Eating Disorders It has not always done so, but Western society today equates thinness with health and beauty Thinness has become a national obsession

Eating Disorders

It has not always done so, but Western society today equates thinness with health and beauty Thinness has become a national obsession

There has been a rise in eating disorders in the past three decades The core issue is a morbid fear of weight gain

Two main diagnoses:

Anorexia Nervosa

The main symptoms of anorexia nervosa are: A refusal to maintain more

than 85% of normal body weight

Intense fears of becoming overweight

Distorted view of weight and shape

Amenorrhea

Anorexia Nervosa

There are two main subtypes: Restricting type

Lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food

Show almost no variability in diet Binge-eating/purging type

Lose weight by forcing themselves to vomit after meals or by abusing laxatives or diuretics

Like those with bulimia nervosa, people with this subtype may engage in eating binges

Anorexia Nervosa

The “typical” case: A normal to slightly overweight female has been on a

diet Escalation toward anorexia nervosa may follow a

stressful event Separation of parents Move away from home Experience of personal failure

Most patients recover However, about 2% to 6% become seriously ill and die as a

result of medical complications or suicide

Anorexia Nervosa: The Clinical Picture

The key goal for people with anorexia nervosa is becoming thin The driving motivation is fear:

Of becoming obese Of giving in to the desire to eat Of losing control of body size and shape


Despite their dietary restrictions, people with anorexia nervosa are preoccupied with food This includes thinking and reading about food and

planning for meals This relationship is not necessarily causal

It may be the result of food deprivation, as evidenced by the famous 1940s “starvation study” with conscientious objectors


Persons with anorexia nervosa also think in distorted ways: Usually have a low opinion of their body shape Tend to overestimate their actual proportions

Adjustable lens assessment technique Hold maladaptive attitudes and misperceptions

“I must be perfect in every way” “I will be a better person if I deprive myself” “I can avoid guilt by not eating”


People with anorexia nervosa also display certain psychological problems:

Anorexia Nervosa: Medical Problems

Caused by starvation:

Bulimia Nervosa

Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges: Bouts of uncontrolled overeating during a limited period

of time Eat objectively more than most people would/could eat in a

similar period

Bulimia Nervosa

The “typical” case: A normal to slightly overweight female has been on an

intense diet Research suggests that even among normal

participants, bingeing often occurs after strict dieting Like anorexia nervosa, about 90%–95% of

bulimia nervosa cases occur in females The peak age of onset is between 15 and 21

years Symptoms may last for several years with

periodic letup

Bulimia Nervosa

The disorder is also characterized by inappropriate compensatory behaviors, which mark the subtype of the condition: Purging-type bulimia nervosa

Forced vomiting Misusing laxatives, diuretics, or

enemas Nonpurging-type bulimia

nervosa Fasting Exercising frantically

Bulimia Nervosa

Patients are generally of normal weight Often experience marked weight fluctuations Some may also qualify for a diagnosis of anorexia

“Binge-eating disorder” is a related diagnosis Symptoms include a pattern of binge eating with NO

compensatory behaviors (such as vomiting)

Bulimia Nervosa: Binges

People with bulimia nervosa may have between 1 and 30 binge episodes per week

Binges are often carried out in secret Binges involve eating massive amounts of food very

rapidly with little chewing Usually sweet, high-calorie foods with soft texture

Binge-eaters commonly consume between 1,000 and 10,000 calories per binge episode

Overlapping Patterns Of Anorexia Nervosa, Bulimia Nervosa, And Obesity

Bulimia Nervosa: Binges

Binges are usually preceded by feelings of great tension and/or powerlessness

Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and being discovered

Bulimia Nervosa: Compensatory Behaviors

After a binge, people with bulimia nervosa try to compensate for and “undo” the caloric effects

The most common compensatory behaviors: Vomiting

Fails to prevent the absorption of half the calories consumed during a binge

Repeated vomiting affects the ability to feel satiated greater hunger and bingeing

Laxatives and diuretics Also largely fails to reduce the number of calories consumed

Bulimia Nervosa: Compensatory Behaviors

Compensatory behaviors may temporarily relieve the negative feelings attached to binge eating Over time, however, a cycle develops in which purging

bingeing purging…

Bulimia Nervosa vs. Anorexia Nervosa



Binge Eating Disorder

Repeated eating binges during which they feel no control over their eating

These individuals do not perform inappropriate compensatory behavior

As a result of their frequent binges, around two-thirds of people with binge eating disorder become overweight or even obese

What Causes Eating Disorders?

Most theorists and researchers use a multidimensional risk perspective to explain eating disorders: Several key factors place individuals at risk More factors = greater likelihood of developing a

disorder Leading factors:

Psychological problems (ego, cognitive, and mood disturbances) Biological factors Sociocultural conditions (societal, family, and multicultural

pressures)

Psychodynamic Factors: Ego Deficiencies

Hilde Bruch developed a largely psychodynamic theory of eating disorders Argued that eating disorders are the result of disturbed

mother–child interactions, which lead to serious ego deficiencies in the child and to severe perceptual disturbances

Psychodynamic Factors: Ego Deficiencies

Bruch argues that parents may respond to their children either effectively or ineffectively Effective parents accurately attend to a child's biological

and emotional needs Ineffective parents fail to attend to child's needs; 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

internal needs and turn, instead, to external guides

Clinical reports and research have provided some empirical support for this theory

Cognitive Factors

Bruch's theory also contains several cognitive factors, like improper labeling of internal sensations and needs According to cognitive theorists, these deficiencies

contribute to a broad cognitive distortion that lies at the center of disordered eating (e.g., negative self-judgment based on body shape and weight)

Mood Disorders

Many people with eating disorders, particularly those with bulimia nervosa, experience symptoms of depression Theorists believe mood disorders may “set the stage”

for eating disorders

Mood Disorders

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 major depressive disorder than do people in the general population

Close relatives of those with eating disorders seem to have higher rates of mood disorders

People with eating disorders, especially those with bulimia nervosa, have serotonin abnormalities

Symptoms of eating disorders are helped by antidepressant medications

Biological Factors

Biological theorists suspect certain genes may leave some people particularly susceptible to eating disorders Consistent with this idea:

Relatives of people with eating disorders are up to 6 times more likely to develop the disorder themselves

Identical (MZ) twins with anorexia: 70% Fraternal (DZ) twins with anorexia: 20% Identical (MZ) twins with bulimia: 23% Fraternal (DZ) twins with bulimia: 9%

These findings may be related to low serotonin

Biological Factors

Other theorists believe that eating disorders may be related to dysfunction of the hypothalamus Researchers have identified two separate areas that

control eating: Lateral hypothalamus (LH) Ventromedial hypothalamus (VMH)

Biological Factors

Some theorists believe that the hypothalamus, related brain areas, and chemicals together 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 particular weight level If weight falls below set point: hunger, metabolic rate

binges If weight rises above set point: hunger, metabolic rate

Dieters end up in a battle against themselves to lose weight

Societal Pressures

Many theorists believe that current Western standards of female attractiveness are partly responsible for the emergence of eating disorders Western standards have changed throughout history

toward a thinner ideal Miss America contestants have declined in weight by 0.28 lbs/yr;

winners have declined by 0.37 lbs/yr Playboy centerfolds have lower average weight, bust, and hip

measurements than in the past

Societal Pressures

Members of certain subcultures are at greater risk from these pressures: Models, actors, dancers, and certain athletes

Of college athletes surveyed, 9% met full criteria for an eating disorder while another 50% had symptoms

20% of surveyed gymnasts appear to have an eating disorder

Societal Pressures

Societal attitudes may explain economic and racial differences seen in prevalence rates Historically, women of higher SES expressed more

concern about thinness and dieting These women had higher rates of eating disorders than women

of the lower socioeconomic classes Recently, dieting and preoccupation with thinness,

along with rates of eating disorders, are increasing in all groups

Societal Pressures

The socially accepted prejudice against overweight people may also add to the “fear” and preoccupation about weight About 50% of elementary and 61% of middle school

girls are currently dieting A recent survey of adolescent girls tied eating disorders

and body dissatisfaction to social networking, Internet activities, and television browsing

Family Environment

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 emphasizing thinness, appearance, and dieting

Mothers of those with eating disorders are more likely to be dieters and perfectionistic themselves

Family Environment

Abnormal interactions and forms of communication within a family may also set the stage for an eating disorder Influential family theorist Salvador Minuchin cites

“enmeshed family patterns” as causal factors of eating disorders These patterns include overinvolvement in, and overconcern

about, family member's lives

Multicultural Factors: Racial and Ethnic Differences

A widely publicized 1995 study found that eating behaviors and attitudes of young African American women were more positive than those of young white American women Specifically, nearly 90% of the white American

respondents were dissatisfied with their weight and body shape, compared to around 70% of the African American teens

The study also suggested that the groups had different ideals of beauty


Eating disorders among Hispanic American female adolescents are about equal to those of white American women

Eating disorders also appear to be on the increase among Asian American women and young women in several Asian countries


Males account for only 5% to 10% of all cases of eating disorders

The reasons for this striking difference are not entirely clear, but Western society's double standard for attractiveness is, at the very least, one reason

A second reason may be the different methods of weight loss favored: Men are more likely to exercise Women more often diet


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: Jockeys Wrestlers Distance runners Body builders Swimmers


For other men, body image appears to be a key factor

Last, some men seem to be caught up in a new kind of eating disorder – reverse anorexia nervosa or muscle dysmorphobia

How Are Eating Disorders Treated?

Eating disorder treatments have two main goals: Correct dangerous eating patterns Address broader psychological and situational factors

that have led to, and are maintaining, the eating problem This often requires the participation of family and friends

Treatments for Anorexia Nervosa

The immediate aims of treatment for anorexia nervosa are to: Regain lost weight Recover from malnourishment Eat normally again


In the past, treatment took place in a hospital setting; it is now often offered in day hospitals or outpatient settings

In life-threatening cases, clinicians may need to force tube and intravenous feedings on the patient This may breed distrust in the patient and create a

power struggle In contrast, behavioral weight-restoration approaches

have clinicians use rewards whenever patients eat properly or gain weight


The most popular weight-restoration technique has been the combination of supportive nursing care, nutritional counseling, and high-calorie diets Necessary weight gain is often achieved in 8 to 12

weeks Researchers have found that people with

anorexia nervosa must overcome their underlying psychological problems to achieve lasting improvement


In most treatment programs, a combination of behavioral and cognitive interventions are included On the behavioral side, clients are required to monitor

feelings, hunger levels, and food intake and the ties among those variables

On the cognitive sides, they are taught to identify their “core pathology”


Therapists help patients recognize their need for independence and control

Therapists help patients recognize and trust their internal feelings

A final focus of treatment is helping clients change their attitudes about eating and weight Using cognitive approaches, therapists correct

disturbed cognitions and educate about body distortions Family therapy is important for anorexia nervosa

treatment The main issues are often separation and boundaries


The use of combined treatment approaches has greatly improved the outlook for people with anorexia nervosa But even with combined treatment, recovery is difficult

The course and outcome of the disorder vary from person to person


Treatments for Bulimia Nervosa

Treatment is frequently offered in eating disorder clinics

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

Programs emphasize education as much as therapy


Cognitive-behavioral therapy is particularly helpful: Behavioral techniques

Diaries are often a useful component of treatment Exposure and response prevention (ERP) is used to break the

binge-purge cycle Cognitive techniques

Help clients recognize and change their maladaptive attitudes toward food, eating, weight, and shape

Typically teach individuals to identify and challenge the negative thoughts that precede the urge to binge


Other forms of psychotherapy 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

Psychodynamic therapy has also been used


Other forms of psychotherapy Various forms of psychotherapy are often

supplemented by family therapy and may be offered in either individual or group therapy format Group formats provide an opportunity for patients to express

their thoughts, concerns, and experiences with one another Group therapy is helpful in as many as 75% of cases


Antidepressant medications During the past 15 years, all groups of antidepressant

drugs have been used in bulimia nervosa treatment Drugs help as many as 40% of patients

Medications are best when used in combination with other forms of therapy


Left untreated, bulimia nervosa can last for years Treatment provides immediate, significant

improvement in about 40% of cases An additional 40% show moderate response

Follow-up studies suggest that 10 years after treatment about 75% of patients have fully or partially recovered


Relapse can be a significant problem, even among those who respond successfully to treatment Relapses are usually triggered by stress Relapses are more likely among persons who:

Had a longer history of symptoms Vomited frequently Had histories of substance use Have lingering interpersonal problems

Documents

Eating Disorders It has not always done so, but Western society today equates thinness with health and beauty Thinness has become a national obsession