unit 3 topic 1 (eating disorders and obesity)
Obesity and the DSM
-From a diagnostic perspective, obesity is not an eating disorder, and it is not included in DSM-5.
Anorexia nervosa
-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. -An important change from DSM-IV to DSM-5 is that in DSM-5 amenorrhea (cessation of menstruation) is no longer required for a person to be given the diagnosis. -Efforts are often made to conceal their thinness by wearing baggy clothes or carrying hidden bulky objects so that they will weigh more when measured by others
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 this disorder. -However, at 2-year follow-up, people who had received either IPT or guided CBT were doing better than those in the behavioral weight loss group (involved exercise and restriction of calories). -dropout rate was much lower for people in the IPT group (7 percent dropped out) than it was in the guided CBT (30 percent) or behavioral weight loss groups (28 percent) -racial and ethnic minorities with BED, interpersonal psychotherapy might be a particularly suitable treatment approach
Family influences for obesity
-Family behavior patterns may also play a role in the development of excessive eating and obesity -In some families, a high-fat, high-calorie diet (or an overemphasis on food) may lead to obesity in many or all family members, including the family pet. -In other families, eating (or overeating) becomes a habitual means of alleviating emotional distress or showing love -Children whose mothers smoked during pregnancy or whose mothers gained a lot of weight during the pregnancy are also at a higher risk of being overweight at age 3 -People who are obese have markedly more adipose cells than people of normal weight -When people with obesity lose weight, the size of the cells is reduced but not their number. -It is possible that overfeeding infants and young children causes them to develop more adipose cells and may thus predispose them to weight problems in adulthood -there is some evidence that obesity might be "socially contagious." -Provocative research findings have shown that 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
Stress and "comfort food"
-Foods that are high in fat or carbohydrates are the foods that console most of us when we are feeling troubled -We are all conditioned to eat in response to a wide range of environmental stimuli (at parties, during movies, while watching TV). -Individuals who are obese have been shown to be conditioned to more cues—both internal and external—than others of normal weight -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 because the individual's emotional tension is reduced
medication for bulimia nervosa
-It is quite common for patients with bulimia nervosa to be treated with antidepressant medications -Patients taking antidepressants do better than patients who are given inert, placebo medication -antidepressants seem to decrease the frequency of binges as well as improve patients' mood and preoccupation with shape and weight
body mass index
healthy: 18.5-24.9 overweight: 25-29.9 obese: 30-39.9 morbidly obese: 40
Lifestyle modifications for obesity
-A first step in the treatment of obesity is a clinical approach that, ideally, involves a low-calorie diet, exercise, and some form of behavioral intervention. -lifestyle modification approaches yield positive benefits for patients, although the results are far from dramatic -However, it is important to keep in mind that for people who are overweight, even small amounts of weight loss may yield some health benefits. -Using meal-replacement products (e.g., calorie-controlled shakes), continuing a relationship with a treatment provider, and maintaining a high level of physical activity all help improve efforts at long-term weight control -Weight Watchers is the only commercial weight loss program with demonstrated efficacy in a randomized controlled trial. -Recent research has shown that focusing on the proportion of fat, protein, or carbohydrates in the diet is far less important than just eating less -for those who are obese, losing weight and maintaining the weight loss present a truly formidable challenge. -When we try to go below set point, marked metabolic and hormonal changes occur -The body goes into "starvation mode" and hunger is increased, the metabolic rate slows, and we also feel less full after eating -energy expenditure decreases significantly following weight loss -relapse rates are so high after weight loss and that people who attempt to lose weight often feel so discouraged
Binge eating disorder
-After a binge the person with BED does not engage in any form of inappropriate "compensatory" behavior such as purging, using laxatives, or even exercising to limit weight gain -There is also much less dietary restraint in BED than is typical of either bulimia nervosa or anorexia nervosa -binge eating disorder is associated with being overweight or even obese -more likely to have overvalued ideas about the importance of weight and shape than patients who are overweight or obese and who do not have BED
Course and outcome of eating disorder
-After medical complications, the second most common cause of death in those who suffer from anorexia nervosa is suicide. -patients who have lost their ability to maintain an "emotionally protective" low body weight are at particularly high risk of suicide -Bulimia nervosa is not associated with increased risk of completed suicide, although suicide attempts are made in 25 to 30 percent of cases -even after a series of treatment failures it is still possible for women with anorexia nervosa to become well again -With regard to bulimia nervosa, in the long term, prognosis tends to be quite good -patients with binge eating disorder also have high rates of clinical remission. -even when well, many individuals who recover from anorexia nervosa and bulimia nervosa still harbor residual food issues -They may be excessively concerned about shape and weight, restrict their dietary intakes, and overeat and purge in response to negative mood states
pathways to obesity
-An important step along the pathway to obesity, however, may be binge eating. -one pathway to binge eating may be through social pressure to conform to the thin ideal, as ironic as this may seem -Being heavy often leads to dieting, which may lead to binge eating when willpower wanes -Another pathway to binge eating may operate through depression and low self-esteem -a pattern of binge eating in response to negative emotions may make a bad situation much worse—increasing weight, depression, and fostering alienation from peers in a vicious cycle
medications for anorexia nervosa
-Antidepressants are sometimes used in the treatment of anorexia nervosa, although there is no evidence that they are especially effective -research suggests that treatment with an antipsychotic medication called olanzapine may be beneficial -These antipsychotic medications also provide benefits in the treatment of anorexia nervosa, which is characterized by distorted beliefs about body shape and size. -one side effect of olanzapine is weight gain.
Bariatric surgery
-Bariatric or gastric bypass surgery is the most effective long-term treatment for people who are morbidly obese -Several different techniques can be used both to reduce the storage capacity of the stomach and, sometimes, to shorten the length of the intestine so that less food can be absorbed. -Before the operation, the stomach might be able to hold about a quart of food and liquid. -After the procedure, the stomach might be able to hold only the contents of a shot glass -Binge eating becomes virtually impossible -Surgical treatment of obesity tends to result in substantial weight loss, averaging between 44 and 88 pounds -levels of the appetite hormone ghrelin are also suppressed after particular types of surgical procedures -some patients manage to find ways to continue to binge eat after surgery and tend to regain their weight over an 18-month period -Although bariatric surgery is not without risk (mortality rates hover around 1 percent), the risk of the surgery should be evaluated against the health risks that accompany untreated obesity.
Individual risk factors: gender and eating disorder
-Being female is a strong risk factor for developing eating disorders, particularly anorexia nervosa and bulimia nervosa -Binge-eating disorder is also much more likely to be found in males as well as in females -being in a relationship may moderate the risk for disordered eating -gay and bisexual men in their 30s and 40s who were in relationships reported less of a drive for thinness and dieted less frequently than men of the same age who were single and without a partner
Bulimia nervosa
-Bulimia nervosa is characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by using inappropriate behaviors such as self-induced vomiting and excessive exercise. -Binge eating and purging now have to occur on average once a week (instead of twice a week) over a 3-month period -if the person who binges or purges also meets criteria for anorexia nervosa, the diagnosis is anorexia nervosa (binge-eating/purging type) and not bulimia nervosa. -anorexia nervosa diagnosis "trumps" the bulimia nervosa diagnosis because there is a far greater mortality rate associated with anorexia nervosa than with bulimia nervosa. -During these early stages, the person diets and eats low-calorie foods -Over time, however, the early resolve to restrict gradually erodes, and the person starts to eat "forbidden foods" such as potato chips, pizza, cake, ice cream, and chocolate -After the binge, in an effort to manage the breakdown of self-control, the person begins to vomit, fast, exercise excessively, or abuse laxatives. -Whereas people with anorexia nervosa often deny the seriousness of their disorder and are surprised by the shock and concern with which others view their emaciated conditions, those with bulimia nervosa are often preoccupied with shame, guilt, and self-deprecation.
Age of onset and gender differences for eating disorder
-Children as young as age 7, though, have been known to develop eating disorders, especially anorexia nervosa -eating disorders can develop at any age, although they typically emerge in adolescence or early adulthood -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 the age range of 21 to 24 -Most patients with binge eating disorder are older than those with anorexia nervosa or bulimia nervosa, generally between 30 and 50 years of age. -Eating disorders have long been regarded as occurring primarily in women (3:1) than men -Overexercising as a means of weight control is also more common in men -Gay and bisexual men have higher rates of eating disorders than heterosexual men do -Because gay men (like women) are seeking to be sexually attractive to men, body dissatisfaction may therefore be more of an issue for gay men than it is for heterosexual men -Other specific subgroups of men who are at higher risk of eating disorders are wrestlers and jockeys, who need to "make weight" in order to compete or work
Cognitive-behavior therapy for anorexia nervosa
-Cognitive-behavior therapy (CBT), which involves changing behavior and maladaptive styles of thinking, has proved to be very effective in treating bulimia nervosa. -Because anorexia nervosa shares many features with bulimia nervosa, CBT is often used with patients with anorexia nervosa as well -The recommended length of treatment is 1 to 2 years -major focus of the treatment involves modifying distorted beliefs concerning weight and food, as well as distorted beliefs about the self that may have contributed to the disorder -The limited success of CBT for patients with anorexia nervosa may be due to the extreme cognitive rigidity that is characteristic of those with this disorder
individual risk factors: dieting and eating disorder
-Dieting is a risk factor for the development or worsening of eating disorders -it was the people who dieted and who also reported more symptoms of depression or who had low selfesteem who were most likely to develop problems with binge eating later. -although dieting itself was a risk factor for future binge eating, low self-esteem and symptoms of depression created additional risk
Family therapy for anorexia nervosa
-For adolescents with anorexia nervosa, family therapy is considered to be the treatment of choice. -typical treatment program involves 10 to 20 sessions spaced over 6 to 12 months -The treatment has three phases -In the refeeding phase, the therapist works with the parents and supports their efforts to help their child (typically a daughter) to eat healthily once more. -After the patient starts to gain weight, the negotiations for a new pattern of relationships phase begins, and family issues and problems begin to be addressed. -in the termination phase of treatment, the focus is on the development of more healthy relationships between the patient and her parents -although individual therapy (which encouraged weight gain, the development of autonomy, and accepting responsibility for food-related issues) was slightly less efficacious overall than family treatment, it was still very acceptable to the adolescents who received it and it still provided some benefit. -Patients who develop anorexia nervosa before age 19 and have been ill for fewer than 3 years seem to do better than patients who have been ill for longer or who have bulimia nervosa
biological causal factors: genetic factors for eating disorder
-Genetic factors play an important role in eating disorders, although specific genes have not yet been reliably identified. -tendency to develop an eating disorder has been shown to run in families -The biological relatives of people with anorexia nervosa or bulimia nervosa have elevated rates of anorexia nervosa and bulimia nervosa themselves. -both anorexia nervosa and bulimia nervosa are heritable disorders -it has been suggested that the contribution of genetic factors to the development of eating disorders may be about as strong as the contribution of genetic factors to bipolar disorder and schizophrenia -Although genes undoubtedly play a role in the etiology of eating disorders, there is little that can be said specifically at this point -Genes may make some people more susceptible to binge eating or to sociocultural influences, or may underlie personality styles (e.g., perfectionism) that increase risk for eating disorders.
individual risk factors: Negative emotionality and eating disorder
-Negative affect (feeling bad) is a causal risk factor for body dissatisfaction -Individuals with eating disorders, who, like people with depression, tend to show distorted ways of thinking and of processing information received from the environment -evidence suggests that negative affect may work to maintain binge eating -Patients often report that they engage in binges when they feel stressed, down, or bad about themselves -negative affect is more likely to be the trigger for dietary restriction, rather than the other way around
Medical issues with obesity
-Obesity brings with it increased risk for many health problems (high cholesterol, hypertension, heart disease, arthritis, diabetes, and cancer) -people who are obese have a reduced life expectancy of 5 to 20 years
biological causal factors: brain abnormalities in eating disorder
-One brain area that plays an important role in eating is the hypothalamus. -Uher and Treasure (2005) reviewed a series of case reports of patients with tumors in the hypothalamus. -Although these were sometimes associated with an increase or loss of appetite, there was no evidence that they resulted in specific eating disorders -damage to the frontal and the temporal cortex did seem to be linked to the development of anorexia nervosa in some cases and bulimia nervosa in others. -temporal cortex is known to be involved in body image perception. -Parts of the frontal cortex (particularly an area called the orbitofrontal cortex) also play a role in monitoring the pleasantness of stimuli such as smell and taste -hypothalamus "senses" weight in some way and keeps things in balance with the ventromedial hypothalamus acting as a "satiety center" and the lateral hypothalamus serving as an "appetite center." -lateral hypothalamus acts as a site that integrates other information relevant for regulating food intake -lateral hypothalamus receives information from many parts of the brain, including the frontal cortex and the amygdala (which is a part of the brain involved in emotion and fear learning) -Animal research suggests that a network involving these (and other) brain areas may be important not only for overeating in response to environmental cues but for suppressing eating in response to fear
individual risk factors: Negative body image and eating disorder
-One consequence of sociocultural pressure to be thin is that some young girls and women develop highly intrusive and pervasive perceptual biases regarding how "fat" they are -sociocultural influences are implicated in the discrepancy between the way many young girls and women perceive their own bodies and the "ideal" female form as represented in the media -Such perceptual biases lead girls and women to believe that men prefer more slender shapes than they in fact do -Many women also feel evaluated by other women, believing that their female peers have even more stringent standards of weight and shape than they do themselves. -body dissatisfaction as an important risk factor for pathological eating -Body dissatisfaction is also associated with dieting and with negative affect
enhanced cognitive-behavior therapy, or CBT-E for bulimia nervosa
-One form of the treatment (the default treatment) is quite focused, targeting eating issues as well as concerns about shape and weight, extreme dieting, purging, and binge eating -The other form of the treatment is broader and also addresses such things as perfectionism, low self-esteem, and relationship problems. -findings show that, as a transdiagnostic treatment, CBT-E is very beneficial -The results also suggest that although IPT is a viable alternative treatment, CBT-E works more quickly
Hormones involved in appetite and weight regulation
-One key element of this homeostatic system is a hormone called leptin -Leptin (the name comes from the Greek word leptos, meaning "thin") is produced by fat cells -It provides a key metabolic signal that informs the central nervous system about the state of the body's fat reserves. -When body fat levels decrease, leptin production decreases and food intake is stimulated -Rare genetic mutations that result in an inability to produce leptin cause people to have an insatiable appetite and result in morbid obesity. -when leptin is given to individuals who are overweight, in the majority of cases it has little effect. -People who are overweight generally have high levels of leptin in their bloodstream -Why do we get hungry at regular times during the day even if we do not even see or smell food? - The reason may lie in a hormone called ghrelin. -Ghrelin (the name comes from a Hindu word meaning "growth") is a hormone that is produced by the stomach -It is a powerful appetite stimulator -Under normal circumstances, ghrelin levels rise before a meal and fall after we have eaten. -People with a rare condition called Prader-Willi syndrome have chromosomal abnormalities that create many problems, one of which is very high levels of ghrelin. -Sufferers are extremely obese and often die before age 30 from obesity-related causes -The food cravings experienced by people with Prader-Willi syndrome can be so extreme that food has to be kept locked away so that they cannot binge.
weight stigma
-People who are obese are often judged harshly by others. They are routinely ridiculed, discriminated against, and stigmatized -A powerful source of this is the media, which perpetuates weight-based stereotypes and often depicts people who are overweight or obese in a very negative light -Juror perceptions may also be biased against women with obesity -raise the possibility that weight-based discrimination could operate against women who are visibly obese in legal situations -Weight bias is even found in health care professionals who may blame patients who are obese for being overweight and having weight-related health problems
Individual risk factors: Perfectionism and eating disorder
-Perfectionism (defined as the pursuit of unattainably high standards combined with an intolerance of mistakes) has long been regarded as an important risk factor for eating disorders -people who are perfectionistic may be much more likely to subscribe to the thin ideal and relentlessly pursue the "perfect body." -It has also been suggested that perfectionism helps maintain bulimic pathology through the rigid adherence to dieting that then drives the binge/ purge cycle -The women with anorexia nervosa scored higher on perfectionism regardless of whether they had the restricting subtype of anorexia nervosa or subtypes that involved either purging or binge eating and purging -research findings support the idea that perfectionism is an enduring personality trait that places people at higher risk for the development of eating disorders -Perfectionism may also have a genetic basis -men with eating disorders are less perfectionistic than are women with eating disorders
biological causal factors: serotonin and eating disorder
-Serotonin is a neurotransmitter that has been implicated in obsessionality, mood disorders, and impulsivity. -It also modulates appetite and feeding behavior -Serotonin is made from an essential amino acid called tryptophan (found from food) -After tryptophan is consumed, it is converted to serotonin via a series of chemical reactions -People with anorexia nervosa have low levels of 5-HIAA, which is a major metabolite of serotonin -levels of 5-HIAA are normal in people with bulimia nervosa -after recovery, both of these patient groups have higher levels of 5-HIAA than control women do; they also have higher levels of 5-HIAA than they had when they were in the ill state -Kaye and colleagues have further suggested that people with serotonin overactivity may use dieting as a way to regulate this by decreasing the amount of tryptophan that is available to make serotonin -A change in the serotonin system will have implications for other neurotransmitter systems too (e.g., dopamine, norepinephrine).
Medications for obesity
-Several medications are approved by the FDA for use in conjunction with a reduced-calorie diet. -Orlistat (Xenical) works by reducing the amount of fat in the diet that can be absorbed once it enters the gut -Other drugs such as lorcaserin (Belviq) work in different ways and target serotonin or other neurotransmitters. -The newest medication to receive FDA approval is Contrave. This is a combination of naltrexone (used to treat drug and alcohol addiction) and bupropion (used to treat depression and to help smokers quit). -All of these medications provide modest clinical benefits and lead to more weight loss than placebo -However, the differences are not especially impressive and typically are much less (around 3-9 percent of initial weight) than patients are seeking
Individual risk factors: Internalizing the thin ideal
-The extent to which people internalize the thin ideal is associated with a range of problems that are thought to be risk factors for eating disorders. These include body dissatisfaction, dieting, and negative affect
Cognitive-behavioral therapy for bulimia nervosa
-The leading treatment for bulimia nervosa is CBT (superior to medications and interpersonal psychology) -combining CBT and medications produces only a modest increment in effectiveness over that attainable with CBT alone -The "behavioral" component of CBT for bulimia nervosa focuses on normalizing eating patterns. -This includes meal planning, nutritional education, and ending binging and purging cycles by teaching the person to eat small amounts of food more regularly. -The "cognitive" element of the treatment is aimed at changing the cognitions and behaviors that initiate or perpetuate a binge cycle. -accomplished by challenging the dysfunctional thought patterns typically present in bulimia nervosa, such as the "all-or-nothing" or dichotomous thinking -CBT challenges the tendency to divide all foods into "good" and "bad" categories. This is done by providing factual information, as well as by arranging for the patients to demonstrate to themselves that ingesting "bad" food does not inevitably lead to a total loss of control over eating -Treatment with CBT clearly helps to reduce the severity of symptoms in patients with bulimia nervosa -patients with the disorder are rarely entirely well at the end of treatment
Prevalence of eating disorders
-The most common form of eating disorder is binge eating disorder. -Anorexia nervosa has a lifetime prevalence of approximately 0.9 percent in women and 0.3 percent in men -Bulimia nervosa is more common, with a lifetime prevalence of 1.5 percent in women and 0.5 percent in men -Binge-eating disorder is the most common eating disorder with a prevalence of 3.5 percent in women and 2.0 percent in men
biological causal factors: set points in eating disorder
-There is a well-established tendency for our bodies to resist marked variation from some sort of biologically determined set point or weight that our individual bodies try to "defend" -One important kind of physiological opposition designed to prevent us from moving far from our set point is hunger -As we lose more and more weight, hunger may rise to extreme levels, encouraging eating, weight gain, and a return to a state of equilibrium. -For patients with bulimia nervosa, these hunger-driven impulses may escalate into uncontrollable binge eating
Treatment of anorexia nervosa
-They have a high dropout rate from therapy, and patients with the binge-eating/purging subtype of anorexia nervosa are especially likely to terminate inpatient treatment prematurely -Anorexia nervosa is very difficult to treat. Treatment is long term, and many patients resist getting well
Medical complications of eating disorders
-When patients with this disorder die, it is most often because of medical complications -Because they are so undernourished, people with this disorder have a difficult time coping with cold temperatures. -Thiamin (vitamin B1) deficiency may also be present; this could account for\ some of the depression and cognitive changes documented in low-weight anorexia patients -anorexia nervosa may result in increased risk for osteoporosis in later life -People with anorexia nervosa can die from heart arrhythmias (irregular heartbeats) -Chronically low levels of potassium (hypokalemia) can also result in kidney damage and renal failure severe enough to require dialysis. -Laxative abuse can lead to dehydration, electrolyte imbalances, and kidney disease as well as damage to the bowels and gastrointestinal tract -Purging can cause electrolyte imbalances and low potassium -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, as are small red dots around the eyes that are caused by the pressure of throwing up -patients with bulimia very often have swollen parotid (salivary) glands caused by repeatedly vomiting. These are known as "puffy cheeks" or "chipmunk cheeks
prevalence of obesity
-With the exception of Asians, obesity is more prevalent in ethnic minorities -rates of obesity are also somewhat higher in men than they are in women. The notable exception here involves African Americans. -common: Non-hispanic black-> hispanic->non-hipanic white-> non-hispanic asian
Association of eating disorders with other forms of psychopathology
-approximately 68 percent of patients with anorexia nervosa, 63 percent of patients with bulimia nervosa, and almost 50 percent of people with binge-eating disorder are also diagnosed with depression -Obsessive-compulsive disorder is often found in patients with anorexia nervosa and bulimia nervosa -there is frequent co-occurrence of substance abuse disorders in the binge-eating/purging subtype of anorexia nervosa as well as in bulimia nervosa -The restrictive type of anorexia nervosa, however, tends not to be associated with higher rates of substance abuse -Comorbid personality disorders are frequently diagnosed in people with eating disorders -Personality disorders in the anxious-avoidant cluster (Cluster C) are found in those with anorexia nervosa as well as those with bulimia nervosa. -dramatic, emotional, or erratic (Cluster B) problems, including borderline personality disorder, are more typically associated with bulimia nervosa -Personality disorders are similarly reported in around 30 percent of patients with BED, with avoidant, obsessive-compulsive, and borderline personality disorders being the most common -People with BED also have high rates of anxiety disorders (65 percent), mood disorders (46 percent), and substance use disorders (23 percent)
Eating disorders across cultures
-as minorities become more and more integrated and internalize white, middle-class societal values about the desirability of thinness, we should expect to see increases in the rates of eating disorders in minorities -young women in Ghana who had anorexia nervosa were also not especially concerned about their weight or shape. Rather, they emphasized religious ideas of self-control and denial of hunger as the motivation for their self-starvation -anorexia nervosa is not a culture-bound syndrome. -anorexia nervosa is not a disorder that occurs simply because of exposure to Western ideals and the modern emphasis on thinness -bulimia nervosa does seem to be a culture-bound syndrome -it seems to occur in people who have had some exposure to Western ideals about thinness, who have access to large amounts of food, and who, because of modern plumbing, can purge in private -social pressures toward thinness may be particularly powerful in higher socioeconomic backgrounds, from which a majority of girls and women with anorexia nervosa appear to come
Diagnostic crossover in eating disorder
-common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder. -Bidirectional transitions between the two subtypes of anorexia nervosa (restricting and binge-eating/ purging) were especially common -Shifts from anorexia nervosa to bulimia nervosa also occurred in about a third of patients -there were no cases of direct transition from the restricting type of anorexia nervosa directly into bulimia nervosa -if someone with anorexia nervosa (binge-eating/purging subtype) gains weight, the diagnosis will change to bulimia nervosa -even after they have crossed over into bulimia nervosa, these women remain vulnerable to relapsing back into anorexia nervosa -Crossovers from the restricting subtype of anorexia nervosa into binge-eating disorder do not seem to occur at all
family influences in eating disorder
-more than one-third of patients with anorexia nervosa reported that family dysfunction was a factor that contributed to the development of their eating disorder -Patients with anorexia nervosa perceive their families as more rigid, less cohesive, and as having poorer communication than healthy control participants do -many of the parents of patients with eating disorders have long-standing preoccupations regarding the desirability of thinness, dieting, and good physical appearance -Both white and ethnic minority (black, Hispanic, and biracial) adolescents with bulimia nervosa perceive their families to be less cohesive than their parents do -In a large sample of college-age women, the strongest predictor of bulimic symptoms was the extent to which family members made disparaging comments about the woman's appearance and focused on her need to diet
Sociocultural influences for obesity
-our genetic makeup and personality, are likely to experience more weight-related problems from living in a culture that provides ready access to high-fat, high-sugar (junk) foods, encourages overconsumption, and makes it easy to avoid exercise. -We put food into our mouths far too quickly, outpacing our natural feelings of fullness. This leads us to keep eating -as the pace of life gets faster, we have less time to prepare food. So we eat out more often or buy more prepackaged or fast food -the food industry is also highly skilled at getting us to maximize our food intake -the culture of supersizing tempts us to buy more than we might choose to buy otherwise simply because it costs only a little bit more -Ultraprocessed foods that are high in sugar, fat, and salt may be capable of triggering an addictive process -evidence that extended access to the high-fat, high-sugar foods resulted in a downregulation of activity in brain reward circuits, perhaps because the brain reward systems had been overstimulated by the excessive consumption of the palatable foods. -overconsumption of ultraprocessed foods could contribute to the development and maintenance of compulsive eating because eating these foods becomes less and less rewarding over time and more and more food is required to obtain the same amount of "reward." -Foods with low nutritional value (high fat, high sugar) are less expensive and also much easier to find than foods with high nutritional value. -Compared to those whose brains showed less activation, adolescents who showed greater activity in the striatum (a brain region involved in reward processing) in response to food commercials gained more weight over the following year -Continued exposure to a culture that provides easy access to highly palatable foods, offers large portions, and bombards people with endless food advertisements may explain why rates of obesity increase in immigrants after they have lived in the United States for a while.
the role of genes in obesity
-our genetic makeup plays an important role in determining how predisposed we are to becoming obese in the modern environment of increased food availability. -Thinness seems to run in families -Twin studies further suggest that genes play a role both in the development of obesity and in the tendency to binge -a genetic mutation has been discovered that is specifically associated with binge eating -Although this mutation was found only in a minority (5 percent) of the people with obesity in the study, all of the obese people with the gene reported problems with binge eating -only 14 percent of people with obesity who did not have the genetic mutation displayed a pattern of binge eating -available evidence suggests that BMI is polygenic and likely is very much influenced by a large number of common genes
individual risk factors: Childhood sexual abuse and eating disorder
-there is some debate about whether sexual abuse is truly a risk factor for eating disorders -One possibility is that being sexually abused increases the risk of developing other disorders that are comorbid with eating disorders -This would mean that abuse is a general risk factor for psychopathology rather than a specific risk factor -Abuse may also increase other known risk factors for eating disorders, such as having a negative body image or high levels of negative affect -the causal pathway from early abuse to a later eating disorder may be an indirect one (rather than a direct one) that involves an array of other intervening variables.
two types of anorexia nervosa
the restricting type and the binge-eating/purging type -The central difference between these two subtypes concerns the way in which patients maintain their very low weight -In the restricting type, every effort is made to limit the quantity of food consumed -Patients with the binge-eating/purging type of anorexia nervosa differ from patients with restricting anorexia nervosa because they either binge, purge, or binge and purge.
The difference between a person with bulimia nervosa and a person with the binge-eating/purging type of anorexia nervosa is
weight. -the person with anorexia nervosa is severely underweight -those with bulimia nervosa are typically of normal weight or sometimes even slightly overweight