge, people with bulimia nervosa try to compensate for and "undo" the caloric effects. Many resort to vomiting.

Anorexia Nervosa Treatment

- Weight restoration *May require hospitalization -Psycho-education -Cognitive Behavioral Therapy (CBT) to target dysfunctional attitudes. * Body shape * Control * Thinness = worth - Family involvement *Communication about eating / food * Attitudes about body shape - Long-term prognosis * Poorer than bulimia - Cognitive-behavior therapy (CBT) *Treatment of choice * Target problem eating behaviors * Target dysfunctional thoughts - Interpersonal psychotherapy * Improve interpersonal functioning * Similarly effective, long-term

Eating Disorder; Two main diagnoses:

1- Anorexia nervosa 2-.Bulimia nervosa

Identifying Eating Disorders:

1. It has not always done so, but Western society today equates thinness with health and beauty. (Thinness has become a national obsession.) 2. There has been a rise in eating disorders in the past three decades; The core issue is a morbid fear of weight gain.

Causes of Eating Disorders

1. What figure most approximates your current figure? 2. What figure represents what you would like to look like (ideal figure)? 3. What figure of the opposite sex do you find most attractive?

Bulimia Nervosa

A disorder marked by frequent eating binges that are followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight. Also known as the binge-purge syndrome.

Anorexia Nervosa

A disorder marked by the pursuit of extreme thinness and by extreme loss of weight.

Binge eating disorder

A third disorder "binge eating disorder- also appears to be on the rise. *Fear of weight gain is not to the same degree as with anorexia or bulimia *People with this disorder display many of the other features found in those disorders.

binge

A third eating disorder called binge. An episode of uncontrollable eating during which a person ingests a very large quantity of food.

Anorexia Nervosa Medical Consequences:

Caused by starvation: * Amenorrhea * Low body temperature * Low blood pressure * Body swelling * Reduced bone density * Slow heart rate * Metabolic and electrolyte imbalances * Dry skin, brittle nails * Poor circulation * Lanugo

Anorexia Nervosa Associated Psychological Disorders:

People with anorexia nervosa also display certain psychological problems: * Depression * Anxiety * Low self-esteem * Insomnia or other sleep disturbances * Substance abuse * Obsessive-compulsive patterns * Perfectionism

Anorexia Nervosa:

The "typical" case: - A normal to slightly overweight female has been on a diet. Dieting is the #1 precipitant! - 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; Some symptoms seem chronic. - Rarely seek treatment.

Amenorrhea

The cessation of menstrual cycles

Anorexia Nervosa Clinical Description:

There are two main sub-types: 1. Restricting type: Lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food. *Show almost no variability in diet. 2. Binge-eating / purging type: Lose weight by forcing themselves t vomit after meals or by abusing laxatives or diuretics. * Like those with bulimia nervosa, people with this sub-type may engage in eating binges.