Chapter 11 - Eating Disorders

Multidimensional Risk Perspective

A theory that identifies several kinds of risk factors that are thought to combine to help cause a disorder. The more factors present, the greater the risk of developing the disorder The most common of these are psychological, biological, and sociocultural factors.

What two brain chemicals are natural appetite suppressants?

Cholecystokinin (CCK) and Glucagon-like peptide-1

What percentage of bulimia nervosa patients are helped by the cognitive behavioral approach?

Nearly 65%

Antidperessants help up to what percentage of bulimia nervosa patients?

40%

Treatment provides immediate, significant improvement in what percentage of patients?

40%

Hile Bruch

A pioneer in the study and treatment of eating disorders and developed a largely psychodynamic theory. Believed that people with eating disorders perceive internal cues, including emotional cues, inaccurately. And, people with eating disorders rely excessively on the opinions, wishes, and views of others. They are more likely than other people to worry about how others view them, to seek approval, to be conforming, and to feel a lack of control over their lives. She argued that disturbed mother-child interactions lead to serious ego deficiencies in the child (including a poor sense of independence and control) and to severe perceptual disturbances that jointly help produce disordered eating. Parents may respond to their children either effectively or ineffectively. Children who receive such parenting may grow up confused and unaware of their own internal needs, not knowing for themselves when they are hungry or full and unable to identify their own emotions. Because they cannot rely on internal signals, these children turn instead to external guides, such as their parents. They seem to be "model children," but they fail to develop genuine self-reliance and "experience themselves as not being in control of their behavior, needs, and impulses, as not owning their own bodies". Adolescence increases their basic desire to establish independence, yet they feel unable to do so. To overcome their sense of helplessness, they seek excessive control over their body size and shape and over their eating habits.

How many women develop full-blown bulimia nervosa in Western countries?

5% Among college students the rate might be much higher.

What percentage of males account for all people with anorexia nervosa and bulimia nervosa?

5%-10%

How many men have eating disorders?

5-10%

How many middle school girls are on a diet?

61%

What percentage of anorexia nervosa cases are female?

90%-95%

What are the four kinds of evidence that theorists suggest that depressive disorders set the stage for eating disorders?

1) Many more people with an eating disorder qualify for a clinical diagnosis of major depressive disorder than do people in the general population. 2) The close relatives of people with eating disorders seem to have a higher rate of depressive disorders than do close relatives of people without such disorders. 3) Many people with eating disorders, particularly bulimia nervosa, have low activity of the neurotransmitter serotonin, similar to the serotonin abnormalities found in people with depression. 4) People with eating disorders are often helped by some of the same antidepressant drugs that reduce depression.

What are the reasons men typically develop anorexia or bulimia nervosa?

1) Requirement and pressures of a job or sport. 2) Body image.

How many binges does an individual with bulimia nervosa have a week?

1-30

The key goal for people with Anorexia Nervosa is becoming thin. The driving motivation is fear of what three things?

1. Of becoming obese 2. Of giving into the desire to eat 3. Of losing control of body shape and weight

What amount of recovered anorexia nervosa patients have recurrences of behavior and why?

1/3 Usually triggered by new stresses such as marriage, pregnancy or a major relocation.

How many students report periodic binge eating or self-induced vomiting?

25%-50%

What medical problems do the starvation habits of anorexia nervosa cause?

Amenorrhea, lowered body temperature, low blood pressure, body swelling, reduced bone mineral density, slow heart rate, and metabolic and electrolyte imbalances also may occur and can lead to death by heart failure or circulatory collapse. They 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.

Motivational Interviewing

An intervention in which clients are motivated to actively make and follow through on constructive choices regarding their eating behaviors and their lives.

What percentage of boys and men are dissatisfied with their bodies?

Appx 56%. Half of males consider themselves overweight, and half underweight.

What percentage of girls and women are dissatisfied with their bodies?

Appx 73%. The vast majority believe they are overweight

How many elementary school girls have tried to lose weight?

As many as half.

Why do laxatives and diuretics completely fail to get rid of calorie intake?

Because most calories have already been absorbed.

What is the key goal for people with anorexia nervosa?

Becoming thin. The driving motivation is fear of becoming obese, giving in to the desire to eat, of losing control of body size and shape.

What percentage of females in Western countries develop the disorder in their lifetime?

Between 0.5% - 4.0%

How many binge episodes per week do people with bulimia nervosa typically have?

Between 1 and 30

What type of therapy is particularly helpful for treating bulimia nervosa?

Cognitive Behavioural Therapy Antidepressant drug therapy is also quite effective.

Starvation Study

Conducted in the 1940s, 36 normal-weight conscientious objectors were put on a semi starvation diet for six months. Like people with anorexia nervosa, the volunteers became preoccupied with food and eating. They spent hours each day planning their small meals, talked more about food than about any other topic, studied cookbooks and recipes, mixed food in odd combinations, and dawdled over their meals. Many also had vivid dreams about food.

Exposure and Response Prevention

Consists of exposing people to situations that would ordinarily raise anxiety and then preventing them from performing their usual compulsive responses until they learn that the situations are actually harmless and their compulsive acts unnecessary.

What is the cognitive processing of an anorexic?

Distorted thinking: -They usually have a low opinion of their body shape. -Overestimate actual proportions. -Maladaptive attitudes and misconceptions.

Weight Set Point

The weight level that a person is predisposed to maintain, controlled in part by the hypothalamus.

What is Western Societies viewpoint on health and beauty?

It equates thinness with it. It is a national obsession.

Pro-Annorexia Sites

Internet sites with the goal of promoting behaviors that the clinical community and most of society consider abnormal and destructive. They view anorexia nervosa (and bulimia nervosa) as lifestyles rather than psychological disorders; others present themselves as nonjudgmental sites for people with anorexic features. Offering tips, disguising techniques, support and feedback, mottos, photos and "thinspiration". Also called "pro-ana" sites.

Psychiatric Hospitalization

Is often planned in advance and occurs on specialized eating disorder units. -Recommended when less intensive treatments have failed. -24-hour community where patients attend various groups focused on body image, coping strategies, and relationships with food. -Individual therapy and medications. -Short term goals include: increasing patient's weight, establishing a normal eating pattern, curing excessive exercise, and beginning to change irrational, maladaptive thoughts about food, weight, and body shape.

What is the typical onset age of bulimia nervosa?

It begins in adolescence or young adulthood (most often between 15 and 20 years of age) and often lasts for years, with periodic letup.

What psychological problems do those with anorexia nervosa have?

Depression, anxiety, low self-esteem, insomnia or other sleep disturbances, substance abuse, and obsessive-compulsive patterns such as cutting the food into specific shapes and rigid food preparation, or excessive exercising with working out being the number one priority in daily activities. They tend to be perfectionistic - a characteristic that typically precedes the onset of the disorder.

Ineffective Parents (Bruch)

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.

What provides the motivation to become thin for those suffering from anorexia nervosa?

Fear

What gender experiences bulimia nervosa most?

Females; 90%-95%

Lanugo

Fine, silky hair that covers some newborn babies.

What are people with anorexia nervosa preoccupied with?

Food. They may spend considerable time thinking and even reading about food and planning their limited meals. Many report that their dreams are filled with images of food and eating.

Alexithymic

Great difficulty putting descriptive labels on one's feelings.

What are eating disorders linked to for males?

Requirements and pressures of a job or sport.

When do anorexia nervosa symptoms appear?

The disorder can appear at any age, but the peak age of onset is between 14 and 20 years.

What percent of the population has binge-eating disorder?

2%-7%

Most victims recover from Anorexia Nervosa but what percentage dies from this disorder?

2-6%

What percent of gymnasts appear to have an eating disorder?

20%

What percentage of people with anorexia nervosa remain seriously troubled for years?

25%

A binge eater commonly consumes around ____ per pings episode and may exceed _____ calories in a day.

3,000; 10,000

What percent of female college athletes display eating behaviors that put them at risk for an eating disorder?

33%

What is the peak age on onset for Bulima Nervosa?

15-21 years old

What is a "typical" case of anorexia nervosa?

-A normal to slightly overweight female hs been on a diet. -Escalation toward anorexia nervosa may follow a stressful event: divorce/separation, major move, personal failure. -Most patients recover. Although, 2-6% become seriously ill and die as a result of complications or suicide.

What are the limitations of treatment for eating disorders?

-As many as 25% of patients remain troubled for years. -Even when it occurs, recovery isn't always permanent. -Anorexic behavior recurs in at least 1/3 of recovered patients, usually triggered by new stresses. -Many patients still express concerns about their weight and appearance. -Lingering emotional problems are common. -12 months after discharge, 30-50% of patients relapse.

What are the psychological problems that people with anorexia nervosa display?

-Depression (usually mild) -Anxiety -Low self-esteem -Insomnia/sleep disturbances -Substance abuse -Obsessive-compulsive patterns -Perfectionism

What are anorexics preoccupied with?

-Despite dietary restrictions, they are preoccupied with food; thinking about food and planning for meals.

People with high body dissatisfaction are more prone to what?

-Eating disorders -Depressive disorders -Anxiety disorders -Body dysmorphic disorder -Problems in interpersonal relationships -Difficulties at work

What are the medical problems associated with anorexia nervosa?

-Metabolic and electrolyte imbalances -Bloating and constipation -Lanugo -Muscle wasting -Loss of bone density -Dry, yellow-orange skin -Slow heart rate -Lower body temperature -Hair loss -Low blood pressure -Poor circulation -Amenorrhea

What are the reasons for relapse?

-Reluctance for treatment in the beginning. -Unwillingness to continue the changes once discharged. -Patients don't receive appropriate outpatient care after discharge. -Economic pressure from insurance companies shorten hospital stays so change that may occur from treatment cannot be realistically accomplished.

What leads to a poor recovery rate for anorexia nervosa?

-The more weight persons have lost and the more time that passes before they enter treatment. -People who had psychological or sexual problems before the onset of the disorder. -People whose families are dysfunctional.

What does body dissatisfaction correlate with?

-Unfavorable peer comparisons -Low self-esteem -Negative parental attitude about weight -Unfavorable media comparisons

What are the positives of treatment for eating disorders?

-Weight gain is often quickly restored. -90% of patients still show improvements after several years. -Menstruation often returns with a return to normal weight. -The death rate from anorexia nervosa is declining.

What are the two main goals when treating eating disorders?

1) Correct dangerous eating patterns. 2) Address broader psychological and situational factors underlying the eating problem. Ex: Anorexia Nervosa -Regain lost weight -Recover from malnourishment -Eat normally again

What are the key symptoms of anorexia nervosa?

1. A refusal to maintain more than 85% of normal body weight. 2. Intense fears of becoming overweight. 3. Distorted view of weight and shape. 4. Amenorrhea - not a criterian for diagnosis but a common medical consequence.

What are the similarities between anorexia nervosa and bulimia nervosa?

1. Both typically begin after a period of dieting by people who are fearful of becoming obese; driven to become thin; preoccupied with food, weight, and appearance. 2. Struggles with depression, anxiety, obsessiveness, and the need to be perfect. 3. People with either have a heightened risk of suicide attempts 4. Substance abuse may accompany either disorder, perhaps beginning with the excessive use of diet pills. 5. The belief that they weigh too much and look too heavy regardless of their actual weight or appearance. 6. Both disorders are marked by disturbed attitudes toward eating.

What are the differences between anorexia nervosa and bulimia nervosa?

1. Those with bulimia nervosa tend to be more concerned about pleasing others, being attractive to others, and having intimate relationships. 2. They also tend to be more sexually experienced and active than people with anorexia nervosa. 3. Particularly troublesome, they are more likely to have long histories of mood swings, become easily frustrated or bored, and have trouble coping effectively or controlling their impulses and strong emotions. 4. As many as one-third of those with bulimia nervosa display the characteristics of a personality disorder, particularly borderline personality disorder. 5. Medical complications; women with bulimia nervosa are amenorrheic or have irregular periods whereas almost all with anorexia nervosa are amenorrheic. 6. The repeated vomiting of bulimia nervosa causes dental problems such as a breakdown of enamel and tooth loss due to the hydrochloric acid. It also causes potassium deficiencies which can lead to weakness, intestinal disorders kidney disease or heart damage.

On average, how many negative thoughts do women have about their bodies each day?

13

What percentage of patients with anorexia nervosa show improved full/partial improvement years after their initial recovery?

85%

What percent of female college athletes suffer from an eating disorder?

9%

How many women have a negative thought about their bodies every day?

97%

How do White American vs African American differ in their opinions of body image?

A 1995 study by the University of Arizona found that 90% of the white American respondents were dissatisfied with their weight and body shape, compared with around 70% of the African American teens.

Ventromedial Hypothalamus (VMH)

A brain region that depresses hunger when activated. Consisting of the bottom and middle of the hypothalamus, reduces hunger when it is activated. Ex: When the VMH is electrically stimulated, laboratory animals stop eating.

Lateral Hypothalamus (LH)

A brain region that produces hunger when activated. Consisting of the side areas of the hypothalamus, it produces hunger when it is activated. Ex: When the LH of a laboratory animal is stimulated electrically, the animal eats, even if it has been fed recently.

Eating Disorders

A category of psychological disorders characterized by abnormal eating and a preoccupation with body image. Females make up 90% of those diagnosed.

What type of therapies are included in most treatment programs for anorexia nervosa?

A combination of behavioural and cognitive interventions. Family therapy is also sometimes used.

What is the most popular weight-restoration technique in recent years?

A combination of supportive nursing care, nutritional counseling, a relatively high-calorie diet and motivational interviewing. Studies find that patients in nursing-care programs usually gain the necessary weight over 8 to 12 weeks.

Nutritional Rehabilitation Program

A combination of supportive nursing care, nutritional counseling, motivational interviewing, and a relatively high-calorie diet.

What is the treatment for eating disorders?

A combination of supportive nursing care, nutritional counselling, and high-calorie diets. Necessary weight gain is often achieved in 8-12 weeks. They must overcome their psychological problems to achieve lasting improvement.

Binge Eating Disorder

A disorder characterized by regular binge eating behaviors, but without the compensatory behaviors that are a part of bulimia nervosa.

Binge-Eating DIsorder

A disorder marked by frequent binges but not extreme compensatory behaviors. They feel no control over their eating. However, they do not perform inappropriate compensatory behavior and as a result of their frequent binges, around 2/3 of people with this disorder become overweight or even obese. It was first recognized more than 50 years ago as a pattern common among many overweight people. Some similar patterns as those with anorexia and bulimia, those with this disorder are typically are preoccupied with food, weight, and appearance; base their evaluation of themselves largely on their weight and shape; misperceive their body size and are extremely dissatisfied with their body; struggle with feelings of depression, anxiety, and perfectionism; may abuse substances; and typically first develop the disorder in adolescence or young adulthood. They aspire to limit their eating, but are not as driven to thinness. Also, unlike the other eating disorders, it does not necessarily begin with efforts at extreme dieting. Nor are there large gender differences in the prevalence of it. Dx Checklist 1. Recurrent episodes. 2. Episodes include at least three of these features: • Unusually fast eating • Absence of hunger • Uncomfortable fullness • Secret eating due to sense of shame • Subsequent feelings of self-disgust, depression, or severe guilt. 3. Significant distress. 4. Episodes take place at least weekly over the course of 3 months. 5. Absence of excessive compensatory behaviors. Identified as a clinical syndrome.

Bulimia Nervosa

A disorder marked by frequent eating binges that are followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight. Also known as binge-purge syndrome. Binging along with vomiting or other behaviors to compensate for the large number of calories ingested. Repeated episodes of uncontrollable overeating, or binges. A binge episode takes place over a limited period of time, often two hours, during which the person eats much more food than most people would eat during a similar time span. People with this disorder repeatedly perform inappropriate compensatory behaviors, such as forcing themselves to vomit; misusing laxatives, diuretics, or enemas; fasting or exercising excessively. Dx Checklist: 1. Repeated binge eating episodes. 2. Repeated performance of ill-advised compensatory behaviors (e.g., 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

A disorder marked by the pursuit of extreme thinness and by an extreme loss of weight. Purposely maintaining a significantly low body weight, intense fears of becoming overweight, has a distorted view of weight and shape, and is excessively influenced by weight and shape in self-evaluations. Significantly low body weight with an intense fear of gaining weight along or using various methods to prevent weight gain. Dx Checklist: 1. Individual purposely takes in too little nourishment, resulting in body weight that is very low and below that of other people 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 judgments of herself or himself, or fails to appreciate the serious implications of her or his low weight.

Enmeshed Family Pattern

A family system in which members are overinvolved with each other's affairs and overconcerned about each other's welfare.

Hypothalamus

A part of the brain that helps maintain/regulate various bodily functions, including eating and hunger.

What amount of those who have suffered from anorexia nervosa continue to have certain emotional problems?

About 1/2. Particularly depression, obsessiveness, and social anxiety. Such problems are particularly common in those who had not reached a fully normal weight by the end of treatment.

Effective Parents (Bruch)

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.

What is the single most powerful contributor to dieting and to the development of eating disorders?

Body dissatisfaction.

When do people normally eat junk food?

Boredom: 69% Depression: 47% Anxiety: 44% Love: 36% Happiness: 33% Self-Confidence: 23%

In bulimia nervosa, binges involve eating massive amounts of food rapidly with little to no what?

Chewing

What kinds of behavioural interventions are used to treat patients with anorexia nervosa?

Clients are typically required to monitor (perhaps by keeping a diary) their feelings, hunger levels, and food intake and the ties between these variables.

What seems to determine a person's weight set point?

Genetic inheritance and early eating practices.

What is Binge-Eating/Purging Type Anorexia Nervosa?

Forcing oneself to vomit after eating; abusing laxatives or diuretics. Like those with bulimia nervosa they may engage in eating binges.

When does the biggest leap in body dissatisfaction tend to occur in females?

From early to mid-adolescence.

What causes eating disorders?

From the multidimensional risk perspective, there are several key factors place individuals at risk. The more factors one has, the greater likelihood of developing an eating disorder. Leading Factors: -Psychological problems (operent conditioning, perfectionism, neuroticism). -Biological factors -Sociocultural conditions (societal, family, and multicultural pressures.

What are the immediate goals of treatment programs for bulimia nervosa?

Helping clients to eliminate their binge-purge patterns and establish good eating habits and the more general goal of eliminating the underlying causes of bulimic patterns.

How do those with anorexia nervosa think?

In distorted ways. They usually have a low opinion of their body shape, and consider themselves unattractive. They are likely to overestimate their actual proportions; the estimates of those with anorexia nervosa are particularly high. It also takes the form of certain 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."

Is serotonin linked to eating disorders?

It is possible. Several research teams have found a link between eating disorders and the genes responsible for the production of this neurotransmitter. Others have measured low neurotransmitter activity in many people with eating disorders. It plays a role in depression and obsessive-compulsive disorder—problems that often accompany eating disorders—so it is possible that low serotonin activity has more to do with those other disorders than with the eating disorders per se. On the other hand, perhaps low activity contributes directly to eating disorders—for example, by causing the body to crave and binge on high-carbohydrate foods.

What sports have the highest rates of eating disorders for males?

Jockeys, wrestlers, distance runners, body builders, swimmers.

What is Restricting Type Anorexia Nervosa?

Lose weight by cutting gout sweets and fattening snacks, eventually eliminating nearly all food. No variability in diet.

Reverse Anorexia Nervosa or Muscle Dysmorphobia

Men with this disorder are very muscular but still see themselves as scrawny and small and therefore continue to strive for a "perfect" body through extreme measures such as excessive weight lifting or the abuse of steroids. They 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 related dysfunctional behaviors such as binge eating.

What is the core issue of someone with an eating disorder?

Morbid fear of gaining weight.

How does cognitive-behavioural therapy assist those with eating disorders?

On the behavioral side, clients monitors feelings, hunger levels, and food intake and the ties among those variables. On the cognitive side, the therapist helps the client change attitudes about eating and weight.

What does repeated vomiting affect?

One's general ability to feel satiated; thus it leads to greater hunger and more frequent and intense binges.

Body Dissatisfaction

People who evaluate their weight and shape negatively.

What are the factors most closely tied to body dissatisfaction?

Perfectionism and unrealistic expectations.

What are the destructive methods used by female athletes to maintain their weight?

Self-Destructive Weight-Control Behavior: 32% Diet Pills: 25% Vomiting: 14% Laxatives: 16% Diuretics: 5%

What are the destructive methods used by female gymnasts to maintain their weight?

Self-Destructive Weight-Control Behavior: 62% Diet Pills: 24% Vomiting: 26% Laxatives: 7% Diuretics: 12%

Although the binge itself may be pleasurable, it is usually followed by feelings of extreme what?

Self-blame, guilt, depression, and fears of weight gain, and being discovered.

Binge-Eating/Purging-Type Anorexia Nervosa

Sufferers of this type lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics, and they may even engage in eating binges.

Restricting-Type Anorexia Nervosa.

Sufferers of this type reduce their weight by restricting their intake of food. First, they tend to cut out sweets and fattening snacks; then, increasingly, they eliminate other foods. Eventually, people with this type of the disease show almost no variability in diet.

People with bulimia nervosa have their binges, they usually eat what kind of food?

Sweet foods with soft textures.

Who has a better recovery rate for anorexia nervosa?

Teenagers over older adults.

Binges are usually followed by feelings of great what?

Tension

Pro-Anorexia Websites

The Eating Disorders Association reports that there are more than 500 pro-anorexia Internet sites. They promote behaviors that the clinical community and most of society consider abnormal and destructive.

What happens when a person's weight falls below their 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.

What happens 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.

Amenorrhea

The absence of menstrual cycles.

Binging

The person eats massive amounts of food very rapidly, with minimal chewing—usually sweet, high-calorie foods with a soft texture, such as ice cream, cookies, doughnuts, and sandwiches. The food is hardly tasted or thought about. Eaters consume an average of 3400 calories during an episode. Some individuals consume as many as 10,000 calories. 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 person feels unable to stop eating. Although the act itself may be experienced as pleasurable in the sense that it relieves the unbearable tension. Followed by feelings of extreme self-blame, shame, guilt, and depression, as well as fears of gaining weight and being discovered.

Acculturation

The process of adopting the cultural traits or social patterns of another group.

Metabolic Rate

The rate at which the body expends energy.

Weight Set Point Theory

The theory that 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.

Interpersonal Psychotherapy

The treatment that is used to help improve interpersonal functioning.

What kinds of cognitive interventions are used to treat patients with anorexia nervosa?

They are taught to identify their "core pathology"—the deep-seated belief that they are 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.

What are some cognitive techniques therapists use with bulimia nervosa clients?

They help clients with bulimia nervosa recognize and change their maladaptive attitudes toward food, eating, weight, and shape. The therapists typically teach the clients to identify and challenge the negative thoughts that regularly precede their urge to binge—"I have no self-control"; "I might as well give up"; "I look fat". They may also guide clients to recognize, question, and eventually change their perfectionistic standards, sense of helplessness, and low self-concept

What are some behavioral techniques therapists use with bulimia nervosa clients?

To keep diaries of their eating behavior, changes in sensations of hunger and fullness, and the ebb and flow of other feelings. This helps the clients to observe their eating patterns more objectively and recognize the emotions and situations that trigger their desire to binge. They may also use exposure and response prevention to 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. Studies find that this treatment often helps reduce eating-related anxieties, bingeing, and vomiting.

What method do clinicians sometimes use in life-threatening cases of anorexia nervosa?

Tube and intravenous feedings., although it might cause the patient to distrust the clinician.

When do bulimic patterns typically begin?

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

How does anorexia nervosa disorder begin?

Typically the disorder begins after a person who is slightly overweight or of normal weight has been on a diet. The escalation may follow a stressful event such as separation of parents, a move away from home, or an experience of personal failure. Although most people with the disorder recover, between 2 and 6 percent of them become so seriously ill that they die, usually from medical problems brought about by starvation, or from suicide.

What must people with anorexia nervosa overcome before they can have lasting improvement?

Underlying psychological problems.

After a binge, people with bulimia nervosa try to compensate for and try to do what?

Undo the caloric effect.

Do families play a role in the development and maintenance of eating disorders?

Yes. Research suggests that as many as half of the families of people with anorexia nervosa or bulimia nervosa have a long history of emphasizing thinness, physical appearance, and dieting. The mothers in these families are more likely to diet themselves and to be generally perfectionistic than are the mothers in other families. Abnormal interactions and forms of communication within a family may also set the stage. Families are often dysfunctional to begin with and that the eating disorder of one member is a reflection of the larger problem.

Does social media affect body dissatisfaction?

Yes. The more time teenage girls spend on social media, the higher their body dissatisfaction. 86% of teens say that social network sites hurt their body confidence.

Does climate affect the statistics regarding the number of people who suffer from eating disorders?

Yes. Women who live in warmer climates (where more revealing clothing is worn) have lower weight, engage in more binge eating and purging, and have more body image concerns than women who live in cooler climates.