Eating Disorders

Binge eaters

This type of eater is ashamed of their eating problems and attempt to conceal their symptoms. Thus, it occurs in secrecy, or as inconspicuously as possible. It occurs until the individual is uncomfortably, or even painfully, full.

Men or Women are 10x more likely to develop an eating disorder

Women

Course for Bulimia Nervosa

beings in adolescence or early adult life. Disturbed eating behavior persists for at least several years in a high percentage of clinic samples. Periods of remission longer than 1 year are associated with better long-term outcome.

Sub-types of Bulimia Nervosa

Purging type and non-purging type

binge

defined as eating in a discrete period of time an amount of food that is definitely larger than most individuals would eat under similar circumstances.

Prevalence for Bulimia Nervosa

lifetime prevalence of this among women is approximately 1%-3%; the rate of occurrence of this disorder in males is approximately one-tenth of that in females.

discrete period of time

refers to a limited period, usually less than 2 hours. a singe episode of binge eating need not be restricted to one setting.

Bulimia Nervosa

repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. They are typically within the normal weight range, although some may be slightly underweight or overweight.

Sub-types of Anorexia Nervosa

restricting and binge eating/purging type

Cognitive-Behavioral view:

Anorexia: • Focus on body dissatisfaction and fear of fatness • Certain behaviors (e.g., restrictive eating, excessive exercise) negatively reinforcing • Reduce anxiety about weight gain • Perfectionism and personal inadequacy lead to excessive concern about weight • Feelings of self-control brought about by weight loss are positively reinforcing • Criticism from family & peers regarding weight can also play a role Bulimia: • Self-worth strongly influenced by weight • Low self-esteem • Rigid restrictive eating triggers lapses which can become binges o Many "off-limit" foods o Restraint Scale measures dieting and overeating • Disgust with oneself and fear of gaining weight lead to compensatory behavior o e.g., vomiting, laxative use • Stress, negative affect trigger binges (look at the notes)

Physical Changes in Anorexia

CARDIAC complications--loss of muscle, enlarged ventricles, arrhythmias, congestive heart failure, sudden death Low blood pressure, heart rate decrease, kidney & gastrointestinal problems Loss of bone mass--osteoporosis Anemia, leukopenia (low white blood cells) Brittle nails, dry skin, hair loss Lanugo (have it because there body is cold) • Soft, downy body hair Depletion of potassium & sodium • Can cause tiredness, weakness, and death

Psychodynamic View

Disturbed parent-child relationship • Over-controlling parent o Dieting a means to gain control and identity (Baruch, 1980) • Conflicted mother-daughter relationship o Bulimia creates a sense of self (Goodsitt, 1997) Personality characteristics • Body dissatisfaction, lack of interoceptive awareness, and negative emotions (Leon et al., 1999) • Perfectionism (Tyrka et al., 2002) • High neuroticism/anxiety (AK) • Shyness, compliant • Low self-esteem

Etiology of Eating Disorders: Genetics -

Family and twin studies support genetic link • First degree relatives of individuals with both disorders more likely to have the disorder • Higher MZ concordance rates for both anorexia and bulimia Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable Adoption studies needed Linkage on chromosome 1 (Grice et al., 2002) • Need for replication

Etiology of Eating Disorders: Neurobiological -

Hypothalamus not directly involved Low levels of endogenous opioids (dopamine may be released) • Substances that reduce pain, enhance mood, & suppress appetite • Released during starvation o May reinforce restricted eating of anorexia • Excessive exercise increases opioids ("runner's high" AK) • Low levels of opioids (beta-endorphins) in bulimia promote craving o Reinforce binging Serotonin & dopamine may also play a role

Physical Changes in Bulimia:

Menstrual irregularities Potassium depletion, dehydration from purging Laxative use depletes electrolytes which can cause cardiac irregularities (hypotension, bradycardia) Salivary gland enlargement, gastric or esophageal tears Loss of dental enamel from vomiting • Teeth appear "jagged" • Russell's sign (knuckles will be callused or red)

Eating Disorder Not Otherwise Specified

1. for females, all of criteria for anorexia nervosa are met except that the individual has regular menses. 2. all of the criteria for anorexia nervosa are met except that, despite significant weight loss, the individual's current weight is in the normal range. 3. all of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than three months. 4. the regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies. 5. repeatedly chewing and spitting out, but not swallowing, large amounts of food. 6. binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.

Suicide rates in anorexia

5% completing suicide 20% attempting suicide

Prognosis of Anorexia Nervosa

70% are able to recover

Diagnostic Criteria for Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) eating, in a discrete period of time, 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, enemas, or other medications; fasting or excessive exercise. C. The binge eating and 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 Specify Type: (1) Purging Type (2) Non-purging Type

Diagnostic 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, i.e., the absence of at least three consecutive menstrual cycles (A women is consider to have amenorrhea if her periods occur only following hormone, e.g., estrogen, adminstration) Specify type: - Restricting type - Binge-Eating/Purging Type

Specific Culture, Age, and Gender Features for Bulimia Nervosa:

In clinic population samples, at least 90% of individuals with this are female.Male with this have a higher prevalence of premorbid obesity than do females.

Associated Physical examination findings and GMC for Bulimia Nervosa:

Recurrent vomiting eventually leads to a significant and permanent loss of dental enamel, especially from lingual surfaces of the front teeth (appear "moth-eaten" teeth). Frequent dental cavities. May develop calluses or scars on the dorsal surface of the hand from repeated trauma from the teeth. Serious cardiac and skeletal myopathies have been reported among individuals who regularly use syrup of ipeaca to induce vomiting. Menstrual irregularity or amenorrhea sometimes occurs among females.

Non-purging Type

This sub-type describes presentations in which the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode.

Binge-Eating/Purging Type

This sub-type is used when the individual has regularly engaged in binge eating or purging (or both) during the current episode. Most individuals with Anorexia Nervosa who binge eat also purge through self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Some individuals included in this sub-type do not binge eat, but do regularly purge after the consumption of small amounts of food.

Anorexia Nervosa

eating disorder appears to be far more prevalent in industrialized societies, in which there is an abundance of food an din which, especially for females, being considered attractive is linked to being thin. It rarely begins before puberty and exists between the ages 13 and 18 years. More than 90% of cases of Anorexia Nervosa occur in females. There is an increased risk of Anorexia Nervosa among first-degree biological relatives of individuals with the disorder. An increased risk of Mood Disorder have also been found among first-degree biological relatives of individuals with Binge-Eating/Purging Type. Twins have found concordance rates for monozygotic twins to be significantly higher than those for dizygotic twins.

Anorexia Nervosa

essential features are that the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of the shape or size of his or her body.

Treatment of Eating Disorders:

o Most individuals don't receive treatment Denial common o Antidepressants Effective for bulimia but not anorexia Drop out and relapse rates high o CBT for bulimia Challenge societal ideals of thinness Challenge beliefs about weight and dieting CBT more effective than medication o Limited evidence suggests that antidepressant medications are not effective in reducing binges o Anorexia Immediate goal is to increase weight to avoid medical complications and avoid death--may mean involuntary hospitalization (AK) Second goal is long term maintenance of weight gain o CBT Alter all-or-nothing thinking Reductions in symptoms through 1 year Also effective for binge-eating disorder o Family-based therapy (FBT) found to be effective

Prevention of Eating Disorders:

o Psycho-educational approaches Dissonance reduction intervention • De-emphasize sociocultural influences o Healthy weight intervention Identify those most at risk and intervene early Develop healthy weight and exercise programs for selves

Type of food consumed in binge eating

sweet, high-calorie foods such as ice cream or cake and carbs

Anorexia Nervosa

the semi-starvation characteristic of this disorder can affect most major organ systems and produce a variety of disturbances. It can also result in significant associated general medical conditions.

Outcome of frequent purging

this behavior of any kind can produce fluid and electrolyte abnormalities, most frequently hypokalemia, hyponatremia, and hypochloremia. The loss of stomach acid through vomiting may produce a metabolic alkalosis, and the frequent induction of diarrhea through laxative abuse can cause metabolic acidosis.

How binge eating is triggered

this is triggered by dysphoric mood states, interpersonal stressors, intense hunger following dietary restraint, or feelings related to body weight, body shape, and food.

Purging Type

this sub-type describes presentations in which the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode.

Restricting Type

this sub-type describes presentations in which weight loss is accomplished primarily through dieting, fasting, or excessive exercise. During the current episode, these individuals have not regularly engaged in binge eating or purging.