PSYCHOPATHOLOGY OF EATING DISORDERS

BY . EHAB ELBAZ

Definition A group of disorders Characterized by a

persistent disturbance of eating and eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.

DSM 5 classification1. Pica2. Rumination disorder3. Avoidant/restrictive food intake disorder4. Anorexia nervosa5. Bulimia nervosa6. Binge eating disorder7. Other specified feeding or eating disorder8. Unspecified feeding or eating disorder

Psychological theories1. Psychodynamic 2. Cognitive 3. Behavioral

1- Psychoanalytic theories Fixation at phallic phase which

characterized by Electra complex. Most common in adolescent females

suggesting a conflict and reaction to the adolescence demands as regard independence and autonomy

Psychodynamic differences between anorexia and bulimia

bulimia anorexia- + Ego - + superego

egodystonic

egosyntonic

symptoms

Obsessive

impulsive

traits

A- In Anorexia Unable to separate psychologically from mother

>>> introjection of the hated mother>>> starvation to inhibit growth and destroy mother

Starvation as way to develop sense of autonomy and control

Starvation to overcome fear of increased sexual desire

Starvation to overcome fear of pregnancy by oral impregnation.

Starvation as a way to stop sexual development to stay child

B- In Bulimia Unable to separate from mother >>> no

transitional object >>> use own body as a transitional object >>> ambivalence about food as a struggle to separate from mother

Eating >>> wish to fuse with caregiver (introjection)

Regurgitation >>> wish to separation (projection)

Other psychodynamic explanations

1. Family systems theory : Child develops AN as a means of diverting attention away from other family problems. It is an irrational way to try to maintain family unity.

2. Bruch (1973) : Attempt by the individual to exert some sort of control (major theme). Need to feel autonomous – independent from parents.

2- Cognitive theory People with eating disorders have

irrational beliefs and faulty schemas that is they will not be valued unless their physical appearance is ideal.

Have distorted body image. Common cognitive distortions incudes

perfectionism , all or non thinking , negative self evaluation

3- Behavioral theories Classical conditioning : associates being

skinny with feeling good >>> continuous dieting

Operant conditioning : being skinny attract people attention >>> reinforce dieting

Observational learning : effect of media and culture to define ideal weight >>> modeling and imitation

Obesity It is not a disorder , it is a form abnormal

eating behavior Psychological causes:1. emotional disturbance 2. hyperphagia as a coping mechanism3. unconscious conflicts4. personality structure