Eating Disorders Chapter 7 Copyright © 2012 by Pearson Education, Inc. All rights reserved

Eating Disorders

Chapter 7

Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Anorexia Nervosa (AN)

A serious condition marked by an inability to maintain a normal healthy body weight-Measured by body mass index (BMI)

Restricting vs. binge eating/purging type


According to the DSM-IV-TR…

Anorexia Nervosa

Restricting or binge

eating/purgingsubtypes

Use weight and shape as a measure of

self-evaluation

Denial of illness

Intense fear of gaining

weight or “feeling fat”

Perception of body size and

weight is distorted

Absence of menstruation, amenorrhea

Also remember being considered

“underweight” by one’s BMI Copyright © 2012 by Pearson Education, Inc. All rights reserved.

So what does AN really look like?


Anorexia Nervosa and the Facts…

Affects 1% of the general population (1 out of 100)

Females are 9x more likely to develop the disorder

Low BMIs & Osteoporosis

Begins in adolescence (usually after puberty)

Highest mortality rate of any psychiatric disorder (10.5x more likely)


Who’s Considered at Risk?

Segments of the population where emphasis is placed on body shape and weight-Actors, dancers, models, athletes, etc.

Personality traits-Perfectionism

-Obsessionality

-Neuroticism

-Low self-esteem

-Developmental tasks (leaving home for college)

-WorriersCan you think of any other populations that would be

considered “at risk” for Anorexia Nervosa?


Comorbidity and AN

80% will suffer from major depression

Up to 75% will suffer from anxiety disorders

Anxiety as a risk factor in the development of AN


Bulimia Nervosa (BN)

A disorder characterized by recurrent episodes of binge eating in combination with some form of compensatory behavior aimed at undoing the effects of the binge or preventing weight gain

Compensatory behaviors

-purging subtype vs. non-purging subtype

It’s important to note that consuming

1,000 calories is the minimum to qualify for a binge session,

but some consume up to 20,000 calories in one binge episode.

Often referred to as the “invisible eating disorder”

because people tend to be of normal weight or overweight.


What one needs to be diagnosed with BN…

Recurrent episodes of binge eatingExperience a lack of control over eatingEngage in recurrent compensatory

behaviors-self-induced vomiting

-misuse of laxatives, diuretics, enemas, or other medications

-fasting or excessive exercise


So what does BN really look like?

Nine times more likely in

females.

Mortality is rare for those with BN compared to

those with AN.


Some causes of BN…

Westernized societal emphasis on the “thin ideals,” culture-bound syndrome

Environmental exposureSocial learningInformation sharing (i.e., hearing about it from

friends or reading material on the disorder)

Personality (i.e., low self-esteem, perfectionism, more impulsive, and have higher rates of novelty seeking behaviors)


Comorbidity and BN

80% of people with BN have another psychiatric disorder

Most common disorders seen in conjunction with BN: anxiety disorders, major depression, substance use, and personality disorders

Examples: Elton John and Princess Diana


Eating Disorders Not Otherwise Specified (EDNOS)

A residual diagnostic category for people who have eating disorders that do not match the classic profile of anorexia nervosa or bulimia nervosa

DSM-IV-TR criteriaBinge eating disorder (BED)


Binge Eating Disorder (BED)

A disorder characterized by regular binge eating behaviors, but without the compensatory behaviors that are part of bulimia nervosa

Still under investigationCommon in people who are overweight

and obese (found in 3.5% of women and 2% of men in the general population meet criteria)


What one needs to be diagnosed with BED…

Recurrent episodes of binge eatingReport of distress over binge eatingAssociated with three or more of the

following:-eating rapidly

-eating past the point of “feeling full”

-eating large amounts of food when not physically hungry

-eating alone due to embarrassment

-feeling disgusted with oneself, depressed, or guiltyCopyright © 2012 by Pearson Education, Inc. All rights reserved.

Impact of Gender and Ethnicity

GenderFemale prevalence rates 9

to 1Reasons

-“Thin ideal”

-Objectification of the female body

-Influence of female hormones

Male athletes

EthnicityStereotypesLack of clear dataNeed for research with

more diverse populations

Factors to consider (i.e., SES, education level, familial influence)


Developmental issues to consider…Weight problemsPrevalence rates in childhood vs. adolescenceSocial

-Leads to social isolation from peers and family

Emotional-Associated with symptoms of depression and anxiety

Physical-Onset of menstruation, percentage of body fat, and more mature “womanly” figures


And the brain says…

Role of the hypothalamusActivity-based anorexiaNeuroendocrine and

neurohormonal factorsBrain structure and brain

functioningFamily “genetics”

Biological factors to consider in the development of eating disorders


But my thoughts tell me...

Patterns of family dysfunction (Salvador Minuchin)

-EnmeshmentDistorted cognitions

-Related to body shape, weight, eating and personal control

Society and Culture

-Western “thin ideals”

-Culture value on beauty

Psychological factors to consider in the development of eating disorders


The Treatment of Eating Disorders


Basic Treatment Goals

Anorexia nervosa-Normalization of eating behavior and weight

-Increase caloric intake and weight gain

Bulimia nervosa-Normalization of eating

-Elimination of binge eating and purging

Binge eating disorder-Normalization of eating

-Elimination of binge eating

-Weight stabilization or weight loss

-Improve psychological factors (i.e., depression, self-esteem, and self-efficacy)


Once hospitalized, then what?Inpatient treatment

-Multidisciplinary team approach

-Maintenance of healthy weight

-Consideration of other factors (i.e., social supports, other medical conditions, work, school, suicidal ideation, etc.)

-Psychotherapy (i.e., individual, group, and family)

-Privileges given as result of compliance with treatment

-Treatment (comprehensive plan, including “food”)


Medication: Quick fix or long-term results?

Biological treatment-Commonly prescribed

-Need for medication specific to symptoms of Anorexia Nervosa

-Fluoxetine (Prozac) is an anti-depressant or Selective Serotonin Reuptake Inhibitor (SSRIs) used to treat Bulimia Nervosa

-No medications have been FDA approved for Binge Eating Disorder


Nutritional Counseling

Nutritional rehabilitation-Dieticians and nutritionists specializing in the

treatment of eating disorders

-Nutritional needs for someone with anorexia nervosa

-Nutritional needs after assessment of someone with bulimia nervosa

-Nutritional needs upon evaluation of someone with binge eating disorder

-Best utilized in conjunction with other treatments


Changing faulty beliefs one step at a time…

Cognitive-behavioral therapy-Focuses on changing one’s perception about body

shape, weight, eating, and sense of control

-Addresses both automatic thoughts and core beliefs

-Replaces negative thoughts and problematic behaviors

-Use of self-monitoring


Interpersonal Psychotherapy (IPT)

IPT-A brief, time-limited therapy approach that focuses

on decreasing eating disorder symptoms by enhancing social skills in relationships

-Addresses four problem areas (i.e., interpersonal disputes, role transitions, abnormal grief, and interpersonal deficits)


Eating Disorders and the Family Unit

Family-based interventions-Minuchin’s and Palazzoli’s views of dysfunctional

family system

-Modern approaches to family therapy

-The Maudsley Method

-Effective with adolescents with eating disorders


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Eating Disorders Chapter 7 Copyright © 2012 by Pearson Education, Inc. All rights reserved