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307.1 Anorexia Nervosa307.1 Anorexia Nervosa
Refusal to maintain a normal body weightAn intense fear of gaining weight, and the
fear is not reduced by weight lossIn females, accompanied by amenorrheaA distorted sense of their body shapeTwo subtypes:
– Restricting– Binge-eating
Associated Features of Associated Features of Anorexia NervosaAnorexia Nervosa
Symptoms of Depression (e.g., low mood, social withdrawal, irritability, insomnia, decreased interest in sex)
Obsessive-Compulsive Disorder Features - both related and unrelated to food
Others: concerns about eating in public, feelings of ineffectiveness, a strong need to control one’s environment, inflexible thinking, limited social spontaneity.
Physical Effects of Anorexia Physical Effects of Anorexia NervosaNervosa
Low Blood Pressure Bradycardia Reduce Bone Mass Dry Skin Brittle Nails Mild Anemia Hair Loss Constipation
Loss of Tooth Enamel Osteoporosis Emaciation Lethargy Amenorrhea Abdominal Pain Cold Intolerance Altered Electrolytes
(e.g., potassium, sodium)
307.51 Bulimia Nervosa307.51 Bulimia Nervosa
Recurrent episodes of binge eating– eating, in a discrete time, a large amount of food– a sense of lack of control over eating
Recurrent inappropriate compensatory behavior in order to prevent weight gain
Binges and compensatory behaviors occur at least twice a week for 3 months
Self-evaluation is unduly influenced by body shape and weight
307.51 Bulimia Nervosa 307.51 Bulimia Nervosa (cont.)(cont.)
The disturbance does not occur exclusively during episodes of Anorexia Nervosa
Two subtypes:– Purging type - during the current episode of Bulimia
Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
– Nonpurging type - the person uses other inappropriate compensating behaviors (e.g., fasting, excessive exercise)
This Is A Test!This Is A Test!
Which is a distinction between anorexia nervosa and bulimia nervosa?a Bingeingb physiological complications commonc pronounced weight lossd depression
The Societal Impact on Eating The Societal Impact on Eating Behaviors, Obesity, and Body Behaviors, Obesity, and Body
ImageImage
Sociocultural VariablesSociocultural VariablesThe cultural ideal for women (especially) and
men has changed dramatically over the years.Playboy centerfolds became thinner between
1958 and 1978, now has leveled off. Average American woman has become heavier.
1/3 of 10th grade girls feel they are overweight (most are not).
Models in women's magazine are becoming thinner.
Does Society Influence Does Society Influence Eating Behavior?Eating Behavior?
Have you ever eaten just because everyone else was?
Have you ever eaten somewhere you didn’t particularly want to just because everyone else wanted to?
Have you ever eaten alone in a restaurant?Do your celebrations and festivities involve
food?Have you ever paid $.25 to “supersize” a meal?
Does Society Influence Does Society Influence Body Image?Body Image?
Do you ever look at a model and wish you looked like him/her?
Do you compare yourself to others at the gym/beach/dance, etc.?
Have you ever been angry, upset, or depressed about how your body looks?
Do you feel ashamed or guilty if you gain a few pounds?
What messages do we get What messages do we get from society about weight from society about weight
related issues?related issues?
Unrealistic Goals:Unrealistic Goals: Average Fashion Average Fashion
Model vs Average WomanModel vs Average Woman
HeightHeight
WeightWeight
BMIBMI
5'4"5'4"
142 lb142 lb
24.324.3
AverageAverageFashion ModelFashion Model
AverageAverageWomanWoman
5'9"5'9"
110 lb110 lb
16.316.3
Personal communication from Wadden TA, July 1997.Personal communication from Wadden TA, July 1997.
Cognitive-Behavioral Cognitive-Behavioral InfluencesInfluences
Fear of fatness and body-image disturbance make self-starvation reinforcing
Criticism from peers and parents about being overweight
Perfectionism and personal inadequacyPortrayals in the media of thinness as ideal, being
overweight as representing lack of willpower or weakness
Dieting itself is often the stimulus for binging
Biological Factors in Eating Biological Factors in Eating DisordersDisorders
Genetic component - concordance rate of 47% for monozygotic and 10% for dizygotic pairs
Although the hypothalamus is a key brain center for regulating eating, does not seem to be a factor in eating disorders
Starvation among anorexic patients may increase the levels of endogenous opioids, resulting in a reinforcing euphoric state
Several studies have found low levels of serotonin in bulimic patients. Antidepressant drugs somewhat effective
Biological TreatmentsBiological TreatmentsFluoxetine found to be superior to placebo in
reducing binge eating and vomiting, also lessened depression and distorted attitudes toward food and eating
Attrition in drug trials much higher than that found in cognitive-behavioral programs (nearly 1/3)
Most patients relapse when medication is withdrawn
Treatment of BulimiaTreatment of Bulimia
In CBT, patient encouraged to question society’s standards for physical attractiveness
Core dysfunctional belief - one’s shape and weight are of paramount importance for acceptance by others
Teach that weight control best accomplished by eating on a regular basis
Only about 1/3 of bulimics treated maintain their gains long-term
Treatment of Anorexia Treatment of Anorexia NervosaNervosa
Immediate goal - help gain weightSecond goal - long-term maintenance of gains
in body weight.Neither medical, behavioral, or traditional
psychodynamic interventions have been very effective
Family therapies, despite claims, has not been adequately studied
Prevalence of NIDDM in Japanese Men Hara et. al., Diabetes Research & Clinical Practice, (1991)
02468
101214161820
Age-adjusted % Men with Diabetes, Ages 40-
70+
Diabetes
Japan Hawaii California
Nutritional Transition and Obesity in ChinaNutritional Transition and Obesity in ChinaPopkin et. al., European Journal of Clinical Nutrition (1993)
16.44
7.73 7.45
2.28
22.33
10.1411.98
4.75
0
5
10
15
20
25
Percent (%)
Rural Urban
Region
% Fat in Diet % with BMI<18.5 % with BMI>25 % with BMI>27
Obesity in Australian Aboriginal PeopleObesity in Australian Aboriginal PeopleJones & White, Annals of Human Biology (1994)
4.3 2.4
16.7
51
22
-5
5
15
25
35
45
55
65
Percent Obese
(BMI>30)
Least Most
Degree of Westernization
Women Men
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