Abnormal Psychology Chapter 8: Eating Disorders

treatment for anorexia nervosa

The most important initial goal is in treatment to restore the patient's weight to a point that is at least within the low- normal range. If body weight is below approximately 75% of average healthy body weight, or if weight has been lost rapidly and the individual continues to refuse food, inpatient treatment is recommended because severe medical complications, particularly acute cardiac failure, could occur if weight is not restored immediately. If the weight loss has been more gradual and seems to have stabilized, weight restoration can be accomplished on an outpatient basis. Treatments for restricting anorexics are similar to those for patients with bulimia, particularly in the CBT-E approach. Every effort is made to include the family: (1) the dysfunctional communication in the family regarding eating must be eliminated and meals must be made more structured and reinforcing and (2) attitudes toward body shape and image are discussed in family sessions. This seems particularly effective in young girls (>19) with a short history of the disorder.

cross-cultural considerations of eating disorders

A particularly striking finding is that these disorders develop in immigrants who have recently moved to Western countries. Earlier surveys revealed that African-American adolescent girls have less body dissatisfaction, fewer weight concerns, a more positive self-image, and perceive themselves to be thinner than they are, compared with the attitudes of Caucasian adolescent girls. Today, the prevalence of eating disorders is now more similar among non-Hispanic whites, African American, Asian American, and Hispanic females. Eating disorders are generally more common among Native Americans than other ethnic groups.

drug treatments for eating disorders

There is some evidence that drugs may be useful for some people with bulimia, particularly during the bingeing and purging cycle. Most effective for bulimia are the same antidepressant medications proven effective for mood disorders and anxiety disorders. Evidence suggests that antidepressants alone do not have substantial long-lasting effects on bulimia nervosa, and current expert opinions suggest that medications are likely most useful in conjunction with psychological treatments.

comorbidity with anorexia nervosa

anxiety disorders and mood disorders are often present in individuals with anorexia with rates of depression occurring at some point during their lives in as many as 71% of cases; often co-occurs with obsessive-compulsive disorder (OCD); substance abuse often occurs and is a strong predictor of mortality, particularly by suicide

integrative model of eating disorders

biological influences: inherited vulnerability (unstable or excessive neurobiological response to stress associated with impulsive eating) social influences: cultural pressures to be thin and family interactions/pressures (ex: social presentation) psychological influences: anxiety focused on appearance and presentation to others and distorted body image

comorbidity with bulimia nervosa

An individual with bulimia usually presents with additional psychological disorders, particularly anxiety and mood disorders. 80.6% of individuals with bulimia had an anxiety disorder at some point during their lives and 66% of adolescents with bulimia presented with a co-occuring anxiety disorder when interviewed. Mood disorders, particularly depression, also commonly co-occur with bulimia, with about 20% of bulimic patients meeting criteria for a mood disorder when interviewed, and between 50% and 70% meeting criteria at some point during the course of their disorder. Substance abuse commonly accompanies bulimia nervosa.

psychological dimensions of eating disorder development

Clinical observations have indicated that many young women with eating disorders have a diminished sense of personal control and confidence in their own abilities and talents. hey also display more perfectionistic attitudes, which may reflect attempts to exert control over their lives. Individuals must consider themselves overweight and manifest low self-esteem before the trait of perfectionism makes a contribution. Women with eating disorders feel like impostors in their social groups and experience heightened levels of social anxiety. This can cause more isolation from the social world. At least a subgroup of these patients has difficulty tolerating any negative emotion and may binge or engage in other behaviors, such as self-induced vomiting or intense exercise, in an attempt to reduce their anxiety or distress

developmental considerations of eating disorders

Differential patterns of physical development in girls and boys interact with cultural influences to create eating disorders. After puberty, girls gain weight primarily in fat tissue, whereas boys develop muscle and lean tissue. As the ideal look in Western countries is tall and muscular for men and thin and prepubertal for women, physical development brings boys closer to the ideal and takes girls further away.

eating disorder facts and statistics

Eating disorders were included for the first time as a separate group of disorders in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV). Until recently, eating disorders, particularly bulimia, were not found in developing countries, where access to sufficient food is so often a daily struggle; only in the West, where food was generally plentiful, have they been rampant. Now this has changed; evidence suggests that eating disorders are going global. Eating disorders tend to occur in a relatively small segment of the population. More than 90% of the severe cases are young females who live in a socially competitive environment. Among women, adolescent girls are most at risk.

Fallon and Rozin Case Study

Enlisting male and female undergraduates, found that men rated their current size, their ideal size, and the size they figured would be most attractive to the opposite sex as approximately equal; indeed, they rated their ideal body weight as heavier than the weight females thought most attractive in men. Women, however, rated their current figures as much heavier than what they judged the most attractive, which in turn, was rated as heavier than what they thought was ideal. Men have different body perceptions than women.

DSM 5 Criteria of Anorexia Nervosa

Features of anorexia nervosa include the following: • Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health • Intense fear of gaining weight or persistent behavior that interferes with weight gain, even though at a significantly low weight • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

DSM 5 Criteria for Binge-Eating Disorder

Features of binge-eating disorder include the following: • Recurrent episodes of binge-eating • The binge-eating episodes are associated with three (or more) of the following: (1) eating much more rapidly than normal, (2) eating until feeling uncomfortably full, (3) eating large amounts of food when not feeling physically hungry, (4) eating alone because of feeling embarrassed by how much one is eating, and (5) feeling disgusted with oneself, depressed, or very guilty afterward • Marked distress regarding binge-eating is present • The binge-eating occurs, on average, at least once a week for three months • The binge-eating is not associated with the recurrent use of inappropriate compensatory behavior

DSM 5 Criteria for Bulimia Nervosa

Features of bulimia nervosa include the following: • Recurrent episodes of binge-eating, characterized by an abnormally large intake of food within any two-hour period, combined with a sense of lack of control over eating during the episode • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise • On average, the binge-eating and inappropriate compensatory behaviors both occur at least once a week for three months. • Self-evaluation is unduly influenced by body shape and weight.

social dimensions of eating disorder development

If cultural pressures to be thin are as important as they seem to be in triggering eating disorders, then such disorders would be expected to occur where these pressures are particularly severe. Dieting is one factor that can contribute to eating disorders along with dissatisfaction with one's body. The "typical" family of someone with anorexia is successful, hard-driving, concerned about external appearances, and eager to maintain harmony. y. To accomplish these goals, family members often deny or ignore conflicts or negative feelings and tend to attribute their problems to other people at the expense of frank communication among themselves. However recently: "It is the position of the Academy for Eating Disorders (AED) that whereas family factors can play a role in the genesis and maintenance of eating disorders, current knowledge refutes the idea that they are either the exclusive or even the primary mechanisms that underlie risk."

CBT for binge-eating disorder

In a study, individuals with BED for one year and found that immediately after treatment with CBT, 41% of the participants abstained from bingeing and 72% binged less frequently. After one year, binge-eating was reduced by 64%, and 33% of the group refrained from bingeing altogether. Additionally, those who had stopped binge-eating during CBT maintained a weight loss of approximately nine pounds over this one-year follow-up period; those who continued to binge gained approximately eight pounds. It appears that IPT (interpersonal therapy) is as effective as CBT for binge-eating. Prozac does not seem too beneficial alone or with CBT. Some racial and ethnic differences are apparent in people with BED seeking treatment. African-American participants tend to have higher BMI, and Hispanic participants have greater concerns with shape and weight than Caucasian participants. Thus, it would seem that tailoring treatment to these ethnic groups would be useful. Males and females may also respond differently. CBT delivered as guided self-help was demonstrated to be more effective than a standard behavioral weight-loss program for BED both after treatment and at a two-year follow-up and this same program is effective when delivered out of a doctor's office in a primary care setting.

anorexia nervosa facts and statistics

Individuals with anorexia tend to maintain a low BMI over a long period, along with distorted perceptions of shape and weight, indicating that even if they no longer meet criteria for anorexia they continue to restrict their eating. 20% of people with this disorder die as a result and about 5% die within 10 years; 20-30% of deaths are suicides, which is 50 times higher than the risk of death from suicide in the general population

bulimia nervosa facts and statistics

Of those treated, approximately 90 to 95% if the individuals with bulimia are women. Males with bulimia have a slightly later age of onset, and a large minority are gay males or bisexual. Once bulimia develops, it tends to be chronic if untreated. Bulimia also has a relatively poor prognosis. The strongest predictors of persistent bulimia were a history of childhood obesity and a continuing overemphasis on the importance of being thin.

CBT-E for bulimia nervosa

Stage 1: teaching the patient the physical consequences of binge-eating and purging, as well as the ineffectiveness of vomiting and laxative abuse for weight control; adverse effects of dieting are also described, and patients are scheduled to eat small amounts of food five or six times per day with no more than a three-hour interval between any planned meals and snacks, which eliminates the alternating periods of overeating and dietary restriction that are hallmarks of bulimia In later stages, CBT-E focuses on altering dysfunctional thoughts and attitudes about body shape, weight, and eating. Coping strategies for resisting the impulse to binge and/or purge are also developed, including arranging activities so that the individual will not spend time alone after eating during the early stages of treatment. There is also evidence that family therapy directed at the painful conflicts present in families with an adolescent who has an eating disorder can be helpful

preventing eating disorders

Stice and colleagues (2007): selecting girls age 15 or over and focusing on eliminating an exaggerated focus on body shape or weight and encouraging acceptance of one's body stood the best chance of success in preventing eating disorders. Stice and Colleagues (2012): established the program "Healthy Weight"; Eating disorder risk factors and symptoms were substantially reduced in the "Healthy Weight" group compared with the comparison group, particularly for the most severely at risk women, and the effect was durable at a six-month follow-up. Over the internet programs too have been shown to be effective in prevention, reducing weight and body shape concerns amongst students.

medical consequences of anorexia nervosa

cessation of menstruation (can be an objective physical index of the degree of food restriction but is inconsistent because it does not occur in all cases); dry skin, brittle hair or nails, and sensitivity to or intolerance of cold temperatures; lanugo, downy hair on the limbs and cheeks; cardiovascular problems, such as chronically low blood pressure and heart rate, can also result; if vomiting is part of the anorexia, electrolyte imbalance and resulting cardiac and kidney problems can result

biological dimensions of eating disorder development

Studies suggest that relatives of patients with eating disorders are four to five times more likely than the general population to develop eating disorders, with the risks for female relatives of patients with anorexia higher. The consensus is that genetic makeup is about half the equation among causes of anorexia and bulimia. Personality traits such as emotional instability and poor impulse control might be inherited. In other words, a person might inherit a tendency to be emotionally responsive to stress and might eat impulsively to relieve stress. Low levels of serotonergic activity, the system most often associated with eating disorders, are associated with impulsivity and binge-eating. At present, the consensus is that some neurobiological abnormalities do exist in people with eating disorders but that they may be a result of semistarvation or a binge-purge cycle rather than a cause, although they may well contribute to the maintenance of the disorder once it is established.

anorexia nervosa

eating disorder characterized by recurrent food refusal, leading to dangerously low body weight; or the person may exercise vigorously to offset food intake so body weight sometimes drops dangerously; often accompanied by an intense fear of obesity and relentless pursuit of thinness; severe almost punishing exercise is common; people with this disorder seldom seek treatment on their own; has a chronic course

bulimia nervosa

eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (e.g., deliberate vomiting, laxative abuse, and excessive exercise); one of the most common disorders on college campuses; the overwhelming majority of individuals are within 10% of their normal weight; accompanied by lack of sense of control

obesity

excess of body fat resulting in a body mass index (BMI, a ratio of weight to height) of 30 or more; produced by the consumption of a greater number of calories than are expended in energy

Paxton, Schutz, Wertheim, and Muir Study

explored the influence of close friendship groups on attitudes concerning body image, dietary restraint, and extreme weight-loss behaviors Results: They found that these friendship cliques tended to share the same attitudes toward body image, dietary restraint, and the importance of attempts to lose weight. They assumed from the study that these friendship cliques are significantly associated with individual body image concerns and eating behaviors. In other words, if your friends tend to use extreme dieting or other weight-loss techniques, there is a greater chance that you will too.

Kelly Klump and colleagues

found strong associations between ovarian hormones and dysregulated or impulsive eating in women prone to binge-eating episodes; emotional eating behavior and binge-eating peaked in the post-ovulatory phases of the menstrual cycle for all women whether they binged or not during other phases of their cycle. High levels of hormones at least partially accounted for these peaks.

Thompson and Stice (2001)

found that risk for developing eating disorders was directly related to the extent to which women internalize or "buy in" to media messages and images glorifying thinness

McKenzie, Williamson, and Cubic (1993)

found that women with bulimia judged that their bodies were larger after they ate a candy bar and soft drink, whereas the judgments of women in control groups were unaffected by snacks; rather minor events related to eating may activate fear of gaining weight, further distortions in body image, and corrective schemes such as purging

binge eating disorder facts and statistics

has a greater likelihood of occurring in males and a later age of onset; a greater likelihood of remission and a better response to treatment in BED compared with other eating disorders; about 20% of obese individuals in weight-loss programs engage in binge-eating, with the number rising to approximately 50% among candidates for bariatric surgery; 30% binge to alleviate "bad moods" or negative affect

purging techniques

in the eating disorder bulimia nervosa, the self-induced vomiting or laxative abuse used to compensate for excessive food ingestion; also includes use of diuretics, excessive exercise, fasting for long periods between binges

obesity facts and statistics

not considered an official DSM disorder; 70% of adults in the United States are overweight, more than 35% meet criteria for obesity

binge eating disorder (BED)

pattern of eating involving distress-inducing binges not followed by purging behaviors; being considered as a new DSM diagnostic category.

binge

relatively brief episode of uncontrolled, excessive consumption, usually of food or alcohol

two subtypes of anorexia nervosa

restrictive type- individuals diet to limit calorie intake binge-eating-purging type- individuals rely on purging, but unlike those with bulimia these individuals binge on relatively small amounts of food and purge more consistently, in some cases each time they eat Few differences exist between these two subtypes on severity of symptoms or personality based on prospective data collected over eight years on 136 individuals with anorexia. Subtyping may not be useful in predicting the future course of the disorder but rather may reflect a certain phase or stage of anorexia. DSM-5 criteria specify that subtyping refer only to the past three months.

The National Comorbidity Survey

results reflected lifetime and 12-month prevalence, not only for the three major eating disorders described here but also for "subthreshold" BED, where binge-eating occurred at a high-enough frequency but some additional criteria, such as "marked distress" regarding the binge-eating, were not met. Results: In adolescents ages 13 to 18 there was a lifetime prevalence rates were 0.3% for anorexia, 0.9% for bulimia, and 1.6% for BED suggesting that many cases of anorexia and BED, but not bulimia, begin after age 18. The median age of onset for all eating-related disorders occurred in a narrow range of 18 to 21 years.

medical consequences of chronic bulimia with purging

salivary gland enlargement caused by repeated vomiting, which gives the face a chubby appearance; repeated vomiting also may erode the dental enamel on the inner surface of the front teeth as well as tear the esophagus; continued vomiting may cause an electrolyte imbalance, can result in serious medical complications if unattended, including cardiac arrhythmia (disrupted heartbeat), seizures, and kidney failure, all of which can be fatal; development of more body fat; intestinal problems resulting from laxative abuse are also potentially serious; they can include severe constipation or permanent colon damage

psychological treatments for eating disorders

short-term cognitive-behavioral treatments that target problem eating behavior and attitudes about body weight and shape became the treatment of choice for eating disorders; factors common to all eating disorders are targeted in an integrated way with essential components of cognitive-behavioral therapy; the principal focus of this protocol is on the distorted evaluation of body shape and weight, and maladaptive attempts to control weight in the form of strict dieting, possibly accompanied by binge-eating, and methods to compensate for overeating such as purging; cognitive-behavioral therapy-enhanced (CBT-E)