Abnormal Psychology Chapter 11

Anorexia Nervosa Statistics

-90-95% of cases occur in females -peak of onset is between 14-18 years old. -between .5-3.5% of all females develop the disorder in their lifetime, and many more display at least some of its symptoms. -most victims recover, however 2-6% become so seriously ill that they die, usually from medical problems brought about by starvation or from suicide.

Bulimia Nervosa vs Anorexia Nervosa- Differences

-Although people with either disorder worry about the opinions of others, those with Bulimia Nervosa tend to be more concerned about pleasing others, being attractive to others, and having intimate relationships. They also tend to be more sexually experienced and active than people with anorexia nervosa. -People with bulimia nervosa are more likely to have long histories of mood swings, become easily frustrated or bored, have have trouble coping effectively or controlling their impulses and strong emotions. More than 1/3 display characteristics of a personality disorder, particularly borderline personality disorder. -Only 1/2 of women with bulimia nervosa are amenorrheic or have irregular menstrual periods, compared to almost all of those with anorexia nervosa. -repeated vomiting bashes teeth and gums leading to serious dental problems as well as dangerous potassium deficiencies which may lead to weakness, intestinal disorders, kidney disease, or heart damage.

Clinical Picture of Anorexia Nervosa

-Becoming thin is the key goal for people with anorexia nervosa, but fear provides their motivation. -people with this disorder are afraid of becoming obese, of giving in to their growing desire to eat, and more generally or losing control over the size and shape of their bodies. -they are preoccupied with food -they think in a distorted way- low opinion of their body shape and consider themselves unattractive. They are likely to overestimate their actual proportions (think that they are larger than they actually are). --takes form in certain maladaptive attitudes and misperceptions.

Cognitive-Behavioral Techniques Treating Bulimia Nervosa

-Exposure and Response Prevention to help break the binge-purge cycle --require clients to eat particular kinds and amounts of food and prevent them from vomiting.

Family Environment Factors of Eating Disorders

-Families that emphasize thinness, physical appearance, and dieting. -abnormal interactions and forms of communication -enmeshed family pattern leads to eating disorders (over involved and over concerned)

Preceding a Binge (after)

-Feelings of great tension -person feels irritable, "unreal", and powerless to control an overwhelming need to eat "forbidden" foods. -extreme self-blame, shame, guilt, and depression, as well as fears of gaining weight and being discovered.

Psychodynamic Factors: Ego Deficiencies- Eating Disorders

-Hilde Brunch --argued that disturbed mother-child interactions led to serious ego-deffenciencies int he child and to severe perceptual disturbances that jointly help produce disordered eating. --effective parents- accurately attend to their children's biological and emotional needs, giving them food when they are crying fro hunger and comfort them when they are crying out of fear. --ineffective parents- fail to attend to their children's needs, deciding that their children are hungry, cold, or tired without correctly interpreting the child's actual condition- children grow up confused and unaware of their internal needs and unable to identify their emotions. they cannot rely on internal signals so they turn to external guides, such as their parents. fail to develop genuine self reliance and believe they aren't in control of their own bodies. To overcome their sense of helplessness, they seek excessive control of their body size and shape and over their eating habits.

Multidimensional Risk Perspective

-Identify several key factors that put individuals at risk for these disorders. -psychological problems (ego, cognitive, and mood disturbances), biological factors, and sociocultural conditions (societal, family, and multicultural pressures).

Cognitive Factors of Eating Disorders

-People with Anorexia nervosa and Bulimia Nervosa judge themselves- often exclusively- based on their shape and weight and their ability to control them.

Bulimia Nervosa

-People with bulimia nervosa- A disorder known as binge-purge syndrome- engage in repeated episodes of uncontrollable overeating, or binges. -Repeatedly perform innapropriate compulsory behaviors such as forcing themselves to vomit; misusing laxatives, diuretics, or enemas; fasting; or exercising excessively.

Compensatory Behaviors Bulimia Nervosa

-after a binge, people with bulimia nervosa try to compensate for and undo its effects. -many resort to vomiting, however, vomiting fails to prevent the absorption of half of the calories consumed during a binge. Also leads to greater hunger and more frequent binges. -use of laxatives and diuretics largely fails to undo the caloric effects of binging. -compensatory behaviors may temporarily relieve the uncomfortable physical feelings of fullness or reduce the feelings of anxiety and self-disgust attached to binge eating. -however, it becomes a cycle which eventually causes people with this disorder to feel powerless and disgusted with themselves.

Antidepressant Medications Bulimia Nervosa

-all types have been used to treat -helped considerably by these drugs -drug therapy works best in combination with other forms of therapy, particularly cognitive-behavioral.

How does Bulimia Nervosa typically begin?

-begins during or after a period of intense dieting, often one that has been successful and earned praise from family members and friends.

Bulimia Nervosa vs Anorexia Nervosa Similarities

-both typically begin after long period of dieting by people who are fearful of becoming obese; driven to become thin; preoccupied with food, weight and appearance; and struggling with depression, anxiety, obsessiveness, and the need to be perfect. -individuals both have a heightened risk of suicide. -substance abuse may accompany either disorder -people with both disorders believe they weight too much and look too heavy regardless of their actual weight or appearance. -both mark disturbed attitudes towards eating.

Cognitive Behavioral Therapy Anorexia Nervosa

-combination of behavioral and cognitive interventions are included. -behavioral side- clients are typically required to monitor their feelings, hunger levels, and good intake. -on cognitive side- they are taught to identify their "core pathology"- the deep seeded belief that they should in fact be judged by their shape and weight and by their ability to control these physical characteristics. they may also be taught alternative ways of coping with stress and of solving problems. -help patients recognize their need for independence and teach more appropriate ways to exercise control. -change their attitudes about eating or weight. identify challenge and change maladaptive assumptions

How are proper weight and normal eating restored?

-day hospitals or outpatient settings -life-threatening situations- force tube and intravenous feedings on patient who refuses to eat. -rewards whenever patients eat properly or gain weight and no rewards if they fail to do so -supportive nursing care, nutritional counseling, and a relatively high calorie diet. -gradually increase patients diet

Anorexia Nervosa Psychological Problems

-depression, anxiety, low self-esteem, and insomnia or other sleep disturbances. -a number grapple with substance abuse -many display obsessive-compulsive patters (rigid rules for food preparation or exercise compulsively. -tend to be perfectionists

Multicultural Factors of Eating Disorders

-different cultures/races have different ideals of beauty -acculturation -gender differences: double standard for attractiveness. --different methods of weight loss by different genders (men-exercise, women-dieting). --often men develop eating disorders because of requirements and pressures of a job or sport or body image. some men have reverse anorexia nervosa or muscle dysmorphia where they are very muscular but see themselves as scrawny and strive for perfect body through extreme measures.

Changing family interactions Anorexia Nervosa

-family therapy -help patient separate their feelings and needs from those of other members of their family.

Behavior Techniques Treating Bulimia Nervosa

-instruct clients to keep diaries of their eating behavior, changes in sensations of hunger and fullness, and the ebb and flow of other feelings. helps clients observe objectively and recognize emotions and situations that trigger their desire to binge.

Mood Disorder Factors of Eating Disorders

-many with eating disorders, particularly bulimia nervosa, experience symptoms of depression. -believe that mood disorders set the stage for eating disorders

Bulimia Nervosa Statistics

-occurs in females 90-95% of the cases. -begins in adolescence or young adulthood and often lasts for several years with periodic letup. -the weight of people with bulimia nervosa usually stays within a normal range, although it may fluctuate markedly within that range. -some people may become seriously underweight and qualify for a diagnosis of anorexia nervosa instead. -25-50% of students report periodic binge eating or self-induced vomiting. -Surveys in western countries suggest that as many as 5% of women develop the full syndrome.

Treatments for Bulimia Nervosa Goal

-often offered in eating disorder clinics -helping clients to eliminate their binge-purge patterns and establish good eating habits and the more general goal of eliminating the underlying cause of bulimic patterns. -programs emphasize education as much as therapy -cognitive behavioral therapy -antidepressant drug therapy

Cognitive Techniques Treating Bulimia Nervosa

-to help clients recognize and change their maladaptive attitudes towards eating, food, weight and shape. -teach individuals to identify and challenge negative thoughts that precede their urge to binge. -help 65%

Binge

-uncontrollable eating -occurs over a limited period of time, often an hour, during which the person eats much more food than most people would eat during a similar time span. -people with bulimia nervosa may have between 1-30 binge episodes per week. -usually carried out in secret -eats massive amounts of food very rapidly, often without chewing (usually sweet, high calorie foods with a soft texture) -food is hardly tasted or thought about -consume between 1,000-10,00 calories during an episode.

Societal Pressure factors of eating disorders

-western society glorifies thinness and also creates a climate of prejudice against overweight people

Two goals for eating disorder treatment

1. correct the dangerous eating pattern as quickly as possible 2. address the broader psychological and situational factors that have led to and maintain the eating problem. -family and friends can also play an important role in helping overcome disorder.

Anorexia Nervosa DSM Categorization

1. refusal to maintain body weight above a minimally normal weight for age and height 2. intense fear of gaining weight, even though underweight. 3. disturbed body perception, undue influence of weight or shape on self-evaluation, or denial of the seriousness of the current low weight. 4. In postmenarcheal females, amenorrhea.

How does Anorexia Nervosa typically begin?

Typically the disorder begins after a person who is slightly overweight or of normal weight has been on a diet. The escalation toward anorexia nervosa may follow a stressful event, such as separation of parents, a move away from home, or an experience of personal failure.

Interpersonal Psychotherapy bulimia nervosa

alternative to cognitive-behavioral therapy -seeks to improve interpersonal functioning

Biological Factors of eating disorders

Believe that certain genes may leave some persons particularly susceptible to eating disorders.

How do people with Anorexia Nervosa reduce their weight?

By restricting their intake of food, a pattern called restricting-type anorexia nervosa. -first they tend to cut out sweets and fattening snacks -then, increasingly, they eliminate other foods. -eventually, they show almost no variability in diet. -they also may lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics, and they may even engage in eating binges, a pattern called Binge-Eating/Purging-type Anorexia Nervosa.

Binge-Eating Disorder

Certain people, a number of them overweight, display a pattern of binge eating without vomiting or other inappropriate compensatory behaviors.

Non-Purging Type Bulimia Nervosa

If individuals compensate by fasting or exercising frantically instead of purging.

How are lasting changes achieved with anorexia nervosa?

Must overcome underlying psychological problems in order to achieve lasting improvement. -education, psychotherapy, and family approaches.

Treatments for anorexia nervosa

help regain lost weight, recover from malnourishment, and eat normally again. -therapists help to make psychological and family changes