Psyc Eating Disorders
Bulimia Nervosa, also known as _____________ is characterized by binges. Binges are:
"binge-purge syndrome," Repeated bouts of uncontrolled overeating during a limited period of time Eat objectively more than most people would/could eat in a similar period
TREATMENT OF BULIMIA NERVOSA: Antidepressant medications During the past 15 years, ____ groups of antidepressant drugs have been used in bulimia nervosa treatment Drugs help as many as __% of patients Medications are best when used ___________________
all 40% in combination with other forms of therapy
Therapists help patients recognize their need for _____________________ Therapists help patients recognize and trust their _____________________
independence and control internal feelings
TREATMENT OF BULIMIA NERVOSA: Various forms of psychotherapy are often supplemented by family therapy and may be offered in either
individual or group therapy format
Therapists use a combination of therapy and education to achieve this broader goal, using a combination of ________________________ approaches; _____________________ have been helpful in some cases
individual, group, and family psychotropic drugs
People with bulimia nervosa may have between ___and___binge episodes per week Binges are often carried out in __________ Binges involve eating massive amounts of food very rapidly with little chewing Binge-eaters commonly consume between as many as __________ calories per binge episode
1 and 30 secret 10,000
BINGE EATING DISORDERS: Between __%-__% of the population display binge eating disorder The binges and many other symptoms that characterize this pattern are similar to those seen in _________ On the other hand, those with binge eating disorder are not driven to __________, the disorder doesn't start following ________, and there are not large _______ differences in the prevalence of this disorder
2 and 7% bulimia thinness a diet gender
BULIMIA NERVOSA: Many teenagers and young adults go on occasional binges or experiment with vomiting or laxatives after hearing about these behaviors from friends or the media According to global studies, __%-__% of students report periodic binge-eating or self-induced vomiting Only some of these individuals :
25-50% qualify for a diagnosis of bulimia nervosa
Multicultural Factors: Males account for only __%-__% of all cases of eating disorders The reasons for this striking difference are not entirely clear, but __________________________________ at the very least, one reason A second reason may be the different methods of ________________________ Men are more likely to ____________ Women more often _____
5% to 10% Western society's double standard for attractiveness is, weight loss favored: exercise Diet
The main symptoms of anorexia nervosa are: A refusal to maintain more than ___ of normal body weight Intense fears of ___________________ Distorted view of ____________ _________________: don't get menstural periods
85% becoming overweight weight and shape Amenorrhea
ANOREXIA NERVOSA: About __%-__% of cases occur in females The peak age of onset is between ________ years Between __%-__% of females in Western countries develop the disorder Many more display at least some symptoms
90%-95% 14 and 18 0.5% and 3.5%
BULIMIA NERVOSA: Like anorexia nervosa, about __%-__% of bulimia nervosa cases occur in females The peak age of onset is between ___________ years Symptoms may last for ___ _________with periodic letup Patients are generally of ___________ weight Often experience marked weight _______________
90%-95% 15 and 21 several years normal fluctuations
BULIMIA NERVOSA: Typical Case
A normal to slightly overweight female has been on an intense diet
Multicultural Factors: A widely publicized 1995 study found that eating behaviors and attitudes of young ______________ women were more positive than those of young _______________ women Specifically, nearly __% of the white American respondents were dissatisfied with their weight and body shape, compared to around __% of the African American teens
African American white American 90% 70%
Anorexia Nervosa: Medical Problems Caused by Starvation: (11)
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
Eating Disorders: Two main diagnoses:
Anorexia nervosa Bulimia nervosa
ANOREXIA NERVOSA: Negatives of treatment:
As many as 25% of patients remain troubled for years Even when it occurs, recovery is not always permanent Lingering emotional problems are common
Bulimia Nervosa vs. Anorexia Nervosa: common features Similarities: (9)
Begin after a period of dieting Fear of becoming obese Drive to become thin Preoccupation with food, weight, appearance Feelings of anxiety, depression, obsessiveness, perfectionism Heighted risk of suicide attempts Substance abuse Distorted body perception Disturbed attitudes toward eating
Given the key role of binges in both bulimia and binge eating disorder, treatments, too, are often similar ______________ therapy, other forms of psychotherapy, and, in some cases, _______________ medications are provided to reduce or eliminate binge patterns and to change __________________
Cognitive-behavior antidepressant disturbed thinking
People with anorexia nervosa also display certain psychological problems: (7)
Depression Anxiety Low self-esteem Insomnia or other sleep disturbances Substance abuse Obsessive-compulsive patterns Perfectionism
TREATMENT OF BULIMIA NERVOSA: Programs emphasize education as much as therapy Cognitive-behavioral therapy is particularly helpful: Behavioral techniques include:
Diaries are often a useful component of treatment Exposure and response prevention (ERP) is used to break the binge-purge cycle
Causes of Eating Disorders: Psychological Factors: Psychodynamic Factor: _____________ ____________ developed a largely psychodynamic theory of eating disorders He argued that eating disorders are the result of disturbed __________________, which lead to serious ____ deficiencies in the child and to severe ________________
Ego Deficiencies Hilde Bruch mother-child interactions ego perceptual disturbances
TREATMENT OF BULIMIA NERVOSA: The immediate aims of treatment for bulimia nervosa are to:
Eliminate binge-purge patterns Establish good eating habits Eliminate the underlying cause of bulimic patterns
____________ therapy is important for anorexia nervosa treatment The main issues are often _______________________
Family separation and boundaries
It seems that some men develop eating disorders as linked to the requirements and pressures of
a job or sport
The highest rates of male eating disorders have been found among: (5)
Jockeys Wrestlers Distance runners Body builders Swimmers
ANOREXIA NERVOSA: Rates of anorexia nervosa are increasing in
North America, Europe, and Japan
The immediate aims of treatment for anorexia nervosa are to: (3)
Regain lost weight Recover from malnourishment Eat normally again
There are two main subtypes OF ANOREXIA NERVOSA:
Restricting type Binge-eating/purging type
Abnormal interactions and forms of communication within a family may also set the stage for an eating disorder Influential family theorist _______________ cites "_____________________" as causal factors of eating disorders These patterns include:
Salvador Minuchin enmeshed family patterns overinvolvement in, and overconcern about, family member's lives
Persons with anorexia nervosa also think in distorted ways:
Usually have a low opinion of their body shape Tend to overestimate their actual proportions Hold maladaptive attitudes and misperceptions
ANOREXIA NERVOSA: Positives of treatment:
Weight gain is often quickly restored Menstruation often returns with return to normal weight The death rate from anorexia nervosa seems to be falling
Causes of Eating Disorders: Social Pressures: Many theorists believe that current ___________________________ are partly responsible for the emergence of eating disorders Western standards have changed throughout history toward a __________ ideal
Western standards of female attractiveness thinner
People with binge eating disorder who are overweight require
additional intervention
Recently, dieting and preoccupation with thinness, along with rates of eating disorders, are increasing in __________ The socially accepted prejudice against ________________may also add to the "fear" and preoccupation about weight
all groups overweight people
Bulimia Nervosa vs. Anorexia Nervosa: Different medical complications: Only half of women with bulimia nervosa experience _________________ vs. almost all women with anorexia nervosa People with bulimia nervosa suffer damage caused by purging, especially from ____________________
amenorrhea vomiting and laxatives
The shift of body concerns among minority groups appears to be partly related to _____________ Eating disorders among ___________________ female adolescents are about equal to those of white American women Eating disorders also appear to be on the increase among
assimilation Hispanic American Asian American women and young women in several Asian countries
A final focus of treatment is helping clients change their ________________________ Using cognitive approaches, therapists correct disturbed ___________________________________
attitudes about eating and weight cognitions and educate about body distortions
ANOREXIA NERVOSA: a Clinical Picture: The key goal for people with anorexia nervosa is ______________ The driving motivation is _______:
becoming thin fear
ANOREXIA NERVOSA: The "typical" case: A normal to slightly overweight female has _________ Escalation toward anorexia nervosa may follow a ___________________ ______ patients recover However, a _______ percentage become seriously ill and die
been on a diet stressful event Most small
People with eating disorders, especially those with ______________________ have serotonin abnormalities
bulimia nervosa
The Bulimia Nervosa disorder is also characterized by inappropriate _____________ behaviors, including: (4)
compensatory Forced vomiting Misusing laxatives, diuretics, or enemas Fasting Exercising excessively
In the past, treatment took place in a hospital setting; it is now often offered in
day hospitals or outpatient settings
ANOREXIA NERVOSA: The use of combined treatment approaches has greatly improved the outlook for people with anorexia nervosa But even with combined treatment, recovery is __________ The ____________________ of the disorder vary from person to person
difficult course and outcome
TREATMENT OF BULIMIA NERVOSA: Treatment is frequently offered in
eating disorder clinics
Treatment of Eating Disorders: Eating disorder treatments have two main goals: Correct dangerous ___________________ Address broader _______________and_____________factors that have led to, and are maintaining, the eating problem This often requires the participation of ___________________
eating patterns psychological and situational family and friends
Causes of Eating Disorders: Social Pressures: Members of certain subcultures are at greater risk from these pressures Societal attitudes may explain _________and____________ differences seen in prevalence rates Historically, women of ________ SES expressed more concern about thinness and dieting
economic and racial higher
Causes of Eating Disorders: Psychological Factors: Psychodynamic Factor: Bruch argues that parents may respond to their children either ____________or_____________ Ineffective parents fail to __________________, they feed when the child is anxious, comfort when the child is tired, etc. Such children may grow up confused and unaware of their own ____________ and turn, instead, to _______________ Clinical reports and research have provided ____________ support for this theory
effectively or ineffectively attend to child's needs; internal needs external guides some empirical
Families may play an important role in the development of eating disorders As many as half of the families of those with eating disorders have a long history of __________________ Mothers of those with eating disorders are more likely to be __________________________
emphasizing thinness, appearance, and dieting dieters and perfectionistic themselves
ANOREXIA NERVOSA: Despite their dietary restrictions, people with anorexia nervosa are preoccupied with _____. This includes thinking and reading about food and planning _____________ This relationship is not necessarily causal It may be the result of ________________ as evidenced by the famous 1940s "____________Study" with conscientious objectors
food for meals food deprivation Starvation
TREATMENT OF BULIMIA NERVOSA: Cognitive techniques Help clients recognize and change their maladaptive attitudes toward ___________________________ Typically teach individuals to identify and challenge the __________________________________
food, eating, weight, and shape negative thoughts that precede the urge to binge
TREATMENT OF BULIMIA NERVOSA: Follow-up studies suggest that 10 years after treatment about 75% of patients have___________________ ____________ can be a significant problem, even among those who respond successfully to treatment And they are usually triggered by __________
fully or partially recovered Relapse stress
BULIMIA NERVOSA: Binges are usually preceded by feelings of ___________ Although the binge itself may be pleasurable, it is usually followed by feelings of :
great tension extreme self-blame, guilt, depression, and fears of weight gain and being discovered
It has not always done so, but Western society today equates thinness with_________________ Thinness has become a ___________ obsession There has been a rise in eating disorders in the past ______ decades The core issue is a morbid fear of ________________
health and beauty national three weight gain
Causes of Eating Disorders: Biological Factors: Other theorists believe that eating disorders may be related to dysfunction of the __________________
hypothalamus
Causes of Eating Disorders: Biological Factors: Some theorists believe that the ______________________________ are responsible for weight set point - a "weight thermostat" of sorts Set by genetic inheritance and early eating practices, this mechanism is responsible for keeping an individual at a __________________________
hypothalamus, related brain areas, and chemicals together particular weight level
Cognitive Factors for Eating Disorders: Bruch's theory also contains several cognitive factors, like : Many people with eating disorders, particularly those with bulimia nervosa, experience symptoms of ______________ Theorists believe depressive disorders may ________________ for eating disorders
improper labeling of internal sensations and needs Depression depression "set the stage"
TREATMENT OF BULIMIA NERVOSA: If clients do not respond to cognitive-behavioral therapy, other approaches may be tried A common alternative is :
interpersonal therapy (IPT); a treatment that seeks to improve interpersonal functioning may be tried
There is empirical support for the claim that mood disorders set the stage for eating disorders: Many more people with an eating disorder qualify for a clinical diagnosis of _____________________than do people in the general population _______________ of those with eating disorders seem to have higher rates of depressive disorders People with eating disorders, especially those with bulimia nervosa, have _____________abnormalities Symptoms of eating disorders are helped by ___________________
major depressive disorder Close relatives serotonin antidepressant medications
In most treatment programs, a combination of behavioral and cognitive interventions are included On the behavioral side, clients are required to ________________________________________ On the cognitive sides, they are taught to _________________________________________
monitor feelings, hunger levels, and food intake and the ties among those variables identify their "core pathology"
Causes of Eating Disorders: Most theorists and researchers use a ______________________ perspective to explain eating disorders: Several key factors place individuals at risk More factors = greater likelihood of developing a disorder Leading factors:
multidimensional risk Psychological problems Biological factors Sociocultural conditions
BINGE EATING DISORDERS: Like those with bulimia, individuals with binge eating disorder engage in repeated eating binges during which they feel ____________ These individuals do not perform inappropriate ________________________ As a result of their binges, ________ of people with this disorder become overweight or obese It is important to recognize, however, that most overweight people ________________________
no control compensatory behaviors two-thirds do not engage in repeated binges
Bulimia Nervosa vs. Anorexia Nervosa: common features -Differences: More than one-third of people with bulimia display characteristics of a _______________disorder, particularly ___________________ disorder
personality borderline personality
Bulimia Nervosa vs. Anorexia Nervosa: common features -Differences: People with bulimia nervosa are more concerned about ________________________________________ People with bulimia nervosa tend to be more sexually _________________________ People with bulimia nervosa are more likely to have histories of ________________________________
pleasing others, being attractive to others, and having intimate relationships experienced and active mood swings, low frustration tolerance, and poor coping
For other men, body image appears to be a key factor some men seem to be caught up in a new kind of eating disorder -
reverse anorexia nervosa or muscle dysmorphobia
Causes of Eating Disorders: Biological Factors: Weight Set Point: If weight falls below set point: this leads to a _________________________________________ If weight rises above set point: ______________________________________ Dieters end up in a battle against themselves to lose weight
rise in hunger, which leads to a lower metabolic rate then this leads to binges drop in hunger, rise in metabolic rate
Now that binge eating disorder has been identified and is receiving considerable study, it is likely that _____________________ will be emerging In the meantime, little is known about the _________________________
specialized treatment programs aftermath of the disorder
The most popular weight-restoration technique has been the combination of ____________________________ Necessary weight gain is often achieved in __-__ weeks
supportive nursing care, nutritional counseling, and high-calorie diets 8 to 12
BULIMIA NERVOSA: Compensatory behaviors may _______________ the negative feelings attached to binge eating Over time, however, a cycle develops in which ______________________
temporarily relieve purging leads to bingeing which leads to purging...
TREATMENT OF BULIMIA NERVOSA: Group formats provide an opportunity for patients to express their _____________________________ Group therapy is helpful in as many as __% of cases
thoughts, concerns, and experiences with one another 75%
In life-threatening cases, clinicians may need to force ________________________________ This may breed _____________ in the patient and create a power struggle In contrast, behavioral weight-restoration approaches have clinicians use ____________ whenever patients __________________________________
tube and intravenous feedings on the patient distrust rewards eat properly or gain weight
Researchers have found that people with anorexia nervosa must overcome their _________________ to achieve lasting improvement
underlying psychological problems
BULIMIA NERVOSA: After a binge, people with bulimia nervosa try to compensate for and "undo" the caloric effects Many resort to _____________ Vomiting Fails to prevent the absorption of __________________________ Repeated vomiting affects the ability to feel _______________________
vomiting half the calories consumed during a binge satiated( full) which leads to greater hunger and bingeing
Left untreated, bulimia nervosa can last for ________ Treatment provides immediate, significant improvement in about __% of cases An additional __% show moderate response
years 40% 40%
Unfortunately, research conducted over the past decade suggests that body image concerns, dysfunctional eating patterns, and eating disorders are on the rise among
young African American women as well as among women of other minority groups