chapter 10

effective parents

accurately attend to their children's biological and emotional needs, giving them food when they are crying from hunger and comfort when they are crying out of fear.

maintenance/preventative therapy strategy

(cognitive-behavioral therapy for anorexia nervosa)Most successful when continued for at least a year beyond recovery

progression of anorexia nervosa

- A normal to slightly overweight female has been on a diet - Escalation toward anorexia nervosa may follow a stressful event (ex: separation of parents, a move away from home, or an experience of personal failure) - Most patients recover but as many as 6% dont and become so seriously ill that they die, usually from medical problems brought about by starvation, or from suicide - many are resistant to treatment - suicide rate among people with anorexia nervosa is five times the rate found in the general population - Around 20% of individuals with this disorder continue to display severe eating disturbances for decades

compensatory behaviors of bullimia nervosa

- After a binge, people with bulimia nervosa try to compensate for and undo its effects. - Vomiting; purging (vomiting actually fails to prevent the absorption of half of the calories consumed during a binge. Furthermore, because repeated vomiting affects one's general ability to feel satiated, it leads to greater hunger and more frequent and intense binges.) - Laxative or diuretics use - Exercising excessively

treatment for anorexia nervosa

- Around one-third of those with anorexia nervosa receive treatment - Immediate aims of treatment for anorexia nervosa: Regain lost weight, Recover from malnourishment, Eat normally again, Restoring weight and normal eating methods - Therapists must then help them to make psychological and perhaps family changes to lock in those gains.

body dissatisfaction

- Body dissatisfaction is the single most powerful contributor to dieting and to development of eating disorders - Ppl who evaluate their weight and shape negatively are experiencing body dissatisfaction - Approx 83% of all girls and women are dissatisfied w their bodies, compared w 74% of all boys and men - Vast majority of dissatisfied females believe their are overweight; half of dissatisfied males consider themselves overweight and half consider themselves underweight

causes of eating disorders: biological

- Certain genes may cause susceptibility to eating disorders; Relatives of ppl w eating disorders are 6 times more likely to develop eating disorders themselves - Brain circuit dysfunction is linked to interconnectivity problems (each of the circuits linked to generalized anxiety, obsessive-compulsive, and depressive disorders also acts dysfunctionally to some degree in people with eating disorders)

potential psychological problems of anorexia nervosa

- Depression, anxiety, low self-esteem, sleep disturbances, substance abuse - perfectionistic: a characteristic that typically precedes the onset of the disorder - obsessive-compulsive patterns (ex: They may set rigid rules for food preparation or even cut food into specific shapes or Ex: exercise compulsively, prioritizing exercise over most other activities in their lives.)

how is thinking distorted in anorexia nervosa

- Don't see their true body shape and will not listen to others telling them they will die - They usually have a low opinion of their body shape, for example, and consider themselves unattractive - likely to overestimate their actual proportions - While most women in Western society overestimate their body size, the estimates of those with anorexia nervosa are particularly high.

bullimia nervosa: binges

- Episodes of uncontrollable eating during which a person ingests a very large quantity of food - Takes place over a limited period of time, often 2 hours, during which the person eats more food than most ppl would eat during a similar time span - May involve 1-30 episodes per week and 2,000-3,400 calories per episode - Often carried out in secret, usually w/ sweet, high-calorie, soft-texture foods - Although the binge itself may be experienced as pleasurable in the sense that it relieves the unbearable tension the individual has been experiencing, it is Followed by extreme self-blame, shame, guilt, depression, weight gain fear, and being discovered - Binges are usually preceded by feelings of great tension. The person feels irritable, "unreal," and powerless to control an overwhelming need to eat "forbidden" foods. During the binge, the person feels unable to stop eating

causes of eating disorders: family environment

- Families may impact and maintain eating disorders - As many as half of the families of ppl w anorexia or builimia nervosa have a long History of emphasis on thinness, appearances, or dieting - Dieting and perfectionistic mothers - Enmeshed family patterns (overinvolvement; overconcern)(minuchin)

clinical picture of anorexia nervosa

- Key goal is becoming thin - Driving motivation is fear - Preoccupation with food occurs (They may spend considerable time thinking and even reading about food and planning their limited meals, dreams are filled with images of food and eating) - Thinking is distorted - Usually have a low opinion of their body shape - Tend to overestimate their actual proportions - Hold maladaptive attitudes and misperceptions (Sufferers tend to hold such beliefs as "I must be perfect in every way," "I will become a better person if I deprive myself," and "I can avoid guilt by not eating.")

causes of eating disorders: brain circuit dysfunction

- Larger and more active insula (structure in the fear circuit), uncommonly large orbitofrontal cortex (structure in the obsessive-compulsive-related circuit) - Hyperactive Striatum (structure in the obsessive-compulsive-related circuit) - smaller prefrontal cortex (a structure in the fear, obsessive-compulsive-related, and depression-related circuits) - abnormal activity levels of serotonin, dopamine, and glutamate (key neurotransmitters in the fear, obsessive-compulsive-related, and depression-related circuits) - hypothalamus

how are lasting changes achieved in anorexia nervosa

- Most people in treatment for anorexia nervosa gain weight successfully in the short term, but clinical researchers have found that those individuals must overcome their underlying psychological problems in order to create lasting improvement - Therapists typically use a combination of education, psychotherapy, and family therapy to reach this broader goal - Psychotropic drugs, particularly antipsychotic drugs, are sometimes used when patients do not respond to those other forms of treatments. Studies suggest that such medications may help with weight gain, but typically not with an individual's anorexia-related cognitive and emotional symptoms - cognitive-behavioral therapy

causes of eating disorder

- Most theorists and researchers use a multidimensional risk perspective - Several key factors place individuals at risk: psychodynamic factors (ego deficiencies), cognitive-behavioral (improper labeling of internal sensations and needs contribute to eating disorder), biological (genes, brain circuit), societal pressures, family environment, multicultural factors (racial and ethnic differences, gender differences), depression

progression of bullimia nervosa

- Normal to slightly overweight female has been on intense diet, often one that has been successful and earned praise from family members and friends - Begins in adolescence or young adulthood (15-20 years), lasts for years w periodic letups - Weight fluctuates but often stays within normal range (Some w this disorder, however, become seriously underweight and may eventually qualify for a diagnosis of anorexia nervosa instead)

compensatory behaviors effectiveness

- Some temporary positive effects; Temporarily relieve the uncomfortable physical feelings of fullness or reduce the feelings of anxiety and self-disgust attached to binge eating. Over time, a cycle develops in which purging allows more bingeing, and bingeing necessitates more purging. The cycle eventually causes people with the disorder to feel powerless and disgusted with themselves - Caloric bingeing effects not undone - Most recognize fully that they have an eating disorder

medical problems of anorexia nervosa

- The starvation habits of anorexia nervosa cause medical problems - Amenorrhea: absence of mentrual cycles - Lowered body temp, low blood pressure, body swelling, reduced bone mineral density, slow heart rate - Metabolic and electrolyte imbalances can lead to death by heart failure or circulatory collapse - Skin, nail, and hair problems (The poor nutrition of people with anorexia nervosa may also cause skin to become rough, dry, and cracked; nails to become brittle; and hands and feet to be cold and blue. Some people lose hair from the scalp, and some grow lanugo (the fine, silky hair that covers some newborns) on their trunk, extremities, and face.)

hypothalamus

- a brain structure that helps regulate various bodily functions including eating an hunger - plays a central role in how the brain processes pleasurable and rewarding experiences, and it helps control our appetite and govern our fluctuating desires for food intake

incidence of bullimia nervosa

1% develop bulimia nervosa in their lifetime 75% females in reported cases 5% of adolescent girls develop full syndrome High rate among college students

typical age of onset for anorexia nervosa

14-20 years

typical age of onset for bulimia nervosa

15-20 years

typical age of onset for binge-eating disorder

22-30 years

incidence and onset of anorexia nervosa

75% of reported cases of anorexia nervosa occur in females Aprox 0.6% of all ppl in western countries develop this problem in their lifetime and many more display at least some of its symptoms Peak onset age btw 14 and 20 years

cognitive-behavioral therapy treatment for anorexia nervosa

A combination of cognitive and behavioral interventions are included in most treatment programs for anorexia nervosa. These techniques are designed to help clients appreciate and change the behaviors and thought processes that keep their restrictive eating going Cognitive side: taught to identify their "core pathology" — the deep-seated belief that they should in fact be judged by their shape and weight and by their ability to control these physical characteristics. The clients may also be taught alternative ways of coping with stress and of solving problems. Behavioral side: clients are typically required to monitor (by written diaries or smartphone apps) their feelings, hunger levels, and food intake and the ties between these variables. therapists seek to help clients with anorexia nervosa change their attitudes about eating and weight The therapists may guide the clients to identify, challenge, and change maladaptive assumptions, such as "I must always be perfect" or "My weight and shape determine my value." They may also educate the clients about the body distortions typical of anorexia nervosa and help them see that their assessments of their own size are incorrect combo of maintenance therapy and family therapy

How are proper weight and normal eating restored in anorexia nervosa?

A variety of treatment methods are used to help patients with anorexia nervosa gain weight quickly and return to health within weeks, a phase of treatment called nutritional rehabilitation - In life-threatening cases, clinicians may need to force tube and intravenous feedings on a patient who refuses to eat - Behavioral weight-restoration approaches offer rewards whenever patients eat properly or gain weight and offer no rewards when they eat improperly or fail to gain weight. - Combo of supportive nursing care, nutritional counseling, and high-calorie diet (Most popular nutritional rehab approach); nurses and other staff members gradually increase a patient's diet over the course of several weeks, The nurses educate patients about the program, track their progress, provide encouragement, and help them appreciate that their weight gain is under control and will not lead to obesity. In some programs, the nurses also use motivational interviewing,

weight set point theory & diet

According to the weight set point theory, when people diet and fall to a weight below their weight set point, their brain starts trying to restore the lost weight. Hypothalamic and related brain activity produce a preoccupation with food and a desire to binge. They also trigger bodily changes that make it harder to lose weight and easier to gain weight, however little is eaten. ​​Once the brain and body begin conspiring to raise weight in this way, dieters actually enter into a battle against themselves. Some people apparently manage to shut down the inner "thermostat" and control their eating almost completely. These people move toward restricting-type anorexia nervosa. For others, the battle spirals toward a binge-purge or binge-only pattern

stats of binge eating disorder

Around 2.8% of pop; most prevalent eating disorder At least 64% are women Later age of onset As a result of their frequent binges, half become overweight or obese

what treatment is used first in cases of bulimia nervosa

Because of its effectiveness in cases of bulimia nervosa, cognitive-behavioral therapy is often tried first, before other therapies are considered. If clients do not respond to it, other approaches with promising but less impressive track records may then be tried

causes of eating disorders: cognitive-behavioral

Bruch: several cognitive factors such as improper labeling of internal sensations and needs contribute to eating disorders - Little control over life may result in excess control of body size, shape, and eating habits - This contributes to a broad cognitive distortion that lies at the center of disordered eating - for example, negative self-judgment based on body shape and weight; This "Core pathology" contributes to all other aspects of the disorders, including repeated efforts to lose weight and he preoccupation with shape, weight, and eating - Ppl w eating disorders display cognitive deficiencies

Long-term success linked to overcoming underlying psychological problems (anorexia nervosa)

Combo of education, psychotherapy, and family therapy used; psychotropic drugs More effective in anorexia nervosa than other therapies; more effective prevention when continued beyond one year Best results when supplemented by other approaches, esp family therapy

binge eating disorder

Disorder marked by frequent binges w/out extreme compensatory acts. As a result of their frequent binges, around half of those with this disorder become overweight or even obese 1. recurrent binge-eating episodes 2. binge-eating episodes include at least 3 of these features: a. Unusually fast eating b. Absence of hunger c. Uncomfortable fullness d. Secret eating due to sense of shame e. Subsequent feelings of self-disgust, depression, or severe guilt 3. significant distress 4. Binge-eating episodes take place at least weekly over the course of 3 months 5. Absence of excessive compensatory behaviors

bullimia nervosa (binge-purge syndrome)

Disorder marked by frequent eating binges followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight 1. Repeated binge-eating episodes 2. repeated performance of ill-advised compensatory behaviors (forced vomiting) to prevent weight gain 3. Symptoms take place at least weekly for a period of 3 months 4. Inappropriate influence of weight and shape on appraisal of oneself

anorexia nervosa

Disorder marked by the pursuit of extreme thinness and by extreme weight loss 1. Individual purposely takes in too little nourishment, resulting in body weight that is very low and below that of other ppl of similar age and gender 2. Individual is very fearful of gaining weight, or repeatedly seeks to prevent weight gain despite low body weight 3. Individual has a distorted body perception, places inappropriate emphasis on weight or shape in self-judgements or fails to appreciate the serious implications of their low weight two main subtypes: restricting type and binge-eating/purging type

similarities btw bullimia nervosa and anorexia nervosa

Distorted body perception, typically begin after a period of dieting by people who are fearful of becoming obese Driven to become thin Preoccupation w food, weight, and appearance Disturbed eating attitudes Feelings of anxiety, depression, obsessiveness, and perfectionism Heightened risk of suicide attempts and fatalities Substance abuse may accompany either disorder, perhaps beginning with the excessive use of diet pills

how are eating disorders treated?

Eating disorder 2 treatment goals 1. Correct dangerous eating pattern as quickly as possible 2. Address broader psychological and situational factors that have led to and maintain eating problem Family and friends can also play an important role in helping to overcome the disorder.

causes of eating disorders: societal pressures

Eating disorders are more common in Western countries than in other parts of the world. Thus, many theorists believe that Western standards of female attractiveness are partly responsible for the emergence of the disorders Western standards for female attractiveness Socially accepted prejudice against overweight ppl Higher risks for eating disorders within certain subcultures (models, actors, dancers, and certain athletes); thinness is especially valued Economic and racial differences in eating disorders prevalence rates (anorexia nervosa and bulimia nervosa were more common among women higher on the socioeconomic scale, Recently, preoccupation with thinness and dieting has increased in all socioeconomic classes, as has the prevalence of eating disorders - teenage girls from low-income families are now more likely than those from wealthier families to binge and display bulimia nervosa and binge-eating disorder - Social networking, internet activity, and tv browsing

why has eating disorders dramatically increased

Eating disorders have dramatically increased as thinness has become a national obsession

eating disorders and family systems theorists

Family systems theorists argue that the families of people who develop eating disorders are often dysfunctional to begin with and that the eating disorder of one member is a reflection of the larger problem. Influential family theorist Salvador Minuchin, for example, believed that an enmeshed family pattern often leads to eating disorder. In an enmeshed system, family members are overinvolved in each other's affairs and overconcerned with the details of each other's lives. On the positive side, enmeshed families can be affectionate and loyal. On the negative side, they can be clingy and foster dependency. Parents are too involved in the lives of their children, allowing little room for individuality and independence. Minuchin argued that adolescence poses a special problem for these families. The teenager's normal push for independence threatens the family's apparent harmony and closeness. In response, the family may subtly force the child to take on a "sick" role — to develop an eating disorder or some other illness. The child's disorder enables the family to maintain its appearance of harmony. A sick child needs her family, and family members can rally to protect her. Although some studies have supported such family systems explanations, they have failed to show that particular family patterns consistently set the stage for the development of eating disorders.

what determines a person's weight set point

Genetic inheritance and early eating practices seem to determine each person's weight set point

causes of eating disorders: depression

Helps set the stage for eating disorders As many as half of people with eating disorders, particularly those with bulimia nervosa, have symptoms of depression Four kinds of evidence that supports the claim that depression sets the stage for eating disorders: 1. Many more ppl w eating disorder are diagnosed w major depressive disorder than in the normal pop 2. Close relatives w eating disorders have higher rates of depressive disorders 3. Similar brain circuit abnormalities are involved in those w eating disorders and depression 4. Antidepressant drugs sometimes help persons w eating disorders

causes of eating disorders: psychdynamic factors

Hilde Bruch (pioneer in the study and treatment of eating disorders): developed a Psychodynamic theory of eating disorders - Disturbed mother-child interactions lead to serious child ego deficiencies (including a poor sense of independence and control) and severe perceptual disturbances that jointly produce disordered eating - parents may respond to their children either effectively or ineffectively. - Children of ineffective parents become confused adults who are unaware of their internal needs, not knowing for themselves when they are hungry or full and unable to identify their own emotions. To overcome their sense of helplessness, they seek excessive control over their body size and shape and over their eating habits. - Ppl w eating disorders innacurately perceive internal cues (alexithymia) (including emotional cues) and are more likely to worry about how they are viewed by others

Other forms of psychotherapy in individual or group formats for bulimia nervosa

Interpersonal psychotherapy, psychodynamic therapy, family therapy, antidepressant meds The various forms of psychotherapy — cognitive-behavioral, interpersonal, and psychodynamic — are often supplemented by family therapy Group formats, including self-help groups, give clients with bulimia nervosa an opportunity to share their concerns and experiences with one another.

two separate areas that control eating

Lateral hypothalamus (LH): produces hunger when activated Ventromedial hypothalamus (VMH): reduces hunger when activated Hypothalamus and related brain structures are activated by chemicals from brain and body, depending on whether the person is eating or fasting

treatment aftermath of anorexia nervosa

Lifetime duration is 6 years Weight is quickly restored and treatment gains may continue for years most females with anorexia nervosa menstruate again when they regain their weight, and other medical improvements follow Medical improvements mean fewer deaths At least 20% experience continued difficulties Psychological problems may persist (particularly depression, obsessiveness, and social anxiety — years after treatment.) recovery, when it does occur, is not always permanent. At least one-third of recovered patients have recurrences of anorexic behavior, usually triggered by new stresses, such as marriage, pregnancy, or a major relocation People whose family or interpersonal relationships are troubled have less positive treatment outcomes. Younger sufferers seem to have a better recovery rate than older patients

causes of eating disorders in men

Link to requirements and pressures of job or sport, body image (Many report that they want a "lean, toned, thin" shape similar to the ideal female body, rather than the muscular, broad-shouldered shape of the typical male ideal. Studies indicate that as many as 42 percent of all men with eating disorders identify as gay, and many of them — although not the majority — endorse a very lean ideal), different patterns of dysfunctional eating (muscularity-oriented disordered eating behaviors in which they eat excessively in order to gain weight and "bulk up." This pattern is particularly common among young African American men)

medical complication of bullimia nervosa

Long-term cardiovascular disease is also not uncommon among individuals with bulimia nervosa. frequent vomiting or chronic diarrhea (from the use of laxatives) can cause a host of serious medical problems, including dangerous potassium deficiencies, which may lead to weakness, intestinal disorders, kidney disease, or heart damage.

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

binge-eating/purging type of anorexia nervosa

Lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics May engage in eating binges This is different than bullimia because they have an excessive low body weight

body project

One of today's promising prevention programs is called Body Project, a program developed and expanded by psychologists Eric Stice and Carolyn Black Becker and their colleagues. Keeping in mind the key factors that predispose people to the development of eating disorders, Body Project offers a total of four weekly group sessions for high school and college-age women. In these sessions, group members are guided through a range of intense verbal, written, role-playing, and behavioral exercises that critique Western society's ultra-thin ideal. The participants also engage in body acceptance exercises, eating and related activities that run counter to the ultra-thin ideal, motivation enhancement techniques, skill-building training, and social support exercises.

causes of eating disorders: multicultural factors - racial and ethnic differences

Prior to this century Eating behaviors, values, and goals of women in minority groups in the US were consierarably healthier than those of non-hispanic white american women Lower weight and body shape dissatisfaction; different ideal girl belief More attainable body dimensions for african american teens Researchers over past two decades Young women of color in US Express body dissatisfaction to the same degree as young non-hispanic white american women Are even more likely to engage in disordered eating behaviors (particularly binge eating) May actually have a higher prevalence of eating disorders, including binge-purge disorder Eating disorders also appear to be rising among young Asian American women These shifts appear to be partly related to the acculturation displayed by many minority group women

treatment aftermath for bulimia nervosa

The average lifetime duration of bulimia nervosa is 6 years Untreated bulimia nervosa can last for years, sometimes improving temporarily but then returning. Treatment provides immediate, significant improvement in about 40% of cases they stop or greatly reduce their bingeing and purging, eat properly, and maintain a normal weight Another 40% show moderate response- at least some decrease in binge eating and purging. Ten years after treatment, about 75% of patients are fully/partially recovered Follow-up studies, conducted years after treatment, suggest that around 75 percent of people with bulimia nervosa have recovered, either fully or partially Relapse can be a problem even among people who respond successfully to treatment Relapses are often trigered by stress such as an upcoming exam, a job change, marriage, or divorce. Relapse is more likely among people who had longer histories of bulimia nervosa before treatment, had vomited more frequently during their disorder, continued to vomit at the end of treatment, had histories of substance abuse, and continue to be lonely or to distrust others after treatment

treatments for bulimia nervosa

Treatment programs for the disorder are often offered in eating disorder clinics. Such programs offer 1. nutritional rehabilitation, which, for bulimia nervosa, means helping clients eliminate their binge-purge patterns and establish good eating habits 2. a combination of therapies aimed at eliminating the underlying causes of bulimic patterns Treatment is frequently offered in eating disorder clinics; 43% receive treatment Eliminate binge-purge patterns and establish good eating habits Eliminate underlying cause of bulimic patterns; combo of therapies Programs emphasize education and therapy Antidepressant drug therapy which is of limited help to people with anorexia nervosa, appears to be quite effective in many cases of bulimia nervosa.

treatments for binge-eating disorder

Treatments often similar to bulimia nervosa Given the key role of binges in this disorder (bingeing without purging) Lifetime duration = 14 years Approximately 44 percent of people with this problem receive treatment Around 60% no longer fit criteria by treatment end; Many of their early gains may continue for years. Only ⅓ of the recovered ppl show total improvement African americans ahve better treatment outcomes than white americans Reduction or elimination of binge-eating patterns and to change disturbed thinking such as being overly concerned with weight and shape Cogntive-beahvioral therapy Other forms of psychotherapy Antidepressant meds Short-term effectiveness; high relapse risk Additional weight management interventions are often needed According to research, psychotherapy is generally more helpful than antidepressants. many of those who initially recover from binge-eating disorder continue to have a relatively high risk of relapse many people with binge-eating disorder also are overweight, and that part of their problem requires additional kinds of intervention. Their weight difficulties are often resistant to long-term improvement, even if their binge eating is reduced or eliminated

Changing family interactions for anorexia nervosa

Valuable treatment part, esp for children and adolescents Involvement of whole family; therapist meets with the family as a whole, points out troublesome family patterns, and helps the members make appropriate changes. Separation of feelings and needs from those of other family members family therapy (or at least parent counseling) can be helpful in the treatment of this disorder

motivational interviewing

an intervention that uses a mixture of empathy and inquiring review to help motivate clients to recognize they have a serious eating problem and commit to making constructive choices and behavior changes

ppl who have repeated eating binges during which they feel no control over their eating and don't engage in inappropriate compensatory behavior

binge eating disorder

this problem does not necessarily begin with efforts at extreme dieting. People typically first develop the pattern later than those with the other eating disorders; most often they are in their twenties

binge eating disorder

what disorder was not formally listed as a clinical category until the publication of DSM-5 in 2013

binge eating disorder

___ disorder is when people frequently go on eating binges but do not force themselves to vomit or engage in other such behaviors. They also do not fear weight gain to the same degree as those with ____ and ____

binge-eating disorder anorexia nervosa and bulimia nervosa

medical problems with binge-eating disorder

binge-eating disorder that includes obesity: - increased risk of diabetes, high blood pressure, heart disease, high cholesterol, strokes binge-eating disorder that doesn't includes obesity: joint pain, headaches, gastrointestinal problems, and shortness of breath

glucagon-like peptide-1 (GLP-1)

brain chemical) the natural appetite suppressant

differences btw bullimia nervosa and anorexia nervosa

bullimia: - More concern about pleasing others, being attractive to others, and having intimate relationships - Tend to be more sexually experienced/active - More likely to have long histories of Mood swings, easily frustrated and bored, and have trouble coping effectively or controlling their impulses and strong emotions - Different medical complications - dental problems more likely - amenorrhea less likely - many display characteristics of a personality disorder (esp. borderline/avoidant personality disorder)

principle behind the body project

cognitive dissonance theory. According to this social psychology theory, when people adopt new attitudes (in this case, anti-thinness attitudes) that contradict their other attitudes and behaviors (for example, pro-thinness and pro-weight-loss attitudes), they will experience emotional discomfort — a state of dissonance that they implicitly seek to eliminate by changing their old attitudes and behaviors.

ineffective parents

fail to attend to their children's needs, deciding that their children are hungry, cold, or tired without correctly interpreting the children's actual condition. They may feed their children when their children are anxious rather than hungry, or comfort them when they are tired rather than anxious.

One population that seems particularly at risk for binge-eating disorder are individuals who live with

food insecurity — that is, a limited, uncertain, or unreliable availability of needed food due to limited financial means

The multidimensional risk perspective for eating disorders

is not as specific as the developmental psychopathology perspective, but it does share many principles with the latter perspective. That is, it too contends that the risk factors for eating disorders unfold over the course of development, that interactions between these factors are key, and that different risk factors and combinations of factors may lead to the same eating disorders.

causes of eating disorders: multicultural factors - gender differences

men are as likely as women to eat in unhealthy ways but account for only 25% of all ppl w reported anorexia nervosa and bulimia nervosa - Reason 1: Double standard for attractiveness: Our society's emphasis on a thin appearance is clearly aimed at women much more than men, and some theorists believe that this difference has made women much more inclined to diet and more prone to eating disorders. - Reason 2: Dif methods of weight loss: men = excercise; women = dieting dieting often precedes the onset of these eating disorders.

muscle dysmorphia or reverse anorexia nervosa

men who are actually quite muscular perceive themselves as scrawny and small and so continue to strive for a "perfect" body through excessive weight lifting, abuse of steroids, or other excessive measures. Individuals with this disorder typically feel shame about their bodies, and many have a history of depression, anxiety, and self-destructive compulsive behavior. About one-third of them also engage in binge eating.

cognitive-behavioral therapy for bulimia nervosa

particularly helpful in cases of bulimia nervosa perhaps even more helpful than in cases of anorexia nervosa. they tailor the techniques to the unique features of bulimia (for example, bingeing and purging) and to the specific beliefs at work in bulimia nervosa. Behavioral technqiues: 1. Diaries of their eating behavior, changes in sensations of hunger and fullness, and the ebb and flow of other feelings 2. Exposure and response prevention (ERP) to help break the binge-purge cycle; the therapists require clients to eat particular kinds and amounts of food and then prevent them from vomiting to show that eating can be a harmless and even constructive activity that needs no undoing Typically the therapist sits with the client while the client eats the forbidden foods and stays until the urge to purge has passed. Studies find that this treatment often helps reduce eating-related anxieties, bingeing, and vomiting. cognitive techniques: Help clients recognize and change maladaptive attitudes toward food, eating, weight, and shape Typically teach individuals to identify and challenge neg thoughts that precede the urge to binge Ex: I have no self-control; I might as well give up; I look fat. may also guide clients to recognize, question, and eventually change their perfectionistic standards, sense of helplessness, and low self-concept

According to research, cognitive-behavioral techniques are often effective in cases of anorexia nervosa, more so than

psychodynamic therapies, psychoeducation, or supportive therapy alone. The approach helps many individuals to restore their weight, overcome their fear of becoming overweight, develop greater self-esteem, correct their body distortions and dissatisfaction, adopt more adaptive eating attitudes, acquire more appropriate eating and exercise habits, and develop better problem-solving skills.

In the cognitive realm, ppl with this eating disorder are more likely than those with the other eating disorders to perceive large portions of food as moderate in size

binge eating disorder

dental problems in bullimia nervosa

repeated vomiting bathes teeth and gums in hydrochloric acid, leading some women with bulimia nervosa to have serious dental problems, such as breakdown of enamel and even loss of teeth.

When a person's weight falls below their particular set point,

the LH and certain other brain areas are activated and seek to restore the lost weight by producing hunger and lowering the body's metabolic rate, the rate at which the body expends energy.

When a person's weight rises above their set point

the VMH and certain other brain areas are activated, and they try to remove the excess weight by reducing hunger and increasing the body's metabolic rate.

weight set point

the weight level that a person is predisposed to maintain, controlled in part by the hypothalamus. Hypothalamus, related brain structures, and chemicals such as GLP-1 working together comprise a "weight thermostat" in the body, which is responsible for keeping an individual at a particular weight level and triggering bodily changes that make weight loss more difficult