Psych final - Eating Disorders

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Body beliefs through the decades
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- women 15-24 are most vulnerable
- anytime your job is on the line based on your looks/body there is a higher prevalence - ex. gymnastics, models, actresses
- Rates increase every year
- anorexia has the highest death rate of any psychiatric disorder
- Onset - teens extending in both directions
- trends by gender, culture, age
- Erikson - identity vs. role confusion - think about body image and identity
- Restriction of energy relative to requirements (lead to low body weight)
- Intense fear of gaining weight and persistent BEHAVIOR that interferes with weight gain
- disturbance in the way which one's body is experienced (almost delusional) ex. if people make pie chart, people with anorexia will put 90% of pie chart on body qualities
- BMI related to severity
- persistent lack of recognition of the seriousness of their own low body wieght - lack of insight
- Recurrent episodes of binge eating (discrete period <2hours in which a large amount of food is consumed and there is a sense of lack of control over eating) - emotional experience and have little control
- Recurrent inappropriate compensatory behavior in order to prevent weight gain (excessive exercise, purging)
- binge eating and compensatory behaviors both occur at least once a week for there months
- Self-evaluation is unduly influenced by body shape and weight
Socioculture etiology- ideal body image is the one that is hardest to attaint at that point in time - emphasis on thinnest - emphasis on aesthetics rather than function - bombardment of over and covert messages that thinness = happiness, success - gender role - ambivalence about masculine/feminine desireBiological etiology- genetic predisposition -pleasure centers (nucleus cercubens) and temperament (anxious about eating) - Endogenous opiods suppress hunger - when in a state of starvation, your body releases opiods provide sense of well being, reliefs pain, anxiety and suppresses appetite - CASCADE (If you give opiod antagonist, naltrexone, this leads to super hunger) - NT-hypothalamus dysfunction - regulation of hunger. gremlin (hunger sensation), leptin (satiety sensation)Behavioral etiology- Modeling - huge role through development (covertly parents scold their children) - Reinforcement for superficial qualities - saying "you look great" can lead to losing more weight - Peer influenceFamily systems etiologyANOREXIA - Intrusive, over-controlling, enmeshed (parents are too involved), overprotective parenting BULIMIA - discord, chaos, low empathy, low nurturing, and rejecting, substance abuse, arguing - need for autonomyPsychodynamic etiology - AN- Maturational fear (fear of growing up) -reaction towards growing up (increased pressure for independence - social and sexual functioning) - replace normal adolescent preoccupations with eating and weight gain - Attempt to separate/individuate from mother (extreme self-discipline provides a sense of uniqueness) - Internalization of an intrusive and umempathetic mother figure - then starve her - harsh super eg0 - can say no, have rigid rules**harsh super ego-feels guilty*Psychodynamic etiology - BN- also an attempt to sperate/individuate from mother - Binging - wish to fuse with mother - purging - wish to separate - lack superego control!!Personality traits- AN- High achievers - perfectionist - "rigid" - S&S are ego-syntonicPersonality traits- BN- outgoing, angry, impulsive - may engage in substance abuse, self-destructive sexual relationships - S&S are ego-dystonicS&S eating disorders- changes in hair, skin, nails, body temp (lanugo hair - like baby) - slowing of metabolic function - fatigue, HA, osteoporosis BN: electrolyte imbalance, heart irregularities, digestion irregularities, dental and esophagus problems, athletic injuries associated to overuseIn-patient treatment*Initial goal - restore physiological status via weight restoration of 2-4 lbs a week - followed by engagement in pyschosocial process - strategies: - daily weights - I&Os - monitor lytes - no bathroom 2 hours after meal - gradually increase caloric intake to avoid circulatory overload - frequent, small meals - MST - meal support therapy - talk about feelings after eating - treat co-morbiditiesCognitive-behavioral approach- self-monitoring of thoughts, feelings, food intake, restriction/purging behaviors (keep journals to record, track negative thoughts) - ID automatic thoughts and restructure core beliefs (self-image, identity) - BN - Maintain appropriate levels of indulgence and self control - AN - teach them they can indulge and identify trigger foods - desensitizeFamily systems approach- family therapy is often employedBiological treatment- appetite stimulations - antidepressants (depressive S&S, OCD, and can help regulate appetiteAssessment of readiness for change1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance *people first need to be aware of a problem before they can change