BYU IS PSYCH 342 Lesson 11

10. Although some people who have anorexia nervosa recover from the illness, studies suggest that ________ percent of these patients remain seriously troubled for many years. a. 80 b. 25 c. 40 d. 65

b. 25

6. Regarding sports and eating disorders, which of the following statements is not accurate? a. Eating disorders and weight maintenance for competitive purposes are on a similar continuum. b. Athletes attend to nutrition more than the general population, so they are more physically fit and less likely to develop eating disorders. c. Male athletes are most likely to develop eating disorders in weight-class competitive sports like wrestling. d. Male athletes are more likely to develop bulimia nervosa than anorexia nervosa or binge-eating disorder.

b. Athletes attend to nutrition more than the general population, so they are more physically fit and less likely to develop eating disorders.

4. Which statement about women with bulimia nervosa is accurate? a. They weigh about 20 percent more than they should. b. They generally maintain their normal weight, with some fluctuations. c. They are substantially below their normal weight. d. They are commonly obese.

b. They generally maintain their normal weight, with some fluctuations.

6. In which situation is bulimia nervosa or anorexia nervosa most likely to begin? a. upon entry into college, when fear of the "freshman fifteen" becomes overwhelming b. after a period of intense dieting that has been successful and has earned praise from others c. reaching the legal age to create social media accounts and engage with others online d. the onset of puberty, when bodies change and begin taking on a more adult form

b. after a period of intense dieting that has been successful and has earned praise from others

1. According to a video by Dr. Cynthia Bulik (embedded in the lesson) about eating disorder treatments, to enable all other treatments to be more effective (not "spinning in the mud") the single most important treatment procedure for clients with anorexia is to first ________. a. set concrete goals because clients tend to want to do everything perfect at once b. increase clients' body weight because the brain doesn't function well when undernourished c. replace clients' negative self-perceptions because eating disorders are mostly cognitive d. help clients' parents understand the condition because they are often part of the problem

b. increase clients' body weight because the brain doesn't function well when undernourished

1. Which psychological problem is often associated with anorexia nervosa? a. autism spectrum disorder b. obsessive-compulsive patterns c. dissociative identity disorder d. antisocial personality disorder

b. obsessive-compulsive patterns

11. Four individuals are receiving treatment for anorexia nervosa. Which person is expected to have a better long-term prognosis? a. the person who lost the most weight and had anorexia the longest b. the person who is the youngest c. the person who has troubled interpersonal relationships d. the person who had psychological or sexual problems before the onset of the disorder

b. the person who is the youngest

3. Which statement is true regarding treatment of bulimia nervosa? a. Antidepressant drugs do not help prevent the person from engaging in purging behaviors. b. Antidepressant drugs are not effective in patients who purge via laxatives or enemas. c. Treatment with antidepressant drugs is more effective than psychotherapy. d. Antidepressant drugs used in combination with psychotherapy are more effective than either treatment alone.

c. Treatment with antidepressant drugs is more effective than psychotherapy.

12. Certain professions are associated with increased risk for anorexia nervosa or bulimia nervosa. Which professional would be at greatest risk of developing one of these eating disorders? a. laborer b. teacher c. actor d. chef

c. actor

13. Which type of medication has been used to help reduce binges and vomiting in persons with bulimia nervosa? a. antipsychotics b. antianxiety drugs c. antidepressants d. beta blockers

c. antidepressants

7. Persons with ________ have a low opinion of their body shape and are likely to overestimate their actual proportions. a. neither anorexia nervosa nor bulimia nervosa b. bulimia nervosa c. both anorexia nervosa and bulimia nervosa d. anorexia nervosa

c. both anorexia nervosa and bulimia nervosa

8. Which type of eating disorder is found almost exclusively in men? a. abdominal dissatisfaction disorder b. non-binging bulimotoxicity c. muscle dysmorphia d. binge-eating disorder

c. muscle dysmorphia

12. The frequent vomiting and chronic diarrhea occasioned by bulimia nervosa may lead to the loss of which important bodily nutrient? a. selenium b. lysine c. potassium d. L-tryptophan

c. potassium

17. In a video in the lesson, Kendra Chillton described her experience with bulimia nervosa that began after she attempted to lose weight following a pregnancy. Her condition became so severe that ________, a. which prompted her to receive professional treatment. her newborn child died b. her physician observed her weight fluctuation c. she had heart failure and her mother became involved d. she began to hallucinate and experience cognitive decline

c. she had heart failure and her mother became involved

4. Which statement is true regarding binge-eating disorder? a. People with binge-eating disorder typically eat only high-calorie foods. b. Binge-eating disorder is the primary cause of obesity in the United States. c. People with binge-eating disorder eat only when hungry but then overeat. d. Binge-eating disorder is associated with being overweight or obese.

d. Binge-eating disorder is associated with being overweight or obese.

9. Which statement best represents the relationship between binge-eating disorder and being overweight or obese? a. Most overweight and obese individuals engage in binge eating. b. Binge-eating disorder is not associated with changes in body weight. c. Binge-eating disorder is not linked to being overweight or obese. d. Roughly half of people with binge-eating disorder become overweight or obese.

d. Roughly half of people with binge-eating disorder become overweight or obese.

2. A therapist is treating a young woman with bulimia nervosa. Which treatment approach would the therapist use to break the binge-purge cycle seen with this condition? a. systematic desensitization b. flooding c. psychodynamic therapy d. exposure and response prevention

d. exposure and response prevention

14. What other mental health conditions commonly co-occur with all eating disorders? a. developmental disorders b. dementia c. personality disorders d. mood and anxiety disorders

d. mood and anxiety disorders

16. Many people with bulimia nervosa also suffer from ________. a. learning disorders b. Asperger's syndrome c. opioid abuse d. mood disorders

d. mood disorders

15. The lesson made the point that because individuals with severe eating disorders tend to respond less positively to treatment than individuals with less severe symptoms, the best strategy is ________, and the next best strategy is ________. a. cognitive behavioral therapy (CBT); psychopharmacology b. medications; group therapy c. interpersonal therapy; family therapy d. prevention; early intervention

d. prevention; early intervention

8. People with alexithymia are not able to ________. a. accurately represent how large they are b. tell when they are hungry c. admit what is causing their eating disorder d. put descriptive labels on what they are feeling

d. put descriptive labels on what they are feeling

2. Common signs of eating disorders include all of the following except ________. a. dry skin and hair, brittle nails, and fine hair on the body (lanugo) b. stomach cramps and (among women) menstrual irregularities c. dental problems, such as enamel erosion and swelling of salivary glands d. extreme concern with body size/shape e. All of these are common signs of different eating disorders.

e. All of these are common signs of different eating disorders.

antidepressant medications and bulimia nervosa

in contrast to people with anorexia nervosa, those with bulimia nervosa are often helped considerably by these drugs drug therapy seems to work best in combination with other forms of therapy, particularly cognitive behavioral therapy

aftermath of anorexia nervosa

positive side: - weight is often quickly restored once treatments for the disorder begins - most females with anorexia nervosa menstruate again when they regained their weight - medical improvements follow treatment of anorexia nervosa - the death rate from anorexia nervosa seems to be falling negative side: - as many as 25% of persons with anorexia nervosa remain seriously troubled for years - when recovery does happen, it is not always permanent - may continue to have certain psychological problems (i.e. depression, obsessiveness, and social anxiety) - the more weight the persons have lost and the more time that passes before they enter treatment, the poorer the recovery rate

symptoms of bulimia nervosa

purging, excessive dieting, and excessive exercise

Treatments of Anorexia Nervosa

the immediate aims of treatment for anorexia nervosa are to help people regain their lost weight, recover from malnourishment, and eat normally again

weight set point

the weight level that a person is predisposed to maintain, controlled in part by the hypothalamus when people diet and fall to a weight below their weight set point, their brain starts trying to restore the lost weight

treatment of binge eating disorder

today's treatments for binge eating disorder are often similar to those for bulimia nervosa: - cognitive behavioral therapy - other forms of psychotherapy - antidepressant medications psychotherapy is generally more helpful than antidepressants Many people with binge eating disorder are also overweight, a problem that requires additional kinds of intervention weight problems are often resistant to long-term improvement, even if regular binge eating is reduced or eliminated

restricting type of anorexia nervosa

type of anorexia nervosa in which weight gain is prevented by refusal to eat (i.e. restricting their intake of food)

Symptoms of Anorexia Nervosa

- Fear of gaining weight/becoming fat/obese, giving in to their growing desire to eat, and losing control over the size and shape of their bodies - preoccupation with food ((which may be a result of food deprivation rather than the cause of food deprivation) - distorted thinking o low opinion of their body shape o consider themselves unattractive o likely to overestimate their actual body proportions o the distorted thinking of anorexia nervosa also takes the form of certain maladaptive attitudes and misperceptions (i.e. believing that they must be perfect in every way , that they will become a better person if they deprive themselves, and that they can avoid guilt by not eating) - psychological problems o depression o anxiety o low self esteem o insomnia or other sleep disturbances o substance abuse o the display of obsessive compulsive patterns (i.e. many exercise compulsively) o perfectionism (a characteristic that typically precedes the onset of the disorder)

psychodynamic factors of eating disorders

- Hilde Bruch developed a largely psychodynamic theory of eating disorders - she argued that disturbed mother child interactions lead to serious ego deficiencies in the child and to sever perceptual disturbances that jointly help produce disordered eating - ineffective parents failed to attend to their children's needs - to overcome their sense of helplessness, children seek excessive control over their body size and shape and over their eating habits - parents of teenagers with eating disorders do tend to define their children's needs rather than allow the child to define their own needs - people with eating disorders perceive internal cues, including emotional cues, inaccurately - people with eating disorders are often described by clinicians as Alexithymic (meaning they have great difficulty putting descriptive labels on their feelings) - people with eating disorders rely excessively on the opinions, wishes, and views of others

Causes of Bulimia Nervosa

- a bulimic pattern typically begins during or after a period of intense dieting - many experiment with vomiting or binges after they hear about these behaviors from friends or the media

consequences of anorexia nervosa

- as many as 6% of people with anorexia nervosa become so seriously ill that they die, usually for medical problems brought about by starvation or by suicide (The suicide rate among people with anorexia nervosa is 5 times the rate found in the general population) - Medical problems: o amenorrhea: the absence of menstrual cycles o lowered body temperature o low blood pressure body o swelling o reduced bone mineral density o slow heart rate o metabolic and electrolyte imbalances o death by heart failure or circulatory collapse o rough, dry, and cracked skin brittle nails o cold and blue hands and feet hair loss from the scalp o the growth of lanugo (define silky hair that covers some newborns)

binges

- binges are typically carried out in secret - a period where the person eats massive amounts of food very rapidly, with minimal chewing - the food is hardly tasted or thought about - binges are usually preceded by feelings of great tension - during the binge comma the person feels unable to stop eating - a binge is followed by feelings of extreme self blame, shame, guilt, and depression, as well as fears of gaining weight and being discovered

Similarities of Anorexia and Bulimia

- both disorders typically begin after a period of dieting by people who are fearful of becoming obese, driven to becoming thin, preoccupied with food , weight comma and appearance, and struggling with depression, anxiety, obsessiveness, and perfectionism - heightened risk of suicide - higher rates of substance abuse - beliefs that one weighs too much and looks too heavy regardless of their actual weight - both disorders are marked by disturbed attitudes toward eating

biological factors of eating disorders

- certain genes may leave some people particularly susceptible to eating disorders - there are dysfunctional brain circuits in people with eating disorders - research suggests that each of the circuits linked to generalized anxiety, obsessive compulsive, and depressive disorders also acts this functionally to some degree in people with eating disorders - the activity levels of serotonin, dopamine, and glutamate are abnormal in people with eating disorders - some researchers believe that dysfunction across or within the brain circuits tide to generalized anxiety, obsessive compulsive, and depressive disorders collectively help cause eating disorders - an explanation for eating disorders may be found in the hypothalamus (a part of the brain that helps regulate various bodily functions, including eating and hunger) o lateral hypothalamus: a brain region that produces hunger when activated o ventromedial hypothalamus: a brain region that depresses hunger when activated

Societal pressures of eating disorders

- eating disorders are more common in Western countries than in other parts of the world and many theorists believe that western standards of female attractiveness are partly responsible for the emergence of eating disorders - thinness is especially valued in the subcultures of performers, fashion models, and certain athletes and members of these groups are more likely to be concerned or criticized about their weight - performers, models, and athletes are more prone to anorexia nervosa and bulimia nervosa - Eating disorders and bodies dissatisfaction were linked to social networking, Internet activity, and television browsing

why some men develop anorexia nervosa or bulimia nervosa

- eating disorders may be linked to requirements and pressures of a job or sport (i.e. the highest rates of male eating disorders have been found among jockeys, wrestlers, distance runners, bodybuilders, and swimmers) - body image appears to be a key factor, just as it is in women - other men get caught up in a different kind of eating disorder called reverse anorexia nervosa (muscle dysmorphia) o muscle dysmorphia: 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

key components of treatment for eating disorders

- establishing a realistic body image and working toward self-acceptance, including by focusing on other aspects of one's life, such as talents and interests. - experiencing emotions (rather than walling them off), practicing emotional regulation, and using emotional coping strategies. - improving eating patterns (such as by changing eating from a solitary activity to a social activity), preventing access to undesirable triggers, and monitoring goals for weight management.

Consequences of Bulimia Nervosa

- heightened risk of suicide - higher rates of substance abuse - dental problems - potassium deficiencies - weakness - intestinal disorders - kidney disease - heart damage

other forms of psychotherapy for bulimia nervosa

- interpersonal psychotherapy: the treatment that is used to help improve interpersonal functioning - psychodynamic therapy - various forms of psychotherapy are often supplemented by family therapy

multicultural factors: gender differences and eating disorders

- males account for only 10% of all people with anorexia nervosa and bulimia nervosa - society's emphasis on a thin appearance is clearly aimed at women much more than men - majority of men select muscular, strong, and broad shoulders to describe the ideal male body and thin, slim, slightly underweight to describe the ideal female body - different methods of weight loss are favored by the two different genders (i.e. men are more likely to use exercise to lose weight, whereas women more often diet to lose weight; remember that dieting often precedes the onset of eating disorders)

multicultural factors: racial and ethnic differences and eating disorders

- most studies conducted up to the time of clueless indicated that the eating behaviors, values, and goals of young African American women we're considerably healthier than those of young non Hispanic white American women - however, research conducted over the past two decades suggests that the body image concerns, dysfunctional eating patterns, and anorexia nervosa and bulimia nervosa are on the rise among young African American women as well as among women of other minority groups - The shift in the eating behaviors and eating problems of African American women appears to be partly related to their acculturation - eating disorders also appear to be on the increase among young Asian American women and young women in several Asian countries

how proper weight and normal eating are restored for those with anorexia nervosa

- nutritional rehabilitation - in life threatening cases, clinicians may need to force tube an intravenous feedings on a patient who refuses to eat - clinicians use behavioral weight restoration approaches an offer rewards whenever patients eat properly or gain weight and offer no rewards when they eat improperly or failed to gain weight - the most popular nutritional rehabilitation approach is a combination of supportive nursing care, nutritional counseling, and a relatively high calorie diet - motivational interviewing

how lasting changes are achieved for those with anorexia nervosa

- people with anorexia nervosa must overcome their underlying psychological problems in order to create lasting improvements - Psychotropic drugs, particularly anti psychotic drugs, or sometimes used when patients do not respond to other forms of treatment , but research has found that such medications are typically of limited benefit for treatment of anorexia nervosa - cognitive behavioral therapy o techniques are designed to help clients appreciate an alter the behaviors and thought processes that help keep their restrictive eating going o behavioral side: clients are typically required to monitor (perhaps by keeping a diary) their feelings, hunger levels, and food intake and the ties between these variables o cognitive side: Clients are taught to identify their core pathology (the deep seated belief that they should in fact be judged by their shape and weight and by their ability to control these physical characteristics) o clients may also be taught alternative ways of coping with stress and of solving problems o therapists help patients with anorexia nervosa to recognize their need for independence and teach them more appropriate ways to exercise control o cognitive behavioral therapists seek to help clients with anorexia nervosa change their attitudes about eating and weight o Cognitive behavioral approach brings the best results when it is supplemented by other approaches, particularly family therapy - changing family interactions o family therapist may try to help the person with anorexia nervosa separate her feelings and needs from those of other members of her family

symptoms of binge eating disorder

- preoccupied with food, weight, and appearance -Often overweight -A sense of lack of control during binging -Chaotic eating behaviors (eating too fast, too much, in private) -Negative self-esteem, poor body image -Often associated with depression, substance abuse, anxiety disorders

What causes eating disorders?

- psychodynamic factors - cognitive behavioral factors - depression - biological factors - societal pressures - family environment - multicultural factors: race and ethnicity - multicultural factors: gender differences

multicultural factors of eating disorders

- race and ethnicity - gender

cognitive behavioral therapy of bulimia nervosa

- therapists often instruct clients with bulimia nervosa to keep Diaries of their eating behavior, changes in sensations of hunger and fullness, and the flow of other feelings - 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 are unnecessary (i.e. the therapist required clients to eat particular kinds and amounts of food and then prevent them from vomiting to show that eating can be harmless and even constructive and does not need undoing - therapists help clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape - therapists teach the clients to identify and challenge the negative thoughts that regularly proceed their urge to binge - therapists may also guide clients to recognize, question, and eventually change their perfectionistic standards, sense of helplessness, and low self concept

differences of anorexia and bulimia

- those with bulimia nervosa tend to be more concerned about pleasing others, being attractive to others, and having intimate relationships - those with bulimia nervosa tend to be more sexually experienced and active - those with bulimia nervosa are more likely to have long histories of mood swings, become easily frustrated or bored, and have trouble coping effectively or controlling impulses and strong emotions (more than 1/3 of those with bulimia nervosa display the characteristics of a personality disorder) - differences in the nature of medical complications o only half of women with bulimia nervosa are amenorrhoeic compared with almost all of those with anorexia nervosa o repeated vomiting present in bulimia nervosa leads to serious dental problems and can cause dangerous potassium deficiencies, weakness, intestinal disorders, kidney disease, or heart damage

Aftermath of Bulimia Nervosa

- treatment produces immediate significant improvement - relapse can be a problem even among people who respond successfully to treatment

Treatments of Bulimia Nervosa

- treatment programs for the disorder are often offered in eating disorder clinics - treatment programs offer 1. nutritional rehabilitation: helping clients eliminate their binge purge patterns and establish good eating habits 2. a combination of therapies aimed at eliminating the underlying causes of the bulimic patterns - cognitive behavioral therapy is particularly helpful in cases of bulimia nervosa (perhaps even more helpful than cases of anorexia nervosa) - antidepressant drug therapy, which is of limited help to people with anorexia nervosa, appears to be quite effective in many cases of bulimia nervosa

family factors of eating disorders

-Having a mother focused on her weight, and on child's appearance and weight -Negative self-evaluation in the family -For bulimia, if childhood obesity runs in the family -For anorexia, if families are competitive, high-achieving, and protective

5. Which of the following statements about biological determinants of eating disorders is most accurate? a. Anorexia nervosa affects multiple aspects of the body except for water retention (because cells retain water at normal levels because anorexics avoid food, not water) and brain functioning (other organs such as heart, skin, and digestive systems are affected). b. Scientists have recently identified a gene (yw8) common to binge-eating disorders, but anorexia nervosa and bulimia nervosa involve multiple genetic factors. c. In cases of severe anorexia, the body responds in ways that limit weight loss, even though the person has little food intake. d. Anorexia nervosa has been found to be 30% heritable.

??? c. In cases of severe anorexia, the body responds in ways that limit weight loss, even though the person has little food intake.

binge-eating/purging type of anorexia

Anorexia in which the individual loses weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics - these people may even engage in eating binges

consequences of binge eating disorder

Becoming overweight/obese

cognitive behavioral factors of eating disorders

Distorted cognitions, sense of control people with anorexia nervosa and bulimia nervosa judge themselves based on their shape and weight and their ability to control them

4. T/F One of the most common psychological disorders in the United States is obesity.

False; Obesity is not a psychological disorder—it is a medical condition.

1. T/F People with bulimia nervosa only force themselves to vomit after binging.

False; Some people with bulimia force themselves to vomit after every meal.

3. T/F People with anorexia nervosa see themselves as too fat, even if they may be extremely thin.

True; People with anorexia may still see themselves as too fat because of their distorted body image.

5. T/F People with bulimia nervosa can benefit from antidepressants.

True; Some people with bulimia nervosa benefit from antidepressants, but medications are not for everyone and additional forms of treatment are still needed.

2. T/F A person's body will respond as if they were starving when she or he starts losing significant amounts of weight.

True; The body will naturally slow down the metabolism of that person, making it more difficult for the person to continue losing weight or keep that weight off.

binge eating disorder

a disorder marked by frequent binges WITHOUT extreme compensatory behaviors

bulimia nervosa (binge purge syndrome)

a disorder marked by frequent eating binges followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight

enmeshed family pattern

a family system in which members are over involved with each other's affairs and over concerned about each other's welfare may contribute to the onset of eating disorders

multidimensional risk pattern

a theory that identifies several kinds of risk factors that are thought to combine to help caused a disorder; The more factors present comma the greater the risk of developing the disorder

motivational interviewing

a treatment intervention that uses a mixture of 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

10. The peak age range during which women develop anorexia nervosa is between ________. a. 14 and 20 b. 17 and 23 c. 19 and 25 d. 11 and 14

a. 14 and 20

5. Which statement best describes eating disorders in men? a. Male eating disorders are often linked to the requirements and pressures of a job or a sport. b. Eating disorders are easier to treat in men. c. Men are significantly more likely to develop anorexia nervosa than bulimia nervosa. d. Men and women develop eating disorders for similar reasons in similar ways.

a. Male eating disorders are often linked to the requirements and pressures of a job or a sport.

20. In general, which statement about feelings that trigger eating is true? a. Positive emotions are less likely than negative emotions to trigger the eating of junk food. b. Anxiety is the feeling that is least likely to trigger the eating of junk or nutritional foods. c. A person is much more likely to eat nutritional foods than junk food when in love. d. Self-confident people basically don't eat junk food.

a. Positive emotions are less likely than negative emotions to trigger the eating of junk food.

11. A video embedded in the lesson that detailed the experiences of a young man with binge-eating disorder indicated that he ate large amounts of food as an emotional coping response (eating for emotional comfort) that he attributed to ________. a. abandonment by his mother, who would feed him sandwiches under his door b. a positive childhood experience with a clown at a fast-food restaurant c. misunderstanding what kinds of foods were healthy vs. unhealthy d. his wanting to gain muscles and "bulk up" like weight lifters he saw on magazines

a. abandonment by his mother, who would feed him sandwiches under his door

3. Which eating disorder has the highest lifetime incidence among North Americans? a. binge-eating disorder b. pica c. bulimia nervosa d. anorexia nervosa

a. binge-eating disorder

7. People with anorexia nervosa are motivated primarily by ________. a. fear b. the desire to be like movie stars and models c. a death wish d. a preoccupation with food

a. fear

9. The starting body weight of a person who develops anorexia nervosa is typically ________. a. slightly overweight or normal weight b. underweight or normal weight c. obese d. significantly underweight

a. slightly overweight or normal weight

19. In people with bulimia nervosa, binges are usually preceded by feelings of ________. a. tension b. low self-esteem c. shame d. disgust

a. tension

compensatory behaviors of bulimia

after a binge, people tried to compensate for and undo its effects - vomiting (which usually fails to prevent the absorption of half the calories consumed during a binge) - the use of laxatives or diuretics (also usually fails to undo the caloric effects of bingeing) - Compensatory behaviors may temporarily relieve the uncomfortable physical feelings of fullness or reduce the feelings of anxiety and self disgust , however, a cycle develops in which purging allows more bingeing, and bingeing necessitates more purging - most people with bulimia nervosa recognize that they have an eating disorder - a bulimic pattern typically begins during or after a period of intense dieting

Family Based Treatment (FBT)

also known as the Maudsley approach involves strong family/parental involvement, with a gradual transition of feeding responsibility from parents to the children with the disorder 1. During the first phase of treatment, family members, including siblings, seek to align with one another and share family meals 2. The second phase shifts more responsibility to the child for self-management of food intake 3. the third phase occurs when healthy weight has been established and the child can focus on independent identity development

anorexia nervosa

an eating disorder marked by the pursuit of extreme thinness and by extreme weight loss - purposefully maintaining significant low body weight - intensely fearing becoming overweight - containing a distorted view of one's weight and shape - excessively influenced by one's own weight and shape in self evaluations