Test 3 Eating disorders

Eating disorder statistics

90%-95% with bulimia are women, most are white and middle to upper-middle class Males with bulimia have slightly later onset, large minority are gay males or bisexual Adolescent girls most at risk Median onset age: 18-21 years Chronic course

DSM criteria of bulimia

A. Recurrent episodes of binge eating characterized by: 1. Eating, in a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting; or excessive exercise C. The binge eating inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months D. Self-evaluation is unduly influenced by body shape and weight E. The disturbance does not occur exclusively during episodes of anorexia nervosa Types: Purging type and nonpurging type

DSM criteria for anorexia nervosa

A. Refusal to maintain body weight at or above minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected) B. Intense fear of gaining weight or becoming fat, even though underweight C. Disturbance in the way in which one's body weight or shape is experienced; undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight D. In post-menarcheal females, amenorrhea, that is, the absence of at least 3 consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration) Types: restricting type, binge-eating/purging type

Drug treatments for Bulimia

Antidepressants that proved effective for mood disorders and anxiety disorders Prozac SSRIs

Associated psychological disorders with bulimia nervosa

Anxiety and mood disorders 20% of patients with bulimia meet criteria for mood disorder and 50%-70% meeting criteria at some point during course of disorder Depression follows bulimia, may be reaction to it Substance abuse

Associated psychological disorders with anorexia nervosa

Anxiety and mood disorders Particularly OCD! 33%-60& have mood disorders Substance abuse Suicide can be associated

Psychological treatments for Bulimia

Cognitive-behavioral treatment Interpersonal psychotherapy treatment

Electrolyte imbalance

Continued vomiting upsets chemical balance of bodily fluids, including sodium and potassium levels. Can result in serious medical complications including cardiac arrhythmia (disrupted heartbeat), seizure, and renal (kidney) failure

Purging type

During current episode of anorexia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging type

During current episode of anorexia nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Restricting type

During the episode of anorexia nervosa, the person does not regularly engage in binge eating or purging behaviors (i.e., self-induced vomiting or the misuse of laxatives or diuretics). Diet to limit calorie intake. Low weight is achieved and maintained through severe undereating

Binge-eating/purging type

During the episode of anorexia nervosa, the person has regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives or diuretics). Rely on purging. Purging attempts to reduce calories have already consumed. Too thin to be bulimic

Anorexia nervosa

Eating disorder characterized by recurrent food refusal, leading to dangerously low body weight. People have an intense fear of obesity and relentlessly pursue tinness

Bulimia nervosa

Eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (for example deliberate vomiting, laxative abuse, and excessive exercise). Eating a larger amount of food than most people would eat under similar circumstances

Causes of eating disorders

Hypothalamus and major neurotransmitter systems- norepinephrine, dopamine, serotonin- determine whether something is malfunctioning when eating disorders occur. Low levels of serotonergic activity associated with impulsivity generally and binge eating specifically. Social factors- media Body dissatisfactions Low self-esteem, perfectionism Bulimia is culturally determined

Cognitive-behavioral therapy for bulimia

Most extensively studied, treatment of choice, targets problem eating behaviors, targets dysfunctional thoughts Starts with saying not effective way of dieting and health risks Gives portions of food 6 times a day every 3 hours to eliminate binge Creates coping strategies Individual does not spend time along after eating

Binge-eating disorder

Pattern of eating involving distress-inducing binges not followed by purging behaviors

Binge

Relatively brief episode of uncontrolled, excessive consumption

Medical effects of bulimia nervosa

Salivary gland enlargement giving person's face chubby appearance, erode dental enamel on inner surface of front teeth and tear esophagus, electrolyte imbalance, develop more body fat than age- and weight-matched healthy controls, intestinal damage: severe constipation or permanent colon damage, calluses on fingers or backs of hands

Purging techniques

Techniques of bulimia including: self-induced vomiting immediately after eating, using laxatives, diuretics, excessive exercise, fasting for long periods of time between binges

Medical effects of anorexia nervosa

Thinning of heat muscle, muscle wasting as body breaks down muscle in order to obtain needed calories, low heart rate and blood pressure, abdominal bloating or discomfort/constipation, loss of bone density, slower metabolism, difficulty tolerating cold, downy hairs on limbs and cheeks for insulation, dry/yellow-orange skin, brittle nails, hair loss

Interpersonal psychotherapy

Treatment that focuses on improving interpersonal functioning by enhancing communication skills SImilarly effective as CBT in the long run Social/interpersonal factors: "typical" family, successful, driven (set high expectations for women), concerned about appearance, maintains harmony (disobedience not tolerated) Resulting improvement of relationships makes people feel hopeful and empowered and increases self esteem

Anorexia facts

Very rare; lifetime prevalence among females less than 1% Females make up 90% of those diagnosed Onset usually early to late adolescence (14-18), evidence this is decreasing Often begins with dieting Chronic: if left untreated will get worse, even treated can get worse Resistant to treatment High SES: upper-middle class economic background (boarding schools, colleges) Disproportionately white (Black Americans have lowest risk rates)