Eating disorders

cultural context
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Terms in this set (33)
cultural context
- eating disorders are more common in industrialized nations
- eating disorder rates have increased in the 20th century

we are obsessed with
- appearance
-dieting and excercise
- image

- for some reason everyone is dissatisfied
-38% of normal weight women think they are overweight; 2/3rds of college women
- $30 billion/ year spent on weight loss products
men and eating disorders
- men are no longer exempt
- men want to be more muscular
- 50% of men say they never diet
anorexia nervosa
characterized by:
- refusal to maintain body weight
- intense fear of weight gain
- disturbances in evaluation of their weight and shape

amenorrhea: absence of a womens period (no longer a required symptom)
refusal to maintain normal weight
- how thin is to thin?
-generally less than 85% of expected body weight for age and height
-BMI<= 18.5
- no clear line
AN: other associated features
- amenorrhea
- perfectionism
- food rituals
- cold, fidgety, restlessness
- undue influence of body shape/ weight on self image
things that may effect self esteem
- personal relationships
- research ability
- teaching ability
- the weather
- what my dog thinks of me
things that effect self esteem with someone with an eating disorder
- weight and shape
- family and friends
- intellectual abilities
- hobby of choice
- work productivity
AN: subtypes
- restricting: dieting, fasting, excessive exercise
- binge/ purge: binging/ purging 1 or 2x/ week and food restriction (must be underweight)
AN: prevalence and course
-1-2% lifetime prevalence
(0.3% for men)
-Slightly more common in Caucasian women
-Usually begins in adolescence (ages 15-19)
-Very chronic: 7 years on average
-Death rate is 5-8%
-High comorbidity with depression, anxiety
-31x risk for suicide (highest rate of suicide among all mental disorders)
AN medical complications
- symptoms of starvation
-lanugo, constipation, cold intolerance
- major organ failure
-cardiovascular
- kidney and liver damage
- osteoporosis and related bone fractures
- get sick often
bulimia nervosa- binge eating and compensatory behaviors -1x per week for minimum of 3 months - cannot occur exclusively during AN - undue influence of weight/ shape on self image - not underweightcompensatory behaviors-fasting/ dieting restriction -vomiting - misuse of laxatives - excessive exercisewhat is a binge- eating within a two hour period an amount of food that is larger than most people would eat in similar conditions - a sense of loss of control over eating during the episodeBN prevalence and course- 1-3% lifetime prevalence - 2x more common in women - white individuals more common - onset between 15 and 29 years old - chronic: 50% remission rate -7.5x suicide rate - comorbidity with depression and nonsuicidal self injuryBN medical complications- electrolyte imbalance - erosion of dental enamal - hypersensitive gag reflex - enlarged salivary glands - results in puffy appearance of face - ruptured espophogas or stomachbinge eating disorder- recurrent episode of binge eating in the absence of inappropriate compensatory behaviorsBED features- eating more rapidly than normal - eating until uncomfortably full or not hungry - eating alone because of embarrassment - feeling disgusted, depressed, or guilty about overeatingBED prevalence and course-2-3 lifetime prevalence - 30% of people with BED are in weight loss programs - more common in women (but more comparable) - no racial / ethnic differences - chronic: duration 8-15 years on averageother specified eating disorder-Clinically significant eating disorder that does not meet criteria for AN, BN, BED -The majority of individuals who seek treatment for EDs are diagnosed with this!sociocultural and environmental factors- thin ideal internalization - childhood abuse - modeling from parents/ siblings/ peers - athletic environment - being overweight as a child - these types of factors can lead to body dissatisfaction, which is another big risk factorbiological theories- genetics: - heritability rates of 40- 60% - personality variables - brain areas: - hypothalamus: regulates body temperature, hunger and thirst, and secretion of hormones - neurotransmitters dysregulation in: - dopamine: reward/ reinforcement - serotonin: appetitepsychological theories- emotion regulation: food restriction, purging -personality factors: high achievers - cognitive models: rigid thinkers, cognitive distortions about the importance of weight and shape - family dynamics: - when individual is allowed little autonomy or personal boundaries - results in deficits in the sense of self/ identity - families often have high conflict, negative emotion is discouragedappearance related safety behaviors- appearance SB: mirror checking, reassurance seeking, camouflaging - SBs are strongly related to beliefs about the importance of appearanceSummers and Cougle study- FSU women with low appearance concerns asked to increase appearance related SBs for a week - compared to the control groups, those in SB increase group reported greater body dissatisfaction, depression, appearance importance, and fear in repsonse to having their picture taken at postWilver and Cougle- FSU women with elevated appearance concerns asked to reduce SBs for two weeks - reported marked reduction in body dissatisfaction, appearance importance, depression, ED symptomstreatment for ED- impatient or partial hospitalization - weight restoration in AN - BN when binge/ purge very severe (after each meal)psychotropic medications- SSRI show efficacyCBT- exposure to feared foods - emotion regulation strategies - coping strategies - cognitive factorsfamily therapy- most effective for adolescents with AN - patient given more autonomy and challenged on perfectionistic idealsadressing the over evaluation of shape or weightthe core psychopathology of eating disorders is the over evaluation of shape and weight - self worth is judged largely or exclusively in terms of shape and weight and the ability to control them - other modes of self evaluation are marginalized - most other features appear to be secondary to the core psychopathology - dieting - repeated body checking and/ or body avoidance - pronounced feeling fatadress the over evaluaton using two strategies1. develop new domains for self evaluation 2. reduce the importance of shape and weightdevelop new domains for self evaluation- encourage patients to identify and engage in (neglected) interests and activities, especially those of a social naturereduce the importance of shape and weight- monitor and eliminate body checking comparisons with others - appearance related safety behaviors also relevant here