Eating Disorder Textbook Notes

Avoidance emotional disorder

-Children -Similar to anorexia nervosa in that the child avoids eating and experiences weight loss and the physical symptoms of anorexia. However, there is no distorted body image or fear of weight gain. -Weight loss, reduced body fat, malnutrition.

EDNOS (Eating Disorders Not Otherwise Specified)

-Includes abnormal eating behaviors that don't fit into the two other categories (over 50% of people who seek treatment for an eating disorder are categorized as EDNOS) -Binge-eating disorder, which involves bingeing without purging, is also included in the EDNOS category

Amenorrhea

-The absence of menstruation which can be a result of an eating disorder -If the eating disorder interrupts the menstrual cycle, it will cause infertility.

Body dysmorphic disorder

-Affects males and females equally -An obsession with a perceived defect in the sufferer's body or appearance. -Increased risk for depression and suicide.

Body Image

-Almost everyone has some degree of body dissatisfaction, something that they would like to change about their bodies. -For some, however, this becomes a pathological concern with body weight and shape, and as a result, body image may become distorted. A distorted body image means that an individuals are unable to judge the size of their own body and do not see themselves as they really are -Body image distortion is common with eating disorders

Eating Disorders in Children

-Although the incidence is much lower than it is in late adolescence and early adulthood, anorexia and bulimia also occur in children under the age of 13 -Eating disorders can be difficult to diagnose in children because most children are finicky eaters at some point in their development

Sociocultural Factors

-An important sociocultural factor is body ideal. What is viewed as an ideal body differs across cultures and has changed throughout history. -The sociocultural ideals about body size are linked to body image and the incidence of eating disorders

Anorexia Nervosa 2

-Anorexia means lack of appetite, but in the case of the eating disorder anorexia nervosa it is a desire to be thin, rather than a lack of appetite, that causes individuals to decrease their food intake. -The overall prevalence of anorexia nervosa is estimated to be about 1% of the population. -characteristics they described are still true of the syndrome today: severe weight loss, amenorrhea, constipation, and restlessness.

Psychological Issues of Bulimia Nervosa

-As with anorexia, people with bulimia have an intense fear of becoming fat. They have a negative body image accompanied by a distorted perception of their body size. Since their self-esteem is highly tied to their impressions of their body shape and weight, they blame all of their problems on their appearance

Anorexia athletica

-Athletes -Engaging in compulsive exercise to lose weight or maintain a very low body weight. -Can lead to more serious eating disorders and serious health problems including kidney failure, heart attack, and death.

Binge-Eating Disorder

-Binge-eating disorder, which is in the EDNOS category, is probably the most prevalent eating disorder. -Unlike anorexia and bulimia, binge-eating disorder is not uncommon in men, who account for about 40% of cases.19 Individuals with binge-eating disorder engage in recurrent episodes of binge eating but do not regularly engage in inappropriate compensatory behaviors such as vomiting, fasting, or excessive exercise -As a result, overweight and obesity are common among people with binge-eating disorder

Bigorexia (muscle dysmorphia or reverse anorexia)

-Bodybuilders and avid gym-goers, more common in men than women -Obsession with being small and underdeveloped. Individuals believe their muscles are inadequate even when they have a good muscle mass. -Sufferers are at risk if they take steroids or other muscle-enhancing drugs.

Behaviors Associated with Bulimia Nervosa

-Bulimia typically begins with food restriction motivated by the desire to be thin. Overwhelming hunger may finally cause the dieting to be interrupted by a period of overeating. Eventually a pattern develops involving semi-starvation interrupted by periods of gorging. During a food binge, a person with bulimia experiences a sense of lack of control.

Selective eating disorder

-Children -Eating only a few foods, mostly carbohydrate. -Malnutrition

Female athlete triad

-Female athletes in weight-dependent sports -A triad of disordered eating, amenorrhea, and osteoporosis. -Low estrogen levels, which interfere with calcium balance, eventually causing reductions in bone mass and an increased risk of bone fractures.

Female Athlete Triad 2

-Female athletes with eating disorders are at risk for a syndrome of interrelated disorders referred to as the female athlete triad -This syndrome includes disordered eating, amenorrhea, and osteoporosis. -The three are linked because the extreme energy restriction that occurs in eating disorders creates a physiological condition similar to starvation, which leads to menstrual irregularities. -Low energy intake reduces the intake of calcium and other nutrients important for bone health

Three categories of eating disorders

-First is anorexia nervosa, which is characterized by self-starvation to reduce weight or prevent weight gain -Second, bulimia nervosa, which involves frequent episodes of bingeing or binge eating during which large amounts of high-calorie foods are consumed. These episodes are almost always followed by guilt, depressing, and purging behaviors such as self-induced vomiting to rid the body of the extra energy -Third, is eating disorders not otherwise specified (EDNOS), which includes abnormal eating behaviors that don't fit into the two other categories (over 50% of people who seek treatment for an eating disorder are categorized as EDNOS)

Body Ideal in Modern America

-From television and movies to magazines and advertisements and even toys, the culture in America today is a culture of thinness. -- -Messages about what society views as a perfect body—the ideal we should strive for—are constantly delivered by the mass media. -Although men are also affected by these messages, American culture still places much more emphasis on the appearance of women's bodies. -This is illustrated by the fact that, as the body dimensions of female models, actresses, and other cultural icons have become thinner over the past several decades, the incidence of eating disorders has increased

Rumination syndrome

-Infants and adults with mental and emotional impairment -Eating, swallowing, and then regurgitating food back into the mouth where it is chewed and swallowed again. -Bad breath, indigestion, chapped lips, damage to dental enamel and tissues in the mouth, aspiration of food leading to pneumonia, weight loss and failure to grow (children), electrolyte imbalance, and dehydration.

Physical Complications of Bulimia Nervosa

-It is the purging portion of the binge-purge cycle that is most hazardous to health in bulimia nervosa. Purging by vomiting brings stomach acid into the mouth. Frequent vomiting affects the GI tract by causing tooth decay, sores in the mouth and on the lips, swelling of the jaw and salivary glands, irritation of the throat, inflammation of the esophagus, and changes in stomach capacity and stomach emptying.3 It also causes broken blood vessels in the face from the force of vomiting, electrolyte imbalance, dehydration, muscle weakness, and menstrual irregularities. Laxative and diuretic abuse can also cause dehydration and electrolyte imbalance. Rectal bleeding may occur from laxative overuse.

Orthorexia nervosa

-No particular group -Obsession with eating food considered to be healthy or beneficial. Focus on the quality of the food, not the quantity. -Harmful to interpersonal relationships.

Bulimia is subdivided into two types based on the type of compensatory behavior used............

-Nonpurging bulimia vs. purging bulimia -Nonpurging bulimia involves behaviors such as fasting or excessive exercise to prevent weight gain, whereas purging bulimia involves regularly engaging in behaviors that may include self-induced vomiting and misuse of enemas, laxatives and diuretics, or other medications -Some bulimic individuals take laxatives to induce diarrhea. Although the patients believe the diarrhea prevents calories from being absorbed, in fact, nutrient absorption is almost complete before food enters the colon, where laxatives have their effect.

Night-eating syndrome

-Obese adults and those experiencing stress -Most of the day's calories are eaten late in the day or at night. A similar disorder, in which a person may eat while asleep and have no memory of the events, is called nocturnal sleep-related eating disorder. It is considered a sleep disorder, not an eating disorder. -Obesity

Self Esteem

-People with eating disorders often have lower self-esteem. Self-esteem refers to the judgments people make and maintain about themselves--a general attitude of approval or disapproval that indicates if the people think they are worthy and capable -People with eating disorders often try to use their relationship with food to gain control over their lives and boost their self-esteem.

Diabulimia (insulin misuse)

-People with type I diabetes -Withholding insulin to cause weight loss or prevent weight gain. -Uncontrolled blood sugar, which can lead to blindness, kidney disease, heart disease, nerve damage, and amputations.

Eating Disorders during Pregnancy

-Pregnant women with eating disorders are at increased risk of caesarean delivery and have a higher rate of miscarriages, premature birth, babies who are small for their age, and congenital malformations. -An eating disorder that is more common in pregnancy is pica. The cause of pica is unknown, but there is some evidence that it results from cultural beliefs related to pregnancy, along with changes in food preferences that occur during pregnancy.

Pica

-Pregnant women, children, people whose family or ethnic customs include eating certain nonfood substances. -Craving and eating nonfood items such as dirt, clay, paint chips, plaster, chalk, laundry starch, coffee grounds, and ashes. -Mineral deficiencies, perforated intestines, intestinal infections.

Based on these behaviors, anorexia is subdivided into two subtypes........

-Restricting Type vs. Binge-Eating/Purging Type -Those with the Restricting Type maintain their low body weight solely by restricting their food intake and increasing their activity. Those with the Binge-Eating/Purging Type also typically restrict their food intake but, in addition, regularly engage in binge-eating and/or purging behaviors

Physical Symptoms of Anorexia Nervosa

-The first obvious physical manifestation of anorexia is weight loss. -Starvation affects mental function, causing those with anorexia to become apathetic, dull, exhausted, and depressed. Physical symptoms include depletion of fat stores; wasting of muscles; inflammation and swelling of the lips; flaking and peeling of skin; and growth of fine hair, called lanugo hair, on the body, and dry, thin, brittle hair on the head that may fall out. -In females, estrogen levels drop and menstruation becomes irregular or stops. This can delay sexual maturation and can have long-term effects on bone density. -In males, testosterone levels decrease.

Treatment of anorexia nervosa

-The goal of treatment for anorexia nervosa is to help resolve the psychological and behavioral problems while providing for physical and nutritional rehabilitation. Treatment requires an interdisciplinary team of nutritional, mental health, and medical specialists and typically requires years of therapy.

Eating Disorders in Men

-The incidence of anorexia and bulimia is much lower among men than women. One reason for the lower incidence is that the cultural pressure for males to be thin is less intense. -Men, however, are less likely to seek treatment because they do not want to be perceived as having a "woman's disease."

Health Complications of Binge-Eating Disorder

-The major complications of binge-eating disorder are the conditions that accompany obesity, which include diabetes, high blood pressure, high blood cholesterol levels, gallbladder disease, heart disease, and certain types of cancer.

Treatment

-The overall goal of therapy for people with bulimia nervosa is to separate eating from their emotions and from their perceptions of success and to promote eating in response to hunger and satiety. Psychological counseling is needed to address issues related to body image and a sense of lack of control over eating. Nutritional therapy addresses physiological imbalances caused by purging episodes as well as providing education on nutrient needs and how to meet them.

Anorexia Nervosa: Psychological Issues

-The psychological component of anorexia nervosa revolves around an overwhelming fear of gaining weight, even in those who are already underweight. -Anorexia is also characterized by disturbances in body image or perception of body size that prevent those affected from seeing themselves as underweight even when they are dangerously thin.

Eating Disorders in Athletes

-The relationship between body weight and performance in certain sports contributes to the higher prevalence of eating disorders in athletes than in the general population. -Compulsive exercise, which has been termed anorexia athletica, is a type of eating disorder that is a particular problem in athletes.

Bulimia Nervosa

-The term bulimia nervosa was coined in 1979 by a British psychiatrist who suggested that bulimia consisted of powerful urges to overeat in combination with a morbid fear of becoming fat and the avoidance of the fattening effects of food by inducing vomiting or abusing purgatives or both. -Today, the estimated overall prevalence for bulimia nervosa is 4%. -Bulimia is characterized by binge eating followed by behaviors such as self-induced vomiting to eliminate the excess calories. Binging and purging are followed by intense feelings of guilt and shame.

Behaviors Associated with Anorexia Nervosa

-These behaviors include restriction of food intake, binge-eating and purging episodes, strange eating rituals, and excessive exercise. -For individuals with anorexia, food and eating become an obsession. -Both hyperactivity and overactivity are behaviors that are also typical of anorexia.

Chewing and spitting

-Those with other eating disorders -The person puts food in his/her mouth, tastes it, chews it, and then spits it out. -Since the food is not swallowed it can result in the same symptoms as starvation dieting.

Eating Disorders and Diabetes

-Treatment involves paying careful attention to diet, exercise, body weight, and blood glucose levels. -Those who take insulin to control their diabetes are at particular risk because they can misuse it to control their weight, a condition that has been termed diabulimia. Insulin is responsible for allowing glucose to enter muscle and adipose tissue cells. If patients cut back on the amount of insulin they take, the sugar in their blood cannot enter these cells, blood levels rise, and glucose is excreted in the urine. This causes weight loss, but at a very high cost. -Both are preoccupied with weight, food, and diet. Because this is expected in diabetes, people with diabetes can use it to hide anorexia or bulimia. They are supposed to watch what they eat, and the diabetes can be blamed for weight loss.

What causes eating disorders?

-We do not completely understand what causes eating disorders, but we do know that genetic, psychological, and sociocultural factors contribute to their development -Genetic=inherited personality traits, genes that affect hunger satiety, and body -Psychological=Low self-esteem, need for self-control, unhealthy body image -Sociocultural=Thin body idea, influences from media, family, and friends, abundant food supply -Typically begin in adolescence when physical, psychological, and social development is occurring rapidly, but they occur in people of all ages, races, and socioeconomic backgrounds. They are more common in women than men.

What are eating disorders?

Eating Disorders: are psychological disorders that involve a persistence disturbance in eating patterns or other behaviors intended to control weight

Bulimia nervosa

Involves frequent episodes of bingeing or binge eating during which large amounts of high-calorie foods are consumed. These episodes are almost always followed by guilt, depressing, and purging behaviors such as self-induced vomiting to rid the body of the extra energy

Anorexia nervosa

Is characterized by self-starvation to reduce weight or prevent weight gain