AP chapter 9

Two types of Anorexia Nervosa have been identified

(1) the restricting type, where every effort is made to limit the quantity of food consumed, and (2) the binge-eating/purging type.

4. NEGATIVE BODY IMAGE

Sociocultural pressure to be thin causes some young girls and women to develop highly intrusive and pervasive perceptual biases regarding how "fat" they are—body dissatisfaction is a risk factor for disordered eating

People with anorexia and bulimia share a common preoccupation with

with their shape and weight

5. DIETING

Risk factor for development or worsening of eating disorders

Biological Factors N=5

1. GENETICS 2. BRAIN ABNORMALITIES 3. SET POINTS 4. NEUROTRANSMITTER/SEROTONIN 5. REWARD SENSITIVITY

Treatment of Obesity

1. Lifestyle Modifications 2. Medications 3. Bariatric Surgery

The Problem of Obesity

--Obesity can be regarded as a state of excessive, chronic fat storage (p. 314) -CDC Estimated Costs of Obesity-related medical care costs in the US, in 2008 dollars: estimated $147 billion. -Annual nationwide productivity costs of obesity-related absenteeism range from $3.3 billion ($79 per individual with obesity) and $6.38 billion ($132 per). -Body mass index (BMI) is a measure of a person's weight relative to height -Obesity is defined on the basis of having a BMI above 30 -BMI of 25.0-29.9 is overweight

Medical Complications of Eating Disorders: Bulimia nervosa

-Mortality rate is twice that found in people of comparable age in the general population. -Electrolyte imbalances and low potassium (risk of heart abnormalities). -Ipecac syrup, a poison that causes vomiting, can damage the heart muscle. -Patients develop calluses on their hands from sticking their fingers down their throats. Tears to the throat can also occur. -Because the contents of the stomach are acidic, patients damage their teeth when they throw up repeatedly. -Mouth ulcers and dental cavities are a common consequence of repeated purging.

Association of Eating Disorders with Other Forms of Psychopathology

-68 percent of patients with anorexia nervosa, 63 percent of patients with bulimia nervosa, and almost 50 percent of people with BED are also diagnosed with depression. -Obsessive-compulsive disorder is often found in patients with anorexia nervosa and bulimia nervosa. -Comorbid personality disorders are frequently diagnosed in people with eating disorders. -More than a third of patients with eating disorders have engaged in self-harming behaviors. -People with BED have high rates of anxiety disorders (65 percent), mood disorders (46 percent), and substance abuse disorders (23 percent). -Two-thirds of a sample of patients with anorexia reported that they were rigid and perfectionistic, even as children.

Treatment of Obesity - Very tough to do

-96% regain weight that they lose within one year -consuming fewer calories/increasing exercise is the key Prevention is best!

1. Lifestyle Modifications

-A first step in the treatment of obesity is a clinical approach that involves a low-calorie diet, exercise, and some form of behavioral intervention. 3 variables that help:******* 1. Using meal-replacement products (e.g., calorie-controlled shakes); 2. continuing a relationship with a treatment provider; 3. maintaining a high level of physical activity. -Among popular diets, a study found that those who followed the Atkins diet lost the most weight. -Weight Watchers is the only commercial weight-loss program with demonstrated efficacy in a randomized controlled trial. -"Crash" diets and extreme treatments are now considered to be outmoded and ineffective approaches.

Anorexia nervosa--range of medical problems:

-Amenorrhea (though not always) -lowered body temperature -low blood pressure -body swelling -osteoporosis (due to reduced bone mineral density) -slowed heart rate -Metabolic and electrolyte imbalances may also occur which can lead to death by cardiac arrest, congestive heart failure, or circulatory collapse.

Age of Onset and Gender Differences

-Anorexia nervosa is most likely to develop in 16- to 20-year-olds. -For bulimia nervosa, the age group at highest risk is young women from 21 to 24. -Most people with binge-eating disorders are older, generally between 30 and 50 years of age. -Recent estimates suggest that there are three females for every male with an eating disorder. One established risk factor for eating disorders in men is same sex attraction. -More likely to be misdiagnosed in men

Course and Outcome of eating disorders

-Anorexic individuals are 18 times more likely to die by suicide than comparably aged women in the general population -Long-term prognosis for bulimia nervosa tends to be quite good, with high rates of remission. Patients with binge-eating disorder also have high rates of clinical remission. -Even when "well," individuals who recover from anorexia nervosa and bulimia nervosa still harbor residual food issues (excessive concern about shape and weight; dietary restriction; mood-related overeating/purging).

MEDICATIONS for Anorexia Nervosa

-Antidepressants may be used; no evidence they are effective -The antipsychotic medication olanzapine may be beneficial

3. Bariatric Surgery

-Bariatric surgery is the most effective long-term treatment for people who are morbidly obese. -It reduces the amount of food that can be consumed at any one time. -Recovery can be difficult, but weight loss may be substantial, averaging between 44 and 88 pounds. -Mortality rates hover around 1 percent.

1. GENDER

-Being female is a strong risk factor for developing eating disorders, particularly anorexia nervosa and bulimia nervosa. -Adolescence is the greatest period of risk for these disorders. -Binge-eating disorder does not follow these patterns: onset is typically well after adolescence, and binge-eating disorder is much more likely to be found in males. -For men (but not for women), sexual orientation is a risk factor for disordered eating.

3. Binge-Eating Disorder

-Binge-eating disorder (BED) has some clinical features in common with bulimia nervosa, but with one important difference: The person with BED binges but does not engage in inappropriate "compensatory" behavior. -Much less dietary restraint in BED -Associated with being overweight or obese

Risk and Causal Factors in Eating Disorders

-Biological Factors -Sociocultural Factors family influences -Psychological -Individual Risk Factors

Treatment of Binge-Eating Disorder

-Due to the high level of comorbidity between binge-eating disorder and depression, antidepressant medications are sometimes used to treat the disorder. -Appetite suppressants and anticonvulsant medications are also used. -Studies suggest that for racial and ethnic minorities with BED, interpersonal psychotherapy might work best.

MYTHS around Eating Disorders

-Eating disorders are a choice: Eating disorders are not choices but complex medical and psychological illnesses -Parents cause eating disorders: Eating disorders are genetically and environmentally influenced diseases -Telling someone to "just eat" is helpful: In no way is this a helpful comment. Neither is "you look good," "this used to be one of your favorite foods," -Everyone has an eating disorder: Eating disorders symptoms are praised by some media but clinical diagnoses are not as common as people think. -Anorexia is the only deadly eating disorder: All eating disorders have deadly potential -There is nothing wrong with fad dieting: Can lead to an eating disorder

Psychological Factors, Hilde Bruch:

-Effective parents: provide discrimination against attention to their child's biological and emotional needs: give food when children are hungry and comfort when they are afraid -Ineffective parents: fail to attend to children's internal needs, instead decide when their children are hungry, cold, or tired, without correctly interpreting the child's actual condition. May feed child when anxious and comfort when tired -Children may grow up confused; unable to differentiate between own internal needs, and unable to identify own emotions or levels of fatigue -children rely on external guides (parents) -fail to develop self-reliance; experience self as not in control of own behavior, needs, and impulses -As adolescence approaches, increasing pressure to establish autonomy but feel unable to do so -To overcome sense of helplessness, seek extreme control over body size, shape, and eating habits -Those "successful" in this attempt to control lean toward restricting type anorexia nervosa -those who are "unsuccessful" lean toward a binge-purge pattern of anorexia or bulimia nervosa

Risk and Causal Factors in Obesity

1. The Role of Genes 2. Hormones Involved in Appetite and Weight Regulation 3. Sociocultural Influences 4. Family Influences 5. Stress and "Comfort Food"

4. Family Influences

-Family attitudes toward food are important because their consequences are likely to remain with us for a long time. -High-fat, high-calorie diet (or an overemphasis on food) may lead to obesity in family members. -Eating (or overeating) may be used as a way to alleviate emotional distress or show love. -Overfeeding infants and young children causes them to develop more adipose (fat) cells and predispose them to weight problems in adulthood. early intervention/prevention is key -Family attitudes toward food are important because their consequences are likely to remain with us for a long time. -High-fat, high-calorie diet (or an overemphasis on food) may lead to obesity in family members. -Eating (or overeating) may be used as a way to alleviate emotional distress or show love. -Overfeeding infants and young children causes them to develop more adipose (fat) cells and predispose them to weight problems in adulthood. -If someone close to us (e.g., a spouse, sibling, or friend) becomes obese, the chance that we ourselves will later become obese can increase by as much as 57 percent.

3. Sociocultural Influences

-Genes alone can sometimes tell us why people differ in weight and eating patterns, but environmental factors also involved -Diathesis-stress perspective is most appropriate -Hyperpalatable foods (especially tasty and rewarding food because of high sugar and fat content) -Time pressures and convenience -The culture of supersizing -A culture that provides ready access to high-fat, high-sugar (junk) foods, encourages overconsumption, and makes it easy to avoid exercise leads to more weight-related problems -Artificial combination of high fat and high sugar contributes to addictive-like eating -Foods with low nutritional value (high fat, high sugar) are also less expensive and much easier to find than foods with high nutritional value -Food advertising triggers automatic and unconscious eating

Bulimic family characteristics include

-High parental expectations -Perceiving one's family to be less cohesive -Other family members who are dieting, preoccupied with appearance, or prone to make critical comments about shape, weight, or eating -Disordered eating attitudes may predate parent-child conflict.

Medical Issues and Prevalence for BED

-Increased risk for high cholesterol, hypertension, heart disease, arthritis, diabetes, and cancer -Reduced life expectancy of 5 to 20 years -More prevalent in ethnic minorities (except Asians) -More prevalent in men than in women -1/3 of US people are normal or healthy weight -2/3 NOT -Since 1980 obesity has doubled -Obesity has increased dramatically in the United States during the past 20 years **************

Weight Stigma

-Judgment and discrimination from others -Weight discrimination is increasing; media is a powerful source -Perpetuates weight-based stereotypes -Often depicts overweight or obese people in a negative light -Weight bias is seen against women who are obese -Bias is also seen among health care professionals, who may blame patients for being overweight or having weight-related problems

COGNITIVE-BEHAVIORAL THERAPY for Bulimia Nervosa

-Leading treatment for bulimia; superior to medications -"Behavioral" component focuses on meal planning, nutritional education, ending binging-and-purging cycles -"Cognitive" element aims at changing the cognitions and behaviors that initiate or perpetuate a binge cycle -New development: transdiagnostic approach to treatment

Clinical Aspects of Eating Disorders: Anorexia Nervosa

-Lifetime prevalence in the U.S. is 0.9 percent in women and 0.3 percent in men -Risk of developing anorexia nervosa increased during the twentieth century -Anorexic individuals are 18 times more likely to die by suicide than comparably aged women in the general population. -Even after a series of treatment failures, it is still possible for women with anorexia nervosa to become well again.

The Importance of Prevention

-Losing weight goes against biological mechanisms designed to keep us at our current weight. -This highlights the importance of not gaining weight in the first place. -According to Hill and colleagues (2003), people can avoid weight gain if they simply eat three fewer bites of food at each meal, take the stairs, and sleep more

Diagnostic Crossover of eating disorders

-Majority of the women in one study experienced diagnostic crossover, which means that once someone has been diagnosed with an eating disorder, they are more likely to be later diagnosed with another eating disorder. -Bidirectional transitions between the two subtypes of anorexia nervosa were especially common. -Shifts from anorexia nervosa to bulimia nervosa occurred in about a third of patients. -Binge-eating disorder and anorexia nervosa appear to be quite distinct disorders.

Risk and Causal Factors in Obesity: bottom line:

-Many Pathways to Obesity -Combination of genetic, environmental, and sociocultural influences -Binge eating is a predictor of later obesity

Sexual assault rates of those with Eating disorders

-More than 50% (1 in 2 women) of those with BED have experienced sexual assault* on the test -As opposed to 1 in 4 women without an eating disorder -1 in 4 women with Anorexia Nervosa experiencing sexual assault -1 in 3 women with Bulimia Nervosa experiencing sexual assault

family influences on anorexia

-More than one-third of patients reported that family dysfunction contributed to the development of their anorexia. -Many have parents who are overly preoccupied with thinness, dieting, and good physical appearance. Associated family behaviors for anorexia include rigidity, parental overprotectiveness, excessive control, and marital discord. -Disordered eating attitudes may predate parent-child conflict.

Medical Complications of Eating Disorders: Anorexia nervosa

-Mortality rate for people with anorexia nervosa is more than five times higher than that for young females ages 15-34 in the general U.S. population. Patients with the disorder most often die of medical complications. Malnutrition also takes a toll on the body (including thinning hair; dry skin; downy hair growth; difficulty coping with cold; feeling tired, weak). -Thiamin deficiency may lead to depression and cognitive changes. -People can die from heart arrhythmias—sometimes caused by major imbalances in key electrolytes such as potassium. -Laxative abuse can lead to dehydration, electrolyte imbalances, kidney disease, and damage to the bowels and gastrointestinal tract.

Prevalence of Binge-Eating Disorders

-Most common form of eating disorder -Worldwide lifetime prevalence is around 2 percent -United States lifetime prevalence is around 3.5 percent in women and 2 percent in men -Prevalence is higher in obese people (6.5 to 8 percent)

FAMILY THERAPY for Anorexia Nervosa

-Most effective treatment option for adolescent patients -Best-studied approach: Maudsley model -Typical treatment program includes 10-20 sessions over 6-12 months -Parents as support team; focus on developing healthier relationships -Randomized controlled trials show that patients treated with family therapy for 1 year do better than control group

Eating Disorders Across Cultures

-Most research has been in the U.S. and Europe, but eating disorders are also clinical problems in South Africa, Japan, Hong Kong, Taiwan, Singapore, India, China, and Korea. -Clinical features of diagnosed eating disorders may vary by culture. -Subclinical problems in Caucasians (body dissatisfaction, dietary restraint, drive for thinness) may place individuals at higher risk for eating disorders. -Assimilation into white, middle-class societal values determines prevalence rates among minority women. -Strong ethnic identity among POC can be a protective factor -Anorexia nervosa isn't culture-bound; bulimia nervosa occurs in people with exposure to Western ideals. -BED most common worldwide eating disorder* test question

4. NEUROTRANSMITTER/SEROTONIN

-Neurotransmitter serotonin is implicated in obsessionality, mood disorders, and impulsivity; also modulates appetite and feeding behavior. -Active area of research

5. REWARD SENSITIVITY

-New research centers on brain pathways and neurotransmitters (such as dopamine) involved in reward processing. -Theory that reward and punishment systems get contaminated: -Normally rewarding stimuli such as food become aversive -Stimuli associated with self-starvation become valued

Obesity and the DSM

-Obesity is not an eating disorder in DSM-5 -Some view obesity as a food addiction

2. BRAIN ABNORMALITIES

-One brain area that plays an important role in eating is the hypothalamus.* on the test -Damage to the frontal and the temporal cortex seem to be linked to the development of anorexia nervosa in some cases, and bulimia nervosa in others.

2. Hormones Involved in Appetite and Weight Regulation

-Our bodies regulate daily quantities of food consumed and balance against our energy output. -Leptin is a hormone that acts to reduce our intake of food. -Inability to produce leptin is associated with morbid obesity. -People who are overweight tend to have high levels of leptin in their bloodstream, but are resistant to its effects. -The hormone ghrelin, produced by the stomach, is a powerful appetite stimulator.

Treatment of Anorexia Nervosa

-Patients are generally pessimistic about potential for recovery; view disorder as chronic; have a high therapy dropout rate -Immediate concern is to restore weight to a non-life-threatening level; may require hospitalization and IV feeding -Aggressive treatment efforts can backfire

3. PERFECTIONISM

-Perfectionism is the pursuit of unattainably high standards combined with intolerance of mistakes. -Perfectionism may help maintain bulimic pathology through the rigid adherence to dieting that then drives the binge/purge cycle. -Perfectionism is more common in women. -Perfection may also have a genetic basis

Research shows that healthcare providers (including counselors), when talking to obese patients, tend to:

-Provide them with less health information -Spend less time with them -View them as undisciplined, annoying, and noncompliant with treatment.

2. Medications

-Several medications are approved by the FDA for use in conjunction with a reduced-calorie diet -All of these medications provide modest clinical benefits, BUT differences are typically much less (around 3-9 percent of initial weight) than patients are seeking -Subutramine (Meridia) was recently withdrawn from the market due to safety concerns.

Binge eating may be caused by:

-Social pressure to conform to the thin ideal, which leads to dieting followed by binge eating when willpower runs out -Depression, low self-esteem, and peer rejection

Treatment of Eating Disorders

-Stigma is a significant barrier to help-seeking. Over and above those challenges, it also robs people who are already vulnerable of their dignity, increases their sense of isolation, and further reduces their self-esteem. One of the most harmful consequences of stigma is that it may act as a barrier for people seeking help. -Research indicates that current access to treatment for eating disorders is alarmingly low, with only 22% sufferers receiving specialist treatment for their eating disorder. -Research shows that it takes an average of 8-10 years for someone to seek help and yet early help-seeking is crucial to curtailing the impact and duration of the illness.

Unresolved Issues

-The Role of Public Policy in the Prevention of Obesity -Does the general public have an investment? -read and consider implications -Listing calories -Limiting drink size (taxing larger sizes) -Promoting exercise (building outdoor space, supporting community fitness center, allowing tax incentives for membership, etc.)

Eating Disorders--History

-The earliest detection of an Anorexia Nervosa was seen in the 1200s-1300s 1380: Catherine of Sienna developed Anorexia Nervosa and termed it infermità (illness). 1689: Gave rise to the first physician diagnosis 1873: The term Anorexia was established and the medical field mobilized to understand the disorder 1888: Physicians began to notice the occurrence of eating disorders in both men and women 1900s: Treatment began to emerge for eating disorders -Parentectomy was the preferred treatment 1903: Bulimic disorders were diagnosed for the first time 1940s: Psychoanalysis influences the eating disorder world 1959: The first case of Binge Eating Disorder (BED) was reported. 1980s: The DSM-III added an eating disorder section 1980s: College counseling centers begin treatment for eating disorders -Celebrities are diagnosed with eating disorders (i.e. Princess Diana) 1983: Karen Carpenter dies of heart failure related to Anorexia Nervosa 1987: DSM-III-R lists Bulimia as a separate eating disorder for the first time, Binge Eating Disorder is mentioned in the DSM for the first time, as a feature of Bulimia 1994: Eating Disorders Not Otherwise Specified (EDNOS) is entered into the DSM-4 2013: Binge Eating Disorder is recognized as its own disorder in the DSM-5 -Treatment is now available and insurance can now cover treatment.

Sociocultural Factors

-The media and publications such as Vogue and Cosmopolitan exert a great deal of influence in defining the culture's "ideal body shape" and creating pressures to be thin. -Model Kate Moss coined the word "rexy" ("anorexic" + "sexy") to describe herself -Classic study done by Anne Becker and colleagues in Fiji: initially being fat was associated with being strong, able to work, kind, and generous; when reassessed in 1998, after television was introduced, women were dieting and expressing concern about their bodies/weight -Social pressures toward thinness may be particularly powerful in higher socioeconomic status backgrounds.

BED Prevalence/ Social Trends:

-The most common eating disorder and highly stigmatized in our society -12-month prevalence among U.S. adults (18+) females is 1.6%, among males is 0.8% -Latest research shows this is actually closer to 50/50 male/female -Prevalence (in the U.S. among females and males) does not differ when looking at racial or ethnic minorities -higher prevalence among those seeking weight-loss treatment -Individuals do not need to be overweight to have BED

1. GENETICS

-The risk of anorexia for relatives is 11.4 times greater than for the relatives of normal controls. -The risk of bulimia for relatives is 3.7 times higher than for the relatives of healthy controls. -Studies suggest anorexia nervosa and bulimia nervosa are heritable disorders.

1. Anorexia Nervosa

-The term anorexia nervosa literally means "lack of appetite induced by nervousness." -A misnomer -At the heart of anorexia nervosa is a pursuit of thinness that is relentless and that involves behaviors that result in a significantly low body weight. -We may think of the disorder as a modern problem, but descriptions of extreme fasting that were probably signs of anorexia nervosa can be found in early religious literature.

1. The Role of Genes

-Thinness seems to run in families. -Genetic mutation associated with binge eating is found in only 5 percent of the obese population. -All obese people with the gene reported problems with binge eating -Only 14 percent of obese people without the genetic mutation had a pattern of binge eating -Evidence suggests that BMI is polygenic and likely influenced by a large number of common genes

MEDICATIONS for Bulimia Nervosa

-Use of antidepressants is common -Goal is to decrease frequency of binges, improve mood and preoccupation with shape and weight

Bulimia Nervosa: What purging really does..

-Vomiting fails to prevent the absorption consumed during a binge -repeated vomiting disrupts body's satiety mechanisms, making them hungrier and leading to more frequent and intense binges -Vasopressin is released by the brain which acts on opioid receptors, causing an anxiety release and an "ahhh" feeling -Compensatory use of laxatives or diuretics fails to undo the caloric effects of bingeing -The only mechanism that can stop the anxiety becomes SIV (self induced vomiting) -Eventually a cycle develops where purging allows more bingeing and bingeing necessitates more purging -cycle eventually results in feelings of powerlessness, uselessness, and disgust with themselves -Most will realize they have an eating disorder, but anxiety over weight gain prevents disruption of the cycle

5. Stress and "Comfort Food"

-When under stress, people and animals eat foods high in fat or carbohydrates. -Weight gain may be explained in terms of learning principles. -We are all conditioned to eat in response to a wide range of environmental stimuli. -Anxiety, anger, boredom, and depression may lead to overeating. -Eating in response to such cues is then reinforced because the taste of good food is pleasurable and emotional tension is reduced

BED—quick considerations

-binge eating disorder continues to affect more people that anorexia and bulimia combined, but many people sadly fly under the radar, often suffering in silence for years due to fear of shame or the stigma that surrounds this illness -Recent estimates suggest that the prevalence of weight discrimination has increased by 66% over the past decade (Academy for Eating Disorders, 2019)

2. Bulimia Nervosa

-characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by using inappropriate behaviors such as self-induced vomiting and excessive exercise. -Bulimia comes from the Greek words bous ("ox") and limos ("hunger"). -Clinical picture is similar to the binge-eating/purging type of anorexia nervosa. -An argument has been made that the binge-eating/purging subtype of anorexia (severely underweight) should be considered another form of bulimia nervosa (normal or slightly above normal weight). -Those with bulimia nervosa are often preoccupied with shame, guilt, and self-deprecation, and efforts at concealment.

Severe nutritional deficiencies may cause (things to watch for):

-skin to become rough, dry, and cracked -nails to become brittle -hands and feet to be cold and blue -Some lose hair from the scalp -some grow lanugo (fine, silky hair that covers some newborns) on their trunk, extremities, and face.

Other common consequences of Bulimia nervosa

-small red dots around the eyes, caused by the pressure of throwing up; -swollen parotid (salivary) glands, caused by repeated vomiting ("puffy cheeks" or "chipmunk cheeks").

Psychological Factors Freudian Psychodynamic:

-unresolved oral conflicts lead to eating disorders unable to separate self from mother fixated at the oral stage -Afraid when approaching adolescence, sexual maturity and separation from parents -unconscious attempt to return to the early oral relationship, by undoing outward signs of maturity

3 major eating disorders in our chapter

1. Anorexia Nervosa 2. Bulimia Nervosa 3. Binge-Eating Disorder

Individual Risk Factors—Psychological (N = 6)

1. GENDER 2. INTERNALIZING THE THIN IDEAL 3. PERFECTIONISM 4. NEGATIVE BODY IMAGE 5. DIETING 6. NEGATIVE EMOTIONALITY

During an average binge, someone with bulimia nervosa may consume as many as

4,800 calories. After the binge, the person begins to vomit, fast, exercise excessively, or abuse laxatives

DSM-5 Criteria Bulimia Nervosa:

A. Recurrent episodes of binge eating. Episode characterized by both: 1. Eating within any 2-hr period, an amount of food that is definitely larger than what most would eat in a similar period of time, under similar circumstances 2. sense of lack of control over eating during the episode B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other meds, fasting, or excessive exercise) C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once 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

Clinical Aspects of Eating Disorders

According to DSM-5, eating disorders are characterized by a persistent disturbance in eating behaviors.

Clinical Aspects of Eating Disorders: bulimia nervosa

Despite decrease in prevalence of bulimia nervosa in recent decades, many young people—particularly adolescent girls and young adult women—show some evidence of disturbed eating patterns or have distorted self-perceptions about their bodies.

2. INTERNALIZING THE THIN IDEAL

Internalizing the thin ideal is associated with body dissatisfaction, dieting, and negative affect.

Prevalence/ Social Trends of Anorexia Nervosa

Lifetime prevalence among females is around 0.9% About a third less common among males than females

Prevalence/ Social Trends bulimia nervosa

Lifetime prevalence among females is around 1.5% About a third less common among males than females

COGNITIVE-BEHAVIOR THERAPY (CBT) for Anorexia Nervosa

Limited success in treating anorexia nervosa

6. NEGATIVE EMOTIONALITY

Negative affect (feeling bad) is a causal risk factor for body dissatisfaction; may also work to maintain binge eating, predict dietary restraint in anorexia nervosa

3. SET POINTS

Our bodies have a well-established tendency to resist variation from some sort of biologically determined set point or weight that our individual bodies try to "defend."

Ours is a fat-phobic society.

We can't deny it. Researchers on public health issues find that individuals deemed overweight or obese are thought to be lazy, weak-willed, unsuccessful, unintelligent, lack selfdiscipline, have poor willpower, and are noncompliant with weight-loss treatment. These stereotypes give way to stigma, prejudice, and discrimination against those living in larger bodies be it at home, the workplace, health care facilities, educational institutions, the media, and even our closest friends.

Anorexia nervosa and the DSM-5

a. restriction of energy intake relative to requirements, leading to a sig. low body weight in the context of age, sex, development trajectory, and physical health b.intense fear of gaining weight or of becoming fat, or persistant behvaior that interferes w/ weight gain, even though at a sig. low weight c. disturbances in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistant lack of recognition of the seriousness of he current low body weight weight loss is often viewed as an impressive achivement and a sign of great self-disipline weight gain is percived as an unacceptable faluire of self-control

Binge eating involves

an out-of-control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances.

To purge is to

remove from the body food that has been eaten