Chpt 8 Psychology- Eating Disorders

Bulimia nervosa (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 - The peak age About 90%-95% of bulimia nervosa cases occur in females - Onset is between 15 and 21 years --> - 6-7% of college women suffer from bulimia at some point - Symptoms may last for several years with periodic letup - Tends to be chronic if left untreated

Bulimia and anxiety/mood disorders

- Anxiety disorders and mood disorders commonly present - Over 80% had an anxiety disorder at some point during their lives

Episode of binge eating characterized by...

- Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. - a sense of lack of control over eating during the episode (e.g. a feelings that one cannot stop eating or control what or how much one is eating)

binge-eating/purging type of anorexia

- 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

Facts & Stats: Avoidance/RestrictiveFood Intake Disorder

- More common in Children than adults - Equally common in males and females in infancy and early childhood - Comorbid with Autism Spectrum Disorder - Adolescents receiving treatment at a specialist clinic, 14% met criteria for ARFID. Those with ARFID were more likely to be (Fisher,et al. (2014), Nicely, et al. (2014)--> tend to be younger and males

Bulimia Nervosa: Associated Features

- Most are within 10% of normal body weight - Purging methods can result in severe medical problems: §Erosion of dental enamel, electrolyte imbalance §Kidney failure, cardiac arrhythmia (disrupted heartbeat), seizures, intestinal problems, permanent colon damage - swollen salivary glands (puffy appearance), associated with vomiting

How does BED differ from bulimia nervosa?

- No compensatory behavior here (vomit, exercising, etc.)

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 (overestimating the proportions) - 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"

Facts & Statistics: Binge-Eating Disorder

- Prevalence: Females 1.6%: males 0.8% - Many persons with binge-eating disorder are obese: - Some, but not all, have concerns about shape and weight - Often older than individuals with bulimia and anorexia - More psychopathology vs. non-binging obese people - Tends to run in families

Medical and Psychological Treatment of Binge Eating Disorder

- Previously used medications for obesity are now not recommended - Psychological treatment -- CBT ---Similar to that used for bulimia ---Appears efficacious - Interpersonal psychotherapy -- Equally as effective as CBT - Self-help techniques ----also appear effective

Medical and Psychological Treatment of Bulimia Nervosa

- Psychosocial treatments: - Cognitive-behavioral therapy (CBT) (treatment of choice) - basic components of CBT: identifying thinking patterns and behavioral habits, then gradual practice of new habits -changing dysfunctional thoughts about weight and previous weight control strategies - Recommend small, frequent meals - Efficacy - CBT in short and long term helps reduce the binge and purging (pretty effective) - Medical and drug treatments - Antidepressants - Can help reduce binging and purging behavior - usually not efficacious in the long-term

bulimia nervosa

- Recurrent episodes of binge-eating. An episode of binge eating characterized by... - concerned with gaining weight as well - The disorder is also characterized by inappropriate compensatory behaviors, which mark the subtype of the condition

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 - lasts three months

Causes of Bulimia and Anorexia: Toward an Integrative Model

- dietary restraint influence by media, culture, standards of ideal body size - Family influences: - Tend to be high achievers Parents are professionals - Perfectionistic - Tend to be concerned about how others perceive them (external opinions are important to them) - Have communication problems/ boundaries are not clearly differentiated - Biological dimensions: - Appears to be some biological influence in the development of these disorders - inherited personality tendency (impulsive) - Psychological dimensions: - Decrease sense of self control, low self-esteem, perfectionistic

restricting type of anorexia nervosa

- lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food -show almost no variability in diet

Typical case of anorexia nervosa

-A normal to slightly overweight female has been on a diet -White, upper social economic status - Escalation toward anorexia nervosa may follow a stressful event: -Separation of parents -Move away from home -Experience of personal failure -Most patients recover: -About 2% to 6% become seriously ill and die as a result of medical complications -As many as 305 die of suicide

Avoidance/Restrictive Food Intake Disorder (ARFID)

-An eating or feeding disturbance: - Apparent lack of interest in eating or food - avoidance based on the sensory characteristics of food - concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: - Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). -Significant nutritional deficiency -Dependence on enteral feeding or oral nutritional supplements. - Marked interference with psychosocial functioning - Mainly avoidance b/c taste, texture, or fear of choking

Prevalence of Anorexia

-At any given point in time between 0.3-0.4% of young women & 0.1% of young men will suffer from anorexia nervosa - Young people between the ages of 15-24 with anorexia have 10 times the risk of dying compared to their same-aged peers -The peak age of onset is between 14 and 18 years uIt rarely begins before puberty or after age 40 -Cross-cultural factors: -Develop in non-Western women after moving to Western countries -Rare in African American women

symptoms of avoidance/restrictive food intake disorder (from particular studies that were mentioned)

-Avoidance -Decreased appetite -Abdominal pain -Fear or vomiting/ choking when they eat

Comorbidity Anorexia

-Bipolar disorder -Anxiety disorders -Depressive disorders -Alcohol and substance use comorbid among these with binge-eating/purging type •Depression (usually mild) •Anxiety •Low self-esteem •Insomnia or other sleep disturbances •Substance abuse •Obsessive-compulsive patterns •Perfectionism (equally serious)

Eating Disorder Women of Color

-Black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior -Research comparing Hispanic and Non-Hispanic adolescents found that Hispanics were significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers -Gordon, Brattole, Wingate, & Joiner, 2006, Presented Identical case studies depicting eating disorder symptom - Only differences in the cases was whether the woman was described as white, Hispanic, Black - Results: 44% identified the white woman's behavior as problematic, 41% identified the Hispanic woman's behavior as problematic, and only 17% identified the black woman's behavior as problematic - The clinicians were also less likely to recommend that the Black woman should receive professional help

WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA

-Expresses a need to "burn off" calories taken in -maintains an excessive, rigid exercise regimen- despite weather, fatigue, illness, or injury -Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive -Seems concerned about eating in public -feels ineffective -Has strong need for control -Shows inflexible thinking -has overly restrained initiative and emotional expression -Dramatic weight loss -Dresses in layers to hide weight loss -Preoccupied with weight, food, calories, fat grams , dieting -refuses to eat certain foods -Frequent comments about feeling "fat" -Develops food rituals -make excuses to avoid mealtimes or situations involving food

Bulimia : Facts and Statistics

-Majority are female - 90%+ -Onset typically in adolescence -Lifetime prevalence is about 1.1% for females, 0.1% for males - 6-7% of college women suffer from bulimia at some point -Tends to be chronic if left untreated

Anorexia: Facts and Statistics

-Majority female and white -From middle- to upper class families -Usually develops around early adolescence -More chronic and resistant than bulimia -Males (usually athletes or homosexual) -Lifetime prevalence -Cross cultural differences: -Develop in non-western women after moving to western countries -Underdiagnosed in African American woman

Treatment for Anorexia

-Most important initial goals is to restore the patients weight to a point that is at least within the low normal range -Body weight below 85% inpatient treatment is recommended - Must work on patients underlying dysfunctional attitudes about body shape, and interpersonal problems

Warning Signs & Symptoms of Bulimia

-Skips meals or takes small portions of food at regular meals -Disappears after eating, often to the bathroom -Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism) -Drinks excessive amount of water or non-caloric beverages - Uses excessive amounts of mouthwash, mints, and gum uHas calluses on the back of the hands and knuckles from self- induced vomiting -Teeth are discolored, stained -Creates lifestyle schedules or rituals to make time for binge-and-purge sessions -Withdraws from usual friends and activites

clinical picture of Anorexia Nervosa

-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 -Fear of losing control of the body and not being able to stop oneself and gain weight and cannot do anything about it -Kind of proud of their diets and ability to control eating habits-- might not admit it though b/c trying to hide

Anorexia Nervosa main symptoms

-refusal to maintain more than 85% of normal body weight - Intense fears of becoming overweight - distorted view of weight and shape - Amenorrhea

Two subtypes of Anorexia Nervosa

-restricting (most common) and binge eating/purging - equally serious in severity

Restrictive type of anorexia treatment

-treatment similar to CBT used for individuals with Bulimia -Work on the high anxiety about becoming obese and losing control of eating - Family therapy: Work on dysfunctional communication regarding food and eating, Discuss attitudes toward body shape and image distribution, and Particularly effective with young girls (less than 19 years old) with a short history of the disorder

How many symptoms must be present in order to diagnose someone with BED?

3 or more: - Easting fast - Getting to be very full -Eating but not really hungry -Feel ashamed of eating behavior, so hide when they eat -Feelings of guilt, depression, are very high after binge episode

Clancy reports that when he is not binging, he doesn't really eat much. Based on the current consensus surrounding the relationship between neurobiological abnormalities and eating disorders, which of the following statements applies to Clancy?

Abnormal serotonin levels are a result of disordered eating and also maintain it.

Prevalence rates for eating disorders also reflect cultural themes. Which factor most likely contributes to the prevalence rate of anorexia found in African American women?

African American women have less body dissatisfaction than Caucasian women.

As with all disorders, an integrative model provides the most comprehensive understanding of how a disorder develops. Select the statement that accurately describes this model in the context of eating disorders.

Analyzing the interaction of social, biological, and psychological factors provides a comprehensive understanding of how eating disorders develop.

extreme fear and apprehension about gaining weight is associated with which eating disorders

Anorexia Bulimia Binge Eating Disorder

The Major Types of Eating disorders r

Anorexia Bulimia Binge Eating Disorder Avoidant/Restrictive Food Intake Disorder

Bulimia Nervosa: Overview and Defining Features

Binge eating - hallmark of bulimia nervosa and binge eating disorder - Eating excess amounts of food in a discrete period of time - Eating is perceived as uncontrollable - May be associated with guilt, shame or regret - May hide behavior from family members - Foods consumed are often high in sugar, fat or carbohydrates - A binge episode is NOT defined by the number of calories

Bulimia Nervosa: the cycle

Compensatory behaviors - designed to "make up for" binge eating (relieve the negative feelings attached to binge eating) - becomes a cycle: purging--> bingeing--> purging...

Which statement characterizes the most likely consequence of the cycle illustrated?

Compensatory behaviors are also performed in an attempt to regulate mood.

Purging-type bulimia nervosa

Forced vomiting Misusing laxatives, diuretics, or enemas

To account for these gender differences, researchers have found the strongest connection with cultural and social factors, especially those portrayed by the media. Which of the following is an example of how social factors influence these differences in body image?

Media messages transmit a need to be thin more to women than men.

Somnambulism, a specific type of parasomnia, occurs during ---- sleep, indicating that people are not acting out a dream while sleepwalking.

NREM

Subtypes of Bulimia

Purging and non purging

What do all eating disorders have in common?

Severe disruptions in eating behavior, and weight and shape have disproportionate influence on self-concept

Which statement best describes the effectiveness of most purging techniques?

They do not compensate for calories consumed and actually cause an increase in body fat.

Researchers have been able to identify and categorize different types of sleep disorders from years of research. Suppose Dr. Kitano is one of these sleep researchers and has instructed participants to record the number of hours they spend in bed each night and how many of these hours are actually spent sleeping. Each participant then divided time spent sleeping by time spent in bed. She is gathering her data through the use of------.

a sleep efficiency calculation

Eating disorders, and ____, have the highest mortality of any psychological disorder.

anorexia nervosa in particular

______ a non-culture-bound syndrome with similar prevalence rates between Western and non-Western cultures. ______ , a culture-bound syndrome with different prevalence rates between Western and non-Western cultures.

anorexia nervosa, bulimia nervosa

Disorder 2 is most like ____ because the prevalence rate is _____ between Western and non-Western cultures.

anorexia nervosa; similar

People with anorexia nervosa are just as fearful as people with bulimia nervosa of gaining weight and losing control over their eating habits. However, people with bulimia are ----- of their diet.

ashamed

polysomnographic (PSG) evaluation

assessment of sleep disorders with monitoring of heart, muscle, respiration, and brain wave functions

binge

brief episode of uncontrolled, excessive consumption

circadian rhythm sleep disorder

condition caused by the body's inability to synchronize with current day/night patterns

insomnia disorder

condition in which insufficient sleep interferes with normal functioning

night eating syndrome

consumption of 1/3+ daily calories after the evening meal, leaving bed to have a snack

dyssomnias

difficulty getting to sleep or in obtaining sufficient quality sleep

primary insomnia

difficulty initiating, maintaining, or gaining from sleep

anorexia nervosa

disorder characterized by calorie restriction and dangerously low body weight

bulimia nervosa

disorder involving recurrent episodes of excessive consumption followed by compensatory purges

narcolepsy

disorder involving sudden and irresistible sleep attacks

binge-eating disorder (BED)

distress-inducing excessive food consumption not followed by purging behaviors

sleep terrors

episode of apparent awakening from NREM with panic and amnesia for the event

obesity

excess body fat resulting in a body mass index (BMI, a ratio of weight to height) of 30 or more

non-purging type bulimia

fasting, exercising frantically

interpersonal psychotherapy therapy

focusing on relationships, working on food and eating patterns

nightmares

frightening and anxiety-provoking dream occurring during rapid eye movement sleep

Dr. Ngumi is recruiting participants for her next study on eating disorders and expects the makeup of her sample to mirror trends found in the prevalence rates for eating disorders. As a result, Dr. Ngumi expects that of the men in the participant group, a --- number will have binge-eating disorder.

greater

These findings support the notion that women believe their current body type is ---- than the body type men find most attractive.

heavier

The ---- mortality rate associated with Disorder 2 (largest on the graph) represents the mortality rate for eating disorders.

higher

Medical treatments for people with --- often include one of several benzodiazepines (Halcion, Ambien), ideally of the ---- category, to reduce daytime sleepiness.

insomnia, short-acting

Medical and Psychological Treatment of Bulimia Nervosa

interpersonal therapy- about relationships (not weight) CBT Behavior therapy CBT and interpersonal more effective than behavior therapy

People with anorexia nervosa are just as fearful as people with bulimia nervosa of gaining weight and losing control over their eating habits. However, people with anorexia are ---- successful at losing weight.

more

Hubert's eating habits illustrate how the binge-eating/purging behavior of people diagnosed with anorexia nervosa differs from people diagnosed with bulimia nervosa, specifically in that Hubert purges -----.

more consistently

Beyond cultural considerations, critical periods in development are also known to influence the prevalence of eating disorders. The ----- changes that young women experience during puberty are likely to cause them to develop characteristics that are ---- the characteristics ascribed to the ideal body type for their gender.

physical; opposite of

sleep apnea

sleep disorder characterized by brief periods when breathing ceases during slumber

disorder of arousal

sleep disorder during NREM sleep that includes sleepwalking and sleep terrors

breathing-related sleep disorder

sleep disruption leading to excessive sleepiness or insomnia, caused by a breathing problem

hypersomnolence disorder

sleep dysfunction involving an excessive amount of sleep that disrupts normal routines

actigraph

small electronic device that is worn on the wrist like a watch and records body movements

bariatric surgery

surgical approach to extreme obesity

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) also distinguishes between two specific types of bulimia nervosa. For a clinician to indicate the presence of the purging type of bulimia nervosa, a patient must exhibit ------ to compensate for calories consumed.

vomiting

difference between bulimia and anorexia

•People with bulimia nervosa are more concerned about pleasing others, being attractive to others, and having intimate relationships •People with bulimia nervosa tend to be more sexually experienced and active • people with bulimia are more likely to have histories of mood swings, low frustration tolerance, and poor coping •People with bulimia may be of any weight but experience health problem related to their purging behavior Anorexia--> underweight Not the definition for bulimia patients •More than one-third of people with bulimia display characteristics of a personality disorder, particularly borderline personality disorder •Different medical complications: •Only half of women with bulimia nervosa experience amenorrhea vs/ almost all women with anorexia nervosa AND •People with bulimia nervosa suffer damage caused by purging, especially from vomiting and laxatives

rapid eye movement (REM) sleep

period when the eyes move rapidly from side to side and dreams occur

parasomnias

abnormal behavior such as nightmares or sleepwalking that occurs during sleep

sleepwalking

abnormal sleep behavior that involves leaving the bed during nonrapid eye movement sleep

Hunger and anxiety are felt in the presence of food--->More food is eaten to reduce anxiety--->Overeating causes _____________ emotions

negative

Dr. White is recruiting participants for a study on bulimia. If he expects his participant group to follow the trends found in the prevalence rates for bulimia, the male participants will be ----- than the female participants.

older

sleep efficiency (SE)

percentage of time actually spent sleeping of the total time spent in bed

Researchers have found that genetics account for up to 50% of the causes of eating disorders, with the inheritance of ---- potentially making it more likely for a person to have a -----.

perfectionism; need for order and control

microsleep

seconds-long nap that occurs when someone has been deprived of rest

No matter the purging technique utilized, medical consequences will likely follow. Select which of the following consequences is likely for the person using the purging technique of vomiting. Seizures Drastic weight loss Eroding dental enamel

seizures and eroding dental enamel

purging technique

self-induced vomiting or laxative abuse used to compensate for excessive food ingestion

rebound insomnia

worsened sleep problem that can occur when medications used to treat the condition are withdrawn

medical problems with anorexia

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