Chapter 9: Eating Disorders

anorexia nervosa

Sufferers of anorexia nervosa, like Shani, are convinced that they need to be extremely thin, and they lose so much weight that they may starve themselves to death.

prefrontal cortex

( a structure in the anxiety -related , obsessive - compulsive - related , and depression - related circuits ) is unusually small

the striatum

( another structure in the obsessive - compulsive - related circuit ) is hyperactive

insula

(a structure in the anxiety related circuit ) is abnormally large and active

the orbitofrontal cortex

(a structure in the obsessive - compulsive -related circuit ) is uncommonly large

brain circuit

A brain circuit is a network of particular brain structures that work together, triggering each other into action to produce a distinct kind of behavioral , cognitive , or emotional reaction.

ventromedial hypothalamus (VMH )

A brain region that depresses hunger when activated .

lateral hypothalamus (LH)

A brain region that produces hunger when activated

hypothalamus

A brain structure that helps regulate various bodily functions, including eating and hunger.

binge eating disorder

A disorder marked by frequent binges without extreme compensatory acts

bulimia nervosa

A disorder marked by frequent eating binges followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight. Also known as binge-purge syndrome.

anorexia nervosa

A disorder marked by the pursuit of extreme thinness and by extreme weight loss.

enmeshed family pattern

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

binge eating disorder

A third eating disorder , binge eating disorder , in which people frequently go on eating binges but do not force themselves to vomit or engage in other such behaviors , also is on the rise. People with binge -eating disorder do not fear weight gain to the same degree as those with anorexia nervosa and bulimia nervosa , but they do have many of the other features found in those disorders

motivational interviewing

A treatment that uses empathy and inquiring review to help motivate clients to recognize they have a serious psychological problem and commit to making constructive choices and behavior changes.

nutritional rehabilitation

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 the past , treatment almost always took place in a hospital , but now it is often offered in day hospitals or outpatient settings .

Effective parents

According to Bruch, parents may respond to their children either effectively or ineffectively. 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.

binge

An episode of uncontrollable eating during which a person ingests a very large quantity of food.

Treatments for Binge-Eating Disorder

Approximately 44 percent of people with binge-eating disorder receive treatment.

cases of anorexia nervosa

Between 75 and 90 percent of all cases of anorexia nervosa occur in females. Although the disorder can appear at any age, the peak age of onset is between 14 and 20 years. Between 0.6 and 4.0 percent of all females in Western countries develop the disorder in their lifetime , and many more display at least some of its symptoms. It seems to be on the increase in North America , Europe , and Japan .

binge eating /purging -type anorexia nervosa ,

First they tend to cut out sweets and fattening snacks ; then, increasingly , they eliminate other foods. Eventually people with this kind of anorexia nervosa show almost no variability in diet . Others , however , lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics , and they may even engage in eating binges , a pattern called binge eating /purging -type anorexia nervosa , which you will read about in more detail in the section on bulimia nervosa .

cognitive-behavioral ideas

If you look closely at Bruch's explanation of eating disorders, you'll see that it contains several cognitive-behavioral ideas . She held, for example, that as a result of ineffective parenting, people with eating disorders improperly label their internal sensations and needs, generally feel little control over their lives, and in turn, want to have excessive levels of control over their body size , shape, and eating habits. According to cognitive -behavioral theorists , these deficiencies contribute to a broad cognitive distortion that lies at the center of disordered eating , namely, people with anorexia nervosa and bulimia nervosa judge themselves -often exclusively -based on their shape and weight and their ability to control them (Mitchell , 2018 ; Fairburn et al., 2015 , 2008). This "core pathology ," say cognitive -behavioral theorists , contributes to all other aspects of the disorders , including the repeated efforts to lose weight and the preoccupation with shape , weight , and eating .

preoccupied with food

In addition, despite their focus on thinness and the severe restrictions they may place on their food intake, people with anorexia are 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 .

Ineffective parents

Ineffective parents , by contrast , 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 .

restricting -type anorexia nervosa

Like Shani, at least half of the people with anorexia nervosa reduce their weight by restricting their intake of food , a pattern called restricting -type anorexia nervosa .

multidimensional risk perspective

Most of today's theorists and researchers use a multidimensional risk perspective to explain eating disorders. That is, they identify several key factors that place a person at risk for these disorders. Generally , the more of these factors that are present , the more likely it is that a person will develop an eating disorder . 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 .

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 (Becker et al., 2017Stice et al., 2017, 2015, 2013). 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 , аnd behavioral exercises that critique Western society's ultra-thin ideal.

anorexia nervosa psychological problems

People with anorexia nervosa also have certain psychological problems, such as depression, anxiety, low self-esteem, and insomnia or other sleep disturbances (Klein & Attia, 2017). A number grapple with substance abuse.

binge eating disorder

People with binge eating disorder have frequent binge-eating episodes in which they feel no control over their eating, but they do not display inappropriate compensatory behaviorsAlthough most overweight people do not have binge eating disorder, half of those with binge eating disorder become overweight . Between 2 and 7 percent of the population have binge -eating disorder . Like sufferers of anorexia nervosa and bulimia nervosa , people with binge eating disorder tend to be preoccupied with food , misperceive their body size, experience body dissatisfaction , and struggle with negative emotions . Unlike anorexia nervosa and bulimia nervosa , most cases of this disorder begin after the age of 20.

bulimia nervosa

People with bulimia nervosa go on frequent eating binges and then force themselves to vomit or perform other inappropriate compensatory behaviors. The binges are often in response to increasing tension and are followed by feelings guilt and self-blame. Compensatory behavior is at first reinforced by the temporary relief from uncomfortable feelings of fullness or the reduction of feelings of anxiety , self-disgust , and loss of control attached to bingeing . Over time, however , sufferers generally feel disgusted with themselves , depressed , and guilty . As many as 90 percent of all cases of bulimia nervosa occur among females .

bulimia nervosa

People with bulimia nervosa go on frequent eating binges, during which they uncontrollably consume large quantities of food, and then force themselves to vomit or take other extreme steps to keep from gaining weight .

think in distorted ways.

Persons with anorexia nervosa also think in distorted ways. They usually have a low opinion of their body shape, for example, and consider themselves unattractive (Klein & Attia, 2017). In addition , they are 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.

anorexia nervosa

Rates of eating disorders have increased dramatically as thinness has become a national obsession. People with anorexia nervosa pursue extreme thinness and lose dangerous amounts of weight . They may follow a pattern of restricting -type anorexia nervosa or binge-eating/ purging-type anorexia nervosa. The central features of anorexia nervosa are a drive for thinness , intense fear of weight gain, and disturbed body perception and other cognitive disturbances . People with this disorder develop various medical problems , particularly amenorrhea . As many as 90 percent of all cases of anorexia nervosa occur among females .

ego deficiencies

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

key neurotransmitters

Similarly , the activity levels of serotonin , dopamine , and glutamate (key neurotransmitters in the anxiety -related , obsessive -compulsive - related , and depression - related circuits are abnormal in people with eating disorders

amenorrhea

The absence of menstrual cycles.

weight set point

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