Abnormal Psych Exam 3 (Eating Disorders)

how many people are overweight in the US?

1 out of every 2 adults and 20% of children

lifetime prevalence rates for anorexic white women?

1.4-2%

what number of anorexic patients have bulimic symptoms?

1/2

what number of bulimic patients have a history of anorexia?

1/3

anorexia in men vs. women

10x more common in women

what percent of adolescent girls have some sort of eating pathology

12%

calories consumed during a binge

2000 to 4000

lifetime prevalence of binge eating disorder and occasional binge eating

3.5% and 4.9% respectively among women 2.0% and 4.0% among men

average fashion model

5'11" and 117 lbs.

average woman in the US

5'4" and 140 lbs

long term outcome of anorexia

50% stop having symptoms 25% are improved 5% starve to death or die of related complications

DSM IV Diagnosis for Bulimia Nervosa

A. Recurrent episode of binge eating. An episode of binge eating is characterized by both of the following: 1. eating in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time or under similar circumstances 2. a sense of lack of control over eating during the episode B. recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise C. the binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months D. self evaluation is unduly influenced by body shape and weight E. The disturbance does not occur exclusively during episodes of anorexia nervosa Specific Type: purging type: during the current episode, the person has regularly engaged in self induced vomiting or the misuse of laxatives, diuretics, or enemas nonpurging type: during the current episode, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self induced vomiting or the misuse of laxatives, diuretics, or enemas

what women have higher rates of body dissatisfaction?

European American and Latina women report higher rates of body dissatisfaction than Black women

Anorexia Nervosa Case Study

Joan's brother died when she was young parents became very overprotective eating the only thing she felt like she could control lived on and off with her parents while an adult regular episodes of binging and purging

comorbid psychological disorders (anorexia)

OCD, depression (symptoms of sad mood, irritability, insomnia, social withdrawal, and diminished interest in sex). depression is a common reaction to starvation

self induced vomiting comorbid with

depression begins at the same time or follows the onset of bulimia likely to be a reaction to bulimia

what does inability to control their eating lead to?

depression, guilt, and low self esteem

bulimia is comorbid with

depression, personality disorders (especially borderline personality disorder), anxiety disorders, and substance use disorders

cohort effects

differences that distinguish one cohort from another

dietary restraint

direct consequence of overly restrictive eating. symptoms include binge eating, preoccupation with food, and perhaps out of control feelings of hunger

electrolyte imbalance

disturbance in the levels of potassium, sodium, calcium, and other vital elements found in body fluids. can lead to cardiac arrest or kidney failure

eating disorder and sexual trauma

does not appear to be a specific correlation 30% of women with eating disorders were sexually abused as children more important risk factor for bulimia

serotonin's role in bulimia

drugs that block serotonin receptors lead to increased food intake and appear to do so by reducing feelings of being satiated after eating low levels of serotonin are associated with both depression and increased impulsivity low levels of serotonin in patients with bulimia

binge eating

eating an amount of food that is clearly larger than most people would eat under similar circumstances in a died amount of time over 35% of people report occasional binge eating 29% report fasting 8% inducing vomiting 5% laxatives typically a secret planned in advance or spontaneous select foods that are high in calories and smooth in texture to make vomiting easier

purging

eliminate consumed food from the body done by 90% of people with bulimia less common forms: laxatives, diuretics, enemas

girls who try to lose weight by fasting for 24 hours or more

engage in more binge eating and develop bulimia more often 5 years later

binge eating disorder

episodes of binge eating but without compensatory behavior (possible new diagnosis) emotional eating is particular problem

eating disorders in males

equal divide between men who want to gain weight and men who want to lose weight male wrestlers have a particularly high prevalence of bulimia more common among gay men

medical complications caused by bulimia

erode dental enamel (esp. front teeth), chipped and ragged looking teeth, consequence of the sensitized gag relax (rumination = the regurgitation and rechewing of food), enlargement of salivary glands (making face look puffy), electrolyte imbalances, rupture of the esophagus or stomach

obesity

excess body fat corresponding with being 20% above expected weight 40% rough marker of being severely overweight calling obesity a mental disorder is controversial

excessive emphasis on weight and shape

exhilarated by positive comments or interest in their appearance but their esteem plummets if negative comment is made

symptoms of anorexia

extreme emaciation, disturbed perception of body, intense fear of gaining weight, cessation of menstruation

anorexia nervosa

extreme emaciation, refusal to maintain a minimally normal body weight, literally means loss of appetite

most effective form of treatment for anorexia

family therapy for adolescents with a short history of the disorder

lifetime prevalence for bulimia nervosa

far greater among women born after 1960 than it was fro those before 1950. risk for women born between 1950 and 1959 was intermediate between the two risk of developing bulimia declines with age 1.5% among US women and .5% among US men

intense fear of gaining weight

fears that relaxing control, even just a little, will lead to a total loss of control fear may grow more intense as the individual loses more weight

laxatives, diuremas, and enemas have

few lasting effects

step wise treatment of anorexia

first step is hospitalization (necessary in cases in which weight loss is extreme, suicidal thoughts are present, the patient is still denying her illness or previous outpatient therapy has been ineffective) weight restoration is necessary key is to elicit as much cooperation as possible set a target weight that is usually 90% of the average weight for a particular age and height

weight set points

fixed weights or small ranges of weight around which one's weight is maintained

adapted to flee famine hypothesis

anorexia symptoms are an adaptive mechanism that evolved to protect our ancestors from starvation in famine conditions. Trigger restlessness, energy, and cognitive distortions about the emaciated state of one's body to enable the starving individual to have both the courage and energy o travel to new locations where food might be more plentiful. could explain persistent denial of the eating disorder that is a common feature in anorexia patients

bulimia's comorbid diseases

anxiety disorder, personality disorder (especially borderline personality disorder), substance abuse particularly excessive use of alcohol and/or stimulants but depression is the most common and most significant

heritability for disordered eating

genetic factors explain 59 to 82% of the variance

cohort

group that shares some feature in common

vomiting prevents absorption of how many calories?

half

concordance rates in twins for bulimia

higher for MZ twins than DZ

weight suppression

highest adult weight minus current weight predicts the maintenance and onset of bulimia ten years later

negative body image

highly critical evaluation of one's weight and shape

non purging anorexia

better adjusted on measures of their mental health

core symptoms that define bulimia

binge eating and purging, sense of lost control during a binge, undue focus on weight and figure

culture of thinness plays a strong role in the development of

bulimia

popular binge food

ice cream

Bulimia Case Study

Tracy's parents were divorced. She was rebellious as a child. Her mother's family was critical during dinner. She could not control her snacking and so chose to purge. Ate a little girl's birthday cake dealt with persistent comments about weight, had low self esteem

Therapy process for Bulimia Case Study

Week 1: Self Monitoring Week 2: Cues and Consequences Week 3: Thoughts, Feelings, and Behaviors Week 4: Perfectionism and All or Nothing Thinking Week 5: Assertive Behavior Week 6: Body Image Week 7: Dieting and Other Causal Factors Week 8: Problem Solving and Stress Reduction Week 9: Healthy Exercise and Relapse Prevention Week 10: Coping with Future Events

cognitive therapy

a. learning to be more aware of thoughts and beliefs b. exploring and clarifying the connection between dysfunctional beliefs and maladaptive behaviors c. examining the truth of those beliefs d. learning to replace the dysfunctional beliefs with more realistic ones e. eventually changing the underlying assumptions that are creating the dysfunctional beliefs

amenorrhea

absence of at least three consecutive menstrual cycles reaction to the loss of body fat not a symptom that precedes anorexia sexual disinterest also common DSM likely to drop amenorrhea as a diagnostic criterion for anorexia because it does not differentiate between women who meet other diagnostic criteria for anorexia and is common in bulimia

when does anorexia begin?

adolescence some clinicians view it as the product of resistance to sexual and psychological maturity/trouble with individuation and separation from the family

increases in cases of anorexia vs. bulimia

cases of anorexia (occur in non Western cultures as well) and have increased less then bulimia

refeeding syndrome

cause od death and other serious complications caused by too rapid changes in phosphorus and electrolyte levels when food is reintroduced

bulimia nervosa

characterized by repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self induced vomiting, misuse of laxatives, or excessive exercise. literal meaning is ox appetite typically have a normal appetite, problem results from trying to maintain a weight below the body's natural set point. view binge eating as a failure of control

childhoods of people with anorexia

characterized by social discomfort, anxiety, and insecure attachments to others

depression, low self esteem and dysphoria

clinical depression can either be a cause or a reaction to eating disorders, while depressed moods, low self esteem, and dysphoria may contribute to the onset or maintenance of symptoms

what are the issues that need to be addressed in psychotherapy for anorexia?

cognitive distortions, superstitious thinking, trouble with expressing emotion, body image misconceptions, self esteem, and autonomy

Sir William Withey Gull

coined the term anorexia in 1874

medical complications caused by anorexia

constipation, abdominal pain, intolerance to cold, lethargy, skin becomes dry and cracked, lanugo (fine, downy hair grows on face or trunk of body), anemia, infertility, impaired kidney functioning, cardiovascular difficulties, dental erosion, and osteopenia (bone loss), electrolyte imbalance

side effects of starvation

constipation, hypotension, skin changes, bloating, abdominal pains, dehydration, and lanugo (downy hair growth)

distorted body image

inaccurate perception of body size and shape deny problems

frequency of disorders (both) since the 1960s and 70s

increased annual incidence stabilizing in recent years

exposure to images of super thin women

increases body image dissatisfaction among girls and young women

having a family member with anorexia

increases one's own risk ten fold

when does bulimia begin?

late adolescence

when do anorexia and bulimia begin?

late adolescence or early adulthood

relatives of people with anorexia are more likely to have

mood disorders

Hilde Bruch

most prolific clinical observers of eating disorders said struggle for the control is the central psychological issue in the development of eating disorders. said girls seem overly conforming and eager to please and they give up too much of the normal adolescent struggle for autonomy perfectionism and interoceptive awareness (try to control their own emotions excessively and lack recognition of internal cues including hunger and various emotional states)

geography of eating disorders

much more common in North America, Western Europe, and industrialized Asian countries. bulimia may be completely culture bound. In 3rd world countries wealth is positively correlated with body weight. in industrialized countries its the opposite

dysphoria

negative mood states commonly triggers episodes of binge eating

does research support bulimia subtypes?

no

medications for anorexia

not shown to be any more effective than placebo

progress 1 years after bulimia treatment

only 1/3 maintain their treatment gains

complications caused by anorexia

osteoporosis, anemia, compromised immune function

frequent feature of anorexia

overactivity (restless, fidgety, engage in excessive exercise)

most important factors in sustained health for anorexia

personality strength, self confidence, being understood

lack of interoceptive awareness

predicted the development of eating disorders 2 years in the future

treatment of anorexia

psychotherapy, cognitive behavior therapy, or combo of both none have shown to be conclusively effective

weight of cultural icons between 1959 and 1988

ration of weight to height declined dramatically

obsessive compulsive disorder

reaction to starvation, not a risk factor for anorexia

antidepressant medication

reduce symptoms of bulimia suggesting that bulimia is a reaction to depression

most dangerous symptom of anorexia

refusal to maintain a minimally normal body weight DSM IV suggests 85% of expected body weight as a rough guideline average victim of anorexia loses 25 to 30% of normal body weight 5% die of starvation, suicide, or medical complications stemming from extreme weight loss

eating disturbances are more common among women who...

report greater exposure to popular media, endorse more gender role stereotypes, or internalize societal standards about appearance

women with bulimia or a negative body image

report more public self consciousness, social anxiety, and perceived fraudulence. show increases in self criticism and deterioration in mood following negative social interactions. people with eating disorders often depend on others for self esteem

early pubertal timing

risk factor for anorexia

physical complications associated with bulimia

sore throat, swollen salivary gland, destruction of dental enamel, potassium depletion (can lead to seizures), urinary infections, kidney failure, irregular menstruation

anorexia is comorbid with

substance abuse, obsessive compulsive disorder, several personality disorders (especially major depression)

control and anorexia

take pride in their self denial, feeling like masters of control

anorexics who binge and purge

tend to have weighed more before their illness, more sexually experienced, more outgoing, less impulse control, more likely to abuse drugs or steal, have more variable moods than restrictors, greater psychological disturbance, poorer prognosis

subtypes of anorexia

validity is questionable, they do not differ in terms of comorbidity, recovery, relapse, or mortality

family relationships

young people with bulimia report considerable conflict and rejection in their families. anorexia generally perceive their families as cohesive and non conflictual. anorexic patients have enmeshed families (families whose members are overly involved in each other's lives). young people with anorexia obsessed with controlling their eating because it is the only thing they can control. however, intrusive parental concern is probably an effect not a cause of anorexia

reverse anorexia

Adonis complex excessive emphasis on extreme muscularity and often accompanied by the abuse of anabolic steroids 3-12% of teenage boys have tried steroids

what percent of anorexics are female?

90-95%

DSM IV Diagnosis of Anorexia

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected) B. Intense fear of gaining weight or becoming fat, even though underweight C. Disturbance in the way in which one's weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight D. in postmenarcheal females, amenorrhea, that is, the absence of at least three consecutive menstrual cycles Specific type: restricting type: during the current episode the person has not regularly engaged in binge eating or purging behavior binge eating/purging type: during the current episode, the person has regularly engaged in binge eating or purging behavior

predisposing factors for anorexia

autonomy, rapid physical change at puberty, premorbid obesity, personality traits, cognitive style, perceptual disturbances, and interpersona and familial difficulties