Chapter 11: Eating Disorders

Barbie

"Why do women have such low self-esteem? There are many complex psychological and societal reasons, by which I mean Barbie." Dave Barry, 1999

Goals of Treatment for Bulimia Nervosa

(Frequently offered in eating disorder clinics) - Eliminate binge-purge patterns - Establish good eating habits - Eliminate the underlying cause of bulimic patterns

Two Main Diagnoses

- Anorexia nervosa - Bulimia nervosa

Treatments for Bulimia Nervosa

- Common alternative is interpersonal therapy (IPT)--a treatment that seeks to improve interpersonal functioning - Psychodynamic therapy has also been used - Family therapy or group therapy - Group therapy is helpful in as many as 75% of cases - Antidepressant medications (drugs may help as many as 40% of patients) If left untreated, can last for years - Treatment provides immediate, significant improvement in about 40% of cases (an additional 40% show moderate response) - Follow-up studies suggest that 10 years after treatment about 75% of patients have fully or partially recovered

Psychological Problems of Anorexia Nervosa

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

Ego Deficiencies (psychodynamic factors)

- Hilde Bruch developed a largely psychodynamic theory based off that eating disorders are the result of disturbed mother-child interactions - Ineffective parents fail to attend to child's needs; they feed when the child is anxious, confort when the child is tired, etc. - some empirical support

Western Societies and Media

- Most vulnerable are those who idealize thinness and have the greatest body dissatisfaction - Nearly 1/2 of US women report feeling negative about their appearance and preoccupied with being or becoming overweight - One survey of 60,000 revealed 90% of women said they would rather have a perfect body than have a mate with a perfect body. 60% of men preferred the reverse

Origins of Eating Disorders

- Mothers - Families of bulimic patients - Families that are competitive, achievement oriented, and protective - Anorexics set perfectionist standards and worry about falling short of expectations - Twin studies have shown eating disorders are more likely to occur in identical than fraternal twins - Culture

Combination of Behavioral and Cognitive interventions for Anorexia Nervosa

- On the behavioral side, clients are required to monitor feelings, hunger levels, and food intake and the ties among those variables - On the cognitive sides, they are taught to identify their "core pathology"

Subtypes of Bulimia Nervosa

- Purging-type bulimia nervosa - Nonpurging-type bulimia nervosa

Goals of treatment for Anorexia Nervosa

- Regain lost weight - Recover from malnourishment - Eat normally again

Two subtypes of Anorexia Nervosa

- Restricting type - Binge-eating/purging type

Clinical Picture of Anorexia Nervosa

- preoccupied with food regardless of their dietary restrictions - Think in distorted ways: Tend to overestimate their actual proportions and Hold maladaptive attitudes and misperceptions

Bulimia Nervosa

A disorder characterized by episodes of overeating, usually of high-calorie foods, followed by compensatory vomiting, laxative use, fasting, or excessive exercise - They overeat the way an alcoholic drinks excessively - They are prone to bouts of depression and anxiety - Bulimia is easier to hide because weight fluctuates within or above normal ranges - Characterized by binges and bouts of uncontrolled overeating during a limited period of time

Binge-eating disorder

A related diagnosis of bulimia nervosa - Symptoms are a pattern of bing eating with NO compensatory behaviors (such as vomiting)

Compensatory Behaviors (Bulimia Nervosa)

After a binge, people with bulimia will try to compensate for and "undo" the caloric effects Most common: - Vomiting - Laxatives and diuretics

Family Environment

As many as half of the families of those with eating disorders have a long history of emphasizing thinness, appearance, and dieting - Mothers of those with eating disorders are more likely to be dieters and perfectionistic themselves - Salvador Minuchin cites "enmeshed family patterns" as causal factors of eating disorders

Key goal for People with Anorexia Nervosa

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

Anorexia Nervosa

Begins with a weight loss diet and an obsession with a mistaken belief that the body is fat Main Symptoms: - A refusal to maintain more than 85% of normal body weight - Intense fears of becoming overweight - Distorted view of weight and shape - Amenorrhea

Culture Influence of Eating behavior

Body ideals vary across cultures and time - In India, women rate their ideals as close to their actual shape - In Africa, bigger is better - In Western culture, the rise in eating disorders is linked to the increase in women having a poor body image

Cognitive Factors

Broad cognitive distortion lies at the center of disordered eating (e.g., negative self-judgement based on body shape and weight)

Relapse with Bulimia Nervosa

Can be a significant problem - Usually triggered by stress More likely among persons who: - Had a longer history of symptoms - Vomited frequently - Had histories of substance use - Have lingering interpersonal problems

Medical Problems from Anorexia Nervosa

Caused by starvation: - Amenorrhea - Low body temperature - Low blood pressure - Body Swelling - Reduced Bone Density - Slow Heart Rate - Metabolic and electrolyte imbalances - Dry skin, brittle nails - Poor circulation - Lanugo

Biological Factors

Certain genes may leave some people particularly susceptible to eating disorders - Relatives of people with eating disorders are up to 6 times more likely to develop the disorders themselves - Identical twins with anorexia: 70% - Fraternal twins with anorexia: 20% - Identical twins with bulimia: 23% - Fraternal twins with bulimia: 9% Eating disorders may be related to dysfunction of the hypothalamus - the hypothalamus, related brain areas, and chemicals together are responsible for weight set point (a "weight thermostat" of sorts

Western Societal View

Equates thinness with health and beauty - Thinness has become a national obsession - The core issue is a morbid fear of weight gain

Patient recovery

Most recover, but about 2-6% become seriously ill and die as a result of medical complications or suicide

Causes of Eating Disorders

Multidimensional risk perspective (more factors= greater likelihood of developing a disorder) Leading factors: - Psychological problems (ego, cognitive, and mood disturbances) - Biological factors - Sociocultural conditions (societal, family, and multicultural pressures)

Binges of Bulimia Nervosa

Often carried out in secret - Involve eating massive amounts of food very rapidly with little chewing (food is usually sweet, high-calorie foods with soft texture) - Commonly consume between 1,000 and 10,000 calories per binge episode - Usually preceded by feelings of great tension and/or powerlessness

Treatments for Anorexia Nervosa

Often offered in day hospitals or outpatient settings - In life-threatening cases, clinicians may need to force tube and intravenous feedings of the patient The most popular weight-restoration technique has been the combination fo supportive nursing care, nutritional counseling, and high-calorie diets - Necessary weight gain is often achieved in 8 to 12 weeks - Using cognitive approaches, therapists correct disturbed cognitions and educate about body distortions - Family therapy is important

Males with Eating Disorders

Only account for 5-10% of all cases Found among: - Jockeys - Wrestlers - Distance runners - Body builders - Swimmers

Cognitive-Behavioral therapy for Bulimia Nervosa

Particularly helpful - Behavioral techniques: diaries; exposure and response prevention (ERP) is used to break the binge-purge cycle - Cognitive techniques: help clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape

Binge Eating Disorder

Repeated eating binges during which they feel no control over their eating - These individuals do not perform inappropriate compensatory behavior - As a result of their frequent binges, around 2/3 of people with binge eating disorder become overweight or even obese

Overlapping Patterns

Some people with anorexia nervosa binge and purge their way to weight loss, and some obese persons binge-eat. However, most people with bulimia nervosa are not obese, and most overweight people do not binge-eat.

Dark Sites of the Internet

There are more than 500 pro-anorexia Internet sites ("Dying to Be Thin" and "Starving for Perfection"

Socially Accepted Prejudice

There is one against overweight people which may also add to the "fear" and preoccupation about weight - About 50% of elementary school girls and 61% of middle school girls are currently dieting - A recent survey of adolescent girls tied eating disorders and body dissatisfaction to social networking, Internet activities, and television browsing

Treatments for Bing-Eating

Treatments are often similar to those for bulimia nervosa

Treatment goals

Two: - Correct dangerous eating patterns - Address broader psychological and situational factors that have led to, and are maintaining, the eating problem

Societal Pressure

Western standards of female attractiveness are partly responsible for the emergence of eating disorders - Miss American contestants have declined in weight by 0.28 lbs/year; winners have declined by 0.37 lbs/year Certain subcultures are at greater risk - Models, actors, dancers, and certain athletes Women of higher SES expressed more concern about thinness and dieting - dieting and preoccupation with thinness, along with rates of eating disorders, are increasing in all groups